Near‐Term Risk for Psychosis and Non‐Psychosis‐Related Suicide: A Retrospective Examination of the Last 30 Days of Life

Introduction and Method Suicide is a major public health problem in the United States. This retrospective exploratory study examined clinician‐identified state‐related risk factors observed within 30 days prior to death by suicide, comparing 24 decedents with psychosis‐related suicide and 133 non‐psychosis‐related suicide. A secondary descriptive analysis was conducted for 47 patients who were evaluated and denied suicidal ideation within 48 h of death by suicide. Results Demographic factors being single and unemployed increased risk across both cohorts. While reporting similar SI histories, decedents with psychosis had higher rates of suicide attempts (67% vs. 38%), anxiety and agitation (83% vs. 77%), substance abuse (79% vs. 40%), comorbid diagnosis (71% vs. 54%), social isolation (71% vs. 54%), and treatment non‐adherence (58% vs. 4%). In contrast, decedents without psychosis reported sleep problems (80% vs. 54%), and acquired capability for suicide (96% vs. 46%). Among psychotic patients who denied having SI, 83% died by suicide within two days of evaluation. Conclusions Suicide risk assessment that places strong reliance on verbalized SI as a gateway to determine risk is insufficient in practice. For optimal clinical management and suicide prevention clinicians need a better understanding of near‐term risk for suicide and to focus assessment and clinical care accordingly.