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.