Suicidal behavior—symptom or disorder?

Abstract

This article examines the diagnostic status of suicidal ideation with and without additional signs of defined or subthreshold mental disorders. Data from the World Health Organization (WHO) study on Psychological Problems in General Health Care (PPGHC) show that 8.8% of all general practice patients report that they recently had a wish to be dead. Among patients with acute depressive episodes, the rate is 34.5%, as compared with 1.3% in persons without any sign of mental disorder. Rates of suicidal ideation in persons with subthreshold disorders (10.4%) are similar to the rate in persons with other, nondepressed forms of mental disorders (12.9%). Still, 30.1% of all persons with suicidal ideation do not have a defined mental disorder, and 21.5% do not even have subthreshold disorders. But in these persons also, suicidal ideation is associated with an increased rate of depressive complaints. Suicidal ideation therefore, in any case, can be seen as an indicator of mental problems. But it seems impossible to lower the thresholds of defined mental disorders so that all forms of suicidal ideation will be covered. Instead, suicidal thoughts must be regarded as a symptom with the status of a disorder itself which should be handled as a comorbid condition if other mental disorders co-occur.