Individuals at high risk for suicide are categorically distinct from those at low risk

In clinical practice, providers tend to somewhat arbitrarily put clients into low, moderate, and high risk categories based upon their perceived suicide risk. Although these categorizations seem to make sense on the surface, they have not led to meaningful decreases in suicide attempts or deaths by suicide. Tracy Witte, Ph.D. of Auburn University, Jill Holm-Denoma, Ph.D. of the University of Denver, and collaborators conducted an empirical study examining whether people at high risk for suicide are categorically distinct from everyone else, versus whether all people exist somewhere along a continuum of suicidality.

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They examined a large sample of predominantly military personnel (77% male, 67% white) using a statistical technique called taxometric analysis. After examining patterns among variables such as number of previous suicide attempts, current suicidal ideation, and current suicide planning, the results unequivocally demonstrated that participants who are at a high risk of suicide are qualitatively different from those who are not. Follow-up external validity analyses showed that people in the high-risk group had notably higher scores on measures of hopelessness, perceived burdensomeness, and suicidal desire/ideation than those in the low risk group. Since our initial study, the results were largely replicated in an independent sample (Rufino et al., 2018).

This knowledge could have critical implications for developing effective, efficient suicide risk assessment and intervention procedures. Specifically, pending additional replication, our results suggest that brief, empirically-based assessments could accurately group people into high and low suicide risk categories. They also indicate that suicide intervention research should focus primarily on those in the high-risk group, as opposed to subclinical samples.  Moving forward, we encourage researchers to examine the predictive validity of the high-risk taxon (i.e., does group membership predict subsequent suicidal behavior?) and to determine which assessment procedures have the highest sensitivity and specificity for identifying people who fall into the high-risk group.


†Witte, T. K., †Holm-Denoma, J. M., Zuromski, K. L., Gauthier, J. M., & Ruscio, J. (2017). Individuals at high risk for suicide are categorically distinct from those at low risk. Psychological Assessment, 29, 382-393. (†Drs. Witte and Holm-Denoma share first authorship of this publication)

Rufino, K., Marcus, D., Ellis, T., & Boccaccini, M. (2018). Further evidence that suicide risk is categorical: A taxometric analysis of data from an inpatient sample. Psychological Assessment, 30, 1541-1547.

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