Suicidal Behavior

2002 31,655 suicide deaths in the US– 10.99 per 100,000

Persons who attempt suicide are 38 to 40 times as likely to commit suicide as are persons without previous attempts

NCS-R (2001-2003)– 3.3% of US residents 18-54 years had seriously thought

about killing themselves in the past 12 months– Of this group, 28.6% made a plan– 32.8% of those who made a plan carried out a serious

attempt– More than 80% of those who reported suicide related

behavior met criteria for DSM-IV mental disorder

Psychiatric Correlates of Suicide

Mood Disorders, borderline personality disorder, disruptive behavior disorders, alcohol and rug use disorders, anxiety disorders (less consistent but some data on panic disorder), anorexia nervosa, schizophrenia

The lifetime risk for suicide in depressed patients is estimated at 2.2%

Patients with depressive disorders have a suicide risk of 60-70%

Psychiatric Factors Associated with Suicide contd.

Hopelessness is significant in the etiology and maintenance of depression and is a significant predictor of suicide

Hopelessness is defined as a system of cognitive schemas whose common denominator is negative expectations about the future

Hopelessness is one of the best predictors of suicide completions in clinical populations

Psychiatric Factors Associated with Suicide contd.

Hopelessness is often related to interpersonal factors can be related to ‘feeling like a burden on others’ or perceived burdensomeness.

Social isolation (a state where interpersonal contacts and relationships are disrupted or nonexistant) has been consistently related to suicidal behavior

In contrast having a social network may be protective

Psychiatric Factors Associated with Suicide contd.

Impulsivity and aggression are also correlates of suicidal behavior (externalizing)

Histories of suicide attempts are significant risk factors for repeated attempts and completions– These attempts may serve as opportunities to

gain competency with self-harm and diminish fear related to pain and death

Additional Psychiatric Factors

Ineffectiveness is a cognitive perception that is associated with suicidal behavior

Ineffectiveness may be associate with psychosocial stressors: unemployment, low income, physical illness, less education, less opportunity

Ineffectiveness paired with perceived burden may accentuate risk

Diathesis/Personality/Stress: Suicidal Behavior

Diathesis

MZ twins at increased risk compared with DZ (30 – 50%)

Family history of suicide increases risk by twofold; gender may interact w/ family history

Six fold increase in children of parents who attempt

Serotonin transporter gene, some links

Lower 5-HIAA in CSF

Psychiatric DX, MDD

Personality

Impulsive aggression

Emotional dysregulation

Anger

Recklessness/sensation seeking?

Hopelessness

Poor problem solving

Stressor

Child physical abuse; child sexual abuse

Social isolation

Unemployment

Poverty

Physical Illness

Perceived burdensomeness

Diathesis/Personality/Stress: Bipolar Depression

Diathesis

Females more at risk than males

Family history of bipolar disorders or unipolar disorders

Monoamine Dysreg

Overactive Norepinephrine

Excess in Dopamine

Personality

Hyperactive

Impulsive

Sensation Seeking

Stressor