1. Suicidal Behavior 2002 31,655 suicide deaths in the US – 10.99 per 100,000 Persons who attempt suicide are 38 to 40 times as likely to commit suicide as are persons without previous attempts NCS-R (2001-2003) – 3.3% of US residents 18-54 years had seriously thought about killing themselves in the past 12 months – Of this group, 28.6% made a plan – 32.8% of those who made a plan carried out a serious attempt – More than 80% of those who reported suicide related behavior met criteria for DSM-IV mental disorder

2. Psychiatric Correlates of Suicide Mood Disorders, borderline personality disorder, disruptive behavior disorders, alcohol and rug use disorders, anxiety disorders (less consistent but some data on panic disorder), anorexia nervosa, schizophrenia The lifetime risk for suicide in depressed patients is estimated at 2.2% Patients with depressive disorders have a suicide risk of 60-70%

3. Psychiatric Factors Associated with Suicide contd. Hopelessness is significant in the etiology and maintenance of depression and is a significant predictor of suicide Hopelessness is defined as a system of cognitive schemas whose common denominator is negative expectations about the future Hopelessness is one of the best predictors of suicide completions in clinical populations

4. Psychiatric Factors Associated with Suicide contd. Hopelessness is often related to interpersonal factors can be related to ‘feeling like a burden on others’ or perceived burdensomeness. Social isolation (a state where interpersonal contacts and relationships are disrupted or nonexistant) has been consistently related to suicidal behavior In contrast having a social network may be protective

5. Psychiatric Factors Associated with Suicide contd. Impulsivity and aggression are also correlates of suicidal behavior (externalizing) Histories of suicide attempts are significant risk factors for repeated attempts and completions – These attempts may serve as opportunities to gain competency with self-harm and diminish fear related to pain and death

6. Additional Psychiatric Factors Ineffectiveness is a cognitive perception that is associated with suicidal behavior Ineffectiveness may be associate with psychosocial stressors: unemployment, low income, physical illness, less education, less opportunity Ineffectiveness paired with perceived burden may accentuate risk

7. Diathesis/Personality/Stress: Suicidal Behavior Diathesis MZ twins at increased risk compared with DZ (30 – 50%) Family history of suicide increases risk by twofold; gender may interact w/ family history Six fold increase in children of parents who attempt Serotonin transporter gene, some links Lower 5-HIAA in CSF Psychiatric DX, MDD Personality  Impulsive aggression  Emotional dysregulation  Anger  Recklessness/sensati on seeking?  Hopelessness  Poor problem solving Stressor Child physical abuse; child sexual abuse Social isolation Unemployment Poverty Physical Illness Perceived burdensomeness

8. Diathesis/Personality/Stress: Bipolar Depression Diathesis Females more at risk than males Family history of bipolar disorders or unipolar disorders  Monoamine Dysreg  Overactive Norepinephrine  Excess in Dopamine Personality  Hyperactive  Impulsive  Sensation Seeking Stressor