Clinical-Psychological and Socio-Demographic Factors of Suicidal Behavior and the Risk of its Chronicity: a Review of Studies

513

Abstract

Relevance. The article presents an overview of studies on clinical, psychological and socio–demographic factors of suicidal behavior and the risk of its chronicity. According to the WHO, 800,000 people die each year by suicide, and many others seek help from medical centers after a suicide attempt. Suicide and suicide attempts are a medical, social and psychological problem. Purpose of the study. Evaluation of the role of various factors in the chronification of suicidal behavior and an increase in its risk. Results. According to numerous studies, most often repeated suicide attempts are made by people with borderline personality disorder and other personality disorders, often in combination with depressive and anxiety symptoms. The motives for suicide in this group of patients may be emotional regulation, coping with dissociation, stress, and more often do not contain the desire to die. This group of patients tend to self-cut in the limbs or attempt self-poisoning. A distinctive feature of suicide attempts in individuals with schizophrenia, severe depression and bipolar disorder is the intention to die, combined with more severe methods of self-harm, in contrast to patients with personality disorders. The risk of chronification of suicidal behavior is higher in people of working age who have experience in the use of psychoactive substances, low social status and wealth, and the unemployed. This group of patients needs to be provided with medical, psycho-social assistance, since without treatment and psychological support, the risk of chronification of suicidal behavior, an increase in symptoms of depression and the completion of suicide increases. Conclusions. Chronic suicidal behavior requires active interdisciplinary team work with patients based on a biopsychosocial model already at the stage of the first hospital admission after a suicide attempt. It is important to take into account the specifics and characteristics of suicidal behavior, work styles may differ depending on the diagnoses, age and motives of suicidal behavior.

General Information

Keywords: suicidal behavior, repeated suicide attempts, chronic suicidal behavior, borderline personality disorder, clinical and psychological factors, sociodemographic factors

Journal rubric: Research Reviews

Article type: scientific article

DOI: https://doi.org/10.17759/cpp.2023310101

Received: 10.11.2022

Accepted:

For citation: Subotich M.I. Clinical-Psychological and Socio-Demographic Factors of Suicidal Behavior and the Risk of its Chronicity: a Review of Studies. Konsul'tativnaya psikhologiya i psikhoterapiya = Counseling Psychology and Psychotherapy, 2023. Vol. 31, no. 1, pp. 9–30. DOI: 10.17759/cpp.2023310101. (In Russ., аbstr. in Engl.)

References

1. Zinchuk M.S., Avedisova A.S., Zhabin M.O., Gekht A.B. Suitsidal'noi v pozdnem vozraste: sotsiokul'tiurnye i klinicheskie faktory riska. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2018. № 118(7). pp. 104—111.

2. Kanevskii V.I., Rozanov V.A. Nekotorye psikhologicheskie faktory povtornykh suitsidal'nykh popytok. Suitsidologiya. 2019. № 10 (2). pp. 12—22. DOI:10.32878/suiciderus.19-10-02(35)-12-22

3. Loulor K.E., Gudson D.T., Kheffel' Dzh.Dzh. Kognitivno-povedencheskaya terapiya depressii: rukovodstvo. Klinicheskaya i spetsial'naya psikhologiya. 2022. Tom 11. № 2. pp. 97–107. DOI: 10.17759/cpse.2022110206

4. Lyubov E.B., Zotov P.B, Nosova E.S. Nauchnaya dokazatel'nost' i ekonomicheskoe obosnovanie preduprezhdeniya suitsidov. Suitsidologiya. 2019. № 2 (35). pp. 23—31. DOI:10.32878/suiciderus.19-10-02(35)-23-31

5. Rychkova O.V. Issledovaniya sotsial'nogo poznaniya pri shizofrenii. Konsul’tativnaya psikhologiya i psikhoterapiya. 2013. Tom 21. № 1. pp. 63–89.

6. Semke V.Ya. Istericheskie sostoyaniya: Uchebnik. M.: Meditsina, 1988. 224 p.

7. Solov’ev A.G., Popov V.V., Novikova I.A. Rannyaya diagnostika i profilaktika psikhicheskikh rasstroistv v pozhilom vozraste: Uchebno-metodicheskoe posobie. Arkhangel'sk: Severnyi gosudarstvennyi meditsinskii universitet, 2016. 160 p.

8. Kholmogorova A.B. Suitsidal'noe povedenie: teoreticheskaya model' i praktika pomoshchi v kognitivno-bikhevioral'noi terapii. Konsul'tativnaya psikhologiya i psikhoterapiya. 2016. Tom 24. № 3. pp. 144–163. DOI:10.17759/cpp.2016240309

9. Chernaya M.I., Kholmogorova A.B., Zubareva O.V., Zhuravleva T.V. Klinicheskie i sotsial'no-psikhologicheskie kharakteristiki patsientov s suitsidal'nymi popytkami. Konsul’tativnaya psikhologiya i psikhoterapiya. 2016. Tom 24. № 3. pp. 69–88. DOI:10.17759/cpp.2016240305

10. The health impact of suicide and self-inflicted injuries in Australia (2019) [Elektronnyi resurs]. Australian Institute of Health and Welfare. 2021. URL: https://www.aihw.gov.au/reports/burden-of-disease/health-impact-suicide-self-inflicted-injuries-2019/contents/about (data obrashcheniya: 21.02.2023).

11. Al-Humairi A.K., Kadhem Q.I., Abdullah S.J., Hussain A.MA. Socio-demographic features and trends of suicide mortality in Babylon province, Irak. AVFT-Archivos Venezolanos de Farmacología y Terapéutica. 2020. Vol.39 (5). pp. 598-603. DOI: 10.5281/zenodo.4264923

12. Berkelmans G., van der Mei R., Bhula, S. Gilissen R. Identifying socio-demographic risk factors for suicide using data on an individual level. BMC Public Health. 2021. Vol. 21 (1). pp. 1—8. DOI:10.1186/s12889-021-11743-3

13. Bertolote J.M., Fleischmann A., De Leo D. et al. Repetition of suicide attempts: data from emergency care settings in five culturally different low- and middle-income countries participating in the WHO SUPRE-MISS Study. Crisis. 2010. Vol. 31 (4). pp. 194—201. DOI: 10.1027/0027-5910/a000052

14. Birchall E., Perry I.J, Corcoran P. et al. The impact of guidance on the supply of codeine-containing products on their use in intentional drug overdose. Eur J Public Health. 2021. Vol. 31. pp. 853—858. DOI: 10.1093/eurpub/ckab082

15. Buelens T., Costantini G., Luyckx K., Claes L. Comorbidity Between Non-suicidal Self-Injury Disorder and Borderline Personality Disorder in Adolescents: A Graphical Network Approach. Front Psychiatry. 2020. Vol. 11. p. 580922. DOI: 10.3389/fpsyt.2020.580922

16. Buelens T., Luyckx K., Kiekens G., et al. Investigating the DSM-5 criteria for non-suicidal self-injury disorder in a community sample of adolescents. J Affect Disord. 2020. Vol. 260. pp. 314 —322. DOI: 10.1016/j.jad.2019.09.009

17. Cheng Y., Li X., Lou C. et al. The association between social support and mental health among vulnerable adolescents in five cities: findings from the study of the well-being of adolescents in vulnerable environments. J Adolesc Health. 2014. Vol. 55 (6 Suppl). pp. 31—38. DOI: 10.1016/j.jadohealth.2014.08.020

18. Chu J., Lin M., Akutsu P.D. et al. Hidden suicidal ideation or intent among Asian American Pacific Islanders: A cultural phenomenon associated with greater suicide severity. Asian Am J Psychol. 2018. Vol. 9 (4). pp. 262—269. DOI: 10.1037/aap0000134

19. Colle L., Hilviu D., Rossi R. et al. Self-Harming and Sense of Agency in Patients With Borderline Personality Disorder. Front Psychiatry. 2020. Vol. 11. 449 p. DOI: 10.3389/fpsyt.2020.00449

20. Crowell S., Derbidge C., Beauchaine T. Developmental approaches to understanding suicidal and self-injurious behaviors. The Oxford handbook of suicide and self-injury / Ed. M.K. Nock. Oxford University Press, 2014. pp. 183-205. https://doi.org/10.1093/oxfordhb/9780195388565.013.0001

21. Culatto P., Bojanic L., Appleby L., Turnbull P. Suicide by homeless patients in England and Wales: national clinical survey. BJPsych Open. 2021. Vol.7 (2). P.e65. DOI: 10.1192/bjo.2021.2

22. De Hert M., McKenzie K., Peuskens J. Risk factors for suicide in young people suffering from schizophrenia: a long-term follow-up study. Schizophrenia Research. 2001. Vol. 47 (2-3). pp. 127—134. DOI: 10.1016/s0920-9964(00)00003-7

23. Ding O.J., Kennedy G.J. Understanding Vulnerability to Late-Life Suicide. Curr Psychiatry Rep. 2021. Vol. 23 (9). 58 p. DOI: 10.1007/s11920-021-01268-2

24. Docherty A.R., Shabalin A.A., DiBlasi E. et al. Genome-Wide Association Study of Suicide Death and Polygenic Prediction of Clinical Antecedents. Am J Psychiatry. 2020. Vol.177 (10). pp. 917—927. DOI: 10.1176/appi.ajp. 2020.19101025

25. Fehling K.B., Selby E.A. Suicide in DSM-5: Current Evidence for the Proposed Suicide Behavior Disorder and Other Possible Improvements. Front Psychiatry. 2021. Vol. 11. p. 499980. DOI:10.3389/fpsyt.2020.499980

26. Gratz K.L. Risk factors for and functions of deliberate self-harm: An empirical and conceptual review. Clin Psychol: Science Pract. 2003. Vol. 10 (2). pp. 192–205. https://doi.org/10.1093/clipsy.bpg022

27. Harris E.C., Barraclough B. Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatry. 1997. Vol.170. pp. 205—208. DOI: 10.1192/bjp.170.3.205

28. Hawton K. Sex and suicide. Gender differences in suicidal behaviour. Br J Psychiatry. 2000. Vol. 177. pp. 484—485. DOI: 10.1192/bjp.177.6.484

29. Hawton K. Restricting access to methods of suicide: Rationale and evaluation of this approach to suicide prevention. J Crisis Intervent Suicide Prevent. 2007. Vol. 28 (Suppl 1). pp. 4—9. DOI: 10.1027/0227-5910.28.S1.4

30. Hawton K., Bergen H., Cooper J. et al.  Suicide following self-harm: findings from the Multicentre Study of self-harm in England, 2000-2012. J Affect Disord. 2015. Vol.175. pp. 147—151. DOI: 10.1016/j.jad.2014.12.062

31. Henriksson M.M., Aro H.M., Marttunen M.J. et al. Mental disorders and comorbidity in suicide. Am J Psychiatry. 1993. Vol.150 (6). pp. 935—940. DOI: 10.1176/ajp.150.6.935

32. Hepple J., Quinton C. One hundred cases of attempted suicide in the elderly. Br J Psychiatry. 1997. Vol.171. pp. 42— 46. DOI: 10.1192/bjp.171.1.42

33. Kaufman J.A., Livingston M.D., Komro K.A. Unemployment insurance program accessibility and suicide rates in the United States. Prev Med. 2020. Vol.141. p. 106318. DOI: 10.1016/j.ypmed.2020.106318

34. Knipe D., Metcalfe C., Hawton K. et al. Risk of suicide and repeat self-harm after hospital attendance for non-fatal self-harm in Sri Lanka: a cohort study. Lancet Psychiatry. 2019. Vol. 6 (8). pp. 659—666. DOI: 10.1016/S2215-0366(19)30214-7

35. Lesk S., Adam G., Schrader l. et al. Suicide in Queensland: Annual Report [Elektronnyi resurs]. Australian Institute for Suicide Research and Prevention, Griffith University. 2020. URL: https://www.griffith.edu.au/__data/assets/pdf_file/0037/1498870/QSRAnnualReport2021.pdf (data obrashcheniya: 21.02.2023).

36. Liu H. Epidemiologic Characteristics and Trends of Fatal Suicides among the Elderly in Taiwan. Suicide Life-Threat Behav. 2009. Vol. 39 (1). pp. 103—113. DOI: 10.1521/suli.2009.39.1.103

37. Matsuishi K., Kitamura N., Sato M. et al. Change of suicidal ideation induced by suicide attempt. Psychiatry Clin Neurosci. 2005. Vol. 59 (5). pp. 599—604. DOI: 10.1111/j.1440-1819.2005.01421

38. McDaid D., Brendan K. An economic perspective on suicide across the five continents. Oxford Textbook of Suicidology and Suicide Prevention / Eds. D. Wasserman, C. Wasserman. 2022. Vol. 1. pp. 409—420. DOI: 10.1093/med/9780198570059.003.0049

39. Michaud L, Brovelli S, Bourquin C. Le paradoxe du genre dans le suicide : des pistes explicatives et pas mal d’incertitudes. Revue médicale suisse. 2021. Vol. 17 (744-2). pp. 1265—1267. DOI: 10.53738/REVMED.2021.17.7442.1265

40. Miller I.W., Camargo C.A. Jr., Arias S.A. et al. Suicide Prevention in an Emergency Department Population: The ED-SAFE Study. JAMA Psychiatry. 2017. Vol. 74 (6). pp. 563—570. DOI: 10.1001/jamapsychiatry.2017.0678

41. Moitra M., Santomauro D., Degenhardt L. et al. Estimating the risk of suicide associated with mental disorders: A systematic review and meta-regression analysis. J Psychiatr Res. 2021. Vol. 137. pp. 242—249. DOI: 10.1016/j.jpsychires.2021.02.053

42. Oexle N., Rüsch N. Stigma – Risikofaktor und Konsequenz suizidalen Verhaltens: Implikationen für die Suizidprävention. Nervenarzt. 2018. Vol. 89 (7). pp. 779—783. DOI: 10.1007/s00115-017-0450-8

43. Olfson M., Wall M., Wang S. et al. Suicide After Deliberate Self-Harm in Adolescents and Young Adults. Pediatrics. 2018. Vol.141 (4). p. e20173517. DOI: 10.1542/peds.2017-3517

44. Otsuka K., Nakamura H., Kudo K. et al. The characteristics of the suicide attempter according to the onset time of the suicidal ideation. Ann Gen Psychiatry. 2015. Vol. 14. 48 p. DOI:10.1186/s12991-015-0087-6

45. Peters E.M., Yates K., DeVylder J. et al. Understanding the inverse relationship between age and psychotic symptoms: The role of borderline personality traits. Acta Psychiatr Scand. 2022. Vol.146. pp. 484—491. DOI: 10.1111/acps.13475

46. Phillips J.A., Hempstead K. Differences in US suicide rates by educational attainment. Am J Prev Med. 2017. Vol. 53 (4). pp. e123—e130. DOI: 10.1016/j.amepre.2017.04.010

47. Platt S., Bille-Brahe U., Kerkho A. et al. Parasuicide in Europe: The WHO/EURO multicentre study on parasuicide. I. Introduction and preliminary analysis for 1989. Acta Psychiatr Scand. 1992. Vol. 85 (2). pp. 97—104. DOI: 10.1111/j.1600-0447.1992.tb01451.x

48. Polewka A. Chrostek-Maj J. Kroch S. Psychosocial aspects of the suicidal attempts of polish females. Arch Psychiatr Psychother. 2001. Vol. 3 (2). pp. 51—60.

49. Qin P., Agerb, E., Westergård-Nielsen N. et al. Gender differences in risk factors for suicide in Denmark. Br J Psychiatry. 2000. Vol. 177 (6). pp. 546—550. DOI: 10.1192/bjp.177.6.546

50. Ramdurg S., Goyal S., Goyal P. et al. Sociodemographic profile, clinical factors, and mode of attempt in suicide attempters in consultation liaison psychiatry in a tertiary care center. Ind Psychiatry J. 2011. Vol. 20 (1). pp. 11—16. DOI: 10.4103/0972-6748.98408

51. Randall J.R., Sareen J., Chateau D., Bolton J.M. Predicting Future Suicide: Clinician Opinion versus a Standardized Assessment Tool. Suicide Life-Threatening Behavior. 2019. Vol. 49 (4). pp. 941—951. DOI: 10.1111/sltb.12481

52. Reynolds P., Eaton P. Multiple attempters of suicide presenting at an emergency department. Can J Psychiatry. 1986. Vol. 31 (4). pp. 328—330. DOI: 10.1177/070674378603100408

53. Runeson B., Haglund A., Lichtenstein P., Tidemalm D. Suicide risk after nonfatal self-harm: a national cohort study, 2000-2008. J Clin Psychiatry. 2016. Vol. 77 (2). pp. 240—246. DOI: 10.4088/JCP.14m09453

54. Saab M.M., Murphy M., Meehan E. et al. Suicide and Self-Harm Risk Assessment: A Systematic Review of Prospective Research. Arch Suicide Res. 2021. Vol.26 (4). pp. 1645-1665. DOI:10.1080/13811118.2021.1938321

55. Stiglmayr C.E., Shapiro D.A., Stieglitz R.D. et al. Experience of aversive tension and dissociation in female patients with borderline personality disorder — a controlled study. J Psychiatr Res. 2001. Vol. 35 (2). pp. 111—118. DOI:10.1016/S0022-3956(01)00012-7

56. Temes C.M., Frankenburg F.R., Fitzmaurice G.M., Zanarini M.C. Deaths by Suicide and Other Causes Among Patients With Borderline Personality Disorder and Personality-Disordered Comparison Subjects Over 24 Years of Prospective Follow-Up. J Clin Psychiatry. 2019. Vol. 80 (1). p. 18m12436. DOI: 10.4088/jcp.18m12436

57. Tidemalm D., Långström N., Lichtenstein P., Runeson B. Risk of suicide after suicide attempt according to coexisting psychiatric disorder: Swedish cohort study with long term follow-up. BMJ. 2008. Vol. 337. p. a2205. DOI: 10.1136/bmj.a2205

58. Urnes O. Selvskading og personlighetsforstyrrelser. Tidsskr Nor Laegeforen. 2009. Vol. 129 (9). P. 872. DOI:10.4045/tidsskr.08.0140

59. Vijayakumar L. Suicide and its prevention: The urgent need in India. Indian J Psychiatry. 2007. Vol. 49 (2). pp. 8—14. DOI: 10.4103/0019-5545.33252

60. Wedig M., Silverman M., Frankenburg F. et al. Predictors of suicide attempts in patients with borderline personality disorder over 16 years of prospective follow-up. Psychological Medicine. 2012. Vol. 42 (11). pp. 2395—2404. DOI:10.1017/S0033291712000517

61. Yıldız M., Orak U., Walker M.H., Solakoglu O. Suicide contagion, gender, and suicide attempts among adolescents. Death Stud. 2019. Vol. 43 (6). pp. 365—371. DOI: 10.1080/07481187.2018.1478914

Information About the Authors

Mariya I. Subotich, Junior Researcher, Department of Crisis Conditions and Psychosomatic Disorders, N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia, ORCID: https://orcid.org/0000-0002-5138-3107, e-mail: psysklif@gmail.com

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