Can Suicide Be Prevented?

Suicide-completed and attempted-represents a major clinical and public health challenge. The CDC has ranked suicide as the 11th leading cause of death among persons over age 10 (33,289 suicide deaths were reported in the United States in 2009, and this rate has been stable for many years).¹

Suicide rates have been consistently 3 to 7 times higher in men, especially in men older than 65 years. There are marked differences in rates of completed suicide among ethnic groups: Native Americans and Inuits are at very high risk, followed by white, African American, and Latino persons. Rates also vary among geographic areas and are greater in sparsely populated regions in North America.

About 90% of suicides occur in persons with a clinically diagnosable psychiatric disorder.^2-4 The standardized mortality risk ratio is higher for patients with major mood disorders than for the general population. For patients with unipolar major depressive disorder (UP-MDD), standardized mortality ratios show a 20-fold increase over the general population of patients with bipolar disorder (BPD) or depression who have ever been hospitalized.^2,5 Suicide risk in patients with UP-MDD is strongly related to illness severity. Patients who have been hospitalized with UP-MDD are at greater risk than those treated as outpatients: higher depression-rating scores further boost the risk and support the view that current depressed mood is the most frequent condition associated with suicide.^1,2,6

Our analysis of 28 studies involving 823 suicides among 21,500 patients with BPD found a weighted mean annual incidence of suicide of 390 per 100,000. That rate is 26 times higher than in the international general population, which is approximately 15 per 100,000.⁷ We also found that the risk of suicide among nearly 3000 outpatients with BPD type I or II was several-fold higher than in patients with UP-MDD.⁸

Reducing suicide risk

Even though many patients at risk for suicide receive various treatments, their effects on suicide risk appear to vary. Fewer than one-third of persons who commit suicide are receiving psychiatric treatment at the time of their deaths.^1,9 Evidence pertaining to potential anti-suicidal effects of various psychotropic drugs on suicide risk has been strikingly limited as well as inconsistent and inconclusive. Particularly surprising, there is only inconsistent evidence that antidepressants may help prevent suicides.^10-13

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