The path not taken: Distinguishing individuals who die by suicide from those who die by natural causes despite a shared history of suicide attempt

OBJECTIVES: This study aimed to identify variables that distinguish suicide risk among individuals with previous suicide attempts. METHOD: Using psychological autopsy procedures, we evaluated 86 decedents who had at least one lifetime suicide attempt before eventual death by suicide (n = 65) or natural causes (n = 21). RESULTS: The Suicide Death group was more likely to be male, to have alcohol in the toxicology report at time of death, and to have a depression diagnosis, while the Natural Cause Death group was more likely to have personality disorder traits, a polysubstance use disorder, higher reported health stress, and an antidepressant in the toxicology report at time of death. Hopelessness and ambivalence were found to distinguish between groups during the 6 months before death. CONCLUSIONS: These findings suggest important differences between individuals with a shared history of a suicide attempt who die by suicide versus natural causes.