JPBS

Objective: Precipitating circumstances are life events that occur prior to suicide death. These events elevate risk through their interactions with individual characteristics, environmental factors, and internal processes. Thus, the influence of any one event on suicide requires understanding the social context within which it occurs. This study aimed to identify contextual patterns of precipitating circumstances using suicide narrative reports. Methods: The National Violent Death Reporting System (NVDRS) is a surveillance system that aggregates data from all violence-related fatalities in the US, including suicide. This dataset includes a qualitative narrative for each case with in-depth information about the circumstances surrounding the death. For each circumstance, 100 randomly selected narrative reports were reviewed and coded via inductive summative content analysis. Results: A total of 1670 narrative reports were analyzed, across 17 distinct circumstance categories. For each circumstance, contextual factors causing, surrounding, and stemming from the circumstance were identified. For example, the circumstance “financial crisis” was often caused by a recent job loss, chronic unemployment, substance use, or a medical condition. This crisis manifested 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. Conclusion: This study highlights that rarely does a single crisis elevate suicide risk, but rather each death reflects a web of related circumstances and their compounding effects. Recognizing these interconnected factors is essential for developing more comprehensive prevention strategies that address multiple, overlapping stressors rather than focusing on isolated risk factors.

suicide; NVDRS; precipitating circumstances; qualitative