psychiatric disorders
Suicidal Behavior
Etiology of Suicidal Behavior
Suicide is a complex health-related event that involves a set of genetic, environmental, and psychological and behavioral factors. Psychological autopsy studies clearly show that in each instance of suicide, decedents were experiencing multiple risk factors for suicide. Death by suicide is much more common among people with a psychiatric illness than among age- and sex-matched controls ( Etiology references ). In some studies, almost 90 % of people who die by suicide have a diagnosable mental health condition at the time of their death ( One of the most common, potent, and remediable risk factors for suicide is Depressive Disorders . For patients with depression, suicide risk can increase during periods when depression is more severe, and when several other risk factors converge. Also, suicide appears to be more common when severe Overview of Anxiety Disorders , impulsivity, substance use, and sleep problems are part of major depression or Other risk factorsfor suicide include the following: Most other serious mental health conditions Previous suicide attempts Personality disorders (eg, Borderline Personality Disorder (BPD) ) Impulsivity and aggression Traumatic childhood experiences Family history of suicide and/or psychiatric conditions Use of alcohol, illicit drugs, and prescription analgesics Serious or chronic physical health conditions (eg, chronic pain, Traumatic Brain Injury (TBI) ) Times of loss (eg, death of family or friends) Relationship conflict (eg, divorce) Work disruption (eg, unemployment) Periods of career transition (eg, changing one's military status from active duty to veteran status or retirement) Financial stress (eg, economic downturns, underemployment) Bullying or other humiliating experiences (eg, cyberbullying, social rejection, discrimination, occupational or legal problems) (See table.) People with Schizophrenia die by suicide at a much higher rate compared to the general population, with as many as 10% of patients with schizophrenia dying by suicide. Drivers of suicide risk among people with schizophrenia include early phase illness, depressive episodes, hallucinations, lack of access to or nonadherence to effective treatment, disability, hopelessness, and akathisia. Other well-known psychosocial risk factors for suicide include relationship disruption, unemployment, and loss. Alcohol and illicit drugs may increase disinhibition and impulsivity as well as worsen mood. Between 30% and 40% of people who die by suicide have consumed alcohol before the attempt, and about half of them were intoxicated at the time. Younger people, who are generally more prone to impulsive behavior , are particularly susceptible to alcohol's effects; moderate levels of intoxication can result in their using more lethal suicide methods ( Etiology references ). However, people with an Serious physical health conditions, especially those that are chronic and painful, contribute to about 20% of suicides in older patients. Recently diagnosed or new-onset physical health conditions can also increase suicide risk (eg, diabetes, seizure disorder, pain conditions, multiple sclerosis, cancer, infection, HIV/AIDS). These health conditions can directly impact physiologic brain functioning and, thus, increase suicide risk. The psychological effects of disability, pain, or a new diagnosis of a serious health condition can also increase the risk of suicide. People with Overview of Personality Disorders are prone to suicide, especially people with Traumatic childhood experiences, particularly the Overview of Child Maltreatment , are associated with suicide attempts and perhaps completed suicide. The genetics of suicide risk are an important area of research and appear to influence suicide risk. While suicide risk can run in families, genes appear to account for only a portion of that risk ( Etiology references ). A family history of suicide, suicide attempts, or psychiatric disorders is associated with an increased risk of suicide. There is also evidence that suggests genetic and environmental interactions contribute to suicide risk ( Etiology references ). Epigenetic changes (eg, DNA methylation) affecting gene expression may increase or decrease risk for suicide by affecting neurophysiology, cognition, or stress regulation. This means that negative experiences such as trauma and, conversely, positive experiences such as the social support of psychotherapy can actually change gene expression and significantly affect an individual’s resilience and risk for suicide. Psychological traits such as a tendency toward impulsivity, cognitive rigidity, interpersonal rejection sensitivity, or severe neuroticism can also increase risk. 1.Chesney E, Goodwin GM, Fazel S: Risks of all-cause and suicide mortality in mental disorders: a meta-review.World Psychiatry3(2):153-160, 2014. doi: 10.1002/wps.20128 2.Arsenault-Lapierre G, Kim C, Turecki G: Psychiatric diagnoses in 3275 suicides: a meta-analysis.BMC Psychiatry4:37, 2004. doi: 10.1186/1471-244X-4-37 3.Park CHK, Yoo SH, Lee J, et al: Impact of acute alcohol consumption on lethality of suicide methods.Compr Psychiatry75:27-34, 2017. doi: 10.1016/j.comppsych.2017.02.012 4.Galfalvy H, Haghighi F, Hodgkinson C, et al: A genome-wide association study of suicidal behavior.Am J Med Genet B Neuropsychiatr Genet168(7):557-563, 2015. doi:10.1002/ajmg.b.32330 5.Cheung S, Woo J, Maes MS, et al: Suicide epigenetics, a review of recent progress.J Affect Disord265:423-438, 2020. doi: 10.1016/j.jad.2020.01.040 