Table 3. Suicide Risk and Interventions in Specific Subgroups.* .
Subgroup | Suicide Rate no./100,000 |
Risk Factors | Interventions (Outcome to Be Prevented) |
---|---|---|---|
Children, adolescents, and young adults (age 10–24 yr) | 10 | Negative life events, mental disorders, substance misuse, access to lethal means | Psychological treatment — psychotherapy based on understanding one's mental state (self-harm in girls) |
Older adults (age ≥70 yr) | 43 | Functional disability, social isolation, malignant diseases, chronic diseases | Telephone counseling (suicide); multifaceted program of psychoeducation, depression screening, group therapy, and clear referral pathways (suicide among rural women); integration of mental health into primary health care (self-harm) |
Discharged psychiatric patients (first 90 days after discharge) | 178 | Recent self-harm, severe mental illness, first psychotic episode | Pharmacologic treatment for underlying disorders; psychological treatment — cognitive behavioral therapy, problem-solving therapy, or both (suicide) |
Prisoners | 23 | Housing in single-occupancy cell, remanded status, life sentence, violent-offense conviction, psychiatric disorders, alcohol use disorders | Removal of ligature points (suicide) |
Military and veteran populations | 20 | Early separation from service, recent deployment, lower rank, younger age, clinical depression, multiple disorders | Safety planning intervention, which involves prioritizing coping strategies and telephone contact to monitor risk (self-harm) |
Nonheterosexuals | Same as rate for general population | Same as risk factors for general population | Addressing suicidal risks openly with clinicians and addressing internalized stigma (self-harm) |
People who have harmed themselves | 439 (1-yr rate) | Past self-harm, physical health problems, male sex, suicidal intent, violent selfharm (use of firearms, hanging, or cutting), age of 45–64 yr (vs. younger age) | Psychological treatment — cognitive behavioral therapy, problem-solving therapy, or both (self-harm) |
Suicide rates refer to those in the United States, but the interventions are applicable to subgroups in all high-income (and possibly middle-income) countries. More detailed descriptions and references are provided in the Supplementary Appendix, available with the full text of this article at NEJM.org.