Slowly but surely, psychiatric scientists are unmasking the factors that
heighten people's risk of committing suicide, experts on the subject indicated
at the annual meeting of the Canadian Psychiatric Association in St. John's,
Newfoundland, in August.
James Bolton, M.D.: "Comorbidity is very important in suicide
Credit: Joan Arehart-Treichel
Some of the variables are childhood adversity, medical illnesses,
impulsivity, aggression, and certain personality disorders, James Bolton,
M.D., an assistant professor of psychiatry at the University of Manitoba,
Studies have shown that physicians are at a somewhat higher risk of suicide
than is the general population, Michael Myers, M.D., a professor of clinical
psychiatry at the State University of New York Downstate Medical Center and an
authority on physicians' psychiatric problems, said. However, physicians who
are perfectionists, narcissists, or rugged individualists are at even greater
risk of committing suicide, he explained.
Bolton and his colleagues used data from the U.S. National Epidemiologic
Survey on Alcohol and Related Conditions to identify risk factors for suicide
in people with major depression. Out of some 35,000 persons who took part in
the survey, some 6,000 had a major depression, and out of this sample, 169
subsequently made a suicide attempt. Bolton and his team then looked to see
which characteristics besides depression might have predicted suicide
attempts. The answer was posttraumatic stress disorder or borderline
personality disorder. "So comorbidity is very important in suicide
attempts," Bolton asserted.
Myers concurred. If physicians who are perfectionistic or narcissistic are
also depressed, they can be in especially grave danger of suicide, he noted.
The same is the case for physicians who are depressed and abuse substances, he
Martine Flament, M.D., Ph.D., of the University of Ottawa reported that she
and her colleagues had conducted a study of 49 child or adolescent suicide
attempters in a pediatric emergency room and compared them with age- and
gender-matched control subjects. Their findings showed that both the trait of
impulsivity and the presence of depression were highly prevalent in children
and youth attempting suicide.
Not getting help, especially the right kind of help, can also predispose
people to suicide. Alain Lesage, M.D., of the University of Montreal and
colleagues interviewed the families of 102 people who had killed themselves to
find out whether the latter had sought professional help or not. More than
half had visited a mental health specialist during the year preceding their
deaths. But only 5 percent had had any contact with addiction services, even
though two-thirds suffered from substance abuse as well as depression. So
there is a need for "greater coordination and integration of mental
health specialists and addiction services within the health care
system," Lesage urged.
And just as psychiatrists are unmasking the many variables that increase
people's risk of suicide, they are also starting to identify the ingredients
that shield people from it, speakers at the meeting indicated.
For example, most people who think about suicide do not actually attempt
it, Bolton noted. The situation is similar for suicide attempts, Jennifer
Brasch, M.D., pointed out—most people who attempt suicide actually do
not end up killing themselves. Brasch is medical director of the psychiatric
emergency service at St. Joseph's Healthcare in Hamilton, Ontario.
So what is it that keeps people from moving beyond suicidal ideation to
suicide attempts, or from suicide attempts to completed suicide?
"We don't really understand how the shift takes place," Brasch
admitted. So she is trying to find the answers, and in a novel way.
The way is a Web site that she launched a year
It invites people who have recovered from being suicidal to post their
stories. To date, some 7,300 people from 89 countries have visited the site,
and 57 have recorded their suicide recovery stories. The stories are starting
to give Brasch insights into some of the ingredients that help people recover
from suicidality, she said—for instance, knowing that a therapist was
there for them during their anguish. In fact, connection with other people has
been a major lifeline in every story she has received so far, she said.▪