Suicide is a public health concern influenced by biological, psychological, and social factors. A risk factor is a characteristic or condition that increases the likelihood of an outcome, representing a correlation observed in population studies. Understanding these associations is fundamental to prevention efforts, allowing clinicians and support systems to identify individuals who may benefit most from intervention. While many elements contribute to a suicidal crisis, two factors consistently show the strongest statistical association with death by suicide.
Prior Suicide Attempts as the Strongest Indicator
The most significant predictor of death by suicide is a history of one or more prior suicide attempts. This factor represents a substantial and enduring risk, often referred to as “repetition risk” in suicidal behavior. Individuals who have previously attempted suicide are estimated to be 25 to 40 times more likely to die by suicide compared to the general population. This magnitude of risk makes a prior attempt the highest priority signal in a clinical risk assessment.
A previous attempt demonstrates that an individual has crossed the psychological barrier from suicidal ideation to action. This transition is a powerful predictor of future behavior because it shows the individual has overcome the natural instinct for self-preservation. The lethality of the initial attempt does not negate the risk, as even attempts with lower medical severity indicate a high degree of underlying distress. The risk is particularly pronounced in the first few months following an attempt, but it remains elevated for years afterward.
The Role of Underlying Mental Health Conditions
The presence of specific mental health disorders represents the second strongest risk factor for suicide. Nearly all people who die by suicide have a diagnosable mental health condition, though many were not formally diagnosed at the time of death. Mood disorders are particularly implicated, including Major Depressive Disorder and Bipolar Disorder. For example, individuals with Schizophrenia spectrum disorder are approximately 15 times more likely to die by suicide than the general population, and those with Bipolar Disorder are about 13 times more likely.
These conditions elevate risk because they often involve intense feelings of hopelessness, leading to the belief that suffering is permanent and inescapable. Disorders like Bipolar Disorder and Schizophrenia can also include symptoms such as impulsivity and altered reality, which impair judgment during a crisis. The co-occurrence of a Substance Use Disorder (SUD) significantly compounds the danger. Alcohol and drug misuse increase impulsivity and reduce inhibitions, making a person more likely to act on suicidal thoughts.
Urgent Resources and How to Seek Help
If you or someone you know is experiencing suicidal thoughts, seek help immediately using established crisis resources. The 988 Suicide & Crisis Lifeline is a free, confidential service available 24 hours a day, seven days a week, across the United States. You can connect with a trained crisis counselor by calling or texting 988, or by using the chat feature on the Lifeline’s website.
For those concerned about a loved one, immediate safety steps include removing access to all lethal means, such as firearms or medications, until the crisis has passed. Individuals who are Veterans can press 1 after dialing 988 to connect directly with the Veterans Crisis Line. While crisis lines offer immediate support, managing the long-term risk associated with prior attempts and mental health conditions requires professional treatment. Ongoing care with a mental health professional, such as a therapist or psychiatrist, is necessary for reducing the risk of future crises.