We may have been asking the wrong questions all along. We should ask, “when a person is at risk?”
Although we know that depression can increase the risk of suicide, most depressed individuals will not seriously consider it on any given day. We need to be able to tell the moment that a person is at risk of suicide. This will help them to get support as soon as possible.
This is a promising idea, based on our preliminary research in a Perth mental hospital and recently published.
Read more: Focusing on people at ‘high risk’ of suicide has failed as a suicide prevention strategy.
What we did
Inpatients from the Perth Clinic psychiatric facility were involved in a “proof-of-concept” study. In each room, patients were asked to fill out questionnaires using iPads. More than 20,000 patients took part in the study over more than ten years, which resulted in approximately 350,000 questionnaires completed.
The data collected from questionnaires was then compared to 110 hospital inpatients who attempted suicide over a 25-day average period. The majority of these patients (78%) were female and diagnosed with major depression or anxiety disorder. These patients ranged in age from 14 to 77.
In interviews with patients, the nurses rated about half of them as “low” or “no risk” for suicide.
Then, we looked at the data patterns to see if any patterns would indicate who was more likely to attempt suicide in a short time frame and what period.
In the hospital, we asked patients to fill out questionnaires to determine who was most at risk for suicide. Twenty47studio/GettyImages
Read more: How do I do ‘suicide watch’ at home?
What we found
On the day after a suicide attempt, we found that a person’s perception of being a burden on their friends and family greatly increased.
Patients reported a greater loss of hope the day before they attempted suicide. They felt they couldn’t change the things that were important to them.
This data was used to create an algorithm that monitors spikes in key risk factors and other indicators of increased suicide risk.
The algorithm is now in place at the hospital and alerts staff of at-risk patients. This allows for targeted and immediate intervention when the risk of suicide attempts is highest.
Read more: How to ask someone you’re worried about if they’re thinking of suicide.
How can we apply these findings?
Is often not in line with reality when it comes to the key signals that we identified as indicators for short-term suicide risk – perceptions such as hopelessness or burden.
While some people think that they are burdens, their family and friends disagree. These friends and families are not burdened at all. They struggle to decide when and how to help. Perceptions of hopelessness are often temporary and do not always reflect reality.
Clinical staff can help patients reevaluate their misguided beliefs and develop coping skills together.
A core belief such as “I am burdened” can be replaced with “I would not think that a loved one is a burden if he or she was suffering.”
Staff members work with patients to reevaluate their perceptions. Monkey Business Images/Shutterstock
Read more: What makes a good psychologist or psychiatrist, and how do you find one you like?
Where to now?
Our aim is now to test our approach on a greater number of psychiatric patients across multiple sites in Australia to see if it gives staff enough time to intervene and stop imminent suicides.
Our methods will also be tested in the community. This includes predicting suicide risk among students and remotely monitoring those at risk who are seen by their GP or primary care.
We are, for example, working with GPs on extending Perth Clinic’s daily tracking system to track symptoms between GP appointments. This approach allows GPs to monitor the effectiveness and identify times of increased risk.
Suicide prevention is a multi-faceted issue. We must also address the complex webs of social, socioeconomic, and other factors that contribute to the distress that we see among people who are contemplating suicide.
