Subtitle: New research uncovers a distinct genetic profile among those who die by suicide without known mental health warning signs, challenging prevention strategies.
Rethinking Suicide Risk: Beyond the Traditional Signs
For families and friends left behind after a suicide, shock is often mingled with anguish: I didn’t know. There were no signs. This scenario is tragically common—about half of people who die by suicide have never exhibited obvious suicidal thoughts or behaviors. Many also lack diagnoses of mental illnesses typically linked with suicide risk, such as depression or anxiety. Are these simply missed cases, overlooked by traditional mental health screening? Or is something deeper at play?
A groundbreaking genetics study led by the University of Utah suggests a surprising answer: these individuals do not merely slip through the cracks of current psychiatric care. They might, in fact, represent an entirely distinct group with fundamentally different risk factors compared to those whose suicidality is detected and documented.
The Study: Looking for Hidden Patterns in Genes
Researchers set out to unravel differences between two groups of people who died by suicide: those with no record of prior suicidal thoughts or nonfatal attempts, and those with documented suicidality. Analyzing anonymized genetic data from more than 2,700 individuals, the team searched for genetic markers associated with psychiatric disorders—traits long considered bedrocks of suicide risk.
The findings were striking. The subgroup with no prior suicidality had fewer genetic risk factors for major conditions like depression, anxiety, PTSD, and even Alzheimer’s disease than their counterparts who had shown warning signs. Even traits like neuroticism and mild depression did not appear more likely in this group than in the general population.
Not Simply Undiagnosed Depression
For years, much of suicide prevention has focused on identifying and alleviating mood disorders. The assumption: if someone dies by suicide but had no diagnosis, their condition must have gone unrecognized or untreated. However, this new genetic evidence challenges that narrative.
According to Dr. Hilary Coon, professor of psychiatry and the study’s first author, many people in the low-warning-sign group genuinely do not exhibit the biological or behavioral hallmarks of depression or related psychiatric illnesses. “There are a lot of people out there who may be at risk of suicide where it’s not just that you’ve missed that they’re depressed,” Coon explains. “It’s likely that they’re in fact actually not depressed.”
What Does This Mean for Prevention?
Current strategies often put depression screening at the center of suicide prevention. While effective for many, this approach might miss an entire subset of at-risk individuals whose genetic and clinical profiles simply don’t match known patterns. In these cases, broadening how we define—and search for—risk is essential.
Toward Broader, More Inclusive Risk Detection
These new findings prompt urgent questions. If typical psychiatric screening isn’t enough, how do we identify those who are quietly at risk? Coon’s ongoing research is beginning to explore other factors, such as chronic physical health problems, inflammation, or respiratory conditions, that might contribute to suicide risk in unexpected ways. There are hints, too, that resilience traits may play a protective role, while environmental stressors could trigger vulnerabilities invisible in traditional assessments.
It’s crucial to emphasize: genetics are only part of the story. No single gene, or combination of genes, can predict suicide. Rather, a subtle interplay exists between biology, life circumstances, and societal influences. This complexity means doctors and researchers must look beyond psychiatric symptoms to understand who is truly at risk.
Changing the Field: A New Vision for Suicide Prevention
The implications of this research are profound. A one-size-fits-all approach—no matter how thorough—misses critical nuances. As Dr. Coon notes, “We hope our work will begin to define subsets of individuals at risk, and also the contexts in which these risk characteristics may be important.”
Going forward, interventions must be more tailored, flexible, and responsive to the diversity of risk profiles. For some, psychiatric care and monitoring remain crucial. For others, understanding broader health or life challenges may be equally vital.
Hope and Help
Ultimately, these advances aim to expand the reach of suicide prevention, providing more effective support not only to those struggling with mental health challenges, but also to those whose suffering is less visible. Broadening our perspective, and ensuring care accounts for this complexity, could help save lives that previously would have gone unnoticed by conventional means.
If you or someone you know is in distress, support is available—call 988 in the United States for immediate, confidential help.
Reference
Coon, H., et al. (2024). Genetic Liabilities to Neuropsychiatric Conditions in Suicide Deaths With No Prior Suicidality. JAMA Network Open.
Note: This article is based on findings summarized by the University of Utah and published in JAMA Network Open. For additional information and support resources, visit the American Foundation for Suicide Prevention or your local mental health services.
