Suicide Prediction Factors — MRCPsych Paper B MCQ

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ModerateLiaison PsychiatrySuicide Prediction FactorsMRCPsych Paper B

An adult is assessed by liaison psychiatry after an episode of self-harm. At a population level, which of the following factors is associated with an increased risk of subsequent death by suicide?

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Correct answer: B — Multiple previous episodes of self-harm

Explanation lettering: C = shown as A · D = shown as C · E = shown as D · A = shown as E

B is correct. Longitudinal evidence shows that multiple previous episodes of self-harm are associated with an increased risk of subsequent suicide. Female sex and younger age are plausible distractors because they are associated with non-fatal repetition of self-harm; death by suicide after self-harm is instead more strongly associated with male sex and increasing age. Employment and cohabitation are not established adverse markers in this context. Importantly, no isolated factor reliably predicts whether an individual will die by suicide. NICE NG225 therefore advises against using risk scales or global low-, medium- or high-risk categories to predict suicide or determine discharge. A comprehensive psychosocial assessment and individual risk formulation remain essential.

Reference: Liu BP et al. Associating factors of suicide and repetition following self-harm: a systematic review and meta-analysis of longitudinal studies. eClinicalMedicine. 2022;49:101461. https://pubmed.ncbi.nlm.nih.gov/35747199/