From Chronic to Acute Risk: A New Study of the Days Before an Attempt

Researchers have learned a great deal about the factors linked to suicide risk in young people. Several recent reviews bring that evidence together, including a systematic review and meta-analysis in JAMA Network Open (Geoffroy et al., 2026) and umbrella reviews in the Journal of Psychiatric Research (McEvoy et al., 2023) and the Journal of Youth and Adolescence (Richardson et al., 2024).

These reviews help inform prevention, both "upstream," before risk develops, and "downstream," when it comes to recognizing and treating young people at risk. But according to Dr. Alan L. "Lanny" Berman, Senior Advisor to the Johns Hopkins Center for Suicide Prevention, they still leave two important gaps.

Two questions the reviews cannot answer

The first is about pathways. Reviews can list risk and protective factors, but they say less about how those factors interact over time, or why protective factors sometimes fail to protect.

The second is about timing. Many people live with some level of risk for long periods. Much less is known about what happens in the days to hours before suicidal behavior, when longer-term risk becomes immediate. That shift from chronic to acute risk is where timely help could matter most.

Why these questions are hard to study

Ideally, Dr. Berman writes, these questions would be answered through psychological autopsy studies, which learn about people who died by suicide through interviews with those who knew them. But that method has limits. It is difficult to gather enough cases for meaningful combined findings, and it depends on what family members and others can report.

The next best approach is to learn directly from people who survived a suicide attempt. Very few studies, however, focus on the group whose experiences most closely resemble those of people who died: survivors of medically serious attempts.

A new multi-site study

Working with colleagues in the Johns Hopkins Department of Psychiatry, Dr. Berman is launching a multi-site study to address these gaps. The team plans to conduct in-depth interviews with a large number of people who survived a medically serious suicide attempt, focusing on symptoms and behaviors in the seven days before the attempt.

The goal is to identify the motivators, circumstances and other factors that move a person from chronic risk to acute risk. Clearer answers could help clinicians, families and crisis services recognize when someone needs help right away, and respond sooner.

Honoring the people who take part

A study like this depends on people willing to talk about one of the hardest periods of their lives. Their experience, shared in their own words, is what makes it possible to learn what might help others in the future.