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Sursely, Dissertation FINAL2.33 MB
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Dissertation
The precipitating circumstances of adult suicide deaths: patterns, context, and the state of prevention research
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Spring 2025
DOI: 10.25820/etd.007855
Abstract
Background: Suicide is the 11th leading cause of death in the United States, and rates have risen steadily since the year 2000. Negative life events such as financial strain and interpersonal conflict are associated with heightened risk of suicide. This risk might be greatest in short timeframes following the onset of a crisis, but little is known about which crises co-exist, and how they unfold and interact in real-world cases. Additionally, the extent to which suicide prevention interventions address crises remains unclear. The purpose of this dissertation was to better characterize precipitating crises preceding suicide completion, and to evaluate the availability of targeted interventions.
Methods: We performed two studies using data from the National Violent Death Reporting System (NVDRS). In the first study we used Latent Class Analysis (LCA) to identify distinct patterns of precipitating crises in adults who had died by suicide from 2013-2021, and examined the demographic correlates of class membership. In the second study we used inductive summative content analysis to analyze qualitative NVDRS narrative reports to determine the details of precipitating crises. In the final study, we conducted an umbrella review, synthesizing systematic reviews of interventions targeting precipitating circumstances known to increase suicide risk.
Results: Using LCA we identified six classes of crises, including (1) co-occurring substance use, alcohol, relationship, and eviction (2) physical health (3) “other” (4) criminal legal (5) co-occurring job, financial, and intimate partner, and (6) intimate partner crises. Qualitative analysis revealed that each of these crisis types encompassed a diverse array of interconnected stressors. For example, the circumstance “financial crisis” was often caused by a recent job loss, chronic unemployment, substance use, or medical condition. This crisis manifested itself as either general financial stress, accumulated debt, or a failing business. As a result of the financial crisis, individuals experienced housing issues, interpersonal conflict, compromised medical care, bankruptcy, and a loss of material goods. Finally, in our umbrella review, we identified 35 systematic reviews covering 52 individual-level interventions targeting intimate partner violence, physical health problems, suicide bereavement, financial problems, housing, disaster exposure, incarceration, and job problems. Findings of this review highlighted substantial gaps in available interventions, with limited evaluations of effectiveness and significant methodological limitations.
Conclusions: The results of this dissertation highlight that suicide prevention interventions must move beyond addressing single risk factors to consider the broader, interconnected stressors that contribute to suicide. Despite the well-documented role of crises in suicide risk, evidence-based interventions remain scarce and inadequately evaluated. Future research should prioritize systematic assessment and implementation of interventions designed to address overlapping crisis events, with an emphasis on holistic, multi-domain prevention strategies.
Details
- Title: Subtitle
- The precipitating circumstances of adult suicide deaths: patterns, context, and the state of prevention research
- Creators
- Amanda M Sursely
- Contributors
- Jonathan M Platt (Advisor)Sarah H Nash (Committee Member)Emily K Roberts (Committee Member)Anne G Sadler (Committee Member)James C Torner (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Epidemiology
- Date degree season
- Spring 2025
- DOI
- 10.25820/etd.007855
- Publisher
- University of Iowa
- Number of pages
- xii, 257 pages
- Copyright
- Copyright 2025 Amanda M Sursely
- Language
- English
- Date submitted
- 04/11/2025
- Description illustrations
- illustrations, tables
- Description bibliographic
- Includes bibliographical references (pages 236-257).
- Public Abstract (ETD)
- Suicide is the 11th leading cause of death in the United States, and rates are rising each year. Negative life events such as financial strain and relationship conflicts are associated with an increased risk of suicide, especially in the days or weeks immediately after they occur. We define this acute period as a crisis, but little is known about how crises co-occur and develop in real-world cases. Additionally, it remains unclear whether suicide prevention efforts are effective at addressing crises. The purpose of this dissertation was to better understand the details and overlap of crises preceding suicide, and to evaluate the availability of targeted interventions. We identified six patterns of crises among people who died by suicide, including (1) co- occurring substance use, alcohol, relationship, and eviction (2) physical health (3) criminal (4) co-occurring job, financial, and intimate partner (5) intimate partner and (6) “other” crises. Analysis of real-world suicide narratives highlighted that each of these crises encompass a diverse array of situations and stressors. We also identified 35 reviews on suicide prevention targeting intimate partner violence, physical health problems, suicide bereavement, financial problems, housing, disaster exposure, incarceration, and job problems. However, no review was able to draw solid conclusions about which interventions may be effective and evidence remains limited. These findings highlight the need for suicide prevention efforts that go beyond single risk factors to address overlapping crises. Future research should prioritize the implementation of interventions that recognize and address the complexity of the life circumstances that lead to suicide.
- Academic Unit
- Epidemiology
- Record Identifier
- 9984831125102771
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