A large-scale study by the Institute of Mental Health (IMH) has revealed that individuals who died by suicide displayed, on average, four acute warning signs in the week leading up to their death, compared to less than one sign among the general population.
The study, titled Seeking Answers: A Psychological Autopsy of Exploring and Analysing Risk Factors (SPEARS), was released on 17 September 2025.
It marks Singapore’s first use of the psychological autopsy method, offering a detailed retrospective examination of lives lost to suicide.
Researchers emphasised that suicide is rarely caused by a single factor.
Instead, it results from the interplay of immediate stressors such as relationship breakdowns, clinical conditions, and underlying vulnerabilities, including family history of mental illness.
Warning signs and risk factors
The study used the American Association of Suicidology’s “IS PATH WARM” framework, which outlines ten acute warning signs: Ideation, Substance abuse, Purposelessness, Anxiety, feeling Trapped, Hopelessness, Withdrawal, Anger, Recklessness, and Mood changes.
Findings showed that 40.3% of those who died by suicide had a history of suicide attempts, compared to 4.1% in the control group.
More than a quarter had made an attempt in the past year. Additionally, 11.9% had uploaded unusual social media posts in the week before death, against 1.4% of controls.
Beyond warning signs, cases were more likely to have lower educational attainment, higher unemployment, and changes in religious participation.
Lifestyle differences were also evident, with higher rates of smoking, weekly alcohol consumption, and lack of hobbies.
Mental and physical health challenges
The majority of cases (71%) had a diagnosed mental health condition, most commonly major depressive disorder, schizophrenia, or bipolar disorder.
Over half reported moderate to severe depressive symptoms in the month before their death.
Cases also reported poorer physical health, greater functional limitations, and significantly higher rates of insomnia compared to controls.
Relationship difficulties were another prominent factor, with a higher likelihood of recent break-ups or unstable partnerships.
Need for awareness and open dialogue
The study identified gaps in suicide prevention, including limited mental health literacy.
Many suicide loss survivors were unable to distinguish between ordinary stress and serious conditions such as depression or psychosis.
Associate Professor Mythily Subramaniam, principal investigator of the study, stressed that suicide results from the convergence of struggles becoming overwhelming.
She highlighted the importance of recognising that “these overwhelming moments can happen in anyone’s life.”
Senior Consultant Professor Chong Siow Ann noted that warning signs can be subtle or mistaken for normal stress.
He added: “With better mental health literacy, families, teachers, employers, and peers can become more confident in recognising when something is amiss and intervening early.”
Both experts underscored the importance of direct conversations about suicide, countering the misconception that raising the topic could implant the idea.
Prof Chong stated that silence risks further isolation, while conversations can provide relief and open avenues for help.
First-of-its-kind local insights
The SPEARS study involved 73 cases and 73 matched controls, with participants ranging in age from 11 to 76 years.
Researchers interviewed next-of-kin and care providers, alongside reviewing coroners’ reports, to develop a holistic understanding of the circumstances leading to suicide.
The findings are particularly significant as much prior research comes from Western contexts.
The IMH team noted that while risk factors overlap, cultural and social differences affect how people experience distress and seek help.
Community group launches study to uncover true suicide numbers after Singapore’s first prevention White Paper
Earlier on 10 September, World Suicide Prevention Day, SG Mental Health Matters launched a new study under Project Hayat to estimate the true number of suicides in Singapore.
The initiative builds on its 2024 White Paper, which had called for a national suicide prevention strategy using the S.A.V.E. L.I.V.E.S. framework.
The launch followed shock over revised statistics for 2023, when final figures showed 434 suicides, nearly 35 per cent higher than the provisional estimate of 322 deaths.
Former Nominated Member of Parliament Anthea Ong, who co-leads the effort, stressed that solutions cannot be built on incomplete data.
The study, led by Dr Rayner Tan of the NUS Saw Swee Hock School of Public Health, will apply the Network Scale-Up Method, a statistical tool never before used on suicides locally.
Suicide remains the leading cause of death among Singaporeans aged 10 to 29, with men—especially youth, elderly, and Indian men—most at risk.
To address this, SG Mental Health Matters and NUS have submitted a S$1 million grant proposal for a study on male suicide risk, focusing on the social conditions driving despair.
If you or someone you know is struggling with thoughts of suicide, please seek help immediately. In Singapore, you can contact the Samaritans of Singapore (SOS) at 1-767 or text 9151 1767 for support. You’re not alone, and help is available.
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