The duality of risk from threats: Are homicidal threats a novel determinant for suicide risk?

Suicide and homicide have long been considered to sit at opposing ends of a continuum of deliberate harm, initially emerging as separate fields of practice. While it is now accepted that suicide and homicide are associated, the evidence base for how they are associated is far from complete. Surfacing from this body of knowledge are questions of clinical and ethical responsibilities, such as assessors of risk to moving to a default position of evaluating risk to self and others, regardless of which is the presenting problem. The current study examined longitudinal suicide risk among those known to have uttered homicidal threats. 757 threateners, known to the health and/or criminal justice systems for threatening to kill a person other than themselves, were examined via case matching methodology to reveal deaths recorded in a national coronial database. Over the follow up period, 11% of the threateners died, and over half of them (57.5%) perished from suicide. Threateners who died lost on average 47 years of potential life. That is, they lost more than half their life when compared to the average life expectancy of Australians. Further offending was also associated with higher mortality as was having a history of mental health treatment. This study provides support for the duality of risk from uttered threats as threatening homicide was found to be a novel predictor of suicide risk.