PSYCHOBIOLOGICAL MODEL OF
THE SUICIDAL PROCESS
Kees van Heeringen
Although suicidal behaviour rarely occurs without a context of psychiatric problems, there are several reasons to separate the study of suicidal behaviour from that of psychiatric disorders. Cross-sectional and longitudinal studies have shown that the occurrence of suicidal behaviour is not limited to the boundaries of classical psychiatric diagnostic categories. Almost all psychiatric disorders are characterized by an increased risk of suicidal behaviour. Hence, the existence of one or more suicidal syndromes has been proposed independently of psychiatric disorders (Ahrens and Linden, 1996). Moreover, familial transmission of suicide occurs independently of the transmission of psychiatric disorders (Brent et al, 1996). There is thus no simple linear causal association between psychiatric problems and suicidal behaviour.
Evidence is accumulating that suicidal behaviour results from the interaction between stressor-induced state-dependent characteristics such as psychiatric problems, and trait-like factors, which may include characteristics related to personality. Based on currently available knowledge a stress-diathesis model can be used to describe this interaction (e.g. see Mann et al, 1999). In this model, the “stress” concept refers to psychiatric, psychological or biological phenomena, which occur