A risk index for 12-month suicide attempts in the National Comorbidity Survey Replication (NCS-R)

Abstract

BACKGROUND Clinical judgments about the likelihood of suicide attempt would be aided by an index of risk factors that could be quickly assessed in diverse settings. We sought to develop such a risk index for 12-month suicide attempts among suicide ideators. METHOD The National Comorbidity Survey Replication (NCS-R), a household survey of adults ages 18+, assessed 12-month occurrence of suicide ideation, plans, and attempts in a subsample of 5692 respondents. Retrospectively assessed correlates include history of prior suicidality, socio-demographics, parental psychopathology, and 12-month DSM-IV disorders. RESULTS Twelve-month prevalence estimates of suicide ideation, plans, and attempts are 2.6%, 0.7%, and 0.4%. Although ideators with a plan are more likely to make an attempt (31.9%) than those without a plan (9.6%), 43% of attempts were described as unplanned. History of prior attempts is the strongest correlate of 12-month attempts. Other significant correlates include shorter duration of ideation, presence of a suicide plan, and several socio-demographic and parental psychopathology variables. Twelve-month disorders are not powerful correlates. A four-category summary index of correlates is strongly related to attempts among ideators (AUC = .88). The distribution (conditional probability of attempt) of the risk index is 19.0% very low (0.0%), 51.1% low (3.5%), 16.2% intermediate (21.3%), and 13.7% high (78.1%). Two-thirds (67.1%) of attempts were made by ideators in the high risk category. CONCLUSIONS A short, preliminary risk index based on retrospectively reported responses to fully structured questions is strongly correlated with 12-month suicide attempts among ideators, with a high concentration of attempts among high-risk ideators.