Suicidal behavior is a major problem worldwide and, at the same time, has received relatively little empirical attention. This relative lack of empirical attention may be due in part to a relative absence of theory development regarding suicidal behavior. The current article presents the interpersonal theory of suicidal behavior. We propose that the most dangerous form of suicidal desire is caused by the simultaneous presence of two interpersonal constructs—thwarted belongingness and perceived burdensomeness (and hopelessness about these states)—and further that the capability to engage in suicidal behavior is separate from the desire to engage in suicidal behavior. According to the theory, the capability for suicidal behavior emerges, via habituation and opponent processes, in response to repeated exposure to physically painful and/or fear-inducing experiences. In the current article, the theory’s hypotheses are more precisely delineated than in previous presentations (Joiner, 2005), with the aim of inviting scientific inquiry and potential falsification of the theory’s hypotheses.

/pdf/the-interpersonal-theory-of-suicide-38t99pb95m.pdf

The Interpersonal Theory of Suicide

Suicidal behavior is a leading cause of injury and death worldwide. Information about the epidemiology of such behavior is important for policy-making and prevention. The authors reviewed government data on suicide and suicidal behavior and conducted a systematic review of studies on the epidemiology of suicide published from 1997 to 2007. The authors' aims were to examine the prevalence of, trends in, and risk and protective factors for suicidal behavior in the United States and cross-nationally. The data revealed significant cross-national variability in the prevalence of suicidal behavior but consistency in age of onset, transition probabilities, and key risk factors. Suicide is more prevalent among men, whereas nonfatal suicidal behaviors are more prevalent among women and persons who are young, are unmarried, or have a psychiatric disorder. Despite an increase in the treatment of suicidal persons over the past decade, incidence rates of suicidal behavior have remained largely unchanged. Most epidemiologic research on suicidal behavior has focused on patterns and correlates of prevalence. The next generation of studies must examine synergistic effects among modifiable risk and protective factors. New studies must incorporate recent advances in survey methods and clinical assessment. Results should be used in ongoing efforts to decrease the significant loss of life caused by suicidal behavior.

/pdf/suicide-and-suicidal-behavior-41x9ufvkfm.pdf

Suicide and Suicidal Behavior

Background 

Suicide is a leading cause of death worldwide; however, the prevalence and risk factors for the immediate precursors to suicide – suicidal ideation, plans and attempts – are not wellknown, especially in low- and middle-income countries.

Aims 

To report on the prevalence and risk factors for suicidal behaviours across 17 countries.

Method 

A total of 84 850 adults were interviewed regarding suicidal behaviours and socio-demographic and psychiatric risk factors.

Results 

The cross-national lifetime prevalence of suicidal ideation, plans, and attempts is 9.2% (s.e.=0.1), 3.1% (s.e.=0.1), and 2.7% (s.e.=0.1). Across all countries, 60% of transitions from ideation to plan and attempt occur within the first year after ideation onset. Consistent cross-national risk factors included being female, younger, less educated, unmarried and having a mental disorder. Interestingly, the strongest diagnostic risk factors were mood disorders in high-income countries but impulse control disorders in low- and middle-income countries.

Conclusion 

There is cross-national variability in the prevalence of suicidal behaviours, but strong consistency in the characteristics and risk factors for these behaviours. These findings have significant implications for the prediction and prevention of suicidal behaviours.

/pdf/cross-national-prevalence-and-risk-factors-for-suicidal-5516jqu5jf.pdf

Cross-National Prevalence and Risk Factors for Suicidal Ideation, Plans, and Attempts

https://www.thelancet.com/pdfs/journals/lanpsy/PIIS2215-0366(16)30030-X.pdf

Suicide prevention strategies revisited: 10-year systematic review

Suicide is a worldwide phenomenon. This review is based on a literature search of the World Health Organization (WHO) databases and PubMed. According to the WHO, in 2015, about 800,000 suicides were documented worldwide, and globally 78% of all completed suicides occur in low- and middle-income countries. Overall, suicides account for 1.4% of premature deaths worldwide. Differences arise between regions and countries with respect to the age, gender, and socioeconomic status of the individual and the respective country, method of suicide, and access to health care. During the second and third decades of life, suicide is the second leading cause of death. Completed suicides are three times more common in males than females; for suicide attempts, an inverse ratio can be found. Suicide attempts are up to 30 times more common compared to suicides; they are however important predictors of repeated attempts as well as completed suicides. Overall, suicide rates vary among the sexes and across lifetimes, whereas methods differ according to countries. The most commonly used methods are hanging, self-poisoning with pesticides, and use of firearms. The majority of suicides worldwide are related to psychiatric diseases. Among those, depression, substance use, and psychosis constitute the most relevant risk factors, but also anxiety, personality-, eating- and trauma-related disorders as well as organic mental disorders significantly add to unnatural causes of death compared to the general population. Overall, the matter at hand is relatively complex and a significant amount of underreporting is likely to be present. Nevertheless, suicides can, at least partially, be prevented by restricting access to means of suicide, by training primary care physicians and health workers to identify people at risk as well as to assess and manage respective crises, provide adequate follow-up care and address the way this is reported by the media. Suicidality represents a major societal and health care problem; it thus should be given a high priority in many realms.

https://www.mdpi.com/1660-4601/15/7/1425/pdf

Epidemiology of Suicide and the Psychiatric Perspective.

Resumen Eficacia de una intervencion de informacion y contactos en los casos de intento de suicidio: ensayo controlado aleatorizado en cinco paises Objetivo Determinar si una intervencion de informacion breve y contactos es una medida eficaz para reducir la mortalidad posterior por suicidio entre quienes han intentado suicidarse en los paises de ingresos bajos y medios.Metodos Un total de 1867 personas que habian intentado suicidarse seleccionadas por personal medico en los servicios de urgencia de ocho hospitales colaboradores en cinco lugares con distinto contexto cultural (Campinas, Brasil; Chennai, India; Colombo, Sri Lanka; Karaj, Republica Islamica del Iran; y Yuncheng, China) participaron entre enero de 2002 y octubre de 2005 en un ensayo controlado aleatorizado para someterse bien al tratamiento habitual, o bien al tratamiento habitual mas una intervencion consistente en una sesion breve de informacion y educacion del paciente y una serie de contactos de seguimiento (I+C). Globalmente, finalizaron el estudio el 91% de los pacientes. La variable principal de medicion del resultado del estudio fue la muerte por suicidio en los 18 meses de seguimiento.Resultados En el grupo sometido a I+C se observo una tasa de defunciones por suicidio significativamente menor que en el grupo tratado de la forma habitual (0,2% frente al 2,2%, respectivamente; c² = 13,83,

/pdf/effectiveness-of-brief-intervention-and-contact-for-suicide-4t1iv441sg.pdf

Effectiveness of brief intervention and contact for suicide attempters: a randomized controlled trial in five countries

Background. The objectives were to assess thoughts about suicide, plans to commit suicide and suicide attempts in the community, to investigate the use of health services following a suicide attempt, and to describe basic socio-cultural indices of the community.Method. The community survey was one component of the larger WHO multisite intervention study on suicidal behaviours (SUPRE-MISS). In each site, it aimed at randomly selecting and interviewing at least 500 subjects of the general population living in the catchment area of the emergency department where the intervention component of the study was conducted. Communities of eight SUPRE-MISS sites (in Brazil, China, Estonia, India, Iran, South Africa, Sri Lanka, and Viet Nam) participated plus two additional sites from Australia and Sweden conducting similar surveys.Results. Suicide attempts (0·4–4·2%), plans (1·1–15·6%), and ideation (2·6–25·4%) varied by a factor of 10–14 across sites, but remained mostly within the ranges of previously published data. Depending on the site, the ratios between attempts, plans, and thoughts of suicide differed substantially. Medical attention following a suicide attempt varied between 22% and 88% of the attempts.Conclusions. The idea of the suicidal process as a continuous and smooth evolution from thoughts to plans and attempts of suicide needs to be further investigated as it seems to be dependent on the cultural setting. There are indications, that the burden of undetected attempted suicide is high in different cultures; an improved response from the health sector on how to identify and support these individuals is needed.

/pdf/suicide-attempts-plans-and-ideation-in-culturally-diverse-30n5hdm13v.pdf

Suicide attempts, plans, and ideation in culturally diverse sites: the WHO SUPRE-MISS community survey.

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Effectiveness of brief intervention and contact for suicide attempters: a randomized controlled trial in five countries

Suicide attempts, plans, and ideation in culturally diverse sites: the WHO SUPRE-MISS community survey.