Suicide Prevention: Protective Factors and Interventions

Given the unfortunate prevalence of suicide, and our inability to accurately predict who is going to engage in suicidal behavior, today we focus on what we can do. We focus on the positive. What are protective factors against suicidal behaviors and what can be done to mitigate some risk factors?

Protective Factors

Research has demonstrated that there are factors that have somewhat of a defensive effect against suicidal behavior. These include:

• Positive coping strategies¹
• Access to appropriate and effective treatment ²
• Having the support of family and community (Strong personal relationships are especially important for adolescents and the elderly.)³
• Being married or in a committed relationship⁴
• Having young children⁵
• Being a twin⁶
• Education (The more education one has, the less likely one is to attempt suicide.)⁷
• Being able to control one’s impulses (Suicidal behavior is often acted on impulsively, a decision often being made in minutes. The ability to control one’s urges allowing the suicidal thoughts time to pass is critical.)⁸
• Being responsible⁹
• Being optimisitc¹⁰
• Future-orientation (the belief that the future is changeable)¹¹

Interventions

Aside from protective factors, what can actively be done to mitigate one’s risk for suicide? Treatment.

Treatment is one of the most important components to ameliorating suicidal risk.  While we can’t treat some of the major risk factors for suicidal behavior, such as gender, race, or age, we can treat those with psychiatric diagnoses and prior suicide attempts, two very strong independent risk factors for suicide. There are various forms of therapy shown to be effective for suicidal behavior including cognitive-behavioral therapy (CBT), dialectical behavioral therapy (DBT), and collaborative assessment and management of suicidality (CAMS)^12,13.

Means restrictions is another effective intervention that prevents suicides. Access to lethal means of suicide is a critical risk factor for suicidal behavior. The theory of means restriction is that by removing access to the lethal method, it delays the attempt. This delay gives the individual time to reconsider. Ideally, they may not attempt at all. Or, theoretically, they are forced to attempt with a less lethal method, hopefully, decreasing the chance of completing suicide¹⁴. Current data suggests that if you restrict one method, a suicidal person will not just find another. There have been multiple studies of means restrictions, and that data ultimately shows that while the suicide rates of other methods go up slightly, the overall suicide rate decreases. In other words, while some people go on to attempt suicide via a different method, a significant proportion do not attempt at all^15,16,17. Means restriction works.

So far, these interventions are not avenues most of us can pursue. Treatment should be left to the professionals and means restriction is usually left to law enforcement and legislation (e.g., firearm access laws, etc.) But what can the rest of us do? If someone you care about is having thoughts of suicide, the two quickest ways to alleviate suicidal risk is by getting rid of the method, which should be left to the professionals, or alleviating the isolation, which is where we can all help. Most major cities have 24-hour crisis lines. There is also the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). Getting the person to talk to someone at a crisis line can often be enough to deter suicidal action. What if you can’t get the person to call one of these lines? Talk to them yourself. Just talk. About almost anything, really. The key is you want to buy time. Suicidal thoughts tend to pass. People are at their highest risk for only a few minutes to a few hours¹⁸. If you can safely stay with them and talk, or even talk on the phone with them for a little while, that may be all it takes to prevent a suicide.

To be clear, if someone you care about is suicidal, has a plan, a method, access to the method, and intent to act, calling 911 is the only safe option. Never put yourself in danger.

National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) or visit suicidepreventionlifeline.org/

References

1. Centers for Disease Control and Prevention (2013). Preventing Suicide. National Center for Injury Prevention and Control, Division of Violence Prevention. Retrieved from: http://www.cdc.gov/features/preventingsuicide/
2. Ibid.
3. World Health Organization. (2014). Preventing suicide: A Global imperative. Retrieved from http://apps.who.int/iris/bitstream/10665/131056/1/9789241564779_eng.pdf?ua=1&ua=1
4. Collins, K. R., Best, I., Stritzke, W. G., & Page, A. C. (2016) Mindfulness and zest for life buffer the negative effects f experimentally-induced perceived burdensomeness and thwarted belongingness: Implications for theories of suicide. Journal of Abnormal Psychology, 125(5), 704-714. doi: 10.1037/abn000167
5. Tomassini, C., Juel, K., Holm, N. V., Skytthe, A., & Christensen, K. (2003). Risk of suicide in twins: 51 year follow up BMJ (327) 373-374.
6. Ibid.
7. Kessler, R. C., Borges, G., & Walters, E. (1999). Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Archives of General Psychiatry, 56, 617-626.
8. Bogg, T. & Roberts, B. W. (2004). Conscientiousness and health-related behaviors: A Meta-analysis of the leading behavioral contributors to mortality. Psychological Bulletin, 130(6), 887-919. doi: 10.1037/0033-2909.130.6.887
9. Ibid.
10. Yu, E. A. & Chang, E. C. (2016). Optimism/pessimism and future orientation as predictors of suicidal ideation: Are there ethnic differences? Cultural Diversity and Ethnic Minority Psychology, 22(4), 572-579. doi: 10.1037/cdp0000107
11. Bertolote, J. M., Fleischmann, A., DeLeo, D., & Wasserman, D. (2004). Psychiatric diagnoses and suicide: Revisiting the evidence. Crisis, 25(4), 147-155. doi: 10.1027/0227-5910.25.4.147
12. Spruill, T. (2017). Disarming the suicidal mind: Evidence-based assessment and intervention. Vyne Education. Minneapolis, MN.
13. Yip, P. S., Caine, E. Yousuf, S., Wu, K. C. & Chen, Y. (2012). Means restriction for suicide prevention. Lancet, 379, 2393-2399.
14. Westefeld, J. S., Gann. L. C., Lustgarten. S. D., & Yeates, K. J. (2016). Relationships between firearm availability and suicide: The Role of psychology. Professional Psychology: Research and Practice, 47(4), 271-277. doi: 10.1037/pro0000089
15. Sinyor, M. & Levitt, A.J. (2010). Effect of a barrier at Bloor Stree Viaduct on suicide rates in Toronto: Natural experiment. BMJ, 34. doi: 10:1136/bmj.c2884
16. Barber, C. W., & Miller, M. J. (2014). Reducing a suicidal person’s access to lethal means of suicide: A Research agenda. American Journal of Preventive Medicine, 47(3S2), S264-S272.
17. Westefeld, J. S., Gann. L. C., Lustgarten. S. D., & Yeates, K. J. (2016). Relationships between firearm availability and suicide: The Role of psychology. Professional Psychology: Research and Practice, 47(4), 271-277. doi: 10.1037/pro0000089