Are There Multiple Paths To Suicide?

A recent paper by researchers from the Australian Institute for Suicide Research and Prevention discussed a commonly held model of suicide as a process that starts with suicidal ideation and ends with dying by suicide. The authors suggest that this model should not be generalized to all people at risk for suicide and propose that research that contributes to developing a better understanding of the psychological processes associated with suicide will help the field develop more effective methods for identifying people at risk.

The authors focused on a widely held model of a continuum that progresses from thinking about suicide, to planning suicide, attempting suicide, and finally to dying by suicide. This model implies that suicide can be prevented by identifying people who are thinking about or planning suicide and intervening to stop them from progressing along this continuum. The authors suggest that although the continuum model may accurately portray the experiences of a segment of the at-risk population, it should not be generalized as the only path to dying by suicide. Studies indicate that a substantial minority of people (e.g. 29 percent in one study; 34 percent in another) who report ideation develop a suicide plan. But only a relatively small percentage of people who experience suicidal ideation attempt suicide. An even smaller proportion die by suicide (6 percent, according to one study).

The authors propose that the field of suicide prevention needs to understand how to (1) identify people suffering from suicidal ideation, or who have created a suicide plan, and who will eventually attempt suicide and (2) identify people at risk for suicide without an extended period of ideation and planning. The authors also point out that some risk factors for suicide, including depression and ideation, fluctuate over time. Day-to-day changes in whether a person is exhibiting ideation or depression affect the ability of some screening tools to measure these risks.

The authors also suggest that although more research on the relationship among suicidal thoughts, planning, and attempts is needed, the association of suicide with past suicide attempts, as well as past suicidal ideation – especially ideation that is pronounced, persistent, and includes a strong intent to die – can help practitioners understand who may be at high risk and in need of immediate professional intervention.

Sveticic, J., & De Leo, D. (2012). The hypothesis of a continuum in suicidality: A discussion on its validity and practical implications. Mental Illness, 4(e15):73-78.