Risk Factors for Suicide Ideation Differ From Those for the Transition to Suicide Attempt: The Importance of Creativity, Rigor, and Urgency in Suicide Research

We were invited to comment on the article by May and Klonsky (2016) titled “What Distinguishes Suicide Attempters From Suicide Ideators? A Meta-Analysis of Potential Factors.” We were delighted to see the authors calling attention to the fact that the risk factors for onset of suicide ideation differ from those for the transition from suicide ideation to attempt. Our commentary focuses on three points: (a) despite the authors' framing it as such, this is not a new research question, but one with a substantial history; (b) this meta-analysis excludes most of the available data on this topic and focuses instead on results from small and nonrepresentative studies, limiting the validity of the inferences that can be drawn from this analysis; and (c) this meta-analysis was designed in a way that precludes the examination of actual risk factors for the transition from suicidal thought to action. We conclude by discussing some important considerations for future research.