STRESS AND SUICIDAL
Lil Träskman-Bendz and Åsa Westrin
As described in Chapter 1, longitudinal and psychological autopsy studies have provided evidence for a strong association between suicidal behaviour and psychiatric disorders. There are, however, a number of reasons to separate the study of suicidal behaviour from the study of psychiatric disorders.
First, the occurrence of suicidal behaviour is not bound to the borders of classical psychiatric disorders such as depression or schizophrenia, and it is more common in some somatic disorders, such as cancer, or neurological disorders than in others (Stenager and Stenager, 1998). Second, familial transmission of suicidal behaviour occurs independently of psychiatric disorders (Brent et al, 1996). Hence the existence of one or more suicidal syndromes independent of major psychiatric disorders has been proposed (Ahrens and Linden, 1996).
Evidence is accumulating that such a syndrome can be explained, at least partly, in terms of a “stress-vulnerability” model for suicidality and depression (Coccaro and Astill, 1990; Van Praag, 1996; Deakin, 1998). Increasing possibilities to study biological characteristics of psychopathological phenomena including suicidal behaviour have led to the identification of the role of monoamines and of mechanisms within the stress system in this vulnerability (Stratakitis and Chrousos, 1995). In the next chapter Van Praag will provide a detailed example of an interaction between stress and psychological characteristics by