Is the Prevention Paradox Useful in Suicide Prevention Theory and Strategies?

Background:Little progress has been made in the areas of suicide prediction,explanation, and prevention mainly because of the difficulty in-herent in examining a low base-rate behavior such as suicidalbehavior. Objectives: Geoffrey Rose’s prevention paradox occurs when the majorityof cases with an adverse outcome come from a population oflow or moderate risk, and only a few from a ‘high risk’ group.The present study intends to test whether the prevention para-dox applies to the initiation of suicide attempts. Methods: Children born 1980-1985 were followed from age 15 to 29 (N=300,000). Data was analyzed using a discrete-time Coxmodel to allow for changing covariates over time. From admin-istrative registers a number of variables correlated with suicidalbehavior based on suicide prevention theories were collected,and thereby identify a high-risk group. These variables wereindividual risk factors such as living in a disadvantaged area,parental circumstances and behavior, and individual resourcedeficits recorded on yearly basis. An event history from birthto adulthood is used to estimate hazards at ages 15 to 29 years. The inclusion of event history information in the sta-tistical model refines the research question: Can we identifya high risk group (<5%) in the population from whom thesuicide attempts exclusively recruited? Findings: Family background and parental factors such as mental illness,suicidal behavior, violence, unemployment and family separa-tion all contributed independent information to prediction ofadolescent’s suicide attempts. The young person’s hospital-ization for psychiatric disorder (ADHD, anxiety, depression,severe stress reaction and adjustment disorders) contributedto the explanation model. Discussion and Conclusion: There are many factors contributing to suicide risk therefore itis challenging to identify a high risk group (<5%) in the pop-ulation. These findings illustrate that population-based ratherthan targeted strategies may be more beneficial for suicideprevention.