Suicidal Tendencies (Suicidality): Causes

Pathogenesis (development of disease)

Suicidality describes a mental state in which thoughts, fantasies, impulses, and actions are directed toward purposefully bringing about one’s own death. Suicidality is the termination of one’s own life brought about by a person willfully and in awareness of the irreversibility of death. A suicide plan exists when a specific method is formulated by which the individual plans to exit life. Suicide methods are:

• Hanging/suffocation
• Fall into the depths
• Poisoning by drugs
• Throwing oneself in front of train/car
• Poisoning by gases (mostly carbon monoxide).
• Shooting (shot in the head)
• Drowning, poisoning (pesticides, rat poison, household chemicals), slitting wrists, car accident, etc.

Men resort to the so-called “hard” suicide methods of hanging, strangulation or suffocation. Women use “soft” methods such as poisoning with an overdose of drugs, etc….

Etiology (causes)

Biographical causes

• Age – Increasing age/older people (esp. men) without closer contact with family.
• Children of parents with antisocial personality disorder (3-4 times the risk of a suicide attempt) or their own suicide attempts
• Widowed
• Severe life situations
  • Separation situations
  • Loss of close friends, life partners or children
  • Close friends or relatives have committed suicide
  • Loss of job
  • Financial problems etc.
• Sexual minorities – transsexuals
• Traditional male image – impertinence, aggressiveness, high risk taking (2.4 times the risk).
• Person has already attempted suicide
• Professions – physicians, esp. female physicians; farmers; police officers; social workers; artistic professions; sailors
• Socioeconomic factors – unemployment; financial problems, threat of foreclosure; living in poverty.

Behavioral causes

• Consumption of stimulants
  • Alcohol abuse (50% of all cases)
• Drug use
  • Cannabis* (hashish and marijuana)
    • Parental use → increased risk of child suicide attempt.
    • Use by child/adolescent before age 18 increases risk of later depression and suicides
• Psycho-social situation
  • Chronic stress
  • Hopelessness (e.g., symptom of major depressive episode)
  • Loss of self-esteem
  • Overwhelming feelings of guilt

Causes related to illness

• Hypotension; systolic blood pressure:
  • <100 mmHG (12.5% had suicidal ideation; vs. 10.8% with normal blood pressure)
  • <95 mmHG (13.7% had suicidal ideation; vs. 10.8% with normal blood pressure)
  • <90 mmHG (16.6% had suicidal ideation; vs. 10.8% with normal blood pressure)
• Mental illness
  • Depression – particularly high risk on sunny days, which increase drive to act, fatal especially in patients with major depression; frequency peaks in spring, when daytime hours increase
  • Bipolar disorder
  • Attention-deficit/hyperactivity disorder (ADHD) – suicidality in “attention deficit disorder” (with or without hyperactivity).
  • Anxiety disorders
  • Burnout syndrome
  • Panic disorder/panic attack
  • Post-traumatic stress disorder
  • Schizophrenia – belongs to the group of psychoses.
  • Social phobia
• Traumatic brain injury (TBI) (1.9-fold risk).
• Severe eating disorders
  • Anorexia nervosa (anorexia nervosa)
  • Bulimia nervosa (binge eating disorder)
• Severe physical/chronic illness
  • Chronic fatigue syndrome (CMS)
  • Chronic pain – esp. excruciating pain.
  • Commotio cerebri (concussion) – suicide (suicide; three times higher).
  • Heart disease
    • Angina pectoris (“chest tightness”; sudden onset of pain in the heart area): +19% (vs. general population), for myocardial infarction: +28%, cardiomyopathy (heart muscle disease): 41%, for atrial flutter or fibrillation: +42%, heart failure (cardiac insufficiency): 48%, ventricular tachycardia (arrhythmia originating in the ventricles at 100-150 beats/min. ): +53% and condition after cardiac arrest: about 500%.
  • Neurological diseases
    • Adjusted relative incidence rate (IRR):1.8, which was significant with a 95% confidence interval of 1.7 to 1.8.
      • Huntington’s disease (IRR 4.9), amyotrophic lateral sclerosis (IRR 4.9), Guillain-Barré syndrome (IRR 2.2), multiple sclerosis (MS) (IRR 2.2), and neuromuscular disease (IRR 1.9).
    • Epilepsy (seizures) – up to 10-fold higher than general population rates; suicidal intent could be demonstrated in a retrospective cohort study in epilepsy patients before diagnosis: first attempt at suicide 2.9 times higher
    • Post-apoplex (after a stroke).
  • Severe insomnia (sleep disturbance/insb. sleep through).
  • Psoriasis (psoriasis)
• Severe eating disorders
  • Anorexia nervosa (anorexia nervosa)
  • Bulimia nervosa (binge eating disorder)
• Self-injury: self-injurious behavior (SVV) or autoaggressive behavior.
  • Acute suicide risk in the first month after self-injury increased by about 180 times
  • Risk of death due to acute alcohol or drug intoxication 34 times higher than in the control group
• Final-stage tumor disease (final stage, last phase of progressive disease before death) (60% more suicides than normal population): e.g., bronchial carcinoma (lung cancer) (420%)

Medication

• Hormonal contraception (“birth control pills,” etc.)-users versus women who never used hormonal contraceptives during the study period:
  • Suicide attempt 1.97-fold (95 percent confidence interval 1.85-2.10) more frequent.
  • 3.08-fold (1.34-7.08) more often completed suicide.
  • Strongest association two months after starting contraception (birth control)
  • Combined hormonal contraceptives (CHD; combination of estrogens and progestins) relative risk of 1.91 (1.79-2.03)
  • Monopreparations with progestin relative risk of 2.29 (1.77-2.95).
  • Vaginal rings (usually contain a progestin) relative risk of 2.58 (2.06-3.22)
  • Contraceptive patches (progestin product) relative risk of 3.28 (2.08-5.16)
• 5-Alpha reductase inhibitors (finasteride and dutasteride).
• Suicidality in acne patients treated with isotretinoin (2.8%).