Is There a Way to Protect a Family from Suicide?

Suicide shatters families, and shattered families weaken communities, states, and nations. One of the things that hurt families the most – besides the death of a loved one – is a belief that “they missed signs leading up to the death.” Lois M. Collins at The Deseret News reported on a new study that shares interesting new data on suicide. 

A new study from the University of Utah offers both comforting and frustrating new evidence that there might not have been any traditional signals of a struggle. While a death by suicide for some is preceded by suicidal ideation and behavior, including survived attempts, about half of those who take their own lives have no documented suicidal thoughts or behaviors and no known mental health conditions linked to suicide risk, such as depression.

There were no clear indicators of risk.

Those are the findings of a genetic study in which university researchers teamed up with the Utah Office of the Medical Examiner to try to learn more about the drivers of suicide, using genotyping data from 2,769 de-identified electronic health records and clinical notes of individuals who died by suicide. They thoroughly analyzed the genetic data of those who died to analyze genetic risk….

The study showed that those who died by suicide without earlier suicidal behaviors had fewer psychiatric diagnoses and underlying genetic risk factors for mental health conditions than those who exhibited warning signs, according to Hilary Coon, a professor of psychiatry in the Spencer Fox Eccles School of Medicine t the University of Utah and the study’s first author.

She told Deseret News that the sheer number of suicide deaths with no previous indicators, including depression diagnosis, suggests it’s not just a matter of many not having sought treatment or due to gaps in screening or care. It indicates that paying attention to mental health remains very important, but that emphasis alone is not likely to identify all who may ultimately end their own lives….

The Centers for Disease Control and Prevention reported that in 2023, 49,000 individuals in the U.S. ended their own lives, making suicide the 11^th leading cause of death nationally.

Coon describes suicide as a complicated behavior. She noted that what’s going on with someone who is young and impulsive or dealing with significant depression is different from someone later in life who has chronic health conditions or other stressors, for instance. She spoke of suicide survivors who said they were not depressed or anxious, but rather were in situations that felt unmanageable.

She also noted that at some point everyone experiences traumas and events that are challenging and most don’t take their lives. But the difference between those who do and those who don’t is hard to untangle.

Traditional screening is likely ineffective in many cases, she said.

“Prior suicidality is the most robust estimator of suicide death, but the association with this estimator is imperfect, and many suicide deaths occur in its absence,” per the study.

Regarding clinical interventions, the study said “a focus solely on mental illness risk reduction may be less effective for individuals for whom this underlying liability may be substantially lower.” It added that “further understanding of clinical characteristics, underlying genetic liabilities, and external exposures” in those cases without known previous suicidal behaviors or mental health challenges “will be required to direct more targeted interventions.”

Clinicians do a good job of understanding people who have warning signs. The others, we don’t know who they are,” Coon said.

There are numerous reasons why clinicians do not know some of the interventions needed. Here are a few discovered by looking at the genetic data:

·         “Those without earlier suicidal ideation and behavior had fewer risk factors for a variety of psychiatric conditions – not just depression, but also anxiety, Alzheimer’s disease and post traumatic stress disorder. They appeared to have less genetic vulnerability to other conditions, like heart disease….

·         “The researchers note some limitations, including that some with previous suicidal notions may not have had those captured in the data.

·         “They also noted most of those in the data were of European ancestry, so findings might not be generalizable to all groups.

According to Coon, “future research will try to tease out some of the hidden risk factors. People in similar situations have different degrees of resilience.” She also pointed “out that genetic risk factors that may play a role still have a very small effect on risk overall and that none of them actually cause suicide….”