What distinguishes suicide attempters from suicide ideators? A meta-analysis of potential factors.
Abstract
Most suicide ideators do not attempt suicide. Thus, it is useful to understand what differentiates attempters from ideators. We meta-analyzed 27 studies comparing sociodemographic and clinical variables between attempters and ideators. When comparing ideators to nonsuicidal individuals, there were several large effects. For example, depression and PTSD were markedly elevated among ideators (d = .85–.90). In contrast, when comparing attempters to ideators, all 12 variables had negligible to moderate effects. Specifically, depression, alcohol use disorders, hopelessness, gender, race, marital status, and education all were similar in attempters and ideators (d = −.05 to .31). Anxiety disorders, PTSD, drug use disorders, and sexual abuse history were moderately elevated in attempters compared to ideators (d = .48–.52). Implications for theory and practice are discussed.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
None of these psychological processes reliably differentiate between ideators and attempters, so they may increase vulnerability to mental health problems but are unlikely to be involved in the final common pathway to suicide attempts.
“Since none of these psychological processes reliably differentiate between ideators and attempters (May and Klonsky, 2016; Franklin et al., 2017), they may increase some individuals’ vulnerability towards experiencing mental health problems, but are unlikely to be involved in the final common pathway to suicide attempts.”
From The Psychological Pathway to Suicide Attempts: A Strategy of Control Without Awareness (2021) · cites this paper as May and Klonsky, 2016
Many well established risk factors for suicide, such as depression, impulsivity, and hopelessness, do not meaningfully differentiate individuals with suicidal thoughts from those who have made an attempt.
“Several large epidemiological and meta-analytical studies provide empirical support for this framework and have found that many well established risk factors for suicide (such as depression, impulsivity, and hopelessness) do not meaningfully differentiate individuals with suicidal thoughts from those who have made an attempt.1, 5, 6, 7”
From Predictors of future suicide attempt among adolescents with suicidal thoughts or non-suicidal self-harm: a population-based birth cohort study (2019) · cites this paper as [5]
These factors appear to be associated with suicide attempts because they are associated with the development of suicidal thoughts or non-suicidal self-harm, but are not involved in the transition.
“However, our results are consistent with previous research5, 20 that has suggested that these factors appear to be associated with suicide attempts because they are associated with the development of suicidal thoughts or non-suicidal self-harm, but are not involved in the transition.”
From Predictors of future suicide attempt among adolescents with suicidal thoughts or non-suicidal self-harm: a population-based birth cohort study (2019) · cites this paper as [5]
Cites
The Hospital Anxiety and Depression Scale
Zigmond, A. S., & Snaith, R. P. (1983) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1983.tb09716.x · Cited by 47,139 · see citing works
Quantifying heterogeneity in a meta‐analysis
Higgins, J. P. T., & Thompson, S. G. (2002) · Statistics in Medicine · doi:10.1002/sim.1186 · Cited by 36,763 · see citing works
Nock, M. K., Hwang, I., Sampson, N. A., & Kessler, R. C. (2010) · Molecular Psychiatry · doi:10.1038/mp.2009.29 · Cited by 1,125 · see citing works
Silverman, M. M., Berman, A. L., Sanddal, N. D., O'Carroll, P. W., & Joiner, T. E. (2007) · Suicide and Life-Threatening Behavior · doi:10.1521/suli.2007.37.3.264 · Cited by 991 · see citing works
Nock, M. K., Hwang, I., Sampson, N., Kessler, R. C., Angermeyer, M., Beautrais, A., Borges, G., Bromet, E., Bruffaerts, R., de Girolamo, G., et al. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000123 · Cited by 912 · cited 1× · see citing works
“For example, certain panic attack symptoms, such as feeling like one might die or go crazy, appear to have an enhanced relationship to the transition to attempt (Katz, Yaseen, Mojtabai, Cohen, & Galynker, 2011; Nock et al., 2009).”
BackgroundSareen, J., Cox, B. J., Afifi, T. O., de Graaf, R., Asmundson, G. J. G., ten Have, M., & Stein, M. B. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.11.1249 · Cited by 824 · see citing works
Klonsky, E. D., & May, A. M. (2014) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12068 · Cited by 740 · see citing works
Self-citationKlonsky, E. D., May, A. M., & Glenn, C. R. (2013) · Journal of Abnormal Psychology · doi:10.1037/a0030278 · Cited by 692 · see citing works
Self-citationTowards an integrated motivational–volitional model of suicidal behaviour
O'connor, R. C. (2011) · International Handbook of Suicide Prevention · doi:10.1002/9781119998556.ch11 · Cited by 552 · see citing works
Chronic Pain Conditions and Suicidal Ideation and Suicide Attempts: An Epidemiologic Perspective
Ratcliffe, G. E., Enns, M. W., Belik, S.-L., & Sareen, J. (2008) · The Clinical Journal of Pain · doi:10.1097/ajp.0b013e31815ca2a3 · Cited by 304 · see citing works
Miller, M., Azrael, D., & Barber, C. (2012) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-031811-124636 · Cited by 265 · see citing works
A twin study of genetic and environmental influences on suicidality in men
FU, Q., HEATH, A. C., BUCHOLZ, K. K., NELSON, E. C., GLOWINSKI, A. L., GOLDBERG, J., LYONS, M. J., TSUANG, M. T., JACOB, T., TRUE, M. R., et al. (2002) · Psychological Medicine · doi:10.1017/s0033291701004846 · Cited by 245 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Suicide, Suicide Attempts, and Suicidal Ideation
Klonsky, E. D., May, A. M., & Saffer, B. Y. (2016) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-021815-093204 · Cited by 1,675 · see citing works
Self-citationIdeation-to-action theories of suicide: a conceptual and empirical update
Klonsky, E. D., Saffer, B. Y., & Bryan, C. J. (2018) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2017.07.020 · Cited by 673 · see citing works
Self-citationMars, B., Heron, J., Klonsky, E. D., Moran, P., O'Connor, R. C., Tilling, K., Wilkinson, P., & Gunnell, D. (2019) · The Lancet Psychiatry · doi:10.1016/s2215-0366(19)30030-6 · Cited by 546 · see citing works
Self-citationSafety planning-type interventions for suicide prevention: meta-analysis
Nuij, C., van Ballegooijen, W., de Beurs, D., Juniar, D., Erlangsen, A., Portzky, G., O'Connor, R. C., Smit, J. H., Kerkhof, A., & Riper, H. (2021) · The British Journal of Psychiatry · doi:10.1192/bjp.2021.50 · Cited by 270 · see citing works
Rumination, Suicidal Ideation, and Suicide Attempts: A Meta-Analytic Review
Rogers, M. L., & Joiner, T. E. (2017) · Review of General Psychology · doi:10.1037/gpr0000101 · Cited by 245 · see citing works
Mars, B., Heron, J., Klonsky, E. D., Moran, P., O'Connor, R. C., Tilling, K., Wilkinson, P., & Gunnell, D. (2019) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12878 · Cited by 185 · see citing works
Self-citationRecent advances in differentiating suicide attempters from suicide ideators
Klonsky, E. D., Qiu, T., & Saffer, B. Y. (2017) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000294 · Cited by 193 · see citing works
Self-citationXiao, Y., Cerel, J., & Mann, J. J. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.13513 · Cited by 166 · see citing works
Adolescent self-injurers: comparing non-ideators, suicide ideators, and suicide attempters.
Stewart, J. G., Esposito, E. C., Glenn, C. R., Gilman, S. E., Pridgen, B., Gold, J., & Auerbach, R. P. (2017) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2016.09.031 · Cited by 139 · see citing works
A structural test of the integrated motivational-volitional model of suicidal behaviour
Dhingra, K., Boduszek, D., & O'Connor, R. C. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.03.023 · Cited by 105 · see citing works
Holliday, R., Borges, L. M., Stearns-Yoder, K. A., Hoffberg, A. S., Brenner, L. A., & Monteith, L. L. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.01998 · Cited by 92 · see citing works
People Who Die by Suicide Without Receiving Mental Health Services: A Systematic Review
Tang, S., Reily, N. M., Arena, A. F., Batterham, P. J., Calear, A. L., Carter, G. L., Mackinnon, A. J., & Christensen, H. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2021.736948 · Cited by 89 · see citing works
Mental disorders and risk of suicide attempt in prisoners
Favril, L., Indig, D., Gear, C., & Wilhelm, K. (2020) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-020-01851-7 · Cited by 69 · see citing works
Zou, Y., Li, H., Shi, C., Lin, Y., Zhou, H., & Zhang, J. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2016.12.046 · Cited by 54 · see citing works
Brown, V. M., Wilson, J., Hallquist, M. N., Szanto, K., & Dombrovski, A. Y. (2020) · Neuropsychopharmacology · doi:10.1038/s41386-020-0632-0 · Cited by 48 · see citing works
The differences between suicide ideators and suicide attempters: simple, complicated, or complex
Huang, X., Ribeiro, J. D., & Franklin, J. C. (2020) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000498 · Cited by 50 · see citing works
Paashaus, L., Forkmann, T., Glaesmer, H., Juckel, G., Rath, D., Schönfelder, A., & Teismann, T. (2021) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2580 · Cited by 46 · see citing works
Bryan, C. J., & Bryan, A. O. (2021) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2021.102414 · Cited by 38 · see citing works
The Psychological Pathway to Suicide Attempts: A Strategy of Control Without Awareness
Macintyre, V. G., Mansell, W., Pratt, D., & Tai, S. J. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.588683 · Cited by 26 · see citing works
Yang, L., Zhang, S., Liu, X., Hou, J., & Hou, X. (2023) · Current Psychology · doi:10.1007/s12144-021-01666-y · Cited by 14 · see citing works
Suicide prevention and ketamine: insights from computational modeling
Charlton, C. E., Karvelis, P., McIntyre, R. S., & Diaconescu, A. O. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1214018 · Cited by 7 · see citing works
Interactions of factors in self-injuries among enrolled students: a network approach.
Zhang, Y.-M., Jiang, X.-M., Xie, Y., Lang, N., Liang, M.-L., Zhang, P., OuYang, L.-C., Lv, Z.-W., Liu, C.-W., Zhang, L.-P., et al. (2025) · Annals of General Psychiatry · doi:10.1186/s12991-025-00570-0
“When it measured as a continuous clinical or psychological variable, depression could distinguish those who attempt suicide from those who simply have SI (without SA), while depression diagnosis did not [38].”
- Authors
- May, A. M., & Klonsky, E. D.
- Affiliations
- University of British Columbia (CA)
- Corresponding author
- Klonsky, E. David
- Venue
- Clinical Psychology: Science and Practice
- Published
- 2016-02-11
- Volume
- 23
- Issue
- 1
- Pages
- 5-20
- ISSN
- 0969-5893 (ISSN-L)
- OpenAlex
- W2318381360
- Cited by
- 459
- References
- 12
- Citations by year
- 2026: 16 · 2025: 39 · 2024: 42 · 2023: 43 · 2022: 40 · 2021: 84 · 2020: 60 · 2019: 28 · 2018: 52 · 2017: 32 · 2016: 22
- FWCI
- 6.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Psychology Science and Practice (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
- Keywords
- suicide attempters, suicide risk factors, depression, post-traumatic stress disorder, anxiety disorders, substance use disorders, hopelessness, sexual abuse history, sociodemographic factors
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
