Psychosocial characteristics as potential predictors of suicide in adults: an overview of the evidence with new results from prospective cohort studies

Abstract

In this narrative overview of the evidence linking psychosocial factors with future suicide risk, we collected results from published reports of prospective studies with verified suicide events (mortality or, less commonly, hospitalisation) alongside analyses of new data. There is abundant evidence indicating that low socioeconomic position, irrespective of the economic status of the country in question, is associated with an increased risk of suicide, including the suggestion that the recent global economic recession has been responsible for an increase in suicide deaths and, by proxy, attempts. Social isolation, low scores on tests of intelligence, serious mental illness (both particularly strongly), chronic psychological distress, and lower physical stature (a marker of childhood exposures) were also consistently related to elevated suicide rates. Although there is some circumstantial evidence for psychosocial stress, personality disposition, and early-life characteristics such as bullying being risk indices for suicide, the general paucity of studies means it is not currently possible to draw clear conclusions about their role. Most suicide intervention strategies have traditionally not explored the modification of psychosocial factors, partly because evidence linking psychosocial factors with suicide risk is, as shown herein, largely in its infancy, or, where is does exist, for instance for intelligence and personality disposition, the characteristics in question do not appear to be easily malleable.

Fig. 1. Annual suicide rates (age-standardised) for ages ≥15 years in England and Wales (3-year moving averages) 1861–2007

Source: Suicide in England and Wales 1861–2007: a time-trends analysis. Reproduced with permission following payment to OUP

Fig. 2. Suicide rates (age-standardised) in different regions of the world, 2012

Source: Preventing suicide: a global imperative. Reproduced with kind permission from WHO

Fig. 3. IQ and suicide risk: 17,736 hospitalisations for suicide in 1,109,453 conscripted men

Source: Based on further analyses of data published elsewhere. IQ category 9 (lowest performance) is the referent

Fig. 4. Physical stature and suicide risk: 19,248 suicide hospitalisations in 1,182,114 conscripted men

Source: Based on further analyses of data published elsewhere. Height decile 1 (shortest) is the referent

Fig. 5. Association of psychosocial factors with suicide deaths: 117 suicide deaths in 170,678 individuals from the Health Survey for England and the Scottish Health Survey

Source: Based on further analyses of data published elsewhere