Five decades of research leave suicide prediction barely above a coin toss

Means restriction does not require identifying anyone in advance, and its case turns on how fast the risk moves. KFF Health News reports that people can spend less than an hour between deciding to die and acting. Sometimes five minutes. Anything imposing a delay, such as having to unlock a safe, gives them time to reconsider or gives someone else time to intervene ^[13].

The half-century of flat performance is specific to individuals. Group patterns are well described: gun suicides concentrate among middle-aged white men and veterans, and have risen more recently among women and among some Black and Latino men ^[10]. The forecast that sits near chance is the one about a named patient in a clinic. "I can't tell you which of my patients is likely to die by suicide in the next six months," said Paul Nestadt ^[2]. He treats suicidal patients as a psychiatrist, teaches graduate courses on the subject and has co-authored scores of research papers on how and why people kill themselves ^[3].

Prediction accuracy and treatment efficacy are separate quantities. A psychiatrist who cannot rank his caseload by six-month risk can still treat the patient in front of him. The KFF series examines prevention beyond medication and therapy for people at risk, and calls those two lifesaving ^[14].

The firearm share sets the denominator: if more than 28,000 firearm deaths were more than half of all suicide deaths ^[8], the national total last year was under roughly 56,000 ^[1]. Overall rates dipped while gun suicide rates set records five years running ^[9], so across the recent period where both hold, non-firearm suicide rates fell ^[2]. That pattern cannot test whether blocking one method pushes people toward another, because nothing was blocked. The evidence KFF cites on that question comes from places where a method was made harder to reach and people did not typically switch ^[12].

The reallocation case is thinner than the scientific one. "That's the one that will save the most lives," said Nestadt, medical director at the Johns Hopkins Center for Suicide Prevention, referring to limiting access to lethal means ^[6]. The account lists barriers on buildings and bridges, and cutting the number of pills a person can buy or be prescribed at once, among the promising measures ^[5]. It gives no effect size and no cost per death averted ^[3]. KFF also notes that means restriction may be the most difficult of these approaches to achieve ^[7].

The White House did not respond to specific questions about how its firearms rollbacks may affect the country's gun suicide rate, or about what it is doing to prevent those deaths ^[18]. Spokesperson Lauren Bis said in a statement that "President Trump is committed to Making America Healthy Again and that includes mental health" ^[19]. She pointed to the administration's support for developing psychedelic treatments for mental illness and an announcement of $52.5 million in grants for veteran suicide prevention ^[20]. Veterans are one of the two groups KFF names as having had high suicide rates for years ^[10].