PATHWAYS TO SUICIDE:
THE EPIDEMIOLOGY OF
THE SUICIDAL PROCESS
Ad J.F.M. Kerkhof and Ella Arensman
Vulnerability to suicidal behaviour may be an underlying and latent trait in many people. This trait, however, is not necessarily persistent during all periods of life, nor does it become manifest in a predictable way. The level of this vulnerability varies from time to time, depending upon the course of life and upon a subjective threshold of frustration tolerance. This threshold can be conceived as a subjective standard of quality of life determined by a complex set of psychosocial living conditions, personal relationships, ambitions, fulfilments, values and coincidental factors that may serve as protective factors. Even this threshold may fluctuate over the course of life.
Clinicians are familiar with fluctuations in the risk of suicide, which may indeed change from time to time, from day to day, or even from minute to minute. Yet, undoubtedly there are considerable differences in the basic vulnerability to suicidal behaviour. Many persons will never become suicidal whatever may happen to them, while others will become suicidal when faced with apparently minor setbacks. There may be genetic influences on the presence of this vulnerability as higher concordance rates for suicide in identical twins than in dizygotic twins have been found (Stratham et al, 1998). However, irrespective of whether it is biologically or developmentally determined, this