How to Use Life’s Essential 8 for Suicide Risk Assessment
How can clinicians calculate and interpret a Life’s Essential 8 profile when considering suicide mortality risk?
Some patients being evaluated for suicide risk also have clusters of adverse health behaviors that may signal added vulnerability beyond psychiatric and social factors alone. In this South Korean cohort, poor overall Life’s Essential 8 cardiovascular health, especially poor health behavior scores, was associated with higher suicide mortality, making LE8 a potentially useful adjunctive marker in broader risk formulation.
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Collect all 8 Life’s Essential 8 components
Assess the 4 behavioral components and 4 biometric components used in the study. The behavioral components are diet, nicotine exposure, physical activity, and sleep duration; the biometric components are body mass index, blood glucose, blood lipids, and blood pressure. Use measured biometric data when available and self-reported behavior data as defined in the study.
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Score diet using the study’s dietary inflammatory index approach
Convert the dietary inflammatory index to an LE8 diet score using the study’s categories: 100 for DII less than or equal to -1.53, 80 for -1.54 to -0.33, 50 for -0.32 to 0.30, 20 for 0.31 to 0.75, and 0 for greater than or equal to 0.76. The article used this approach instead of HEI or DASH to allow consistent scoring across survey years.
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Score weekly moderate-to-vigorous physical activity
Assign 100 points for at least 150 minutes per week, 90 for 120 to 149 minutes, 80 for 90 to 119 minutes, 60 for 60 to 89 minutes, 40 for 30 to 59 minutes, 20 for 1 to 29 minutes, and 0 for 0 minutes. This converts weekly activity into the LE8 physical activity component used in the cohort.
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Score nicotine exposure
Assign 100 points to never smokers with no secondhand smoke exposure, 75 to former smokers who quit at least 5 years ago, 50 to former smokers who quit 1.0 to 4.9 years ago, 25 to former smokers who quit less than 1 year ago or nonsmokers currently using electronic cigarettes, and 0 to current cigarette smokers. The study based this score on cigarette smoking, electronic cigarette use, quit duration, and secondhand smoke exposure.
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Score average nightly sleep duration
Assign 100 points for 7.0 to 8.9 hours, 90 for 9.0 to 9.9 hours, 70 for 6.0 to 6.9 hours, 40 for 5.0 to 5.9 hours or at least 10.0 hours, 20 for 4.0 to 4.9 hours, and 0 for less than 4.0 hours. Use the patient’s self-reported average nightly sleep duration.
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Score body mass index using Asia-Pacific cutoffs
Assign 100 points for BMI less than 23.0, 70 for 23.0 to 24.9, 30 for 25.0 to 29.9, 15 for 30.0 to 34.9, and 0 for at least 35.0. These are the BMI cutoffs used in this Korean cohort.
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Score fasting blood glucose and diabetes history
Assign 100 points for no diabetes history and fasting blood glucose less than 100 mg/dL, 60 for no diabetes history and fasting blood glucose 100 to 125 mg/dL, 40 for diabetes history or fasting blood glucose 126 to 154 mg/dL, 30 for 154 to 182 mg/dL, 20 for 183 to 211 mg/dL, 10 for 212 to 239 mg/dL, and 0 for at least 240 mg/dL. This reproduces the blood glucose component used in the article.
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Score non-HDL cholesterol and adjust for lipid-lowering treatment
Assign 100 points for non-HDL cholesterol less than 130 mg/dL, 60 for 130 to 159 mg/dL, 40 for 160 to 189 mg/dL, 20 for 190 to 219 mg/dL, and 0 for at least 220 mg/dL. Subtract 20 points if the patient is using lipid-lowering medication, consistent with the study’s LE8 method.
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Score blood pressure and adjust for antihypertensive treatment
Assign 100 points for systolic blood pressure less than 120 mm Hg and diastolic blood pressure less than 80 mm Hg, 75 for systolic 120 to 129 mm Hg and diastolic less than 80 mm Hg, 50 for systolic 130 to 139 mm Hg or diastolic 80 to 89 mm Hg, 25 for systolic 140 to 159 mm Hg or diastolic 90 to 99 mm Hg, and 0 for systolic at least 160 mm Hg or diastolic at least 100 mm Hg. Subtract 20 points if the patient is using antihypertensive medication.
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Calculate composite, behavior, and factor scores
Average the 8 component scores to obtain the composite LE8 score on a 0 to 100 scale. Also calculate a health behavior score by averaging diet, physical activity, nicotine exposure, and sleep duration, and a health factor score by averaging BMI, blood glucose, blood lipids, and blood pressure. Higher scores indicate better overall cardiovascular health.
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Classify the patient’s LE8 level
Classify the composite LE8 score and the subdimension scores as poor for 0 to 49, intermediate for 50 to 79, and ideal for 80 to 100. These are the established cutoff values used in the study.
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Interpret low scores as an adjunctive suicide risk marker
Use LE8 as part of broader clinical formulation rather than as a stand-alone suicide prediction tool. In this cohort, compared with ideal LE8 scores, poor LE8 scores were associated with a 2.49-fold higher risk of suicide mortality, and poor health behavior scores were associated with a 2.59-fold higher risk, while biometric health factor scores showed no clear association. The inverse association between LE8 score and suicide mortality was stronger in adults younger than 50 years, with a hazard ratio of 0.70 per 10-point increment versus 1.08 in those aged 50 years or older.
Clinical Considerations
- The study was observational, so LE8 should not be interpreted as a causal or stand-alone predictor of suicide mortality.
- LE8 was measured only at baseline, so the article does not show whether changing LE8 over time changes suicide risk.
- Important suicide-related confounders, including several psychiatric conditions and social relationship variables, were not measured, so residual confounding is possible.
- The findings were derived from a Korean population and used a dietary inflammatory index in place of standard HEI or DASH diet scoring, which may limit generalizability and comparability.
Bottom Line
When suicide risk is being formulated, a poor Life’s Essential 8 score, especially a poor health behavior score below 50, can be treated as an added vulnerability marker rather than a diagnostic or causal determinant.
