Suicide and Suicidal Behavior

By Gvion, Yari; Apter, Alan | Public Health Reviews; Rennes, July 1, 2012 | Go to article overview

Suicide and Suicidal Behavior


Gvion, Yari, Apter, Alan, Public Health Reviews; Rennes


INTRODUCTION

Suicidal behavior is a major public health priority. As it has for decades, suicide remains one of the leading causes of death in the western world. The costs of suicide are not only loss of life, but the mental, physical and emotional stress imposed on family members and friends. Other costs are to the public resources, as people who attempt suicide often require help from health care and psychiatric institutes.

Suicide is a final act of behavior that is probably the end result of interactions of several different factors. It is a complex entity, involving biological, genetic and environmental risk factors. Sociopolitical factors are also pertinent to the understanding of suicide. Thus Durkheim1 in his historical treatise on suicide coined the terms anomy, egoistic and altruistic. These ideas are still inferential today. Predictors of suicidal behavior and risk factors include a history of previous suicide attempts, certain demographic variables, clinical symptoms and issues related to medical and social support.2-4

The aim of this paper is to review the literature and the latest developments on the research and knowledge of suicidal behavior and death from suicide. In order to systematically review the literature on the subject, the literature databases Pubmed, PsychLit and ProQuest were searched using the keywords: suicide, psychopathology, mental pain, impulsivity, aggression and communication difficulties References were identified and grouped so as to delineate the major contributions surrounding the issue.

DEFINITIONS: SUICIDE AND SUICIDAL BEHAVIOR

Suicide is defined as an act of intentionally terminating one's own life.5,6 However, this definition does not do justice to the complexity of the concept and the numerous usages of terms across studies. Thus the nomenclature for suicidal ideation and behavior has been the subject of considerable international attention and debate.7-11 The nomenclature of suicide behaviors without fatal outcome varies as well. Sometimes they are referred to as "suicidality" while others term these as "suicide-related behaviors" or "suicidal behavior".11,12 A suicide attempt should possess the following characteristics: (a) self-initiated, potentially injurious behavior; (b) presence of intent to die; and (c) nonfatal outcome.13

Other related behaviors and definitions relevant to this review include deliberate self-harm (DSH), non-suicidal self injury (NSSI), suicidal threats and suicidal gestures.13 There is also some value in separating out near-lethal or medically serious suicide attempt (MSSA) from the non-medically serious suicide attempt (NMSSA).14

EPIDEMIOLOGY

The World Health Organization (WHO) estimates that almost one million people die by suicide each year worldwide, representing an annual global suicide mortality rate of 16 per 100,000.15 In the United States alone suicide claims over 32,500 lives annually.16,17 Besides the increasing number of deaths by suicide, suicide attempts are even more prevalent. It is estimated that they are twenty-fold more frequent in the general population.18,19 Suicide attempts are associated with significant morbidities and constitute a major predictor of later suicide.15,20

However, incidence of suicide is under-reported in the world due to a number of reasons: In some instances, and for different reasons, (for example religious and/or social reasons) suicide as the cause for death might be hidden; in some areas it is completely unreported.21 In many countries around the world, particularly those that are less developed,22 basic data on the prevalence and risk factors for suicide and its immediate precursors-suicidal ideation, plans and attempts-are unavailable. Therefore real figures may be higher than reported23 (see also24-26). Nevertheless, from reported cases, certain trends are apparent. According to WHO estimates for the year 2020 and based on current trends, approximately 1. …

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