Table 2.
Suicide risk and protective factors in MDD
| Risk factors | Protective factors | |||
|---|---|---|---|---|
| Factors affecting threshold for suicidal behaviour | ||||
| Demographic and individual risk factors | Demographic and individual risk factors | |||
| • Male gender | • No personal history of attempted suicide | |||
| • Younger and/or older age | • No family history of suicide and/or attempted suicide | |||
| • Personal history of attempted suicide | • No personal and/or family history for psychotic symptoms and/or disorders | |||
| • Positive family history of suicide | • No personal and/or family history for SUD and/or AUD | |||
| • Marital isolation | • Religious or moral constraints | |||
| • Chronic physical illness | • Concern about social disapproval | |||
| • Parental loss through death before age 11 | • Better coping skills | |||
| • Child history of physical or sexual abuse | • Feelings of responsibility towards family | |||
| • Corporal punishment in adolescence | • Living with children under age 18 | |||
| Symptom risk profile risks | • Supportive relationships | |||
| • Presence of hopelessness | • Positive and valid therapeutic alliance | |||
| • Presence of low self-esteem | • Better impulsivity control | |||
| • Feelings of whortlessness | • Better emotional regulation | |||
| • Feelings of helplessness | ||||
| • Feelings of entrapment | ||||
| • Anhedonia | ||||
| • Cognitive rigidity | ||||
| • Impaired problem solving and/or decision making | ||||
| • Impulsive aggressive personality trait | ||||
| • Early onset of MDD | ||||
| • First episode of MDD | ||||
| • Comorbid SUD and/or AUD | ||||
| • Comorbid BPD | ||||
| Suicide risk factors as triggers | ||||
| Demographic and individual risk factors | Symptom protective risks | |||
| • Social, financial or family crisis or loss | • Good self-esteem | |||
| • Contagion or recent exposure to suicide | • Self-efficacy | |||
| • Social support lacking | • Good problem-solving skills | |||
| Symptom risk profile risks | • Willingness to seek help | |||
| • Comorbid anxiety symptoms | • Positive coping skills | |||
| • Comorbid panic disorder | • Emotional stability | |||
| • Acute alcohol and/or substance intoxication | • Responsibility to family | |||
| • Presence of psychotic symptoms | • Developed self-identity | |||
| • Severity of depressive episode of MDD | • Healthy lifestyle choices | |||
| • Post-partum | ||||
| Circumstantial risk profile risks* | Circumstantial risk profile risks* | |||
| • Reduced or absent desire to live | • Absence of SI, SP, SB or SHB | |||
| • Active SI | • No feelings of hopelessness, desire to die | |||
| • Presence of a SP | • Good connectedness | |||
| • Presence of SB or SHB | • Good therapeutic adherence | |||
| • Acute alcohol and/or substance intoxication | • Positive therapeutic relationship and alliance | |||
| • Unresolvable problems | • Good future planning | |||
| • Presence of auditory imperative hallucinations (order to suicide oneself) | • Solving of previous critical problems | |||
| • Positive social support | ||||
| • Moral objections towards SB | ||||
| • Fear of social disapproval towards SB | ||||
*
these factors should be evaluated, in the moment of clinical observation (Interview Risk Profile), by a psychiatrist or a medical doctor.
MDD: major depressive disorder, SUD: substance use disorder, AUD: alcohol use disorder, BPD: borderline personality disorder, SI: suicidal ideation, SP: suicide planning, SB: suicidal behaviour, SHB: self-harm behaviour