THE SUICIDAL PROCESS
Kevin M. Malone and Maeve Moran
Suicidal behaviour is a serious public-health concern, and associated with increased morbidity and mortality. Suicide is one of the main causes of death among young people, especially young men. There is a consensus that approximately 90 per cent of individuals who commit suicide have a psychiatric illness. However, because suicide is a relatively rare event and the majority of individuals with psychiatric illness will not die as a result of suicide, a psychiatric diagnosis has high sensitivity but low specificity. According to current knowledge the best clinical predictor of completed suicide is a history of previous attempts, but such a history is present in only 20–40 per cent of suicides.
This chapter will outline how psychopharmacological approaches may be useful in the management of the suicidal process. Preceding a discussion of the psychopharmacotherapeutic opportunities provided by the process approach to suicidal behaviour, recent findings regarding its psychobiological underpinnings will be reviewed. Thus the focus will be particularly on trait-dependent characteristics, which define an underlying vulnerability, and less on stressor-related statelike conditions. Based on these findings a model of suicidal behaviour