A meta-analysis of behavioral and event predictors within 24 hours of suicide attempt
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Despite much time, research, and resources dedicated to preventing suicide, the rates of suicide and suicide attempts in the United States are increasing. Progress in understanding and preventing suicide has been challenging because it is an extremely low base rate phenomenon. The vast majority of people who exhibit long-term risk factors and even short-term warning signs of suicide do not attempt or die by suicide. While existing studies on this topic have been synthesized through meta-analyses, their focus has largely been on identifying trait-like characteristics that may predict lifetime suicide attempt or death. Given the poor predictive ability of such long-term risk factors, coupled with the increasing rates of suicide and its societal impact, identification of shorter-term events and behaviors that warn of imminent suicide (i.e., over the next hours, days, weeks) is a public health imperative. The current study is a meta-analysis on the existent literature of behavioral and event warning signs that occurred within 24 hours of suicide attempt or death. The current search yielded 14 studies with 4992 total participants that met inclusion criteria from 19,545 references. The meta-analysis of included studies found that (1) the use of alcohol (OR = 4.16; 95 percent CI: 2.87, 6.04; p [less than] 0.001) and (2) the experience of a negative interpersonal life event (NLE; OR = 3.81; 95 percent CI: 2.83, 5.12; p [less than] 0.001) were each significantly associated with a suicide attempt in the following 24 hours. When these two broad categories were examined more closely, the following predictors are significantly associated with a suicide attempt in the subsequent 24 hours: heavy alcohol use ((OR = 11.79; 95 percent CI: 2.02, 68.95; p = 0.006), CNS depressant use (OR = 3.29; 95 percent CI: 1.41, 7.66; p = .006), a family NLE (OR = 3.70; 95 percent CI: 1.41, 9.69; p = 0.008), a marriage/love NLE (OR = 4.21; 95 percent CI: 3.09, 5.75; p [less than] 0.001), and a friend NLE (OR = 23; 95 percent CI: 3.11, 170.20; p = .002). These novel findings may help inform suicide prevention efforts by highlighting warning signs that an individual may be imminent risk of an attempt within the next day, thereby supporting the allocation of limited resources (e.g., increased monitoring and supervision, hospitalization, suicide prevention interventions) to those who are experiencing acute risk. Future research is needed to examine additional warning signs, to determine whether prediction can be further improved by combining both long-term risk factors and short-term warning signs, and to identify the most effective and efficient interventions for highest risk individuals.
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Ph. D.