Suicide and suicide risk

Introduction

While suicide is not classified as a disease, suicidal behavior (including suicide and attempts) poses a significant public health challenge.
Suicidal behavior has attracted increased research and awareness efforts in the last decade.
Despite a one-third reduction in global suicide rates, deaths from suicide remain prevalent worldwide.
Each suicide death results in substantial emotional repercussions for families and communities.

Suicide: The act of intentionally ending one’s life.
Suicidal behavior: Encompasses all actions related to the intent to end one’s life; this includes both fatal and non-fatal outcomes.
Suicidal Ideation: Refers to thoughts about ending one’s own life, which can be:
- Active: with a specific plan.
- Passive: without a set plan, merely wishing to die.
Suicide Attempts: Defined as deliberate self-injury with inferred or actual intent to die.
- Risk factors include frequency, intent, and content of suicidal ideation (e.g., having a plan, feelings of hopelessness, etc.).
- Non-suicidal self-injury: Self-harm without the intent to die (e.g., self-cutting) is distinct from suicidal behavior in North America, but overlaps with suicidal behavior in Europe.

Suicide risk is influenced by a multifaceted interplay of biological, psychological, clinical, social, and environmental factors.
Risk assessment for suicide is complex and often considers:
- Psychiatric disorders (panic disorder, PTSD, substance use), personality traits, and life circumstances.
- The transition from ideation to attempts can be triggered by co-occurring conditions that increase distress or decrease self-restraint.

The WHO estimates that about 20 people attempt suicide for every suicide death, with variations across countries influenced by method lethality.
Highest incidence of attempts noted in individuals aged 18-34; the lowest rates of completed suicides are in those under 15 years.
Gender disparities: rates of attempted suicide are generally higher in females, yet completed suicides are 2-3 times higher in males, potentially linked to method lethality preferences.

Global incidence shows significant variation, with low rates in Middle Eastern and South American nations versus high rates in Eastern Europe and parts of Asia.
Changes in suicide rates can be influenced by a variety of factors such as economic conditions, access to means, societal norms, and the impact of media reporting on suicides.

Risk of suicide is viewed through a biopsychosocial model involving:
- Distal factors (long-term influences such as genetic predisposition),
- Developmental factors (early-life adversities impacting vulnerability),
- Proximal factors (immediate triggers for suicidal behavior).
Genetic and Biological Factors: Heritability estimates for suicidal behavior range between 17 and 36%. Genetic influences may co-occur with psychological disorders.
Psychological Factors: Impaired problem-solving, hopelessness, impulsivity, and emotional regulation are significant underlying contributors to suicidal ideation.

Risk factors can be categorized into:
- Distal: Genetics and family history.
- Developmental: Experiences like early-life adversity that increase vulnerability.
- Proximal: Immediate triggers such as substance abuse or acute life stresses.

Universal strategies: Population-wide approaches that aim to shift societal risk factors (e.g., media campaigns, reducing access to methods).
Selective strategies: Targeted interventions aimed at groups identified as at higher risk but not yet exhibiting suicidal behavior.
Indicated strategies: Focused treatment for those who demonstrate suicidal ideation or have attempted in the past.

Combination of pharmacological and psychosocial interventions, including CBT and DBT, alongside broader public health initiatives.
Ongoing research into tailored interventions across demographic and social factors is essential.

Individuals with suicidal behaviors experience decreased quality of life, impacting both mental and physical health domains.
The stigma associated with suicide and suicide attempts is a significant barrier to seeking help, necessitating public health campaigns to address these attitudes.

Suicide and attempted suicide carry significant economic costs, highlighting the need for effective prevention strategies.