Suicide is preventable and never inevitable. Regardless of this, greater than 720,000 folks die by suicide yearly, and there are a lot of extra individuals who will make a suicide try of their lifetime (World Well being Organisation, 2024). It’s nicely established that suicide entails a posh and dynamic interplay of organic, psychological, environmental, and socio-cultural elements (O’Connor, 2011). Nonetheless, a wealth of proof has demonstrated the sturdy affiliation between psychiatric problems, together with main depressive dysfunction, character problems and psychotic problems, and elevated danger of suicide amongst completely different populations (Baldessarini & Tondo, 2020; Bradvik, 2018).
Notably, mainstream suicidology, psychiatric and medical disciplines have usually theorised demise by suicide to be the tip results of psychiatric problems, or psychological sicknesses (Hjelmeland & Jaworski, 2019; White, 2017). Nevertheless, as Marsh (2016) asserts, these claims have usually been framed as ‘unassailable truths’ which have dominated views on suicide, and due to this fact additionally suicide prevention efforts. Critically although, it has been argued that the complexity and socio-cultural formation of suicidality can’t be understood, or responded to, inside this angle (White, 2017). As such, you will need to emphasise that a person who has skilled suicidal misery, or survived a suicide try, might not have additionally skilled psychiatric problems or psychological sickness. This reality reminds us that discourses of danger, relatively than an individual’s particular person lived experiences or wants, have usually framed our understanding of suicidal misery, thus limiting our responses to suicide prevention.
Within the present research, Oquendo and colleagues (2024) aimed to deal with the dearth of accessible proof on lifetime suicide makes an attempt amongst in any other case wholesome people, who had not met the standards for any psychiatric problems previous to their first try.
Is suicide merely the ‘finish consequence’ of psychological sickness or can it happen exterior of psychological sickness?
Strategies
The researchers performed secondary evaluation of current cross-sectional knowledge utilizing the US Nationwide Epidemiological Examine of Addictions and Associated Circumstances III (NESARC-III), a nationally consultant population-based survey from 2012-2013. The general pattern was comprised of 36,309 individuals who have been aged between 20 and 65 years previous. Amongst those that had skilled a lifetime suicide try, the goal was to estimate the proportion of individuals whose first suicide try occurred earlier than the onset of any psychiatric dysfunction. Knowledge evaluation was performed utilizing SAS, and the primary outcomes and measures have been:
- Demographics together with age group, intercourse, race and ethnicity
- Lifetime suicide try frequencies amongst general pattern (n=36,309)
- Among the many sub-sample (n=1948), who have been people who had skilled a lifetime suicide try, the self-reported presence or absence of a psychiatric dysfunction earlier than the primary lifetime suicide try
- Amongst sub-sample, separate analyses for intercourse variations (male/feminine), and age variations have been additionally performed (20-34, 35-49, and 50-65 years)
Outcomes
From the general pattern of 36,309 individuals, 1948 people had skilled a number of suicide makes an attempt of their lifetime (5.2%; 95% CI, 4.8% to five.6%). From this sub-sample, 66.8% (95% CI, 64.1% to 69.4%) have been feminine, and 33.3% (95% CI, 30.6% to 35.9%) have been male. The overwhelming majority of those individuals have been White (70.9%), and the others have been Hispanic (14%), Black (9.8%), American Indian or Alaska Native (3.5%), and Asian, Native Hawaiian or Different Pacific Islander (1.8%).
Members with none psychiatric analysis
The research reported that 6.2% (95% CI, 4.9% to 7.4%) of individuals who had made a suicide try of their lifetime didn’t meet the standards for a lifetime psychiatric dysfunction on the time of the survey administration. Moreover, an estimated 13.4% (95% CI, 11.6% to fifteen.2%) of people had reported that their first suicide try occurred earlier than any psychiatric dysfunction onset. Due to this fact, an estimated whole of 19.6% respondents within the sub-sample had skilled a suicide try of their lifetime with out an antecedent psychiatric dysfunction.
Intercourse variations
Notably, there have been no vital intercourse variations within the proportion of people with lifetime suicide makes an attempt who didn’t have a psychiatric dysfunction, nor in these reporting a lifetime suicide try earlier than the onset of any psychiatric dysfunction. Nevertheless, females (n=195) have been extra more likely to have made a suicide try throughout the identical yr because the onset of their first psychiatric dysfunction (14.9%; 95% CI, 12.5% to 17.3%) than males. Furthermore, males (n=410) have been extra more likely to have made a suicide try after the onset of a psychiatric dysfunction (70%; 95% CI, 65.2% to 74.9%) in comparison with females (60.3%; 95% CI, 56.9% to 63.7%).
Age variations
There have been no vital variations throughout the three age teams in relation to the probability of reporting a lifetime suicide try with out a psychiatric dysfunction, nor have been there any vital variations within the onset of suicide makes an attempt throughout the lifespan relative to the onset of psychiatric diagnoses between the three specified age teams.
This analysis means that not all individuals who have made a suicide try of their lifetime have skilled psychiatric problems, or psychological sickness.
Conclusions
The authors conclude that:
These knowledge counsel that suicide risk-reduction methods attending solely to people with psychiatric problems, even when these methods have been to end in good detection and prevention, would miss about 20% of people that go on to aim suicide.
Focussing suicide prevention efforts solely on those that have beforehand skilled a psychiatric dysfunction would miss round 20% of people that go on to aim suicide.
Strengths and limitations
This cross-sectional research gives us with essential and novel findings which reveal that not all individuals who make a suicide try of their lifetime may have skilled psychiatric problems, or psychological sickness, previous to their suicide try (19.6%). Though the research analysed knowledge from a considerable general pattern of 36,309 people, the sub-sample of those that had made a suicide try of their lifetime (n=1948) was comparatively small for a cross-sectional research of this nature. Moreover, cross-sectional research have inherent limitations in relation to establishing trigger and impact, susceptibility of bias, and self-reporting bias the place individuals might misreport info. Furthermore, because the creator acknowledges, the NESARC-III survey doesn’t embody all diagnoses equivalent to autism spectrum, obsessive-compulsive, and intermittent explosive problems that are related to elevated probability of suicide makes an attempt throughout ones’ lifetime (Hirvikoski et al., 2019; Pellegrini et al., 2020).
Given their findings, the authors go a way in direction of suggesting that suicidal behaviour might not essentially be pathological. Nevertheless, additionally they assert that suicide makes an attempt might “manifest like different psychiatric problems, which are sometimes comorbid with one another” (p.576). Moreover, they advocate that suicidal behaviour be recorded as a separate psychiatric dysfunction, which might result in a uniform definition and a diagnostic code which might be helpful for clinicians. Though this suggestion has optimistic implications for suicide danger screening, and thus suicide prevention, different students have challenged the notion that suicidal behaviour is inevitably pathological, and that it needs to be categorized as a psychiatric dysfunction (Hjelmeland & Jaworski, 2019; Marsh, 2016; White, 2017).
Whereas the massive general pattern dimension strengthens the findings, limitations embody a small sub-sample of suicide attempters, self-reporting bias, and excluded diagnoses, elevating essential questions on how we outline and handle suicidal habits
Implications for observe
The findings of this cross-sectional research have vital implications for medical observe, policymakers, future analysis, and suicide prevention insurance policies or methods. Oquendo and colleagues counsel {that a} historical past of suicidal behaviour or suicide makes an attempt needs to be recorded by clinicians, no matter whether or not a person has a psychiatric analysis or not. That is notably essential since a earlier historical past of suicidal behaviour has been proven to be related to an elevated probability of future makes an attempt, and demise by suicide. The authors additionally counsel that recording suicidal behaviour as a separate psychiatric dysfunction might result in a extra uniform definition and diagnostic code, which can show helpful for suicide prevention.
The present suicide danger discount methods usually are not detecting an estimated one-fifth of people who’ve skilled a suicide try of their lifetime. Consequently, suicide danger screening needs to be expanded past psychiatric populations and people who have a pre-existing psychological sickness analysis. Clinicians and psychological well being professionals needs to be conscious that suicidal behaviour might manifest individually, or as comorbidities related to psychiatric problems or psychological sickness and may due to this fact receive and file the historical past of a person’s experiences with suicidal behaviour, no matter whether or not the individual has a pre-existing psychiatric dysfunction or not.
Well being and social care insurance policies ought to take into account implementing broader screening protocols for suicide danger amongst completely different populations. It might be helpful for screening to happen at hospitals, physician surgical procedures, behavioural well being organisations, and different healthcare settings. Well being and social care insurance policies ought to take into account implementing broader screening protocols for suicide danger amongst completely different populations. It might be helpful for screening to happen at hospitals, physician surgical procedures, behavioural well being organisations, and different healthcare settings.
There stays restricted analysis on suicide danger amongst populations that would not have a pre-existing psychiatric dysfunction or psychological sickness. Future analysis may discover the complicated elements which can be related to elevated probability of suicide try amongst this inhabitants, utilizing nationwide healthcare knowledge. Utilizing nationwide healthcare knowledge might enhance affected person security, enhance care and due to this fact scale back suicide danger.
This analysis means that it might be useful to display everybody for earlier experiences of suicide, not simply these with current psychiatric diagnoses.
Assertion of pursuits
The creator has no competing pursuits to declare.
Hyperlinks
Major paper
Oquendo MA, Wall M, Wang S, Olfson M, Blanco C. Lifetime Suicide Attempts in Otherwise Psychiatrically Healthy Individuals. JAMA Psychiatry. 2024;81(6):572–578. doi:10.1001/jamapsychiatry.2023.5672
Different references
Baldessarini, R. J., & Tondo, L. (2020). Suicidal risks in 12 DSM-5 psychiatric disorders. Journal of affective problems, 271, 66-73.
Brådvikm, L. (2018). Suicide risk and mental disorders. Worldwide journal of environmental analysis and public well being, 15(9), 2018.
Hirvikoski, T., Boman, M., Chen, Q., D’Onofrio, B. M., Mittendorfer-Rutz, E., Lichtenstein, P., … & Larsson, H. (2020). Individual risk and familial liability for suicide attempt and suicide in autism: a population-based study. Psychological medication, 50(9), 1463-1474.
Hjelmeland, H., Jaworski, Okay., Knizek, B., & Marsh, I. (2019). Problematic advice from suicide prevention experts. Moral Human Psychology and Psychiatry, 20(2), 79-85.
Marsh, I. (2016). Critiquing Modern Suicidology. In J. White, I. Marsh, M. Kral, & J. Morris (Eds.), Critical Suicidology—Transforming suicide research and prevention for the 21st century (pp. 15–30). UBC Press.
Probert-Lindström, S., Bötschi, S., & Gysin-Maillart, A. (2024). The influence of treatment latency on suicide-specific treatment outcomes. Archives of suicide analysis, 28(3), 1009-1021.
Pellegrini, L., Maietti, E., Rucci, P., Casadei, G., Maina, G., Fineberg, N. A., & Albert, U. (2020). Suicide attempts and suicidal ideation in patients with obsessive-compulsive disorder: A systematic review and meta-analysis. Journal of affective problems, 276, 1001-1021.
White, J. (2017). What can critical suicidology do? Loss of life Research, 41(8), 472–480. https://doi.org/10.1080/07481187.2017.1332901.
World Well being Organisation. (2024). Suicide. https://www.who.int/news-room/fact-sheets/detail/suicide.
