Suicide attempts are a primary reason for child psychiatric emergencies and child psychiatric hospitalizations. The great majority of suicide attempts and completed suicides, about 85 to 95 percent, occur in the context of diagnosable psychiatric disorders, most of which are treatable. Therefore, suicide attempts are a marker for a variety of psychiatric problems and coping difficulties. They provide us with many important clues about which kids are distressed and are a continuing risk for both further suicidal behavior and other types of high-risk behaviors.
It's important to note that actually making a suicide attempt changes a person's behavioral reactivity and vulnerability to future situations and experiences. Some preliminary research data suggests that if you look at suicide attempts over time, there are successively shorter periods between repeat suicide attempts. This suggests a type of desensitization process, such that the threshold for making repeat suicide attempts is lowered once you actually cross that behavioral threshold. Once you've actually taken that step and you've attempted suicide, it's in your behavioral repertoire, and you've experienced the consequences of making a suicide attempt.
It is commonly reported that one consequence of a suicide attempt is to experience some kind of cathartic effect, such as a diminution of anger, depression, or just general distress. That can serve as a rein-forcer and increase the likelihood of a repeat attempt.
If one of the problems that was present prior to making a suicide attempt begins to resolve after the attempt, that's a form of positive reinforcement that increases the likelihood of a repeat attempt when these problems, or cues, occur again. These cues could be internal, such as state of hopelessness, or external, such as a breakup in a relationship.
This fact portends the need for developing relapse prevention interventions, because the probability of predicting repeat suicidal behavior is easier to predict than first-time suicidal behavior.
Different risk factors are correlated with different kinds of developmental paths. There are multiple pathways that get you to the psychological state where suicide is seen as the only way out, so suicidality is a common endpoint of numerous trajectories. The psychological state that's associated with this outcome is one in which the person is experiencing such intensive emotional pain that they can't think about anything except the pain, and can't conceive of any way of solving their problems other than by suicide.
Suicidality is often associated with a variety of other behaviors. In our longitudinal study, we looked at adolescents who had diabetes and found that 15 of 27 who had serious noncompliance with medical regimen issues reported having suicidal ideation at some point. For those who never had serious noncompliance issues, only nine of 64 reported having suicidal ideation. This suggests a very strong relationship with how well they were managing their diabetes.
Nonsuicidal self-harm is another behavior that is associated with suicide attempts. The Great Smoky Mountain Study found that the probability of having a suicide attempt if you've also had nonsuicidal self-harm within the last three months is about 3 percent, whereas the probability of making a suicide attempt if you haven't had nonsuicidal self-harm in the last three months is about .002 percent. …