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Abstract
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he recent signing into law of the $1.9 trillion American Rescue Plan aims to improve the financial security of millions of people with low and middle incomes in the US through extending unemployment benefits, providing direct payments, funding emergency paid leave, and several other measures. The epidemiologic literature connecting financial crises to elevated risk of suicidal behavior raises the possibility that by improving financial security at a population level, the new legislation might help reverse a 2-decades-long gradual national increase in suicide.1
Such a population-based perspective on suicide risk prevention complements the traditional individual-level perspective that has guided much of the research and clinical interventions on suicide prevention during the past half century. The individual-level perspective posits that the incidence of suicide attempts could be reduced through improved detection and intervention involving individual patients. This work has traditionally sought to identify individual clinical indicators to inform risk assessment of fatal and nonfatal suicide attempts and develop etiologic models of risk. The large number of factors associated with suicidal behavior has led to development of theoretic models that emphasize complex interactions between social, psychological, environmental, and biological factors. However, despite advances in the understanding of the clinical and neurobiologic characteristics of individuals who attempt and complete suicide, suicide was the 10th leading cause of death in the US in 2019 and in 2020 accounted for a provisionally estimated 44 834 deaths,2 highlighting the need for new approaches to suicide prevention.
One leading etiologic conceptualization of suicide attempt is the stress-diathesis model.3 The diathesis includes heightened emotional response to stress, a greater propensity for emotion to influence decisions, impaired learning and problem-solving capacity, and several psychiatric disorders. The stressor is often a life event, such as the death of a loved one or financial loss.4 The stress-diathesis model illustrates the complex etiology of suicidal behavior.
Nevertheless, even when multiple measures tapping into this complexity are taken into account, the positive predictive value (PPV) of current models for death by suicide is 1%,5 far below the level of accuracy that patients, family members, and possibly the legal system may expect from a thorough clinical assessment.6 Moreover, many factors, such as psychiatric symptom severity or intensity of emotional response to a life event, can vary during short periods. This variability further complicates prediction of whether and when an individual will attempt suicide...
Language: en |