21. Health economics & services research

Abstract

Theories addressing the phenomenon of suicide have been proposed from varied academic disciplines including sociology, psychiatry, psychology, cognitive neuroscience, genomics, epidemiology, public health and psychoanalysis. In the past few decades, empirical research efforts toward improved understanding, prediction, assessment, treatment, and prevention of suicide have come mainly from within the fields of psychology, psychiatry and neurobiology. For many years, suicidal behavior has been largely viewed as part of specific psychiatric diagnoses (in particular Major Depressive Disorder and Borderline Personality Disorder) and treatment has been largely limited to targeting the disorder and not than the behavior itself or its diathesis. We have proposed a stress diathesis model of suicidal behavior wherein the mood disorder or psychosis or other acute psychiatric condition is the stressor, as is any stressful life event, and the diathesis has components like pessimism, reactive aggressive traits, impaired problem-solving or learning and social distortions). The fact that suicidal behavior often occurs in other psychiatric disorders, such as Bipolar Disorder, Alcoholism, Eating Disorders and Schizophrenia, indicates that we must screen patients much more broadly for suicide risk. At the same time, the observation that most of people with these psychiatric conditions do not engage in such behavior, has led researchers to consider the behavior, or at least the diathesis for suicidal behavior, as a comorbid condition rather than an intrinsic dimension of a psychiatric condition. This shift in conceptualization has led to a newly proposed diagnostic entity included in 2013 in the Diagnostic and Statistical Manual-Fifth Edition (DSM-V) “Suicidal Behavior Disorder” as a “Condition for Further Study.”This article summarizes the research findings that both identify risk factors and challenge common myths regarding causal factors for suicidal behavior, factors not specific to psychiatric diagnosis. A comprehensive hypothetical explanatory and predictive model that incorporates many of these correlates of suicide risk and that provides a foundation for clinical and research advances in the field, is described. The relevance of these findings for improving prevention, treatment, and further research is outlined.