Suicide: An Update | Rates & Risk Factors

Co-Author(s): Dr. Ross Baldessarini

Date and time: 27 Mar 2022 from 10:15 to 11:15

Location: Virtual  Floor Map

Covering Dr. Baldessarini's work on post-hospital discharge risk, and new findings concerning rates and risk factors in bipolar disorder patients as well as an overview of pertinent, changing, and current rates and risk factors for the general population of the US and Canada.

Suicide remains a major challenge for clinical psychiatry. Major psychiatric disorders carry substantial mortal risks, largely owing to suicide, especially in younger patients, but also from adverse outcomes of co-occurring medical disorders in older patients. Important basic relationships among suicidal ideation, attempts, and fatalities require consideration: the ratio of ideation to suicide is ≥200 in the general population, and that of attempts/suicide (an index of lethality) is ≥30 in the general population and ≤10 with major mood
disorders and severe substance abuse. Suicide rates vary widely across cultures, regions, and time. Although suicide rates have tended to decline in many countries in recent years, those in Canada have remained quite stable, whereas rates in the US have been rising steadily, and across regions and age-groups. Risk factors including previous suicide attempt, relative social isolation (well documented in the US, Canada, and Europe), losses, and recent discharge from psychiatric hospitalization are well known, but have limited clinical value in predicting suicidal acts in individuals at particular times. Therapeutics aimed at reducing suicidal risk has been remarkably slow to develop, particularly for medical-pharmacological treatments, though clozapine is the first treatment of any kind with regulatory recognition for an antisuicidal effect in schizophrenia patients, and evidence supporting lithium in major mood disorders is substantial.

Learning Objectives:
Objective #1 Review basic epidemiological facts about suicide risk in US and Canada.
Objective #2 Consider risk factors for suicide and their limitations.
Objective #3 Briefly review effects of modern psychiatric treatments on suicidal risk.

References & Recommended Reading

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Tondo L, Hennen J, Baldessarini RJ: Reduced suicide risk with long-term lithium treatment in major affective illness: a meta-analysis. Acta Psychiatr Scand 2001; 104:163–72.

Meltzer HY1, Alphs L, Green AI, et al. Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). Arch Gen Psychiatry 2003; 60:82–91.

Baldessarini RJ, Goodwin FK: Antisuicidal efficacy of lithium products: Citizen’s petition to the United States Food and Drug Administration, Washington, DC, September, 2005, 50 pp. Available at cp00001-001-vol1.pdf; 10-17-2005.

Baldessarini RJ, Hennen J: Genetics of suicide: An overview. Harv Rev Psychiatry 2004; 12:1–13.

Cipriani A, Pretty H, Hawthon K, Geddes JR. Lithium in the prevention of suicidal behavior and all-cause mortality in patients with mood disorders: systematic review of randomized trials. Am J Psychiatry 2005; 162:1805–19.

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Kessler RC, Berlung P, Borges G, et al. Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990-1992 to 2001 2003 JAMA 2005; 293:2487 95

Pompili M, Tondo L, Baldessarini RJ. Suicidal risk emerging during antidepressant treatment: recognition and intervention. Clin Neuropsychiatry 2005; 2:66–72.

Baldessarini RJ, Tondo L, Davis P, et al. Decreased risk of suicides and attempts during long-term lithium treatment: meta-analytic review. Bipolar Disord 2006; 8:625–39.

Tondo L, Albert M, Baldessarini RJ. Suicide rates In relation to health-care access in the United States. J Clin Psychiatry 2006; 67:517–23.

Baldessarini RJ, Tondo L, Strombom I, et al. Analysis of ecological studies of relationships between antidepressant utilization and suicidal risk. Harv Rev Psychiatry 2007: 15:133–45.

Guzzetta F, Tondo L, Centorrino F, Baldessarini RJ. Lithium treatment reduces suicidal risk in recurrent major depressive disorder. J Clin Psychiatry 2007; 68:380–3.

Tondo L, Lepri B, Baldessarini RJ. Risks of suicidal ideation, attempts and suicides among 2826 men and women with types I and II bipolar, and recurrent major depressive disorders. Acta Psychiatr Scand 2007; 116:419–28.

Khalsa HMK, Salvatore P, Hennen J, et al. Suicidal events and accidents in 216 first-episode bipolar-I disorder patients: predictive factors. J Affect Disord 2008; 106:179–84.

Tondo L, Lepri B, Baldessarini RJ. Suicidal status during antidepressant treatment in 789 Sardinian patients with major affective disorder. Acta Psychiatr Scand 2008;118:106–15.

Baldessarini RJ, Tondo L. Meta-analytic comparison of antisuicidal effects of lithium versus anticonvulsants. Pharmacopsychiatry 2009; 42:72–5.

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Baldessarini RJ, Tondo L. Psychopharmacology for suicide prevention. Chapt 14 in Pompili M, Tatarelli R, editors. Evidence-Based Practice in Suicidology: A Sourcebook. Gottingen: Hogrefe GmbH, 2010, pp 243–64.

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Simon RI, Hales ER (editors). Textbook of Suicide Assessment and Management, second edition. Washington, DC: American Psychiatric Press, 2012.

Undurraga J, Baldessarini RJ, Valenti M, et al. Suicidal risk factors in bipolar I and II disorder patients. J Clin Psychiatry 2012; 73:778– 82.

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Tondo L, Baldessarini RJ. Reduction of suicidal behavior in bipolar disorder patients during long-term treatment with lithium. Chapt 26 in Koslow SH, Ruiz P, Nemeroff CB (editors): A Concise Guide to Understanding Suicide. Cambridge, UK: Cambridge University Press, 2014, pp 217–28.

Baldessarini RJ, Lau WK, Sim J, et al. Suicidal risks in reports of long-term treatment trials for major depressive disorder. Int J Neuropsychopharmacol 2015; Int J Neuropsychopharmacol 2015;19:pyv107.

Forte A, Baldessarini RJ, Tondo L, et al. Long-term morbidity in bipolar-I, bipolar-II, and major depressive disorders. J Affect Disord 2015; 178: 71–8.

Hayes JF, Miles J, Walters K, et al. Systematic review and meta-analysis of premature mortality in bipolar affective disorder. Acta Psychiatr Scand 2015; 131:417–25.

Pompili M, Giordani G, Goracci A, et al. Relationship of non-suicidal self-injury and suicide attempt. J Psychopathology 2015; 21:40–5.

Pompili M, Vichi M, Dinelli E, et al. Relationships of local lithium concentrations in drinking water to regional suicide


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