It is concerning that in 2019 suicide risk factors are still being investigated. The risk paradigm has been shown to be ineffective for identifying people likely to die by suicide and at reducing the prevalence of suicide. The reasons for this are clear. First, individuals are more than a set of risk and protective factors and both distress and coping are influenced by a complex interaction of biological, psychological, and social factors over the lifespan. Second, suicide is a relatively low bar as an outcome measure—quality of life is a patient-centred outcome and reduces the likelihood of habitual suicidal ideation leading to suicide. Third, there is no evidence to support the suggestion from Geulayov and colleagues that follow-up alone or brief interventions are sufficient for people presenting to hospital departments with overwhelming distress either before or after self-harm or suicide attempts. Fourth, suicidality does not sit within a vacuum—it is on a continuum of healthy and unhealthy coping strategies. Finally, correlational data, such as that reported by Geulayov and colleagues, are not causal data that can inform treatment.

中文翻译：

---

住院后自杀：全身治疗失败应成为重点，而不是危险因素

令人担忧的是，2019年自杀风险因素仍在调查中。事实证明，风险范式无法有效识别可能因自杀而死亡的人，并无法降低自杀率。原因很明确。首先，个人不仅具有一系列风险和保护因素，而且在整个生命周期中，困扰和应对都受到生物学，心理和社会因素复杂相互作用的影响。其次，自杀作为结果指标相对较低，生活质量是以患者为中心的结果，可以降低导致自杀的习惯性自杀念头的可能性。第三，没有证据支持Geulayov及其同事的建议，即单独跟踪随访或短暂干预就足以使在自残或自杀未遂之前或之后向医院部门带来极大困扰的人们。第四，自杀并不存在于真空之中，它是健康和不健康应对策略的连续体。最后，相关数据（例如Geulayov及其同事所报告的数据）不是可以告知治疗的因果数据。