Many psychiatric and medical conditions may lead to suicidal thoughts. Which condition has the highest per capita suicidal ideation rate, the highest suicide attempt rate, and the highest suicide completion rate?
I believe mood disorders, and specifically major depressive disorder.
Military vets with PTSD are currently committing suicide at a rate three times higher than the normal population. Borderline personality may also put people at a high risk for suicidal ideation. I agree with Mr. Chong, however, major depressive disorder is probably responsible for the highest numbers for all three items on your list. You might take a look at Why people kill themselves : a 2000 summary of research on suicide
by David Lester ISBN: 0398071144 (cloth) ;ISBN: 9780398071141 (cloth) ;ISBN: 0398071152 (pbk.) ;ISBN: 9780398071158 (pbk.)
I think you might want to approach this differently. It's not the matter of psychiatric condition or objective state, but rather that of subjective state. The state in which most (if not all) suicides occur is that of dispare, and the diminishment of hope in regard to the possibility of their psychological pain ever vanishing. This is true regardless of psychiatric state as diagnosed. The choice of suicide is not primarily that of ending ones life, but first and foremost that of ending ones coping with suffering.
This probably doesn't serve your question, but it might direct some thinking on the matter.
I agree with Cobi. In my clinical experience, people who have suicidal ideation often don't want to die, they just want their emotional pain to stop and experience despair and hopelessness about the future. I think this is an important, but subtle difference, and one that is always worth exploring with a client.
I concur with Cobi and Mark but would add that suicidal ideation at some level is frequently encountered with serious mental illness, especially major depression and bipolar disorder. Apart from persons with SMI it seems to be found when an individual comes to strongly believe that those he/she cares about would be better off without he/she being around or otherwise feels unconnected to those who are important to he/she. Suicidal ideation, as Cobi noted, does not of itself co-occur with an intent to die, or with a specific plan, or having/seeking lethal means. I also feel that suicidal ideation may also emerge in cases where an individual makes habitual contingent suicide threats (e.g., I'll kill myself if I don't get into rehap tonight!) and overtime becomes accustomed to suicidal thoughts as a coping mechanism.
Everyone,
So far there have been a number of great responses about the kind of circumstances and diagnoses that may lead to suicidal ideation and attempts. Can anyone supply information (sources, clinical experience) about the conditions or circumstances that have the highest rates of suicidal ideation and attempts?
Hi there, have a look at Wenzel and Beck's (2005) cognitive model of suicide. Also, suicide mortality rates are usually published on the national office for statistics. I wonder if that might help.
I think it depends a lot on age. We are finding with youth that suicide-related needs are as or more related to Anger than Depression. Perhaps it sometimes becomes about punishing others by killing oneself. I think there is often a different dynamic for older adults where it is often related to health and functioning (through depression)
Unfortunately I'll add another risk factor to the diagnoses already mentioned and this involves substance use disorders. Often intoxication at the time of the attempt can make suicidal people disinhibited enough where they actually make an attempt, and if they make an attempt they are more likely to complete. Check out Leo Sher's book Suicidal Behavior in Alcohol and Drug Abuse and Dependence (2010).
In my experience as a therapist and as a former police officer there are a number of enviromental factors in suicide ideation. Some as previously stated relate to age profile, accessibility of the means, the perceived purpose of the act and its impact. However I have read an article here in Ireland that posits that suicide is similiar to an emotional heart attack. All the signs and symptoms appear to be visible, yet interventions do not prevent the occurrence.
I often suspect that the method used is a form of self-punisment, such as hanging (strangulation) which is a slow way to die as hanging requires expertise that most suicides do not have. For some this act is to silence the 'voice in their head'. Working with young people who are proposing suicide I will explore in detail with them their options, the suffering of the action and the legacy they bequeath to their younger siblings in particular. I will look at their use of alcohol or other substances and also the process addictions such as compulsive gambling. Here in Ireland research has indicated a strong link between one alcoholic drink and the facilitation of suicide in young people.
There is also the cultural aspect of not bringing shame on the family, through some unacceptable behaviour,whether criminal or business related where suicide becomes the option. The family name is redeemed in blood. Indeed culturally we see suicidal bombers and fighters die for their cause and beliefs.
It is my submission that suicide prevention tends to be promoted from a position of 'control' rather than from a point of open discussion which is inclusive and non-judgmental.
Please see the copy and pasted paragraph from a risk assessment tool that I think I have held as an invaluable insight for some time.
It is worth keeping in mind that suicidality can be understood as an attempt by the individual to solve a problem, one that they find overwhelming. It can be much easier for the provider to be nonjudgmental when s/he keeps this perspective in mind. The provider then works with the suicidal individual to develop alternative solutions to the problems leading to suicidal feelings, intent and/or behaviors. The execution of this strategy can of course be more difficult than its conceptualization.
Please find attached a paragraph form the document that I found helpful.
It is worth keeping in mind that suicidality can be understood as an attempt by the individual to solve a problem, one that they find overwhelming. It can be much easier for the provider to be nonjudgmental when s/he keeps this perspective in mind. The provider then works with the suicidal individual to develop alternative solutions to the problems leading to suicidal feelings, intent and/or behaviors. The execution of this strategy can of course be more difficult than its conceptualization.
The literature might also help to get some suggestions to find some answers to your question, e.g.,
1: Chen YJ, Tsai YF, Ku YC, Lee SH, Lee HL. Perceived reasons for, opinions
about, and suggestions for elders considering suicide: elderly outpatients'
perspectives. Aging Ment Health. 2013 Dec 12. [Epub ahead of print]
2: Woods AM, Zimmerman L, Carlin E, Hill A, Kaslow NJ. Motherhood, reasons for
living, and suicidality among African American women. J Fam Psychol. 2013
Aug;27(4):600-6. doi: 10.1037/a0033592.
3: Bagge CL, Lamis DA, Nadorff M, Osman A. Relations between hopelessness,
depressive symptoms and suicidality: mediation by reasons for living. J Clin
Psychol. 2014 Jan;70(1):18-31. doi: 10.1002/jclp.22005.
4: Bryan CJ, Rudd MD, Wertenberger E. Reasons for suicide attempts in a clinical
sample of active duty soldiers. J Affect Disord. 2013 Jan 10;144(1-2):148-52.
doi: 10.1016/j.jad.2012.06.030. Epub 2012 Aug 1.
5: Posner K, Brown GK, Stanley B, Brent DA, Yershova KV, Oquendo MA, Currier GW, Melvin GA, Greenhill L, Shen S, Mann JJ. The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite
studies with adolescents and adults. Am J Psychiatry. 2011 Dec;168(12):1266-77.
doi: 10.1176/appi.ajp.2011.10111704.
6: Purcell B, Heisel MJ, Speice J, Franus N, Conwell Y, Duberstein PR. Family
connectedness moderates the association between living alone and suicide ideation
in a clinical sample of adults 50 years and older. Am J Geriatr Psychiatry. 2012
Aug;20(8):717-23. doi: 10.1097/JGP.0b013e31822ccd79.
7: Segal DL, Marty MA, Meyer WJ, Coolidge FL. Personality, suicidal ideation, and
reasons for living among older adults. J Gerontol B Psychol Sci Soc Sci. 2012
Mar;67(2):159-66. doi: 10.1093/geronb/gbr080. Epub 2011 Jul 16.
8: Jo KH, An GJ, Sohn KC. Qualitative content analysis of suicidal ideation in
Korean college students. Collegian. 2011;18(2):87-92.
9: Zhang Y, Law CK, Yip PS. Psychological factors associated with the incidence
and persistence of suicidal ideation. J Affect Disord. 2011 Oct;133(3):584-90.
doi: 10.1016/j.jad.2011.05.003. Epub 2011 Jun 1.
10: Fishbain DA, Bruns D, Lewis JE, Disorbio JM, Gao J, Meyer LJ. Predictors of
homicide-suicide affirmation in acute and chronic pain patients. Pain Med. 2011
Jan;12(1):127-37. doi: 10.1111/j.1526-4637.2010.01013.x. Epub 2010 Nov 18.
11: Marty MA, Segal DL, Coolidge FL. Relationships among dispositional coping
strategies, suicidal ideation, and protective factors against suicide in older
adults. Aging Ment Health. 2010 Nov;14(8):1015-23. doi:
10.1080/13607863.2010.501068.
12: Meltzer H, Bebbington P, Brugha T, Jenkins R, McManus S, Dennis MS. Personal debt and suicidal ideation. Psychol Med. 2011 Apr;41(4):771-8. doi:
10.1017/S0033291710001261. Epub 2010 Jun 16.
13: Harris KM, McLean JP, Sheffield J, Jobes D. The internal suicide debate
hypothesis: exploring the life versus death struggle. Suicide Life Threat Behav.
2010 Apr;40(2):181-92. doi: 10.1521/suli.2010.40.2.181.
14: Hocaoglu C, Babuc ZT. Suicidal ideation in patients with schizophrenia. Isr J
Psychiatry Relat Sci. 2009;46(3):195-203.
15: Joiner TE Jr, Steer RA, Brown G, Beck AT, Pettit JW, Rudd MD. Worst-point
suicidal plans: a dimension of suicidality predictive of past suicide attempts
and eventual death by suicide. Behav Res Ther. 2003 Dec;41(12):1469-80.
16: Burge M, Lester D. Predicting suicidal ideation in high school students.
Psychol Rep. 2001 Oct;89(2):283-4.
17: Malone KM, Oquendo MA, Haas GL, Ellis SP, Li S, Mann JJ. Protective factors
against suicidal acts in major depression: reasons for living. Am J Psychiatry.
2000 Jul;157(7):1084-8.
18: Mann JJ, Waternaux C, Haas GL, Malone KM. Toward a clinical model of suicidal behavior in psychiatric patients. Am J Psychiatry. 1999 Feb;156(2):181-9.
Suicide is a very complex phenomenon. There’s s no single variable (ie. Psychiatric diagnosis) that can account for the highest risk. From the clinical point of view, the proper exercise to do is to model an -often long- equation of risk and protective factors for each case. Relevance of factors may vary in each case, but in general it’s accepted that the more important general risk factors are i) family history of suicidality, specially completed suicide, ii) present suicidal ideation (especially planning), and iii) a currently active psychiatric disorder, as Bipolar Disorder, MDD, Substance Use Disorder (in particular alcohol dependence), and inter-episodic depression in Schizophrenia. There are some conditions associated with very high risk, as MDD+OCD with obsessive suicidal ideas, mixed depression in BD, or a recently diagnosed terminal disease associated with expected pain or suffering, to name some. In the first two of the latter conditions, patients frequently report suicide impulses that can be hard to resist. Also there are some symptoms that appear frequently in these disorders that can increase the risk, as high irritability/hostility, high anxiety/agitation, or pervasive insomnia. Painful memories of the life lived till that point (early adversity) and/or PTSD, plus a personality disorder (emotional instability and impulsivity cluster), also add more risk to the equation.
Finally, when dealing with a suicide risk patient it is clinically very useful to think in terms of a “suicidal zone”. People go inside suicidal zone when they report suffering of an intense psychic and emotional pain that they experience as intolerable, inescapable and interminable (“The 3 “I”s of suicide).
From the perspective I come from, suicidal thoughts and suicidal ideation are more a product of dispare, distress and emotional pain. Entrapment,and wanting to escapoe from pain (emotional or indee physical) are frequently observed and reported. Ther are many theroetical approcas that can be consisered with arrested flight a developing area. Exploring the works of Keith Hawton (oxford university) and Rory Oconner (Glasgow university) may be a good staring point in light of your question.
Simplistically self harm and suicidal behaviurs are the result or symptons of other problems usually that will have resulted in emotional distress. Some illneses, situation, personal charicteristics and experiences may lead some to be more prone than others. However acuralty identifying and predicting is a significant chalenge. (appologies for any odd spelings etc Dyslexia rule KO!)
I concur with Sergio's conceptualization of a "suicide zone." There is clearly a definite psychological boundary that acutely suicidal persons pass that puts them at high risk and in imminent danger. At this point ideation does not do just to where they are. They have developed a plan, which they have mentally ran through many times, likely acquired means or have ready access (e.g., bridge, railway), and are close to entering or in O'Connor's "volitional phase" (which Keith references above) where the plan will be enacted and a potentially lethal suicide attempt may occur.
Perhaps the perception of their situation as intolerable, inescapable and interminable (“the 3 “I”s of suicide) is progressive and convergent. Risk rises and peaks as they come to believe they are trapped by circumstances that they find intolerable and inescapable. Ideation at its earliest stage may be provoked by the initial assessment of their position as untenable and in the process of deteriorating.
Everyone,
Great answers to this very complex and important issue. Please continue the discussion with further responses if you are able.
Thank you to everyone sharing such insightful perspectives, many of which I agree with. I would like to share my experience as a survivor of several attempts of taking my life into my own hands.
From childhood to now I have mental illness all around me in my family. I have lived, loved and worked with so many people touched by mental illnesses and suicidal thinking, attempts and completion of the act of suicide.
My late mother had bipolar disorder and was in and out of psychiatric hospitals since I can remember. I did not know why, except that she had severe " nerves". it would be when I was 18 that I realised she was suicidal and had been for too many years and hence all the hospitalisations and ect. I was 7 years of age, just as my parents separated and was being bullied at school, pushed and pulled by my parents and the court system wasn't helpful either - to be asked which parent I wanted to live with at that age was traumatic beyond words. I started thinking about dying to relieve unbearable pain, grief, loss, fear of existing everyday. Feeling disconnected from everyone, everything, like I was barely existing.
At 18 I started trying ways to take my life - I didn't have a plan, I did reckless things in hope that they would work and it "wouldn't hurt to die" All I kept seeing was my funeral. I tried several times,many different ways and was hospitalised for a short term. I look back to that time as another life, another person. I have bipolar disorder and am mostly ok and functioning..
My 16 y.o has had 2 hospital admissions, having tried to take her life impulsively one night and self - harming for several years. She has been severely depressed and has crippling social anxiety. She has come along way and is starting to do really well....but I know that she is vulnerable and so keep her doing positive things, keep her connected, distracted and her passions.
My journey to recovery has allowed me to find gifts t never imagined were possible. Today I use my vulnerability as a strength and work as a mh educator and advocate, have travelled the world, learning and sharing inspiring recovery stories from the most amazing people. I have mostly long periods of wellness, my daughter's illness has certainly been a stressor that has been a trigger for depression and severe hyper anxiety, but I have been fighting my way through it with alot of help from others. I have learnt to recognise and manage my health.
But I am one of the lucky ones. I have great support, a great coach and mentor in my psychiatrist, I love my work, am well educated but above all I have a beautiful family. Next week I celebrate 30 years of marriage. Yes the road is bumpy - suicide is devastating - being in so much pain that I didn't want and hated being in my skin yet not knowing how to end the pain - I did feel a burden to those around me, I did feel worthless, hopeless, helpless when I have hit rock bottom. As many have commented previously - this is really complex.
I am still learning and have just been accepted to do a Masters in Suicidology - I figure, the more I know, the more chance I can fight this in myself if and when those feelings come up - which luckily they don't so often. There are still times I do feel unsafe but because I so love my daughter and partner, and do love living I actually know those feelings are temporary and that they will pass. I also talk to trusted peers and my dr. The more I know the more, the more I master this, the more empowered I become and I am not afraid or uncomfortable when I recognise symptoms, signs in a loved one, colleague or someone distressed to be direct and ask uncomfortable questions to assess their risk. Not asking frightens me more.
Through sharing a little of my journey I hope to give others a sense that they are not alone and things, life can get better. It's acknowledging the psyche pain, the soul pain of the person that helps so much, to know and have loved ones give you the time to check in and say I care you are valued, can get a hug when you are in despair can never be underestimated, The sad part is in families their is too much stigma and other issues that can contribute and hinder wellness.
The recovery focussed model that consumers and carers globally have been advocating for is the way to go - wellness is up to me, I don't choose this illness, but I can change the way I manage and live with it - so that most of the time, when we are not in crisis we are actually functioning stable family contributing and enjoying life. .
My daughter found her mojo in singing, songwriting and music, a new alternative, not mainstream school, peers who get her, alittle maturity, her parents learning different ways to help guide her through life constructively and fairly.
Relapse is a possibility for both of us. But at least we get it now and are better prepared from past learnings. One step, one day at a time. I, we will always bounce back.
There are many published documents on recovery frameworks that have been developed by consumers and carers - In Australia as one example that may help with balancing the question and providing concepts to build resilience - without these elements coping mechanisms decline.
Volunteering, being a part and belonging, connectedness, spirituality, work, school, hobbies are all protective factors. This is about our humanness. We will each experience adversity, loss, love, injury, illness. Compassion, kindness, hope, optimism, empowerment, showing recovery and resilience is possible. We just need courage, patience and time. Reaching out to someone vulnerable is
something we can all do. I have been in the dark, known too many others who have been in that same pit - and all we wanted was comfort, a hug, help to relieve pain.
Please try to read - The Meaning of Life - By Viktor Frankl, a holocaust survivor
To love and be loved, to have meaningful work, positive connectedness, to have a home - the opposite for suicidal ideation.
There have been many studies examining risks for suicide. Many factors across multiple life domains are positive predictors. However, because the base rate of suicide is so low, these risk factors are not helpful in predicting whether or not a specific individual will or will not go through with it. The vast, vast majority of folks who carry risk factors do NOT die by suicide. As to alcohol as a risk factor, Thomas Joiner at FSU found in a post-mortem study that a tiny minority of victims had had a lot to drink. On average, I think it was the equivalent of one drink. This would coincide with what Donal mentions above.
There is no single reason, A number of factors associated with suicidal ideation, i.e. depression, other mental illness, substance abuse, drug addiction, different socioeconomic factors such as unemployment, poverty, homelessness, social discrimination and alternative sexual orientation, etc. which may trigger suicidal thoughts.
I found the suicide ideation was accurately predicted, above and beyond what was explained by depression, by an interaction between "Problem Generation Fluency" and "Problem Solving Rigidity." The second part of this interaction was operationalized in terms of low Flexibility scores.
Mark, what is problem generation fluency? Do you have a reference for the study you mention? Best, Keith
Keith, sure, I have a pdf--see attached. I have done a series of studies on "problem generation" since so much is said in the creativity literature about "problem finding." I view problem generation as one part of problem finding, another part being "problem definition." I also edited a book, Problem Finding, Problem Solving, and Creativity, but I am not sure if it is still available. Much of my work relies on ideational tasks, much like divergent thinking tasks. I have also written 1-2 things about creativity and suicide that do not reply on data/ ideation. I can attach one paper on Sylvia Plath as an example. Thank you for asking.
Keith, that message went out before I added the other file. Sorry. Will try again....
The endorsement of the cognitive trio (worthlessness, hopelessness and helplessness) was associated with an increased risk of suicide.
First, I apologize in advance for any grammatical errors that could commit to writing in English , I share a secret with you use a native soil for publications that I do ;) .
Secondly , I find very interesting each and every one of the answers that have been raised . I will carefully read the articles posted by Dr. Junco and theory troubleshooting offering . Also, I think input from Dr. Ozols is very enlightening , and so raised by Dr. Aronson , I think both offer basic of traffic ideation to completed suicide attempt or keys. As Aronson teacher raises , we are betting on studying protective factors that promote resilience in individuals who have made a suicide attempt, in our cultural context because suicidal ideation is very common, both normal and clinical populations , so therefore does not predict anything. Thus , it appears that the socio- cultural aspects have a decisive influence on the modulation of risk factors that are more or less dangerous , and the impact of protective factors is higher or lower , also depends on the type of risk or adverse situation to which the person is exposed . We are currently investigating these aspects in clinical population.
Sorry I have not said, but millions of thanks to everyone for their input
Yes, David, I echo your sentiment. Thanks to all of you who have contributed answers to this important issue. Thanks also for everyone who has stopped by to follow the discussion.
One recent factor is the economic downturn which has thrown many people out of work and contributed to the loss of the middle class. As a result, many individuals, primarily males, who have thought of themselves as the family breadwinner feel despair because they have trouble finding work again, feel a loss of status and meaning in their life, and consider suicide for that reason. In fact I wrote a script that is going into production as a film in about 6 weeks called the Suicide Party about a man about to lose his house and everything he holds dear because he has lost his job and can't find another. So if he can raise enough through the event to save his house and get back on his feet, he'll live. If not, he'll end it all, which leads to a media frenzy and unexpected results. The film is designed to raise an awareness of this problem of economic suicide and contribute to the conversation about this. You can see more details at http://www.gofundme.com/suicide-party
I think if you are just looking at the highest rates of suicide by psychological diagnosis,then that would be bipolar disorder. Whether this is a good correlate of suicidal ideation is another issue; the cyclical nature of bipolar disorder allows for the cognitive and physical energy to actually plan and carry out the act. In my opinion, it is very impoirtant to understand that people don't commit suicide in the depths of their depression. They are at the highest risk as they are going into or coming out of deep depression, which is why therapy should included in the treatment rather than merely expecting medication to be the panacea.
Why is one more inclined to suicide when recovering? Is it because one feels that cannot make it, that is too late?
Blake, when they are seriously depressed they do not have the cognitive focus to develop a plan for ending their lives. They are also physically exhausted and do not have the energy to carry out a plan. As the depression begins to lift, their energy level rises and they have improved cognitive functioning; however they are still filled with feelings of despair, worthlessness, hopelessness and negative views of themselves and their world. This is the critical stage; as the recovery continues their mental anguish will lessen and their emotional state will catch up with the other improvements, but untill that point, suicide is a very real risk.
Neil: Copied below is citation from a paper I just ran across that refers to it as source for mood disorders being the main illnesses connected to suicide. Will try to get that paper copied in here somehow, but might fail, so will get the reference to you here:
. Murray CJL, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet. 1997;349:1436–1442. [PubMed]
The Lancet piece is a bit old, but I'll bet it still holds up. Here's the sentence derived from it: The mood disorders account for the vast majority of suicides and are a leading cause of disability.[3]. The study in which it's quoted was published in Depression and Anxiety, Oct. 2010, pp. 891-932: A review of empirically supported psychological therapies for mood disorders in adults
Steven D. Hollon, Ph.D. and Kathryn Ponniah, D. Clin. Psy.
If you run into any biological factors associated with suicide, I'd be especially interested. Genetics? Lucy Anne Cathcart
Neil: The attached study from Vienna concerns a group of symptoms (Recurrent Brief Depression) that places people at higher risk for suicide. Lucy Anne
Lucy,
Thanks for the article on RBD. It's very interesting to me (and counterintuitive) that patients with brief, remitting episodes of depression would be at greater risk for suicidal behavior than those with chronic major depression.
Neil: To get it straight, Pezawas et al. refer to a Zurich study to the effect that 10% of RBD patients attempt suicide, but 30% of those with both RBD & MDD attempt it.. Lucy Anne
You may want to approach your question from two basic standpoints: first, the stressors/triggers leading to attempted suicide (a good example of this is the "classic" study by Spirito: "Common problems and coping strategies II: Findings with adolescent suicide attempters"); second, the clustering of phenomenological reasons leading to suicidal ideation, as for instance, "hopelessness", "flight/abandon", "appeal" or "challenging". This could perhaps be adequately achieved through grounded theory and/or the development of a multidimensional measure to assess those "reasons/motives".
Impulsivity, aggression, high irritations, hopelessness are the four major component of the suicidal thoughts. When anyone of these factors combined with the depression and anxiety, it become more severe. Though the SSRI known to help in maintain the severe depression like behavior, but in younger generation these antidepressants induce the suicidal behavior (NIMH), the mechanisms behind that induction of suicidal behavior by SSRI in adolescenceis is mostly unknown. One of the possible reason may be imbalance of precursor (5HTP/HT ratio) and serotonin level in extracellular space in the brain which is mediated by the tryptophan hydroxylase2, a rate limiting enzyme in synthesis of serotonin
hope this help
good luck
Here are two conceptual models of the onset of suicidality, which in most cases begins with suicidal ideation: (1) The “Self-regulatory Model” [Baumeister, R., and Vohs, K. Handbook of Self-regulation, K. New York: Guilford Press, 2011] posits suicidality as rooted in a desire to escape negative self-awareness and unpleasant emotions. Adverse personal decisions or occurrences may cause an individual to see himself in an unacceptable way. Self-awareness is minimized in effort to avoid negative self-comparisons (i.e., escape from self). This lessening self-awareness weakens inhibitions against suicidality. This leads to a further weakening of self-regulation and the susceptibility to suicidality rises; (2) The “Looming Vulnerability Model” [Riskind, J., Williams, N., and Joiner, T., The Looming Cognitive Style: A Cognitive Vulnerability for Anxiety Disorders, Journal of Social and Clinical Psychology, 2006, 25(7) 779-801] sees some individuals as having a cognitive style that creates scenarios of rising danger and risk in response to anxiety. Such individuals acquire a processing bias that leads to catastrophization of stress. The resulting emotional distress produces a state of intolerable desperation and urgency. This leads to drastic actions to eliminate distress. Suicidal thoughts may be an effective problem-solver. If they produce relief they may become a “default” coping strategy that can be quickly enacted.
Tony: Thanks for these references and your encapsulating of them. The cognitive vulnerability model certainly sounds like Aaron Beck's automatic negative thinking triad of feeling hopeless about the self, the world and the future, the state of depression he devised cognitive therapy to treat. The catastrophisizing you describe is one of the 5 main faulty cognitions his therapy seeks to correct. Don't you think all this adds to the imperative for making it "OK" (non-stigmatizing, easily accessible) to seek therapy when such disturbing thoughts arise?
In a simplistic way it cold be viewed that suicidal thoughts are not a sign of abnormaily but an understanable human responce to distress, pain (physical and emotional) despair ect. What we know less about is the development from suicidal thoughts and who and when they may progress further into more structured ideation and then potental actions. I think the works of Thomas Joiner in a "desire/capabilities" approach, David Klonsk "ideation to action framework" and the IMV " Integrated Motivational-Volitional" model from Rory O'conner are very helpfuly in understanding not only the ideation but why some may progress to acting on these. They also link well to understand self harm as a coping startergy with or without suicidal ideation. I would support the stance that as we dont know who may progress from thoughts to actions that all suicidal thoughts should be taken seriously and approchest to mitigate for them adopted. Appologies if spelling errors "Dyslexia rules KO!"
Keith is absolutely correct: Suicidal ideation per se is an entirely "normal" response to levels of psychological, emotional, or physical pain or distress beyond an individual's tolerance, resilience, or coping ability. These condition are natural outcomes of unfortunate but, in most cases, normal life events. The onset of suicidal ideation can be seen as an expected response by some people under some conditions. This perspective would destigmatize suicide at a point where an at-risk individual could most readily be helped and prevented from potentially more lethal behaviors. And as Keith notes, none of this is to say that suicide ideation should ever be disregarded.
I am sad to agree with Kieth and Tony. On May 5, 2014 a client of mine chose to jump from a freeway bridge into traffic rather than continue his life. By all empirical measurements his life was better than ever. He could not see it. He was 43 years old. He had been permitted to exist with his own delusions for so long that when the door to a new life really presented itself it became a door into prison not a door out of one. He preferred his own reality to the one he was forced to face when working with me. I will miss him. He was a kind man who lived a life based on so much bad information for so long that in the end it killed him.
He was faced with a level of psychological & emotional pain- real to him- that overwhelmed his rational desire to continue to live. He had little hope for the future because only in the nine months I worked with him was he told that he could expect to live a full life. He had no skills to cope with any issues in life. Not because of a lack of capacity- but because he had lived a life being diverted from the skills required to cope with life. Nobody noticed that they had been enabling him for all those years and crippling his ability to be autonomous. Then when He did not just grow up the family felt abused and I was hired as a last ditch effort to help him learn to live. When he saw the options he chose the right to be wrong. His diagnosis varied between schizophrenia and schizoaffective. I spent more time with him than anyone in the past 5 years and I came to believe his greatest problem was acute neglect. But he had the label in his jacket. Sorry to gush like this- still a bit raw about the whole deal. I hope you find some useful answers.
A growing area of suicidal ideation is economic suicide due to a recent loss of income and earning power resulting from the Great Recession and the continued problem of economic survival today. Many formerly middle income individuals have lost their homes and have joined the new poor, and many people in this situation, especially males, have trouble seeing their way out. In fact, I wrote a script about this which is being filmed in July in Las Vegas and LA called Dave's Suicide Party, about a once successful guy about to lose everything he holds dear. He throws a suicide party with the help of his friends. If he raises enough to save his house and get back on his feet, he'll live. If not, he'll end it all leading to a media frenzy and unexpected results. You can see more about it at www.gofundme.com/suicide-party.
The Six Reasons People Attempt SuicideSuicide is far more understandable than people think.
Published on April 29, 2010 by Alex Lickerman, M.D. in Happiness in this World
Citations:
1.They're depressed. This is without question the most common reason people commit suicide. Severe depression is always accompanied by a pervasive sense of suffering as well as the belief that escape from it is hopeless. The pain of existence often becomes too much for severely depressed people to bear. The state of depression warps their thinking, allowing ideas like "Everyone would all be better off without me" to make rational sense.
2.They're psychotic. Malevolent inner voices often command self-destruction for unintelligible reasons. Psychosis is much harder to mask than depression, and is arguably even more tragic. The worldwide incidence of schizophrenia is 1% and often strikes otherwise healthy, high-performing individuals, whose lives, though manageable with medication, never fulfill their original promise. Schizophrenics are just as likely to talk freely about the voices commanding them to kill themselves as not, and also, in my experience, give honest answers about thoughts of suicide when asked directly. Psychosis, too, is treatable, and usually must be treated for a schizophrenic to be able to function at all. Untreated or poorly treated psychosis almost always requires hospital admission to a locked ward until the voices lose their commanding power.
3.They're impulsive. Often related to drugs and alcohol, some people become maudlin and impulsively attempt to end their own lives. Once sobered and calmed, these people usually feel emphatically ashamed. The remorse is often genuine, but whether or not they'll ever attempt suicide again is unpredictable. They may try it again the very next time they become drunk or high, or never again in their lifetime. Hospital admission is therefore not usually indicated. Substance abuse and the underlying reasons for it are generally a greater concern in these people and should be addressed as aggressively as possible.
4.They're crying out for help, and don't know how else to get it. These people don't usually want to die but do want to alert those around them that something is seriously wrong. They often don't believe they will die, frequently choosing methods they don't think can kill them in order to strike out at someone who's hurt them, but they are sometimes tragically misinformed. The prototypical example of this is a young teenage girl suffering genuine angst because of a relationship, either with a friend, boyfriendbecause of a relationship, either with a friend, boyfriend, or parent, who swallows a bottle of Tylenol, not realizing that in high enough doses Tylenol causes irreversible liver damage. I've watched more than one teenager die a horrible death in an ICU days after such an ingestion when remorse has already cured them of their desire to die and their true goal of alerting those close to them of their distress has been achieved.
5.They have a philosophical desire to die. The decision to commit suicide for some is based on a reasoned decision, often motivated by the presence of a painful terminal illness from which little to no hope of reprieve exists. These people aren't depressed, psychotic, maudlin, or crying out for help. They're trying to take control of their destiny and alleviate their own suffering, which usually can only be done in death. They often look at their choice to commit suicide as a way to shorten a dying that will happen regardless. In my personal view, if such people are evaluated by a qualified professional who can reliably exclude the other possibilities for why suicide is desired, these people should be allowed to die at their own hands.
6.They've made a mistake. This is a recent, tragic phenomenon in which typically young people flirt with oxygen deprivation for the high it brings and simply go too far. The only defense against this, it seems to me, is education.
Apologies if this has already been mentioned but Emile Durkheim provides an interesting sociological perspective on suicide. https://www.ncjrs.gov/App/Publications/abstract.aspx?ID=44396
There is a very interesting discussion in James Hillman's book Suicide and the Soul. Hillman examines how Sociology, Theology, Medicine, and Law have approached suicide, and then speaks to the perspective of the soul. As a clinical psychologist I've found that it's most helpful to say "tell me about your pain" and to respect that pain. If even one person understands how painful one's situation is, that is one reason to stay alive and to muster the courage to pass through it.
I view suicidal ideation from a psychodynamic perspective that I have seen empirically countless times. Suicidal ideation is the ultimate in self-attacking defenses that are used to quell anxiety being driven by primitive murderous rage at a genetic figure. This rage is unacceptable as a child and could lead to death or serious trauma, so produces huge anxiety when it naturally is the response to mistreatment, thus the child learns to habitually bury it by turning it inward as a critical self-attacking voice. It rapidly becomes an unconscious compromise that is percieved at basic self truth. When I help people see this "triangle of conflict" structure, this habit structure, to see how unconscious, automatic this procedure is, but to see that although it once served them as a way to preserve a vital attachment it is now a perpetrator inside them and they could choose otherwise, they usually stop. Please look at all the work by Habib Davanloo and his many students (Jon Frederickson - "Co-creating Change", Allan Abbass, Patricia Couglin, and so on. This has been quite well understood and treated for about 30 years by the dynamic techniques of Intensive Short-Term Dynamic Psychotherapy and its offshoots. Here, drugs, etc. can be seen as self-attacking defenses as well, ways to lower anxiety about rage at an important attachment figure. Of course there are many other triggers, etc., as others here have mentioned, but this dynamic source should not be overlooked as this treatment is so effective.
There are also some interesting perspectives in Lorna Smith Benjamin's, Interpersonal Diagnosis and Treatment of Personality Disorders (Guilford, 1993, 1996). Benjamin examines the interpersonal context of suicide attempts, which will generally look quite different depending on one's diagnosis on Axis II.
One cause that may often be ignored is a financial collapse due to economic conditions, which has been increasing in recent years due to economic turmoil today. Someone who has become used to living a certain way can't imagine suddenly ending up on the street or a homeless shelter and may feel he or she has let his or her family down by not being able to provide for them. This may not be due to a mental illness but a response to conditions that seem impossible to overcome and the person may lack the kind of social supports that can help the person get out of these difficult changed conditions..
I have gone through the discussion on suicidal ideatio. Since suicidal ideation involves mamaladptive thought processe, it will be interesting to explore the role of maladptive metacognitions in suicidal ideation and metacognitions have been lilinked to depression.
The concern I hold in relation to relying on Emile Durkheim's research is that he excluded women from his research.
A colleague of mine once explained that he viewed suicide as an emotional heart attack, and that just like a physical heart attack all the signs and symptoms can be there but we are powerless to predict its occurrence or to stop it. This explanation may benefit the relatives of unpredicted or unexpected suicide.
In Ireland there is research that shows a direct causal relationship between alcohol and suicide in young males.
To me suicide is a functional act often not intended to end life, but to end the emotional pain; to silence the internal dialogue and critic.
There is an assumption that suicidal ideation is a maladaptive thought process - but where is the empirical evidence for that?
Risque suicidaire bipolarité
Type 1
32.4% (15 fois plus que la population générale)
¼ des suicides complétés
Type II
36.3% de risque suicidaire
⅓ avec histoire de suicide
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In autism spectrum disorder with higt functionning
major reasons are: Intimidation, low perception of social competence, awerness of difference from other.
Suicidal ideation is subjective. Although we generally discuss suicidal thoughts in terms of psychological, social and mental health terms it has to be said that not all suicidal ideators have mental health issues. There is, all be it, a minority of people that express suicidal ideas because the feel "I have accomplished everything that I needed to do, so I should simply end it all". There are others that say "life is too much suffering, I should die". In either case there may or may not be deep rooted psychological pain. Most of these ideators do not generally attempt suicide much less complete it. The main cause of suicidal ideation does lie within the realms of mental health, but we still must be aware of others reasons such as "there is nothing in this life for me". Some people do say and mean this and do not fit any criteria for mental illness - they are people who might think "the world is a lemon and I want my money back".Not all ideators are mentally ill.
The usual figure quoted is that 70 to 90% of those who kill themselves are depressed. There are of course many risk factors that also apply in other conditions.
Why does one person want to commit suicide and the other wants to live when they are in the same predicament? We answer this in our paper Miss B and Miss P.....Our contributions on what leads to young persons lack of motivation to live is also attached:
Fellow researchers
Dr.Kenneth Kendler, our universally recognized authority on the genetic and environmental factors to be considered when addressing depression and individual response to stress, has published the latest research he and his colleagues have accomplished. Their results and conclusion are refreshing in their clarity, and enormously challenging. Happy New Year!
Citation
Kendler KS, Ohlsson H, Sundquist K, Sundquist J. Sources of Parent-Offspring Resemblance for Major Depression in a National Swedish Extended Adoption Study. JAMA Psychiatry. Published online December 13, 2017. doi:10.1001/jamapsychiatry.2017.3828
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Desires not met leads to frustration whiche leads to lament then dpression and sucide.
In dynamic psychotherapy, ISTDP, we see recurrent patterns: feeling > anxiety > defenses. When there is great anger, defenses become older and more primitive and stringent, they include self-attack, which creates depressive symptoms when it is unrelenting (due to unresolved rage and resultant unconscious guilt at an important attachment figure). Essentially, the very old compromise was to learn habits to get along with attachment figures, without which we would have died, at the cost of our mood and functioning.
Obviously, all sorts of other genetic, epigenetic, dietary, inflammatory, toxic exposure, and other variables are often at work as well.
With most patients, I see suicidal thoughts disappear within a few sessions when we address the real and ignored core anger at attachment figures and free them up to feel and tolerate feelings.
harbouring of negative thought entities, negative thought forms, negative elementals and negative psychic energies in our energy body and energy centres (chakras).......leads to psychological and psychiatric diseases like depression . may lead to suicidal thoughts. pranic psychotherapy techniques are very effective mode of non pharmacological treatment
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