Comment by smeeth | Hacker News Reader

Comment by smeeth | Hacker News Reader

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You and I seem to have different definitions of "warning signs." From the medpagetoday story you linked:

- 239/657 suicides were people under psychiatric care (please note they used present tense, more of them might have had a history of care)

- 187/657 had a previous attempt (!!!)

- "About 22% of the deaths were accompanied by no known inciting event or identified life stressor" Phrased differently, 78% of suicides accompanied a life event or stressor.

Contrary to popular belief, risk prediction isn't usually rocket science. Suicide correlates are extremely well studied, and any experienced mental health professional can point high risk individuals out to you if they ever cross paths with one.

The most challenging problem often is: what do you do about it? Can you get them the help they need? Can you navigate them through a big bureaucracy like the VA? Do you have grounds to forcibly keep them in in-patient psychiatry? Etc, etc.

Source: Relative is a psychologist @ the VA.

I think you are overstating the predictive power. You can find strong correlations looking backwards, but that doesn't mean that they are good or strong predictors looking forward.

To take just one of your data points as an example, 78% of suicides were preceded by a stressor. If you flip it to make a prediction, what percentage of Life stressors lead to suicide? The number of people who experience major life stressors must be enormous. If tens or hundreds of millions people have major stressors a year, that doesn't help you very much in targeting limited services .

The same holds true for psychiatric care. Prior suicide attempt is probably the exception there, but even that int ~30% predictive power looking foward.

You're missing that the models (including mental models) that professionals use to predict suicidality are not univariate.

When a manic depressive with substance abuse issues and prior suicide attempts walks into a clinic nobody needs a "new cognitive science tool" to tell them if they're high suicide risk, and these cases are a larger proportion of suicides than most people think.

Also that sort of missed the point of my comment, which is perhaps my fault for not being clear enough. Preventing suicide is a two step process:

1) find high risk people

2) prevent their suicide attempts

My comment was simply relaying the POV of someone who does this professionally: as a society we are better than most people think at #1 and worse than most people think at #2.

I think we still might be talking past each other. My assumption would be that we do a pretty terrible job at both #1 and #2 on your list, and we should look at how we can do both better. I don't think it is a competition.

I have no doubt that professionals can predict suicide for some people with actually high confidence, e.g. >50%. Sometimes it is just obvious to anyone with eyes. My point is that despite this, it doesn't mean that they are good at finding suicidal people in general.

If 45k Americans kill themselves per year, how many of those were previously identified as "high risk". How many total are identified as high risk?

Most of the things we consider as "risk factors" are terrible predictors. Take depression or anxiety, which are considered major factors. They only increase the relative risk of suicide between 2 and 5x. That is crap. When your baseline suicide rate is 13/100,000 and your major depressive is 5X more likely, you are still at 65/100,000.

This is just a long winded way of saying that if you want to claim we are good at predicting suicides, we have to take into account all of the false positives, and all of the false negatives.

If someone gave top professionals the job of predicting which 13 people out of 100k would kill themselves, how many do you think they would get right and how many would they miss?

I meant more immediate warning signs, like giving away personal possessions or sudden happiness.

When my friend killed himself, it both was and wasn’t a surprise. On one hand, he had a whole host of risk factors that everyone knew about. In the other hand, he’d gotten therapy and meds and seemed to be doing much better. His texts seemed normal. I’d even taken a training called “mental health first aid” - I knew that if I saw any signs I should ask him directly if he was thinking of suicide.

If there had been a magical way to know that he was in a period of high risk, there are a million things that could have been done besides in-patient. As one example, he had many friends who would have been by his side 24/7 (as had been done when we knew he wasn’t doing well).

I’m extremely skeptical that a technology like this could have worked and detected what was going on with him. I’m even more skeptical that the military would use it in an appropriate way. But still, I do see a glimmer of hope in it.

Of course, the obvious solution and the one that should be higher on everyone’s priority list is to simply stop sending soldiers into wars, stop letting parents get away with beating the shit out of their kids, and stop covering up rape. Unfortunately the mind reading machine is probably more likely to actually get done.

Just to add, I hear what you’re saying about how the hard part is preventing suicide more so than identifying risk. That lines up with what I’ve seen. I don’t think that negates the need to work on both problems.

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