The Science Behind Why Some People Face Higher Suicide Risk

Last week, while reviewing case files, I was struck by a pattern that would have been impossible to see some years ago. Among my adolescent clients experiencing suicidal ideation, nearly 85% shared certain vulnerability factors that created what I now recognize and will call perfect storm of risk. Yet understanding these factors isn’t about creating lists of doom, (of course it might be as well!) But it’s about early identification, targeted intervention, and ultimately, saving lives.

As we continue throughout the Yellow September series, today I want to share what decades of research and my clinical experience in São Paulo have taught me about vulnerability factors for suicide. These aren’t just statistics, they’re roadmaps for prevention that can help families,  educators, and healthcare providers,  recognize when someone needs support before we reach crisis point.

I’m going to use a fictional case example to be able to look at vulnerability factors and what they can mean. 

A case study in how vulnerability factors interact.

X came to me with depression (clinical factor), had been bullied at school (social factor), was struggling with his family’s financial stress (socioeconomic factor), and had recently experienced his parents’ divorce (adverse life event).  Impulsive behaviour (poor emotional skills) And another factor that appeared later was a history of self-harm (inadequate strategies). 

Individually, each of these vulnerabilities factors was manageable. Together, they created a vulnerability profile that research tells us increases suicide risk by x10 compared to adolescents without these presentations.

What struck me most about X’s case wasn’t just the presence of multiple risk factors, but how they amplified each other.

His depression made the social isolation from bullying feel permanent.

The family financial stress made him feel like a burden.

The divorce made him question whether anyone truly cared about his wellbeing.

Impulsive behaviours gave him instant gratification.

He created inadequate strategies to deal with his pain, by cutting.

This isn’t coincidence, it’s the neurobiological reality of how vulnerability factors interact in developing brains.

Put this altogether, and we have a perfect storm of risk for X.

Emotion Regulation Deficits The Core Vulnerability

At the heart of most vulnerability profiles I assess is some form of emotion regulation difficulty. Whether stemming from lack of emotional coping strategies, trauma, mental health conditions, or developmental differences, the inability to effectively manage intense emotions creates conditions where suicide can appear to be a rational solution to such unbearable feelings.

In our case study X’s adolescent brain, and emotional regulation systems are still under construction. The neural pathways that connect emotional centers with cognitive control regions just aren’t fully developed yet.  This means that teenagers naturally have more difficulty managing intense emotions than adults, making them inherently more vulnerable during emotional crises.

The Dangerous Combination of Impulsivity and Lack of Emotional Skills

Research consistently identifies impulsivity as a significant vulnerability factor for suicide, particularly among young people. In practice, this means that those who are still developing their emotional skills, are more likely to act on suicidal thoughts during moments of intense distress.

When someone with high impulsivity experiences suicidal thoughts, they’re less likely to engage the pause button that allows for reflection, problem-solving, or help-seeking before acting on these thoughts.

Understanding the difference between the warning signs versus the risk factors

It’s crucial to distinguish between risk factors, which in X’s case these factors are: clinical, socioeconomic, adverse life events, poor emotional skills,  inadequate strategies versus more dynamic warning signs: saying goodbye to people, planning out how they would commit suicide. 

Risk factors help us understand who might be vulnerable, while dynamic warning signs help us recognize when someone is in immediate danger.

Some examples of Static Risk Factors are:

Family history of suicide

Previous suicide attempts

Self Harm

Clinical factors

Some examples of Dynamic Warning Signs are

Sudden mood improvements after depression (can indicate decision to die)

Giving away possessions

Saying goodbye to people

Researching suicide methods

Carrying out detailed planning of suicide methods

Vulnerability to Strength

Understanding vulnerability factors isn’t about creating fatalistic predictions about who will or won’t survive difficult periods.

Instead, it’s about early identification and targeted intervention that can prevent vulnerable individuals from reaching crisis points.

The goal isn’t to eliminate all risk factors, as many are unchangeable or part of normal human experience.

This is to understand how risk factors interact, recognize when someone needs support, and implement interventions that can tip the balance toward resilience and recovery.

What to do when you spot some risk factors? Open up dialogues, and seek professional help.

What to do when you spot some Dynamic Warning Signs? Seek immediate professional help, if no other help is available then direct yourselves to an emergency department in a hospital.