Relationship Between Environmental Stressors, Mental Disorders and Suicide Risk
One
of the major challenges of suicide research is determining how mental
disorders and environmental stressors interact to create a pathway to
suicide. Recent research on bullying has provided important new insights
into the links between environmental stressors, mental disorders and
suicide risk.
Much of the current discourse on bullying and
suicide posits a direct causal link between the two. Challenging this
assumption, an important recent study that followed high school students
for several years after graduation found that exposure to bullying had
relatively few long term negative outcomes for the majority of youth.
The only subgroup that showed suicidal ideation and behavior in
post-high school follow-up was youth who had symptoms of depression at
the time they were bullied. Bullied youth who did not have co-existing
depression had significantly lower risk for later mental health problems
(Klomek, et al., 2011).
Another recent long term study links
exposure to prolonged bullying to the development of serious mental
disorders in later life. This research, which followed a large sample of
youth and their caregivers from childhood to early adulthood, found
that those who were bullied through childhood and adolescence had high
rates of depression and anxiety disorders in early adulthood. Those with
histories of being both victims and bullies had the most adverse
outcomes as young adults, with even higher rates of mood and anxiety
disorders. In addition, nearly 25% of this group reported suicidal
ideation or behavior as an adult. Those who were bullies but not victims
showed low levels of depression or anxiety and markedly elevated rates
of antisocial personality disorder (Copeland, et al., 2013).
It is
important to note that existing research on bullying has looked at the
outcome of attempted rather than completed suicide. However, the finding
that bullying is most likely to precipitate suicidal thinking and
suicide attempts in youth who are already depressed, or who have
prolonged involvement as both victims and bullies, points to the role of
individual vulnerability in determining the impact of environmental
stressors.
Suicide Contagion
That imitative
behavior (“contagion”) plays a role in suicide has long been observed.
Recent studies have concluded that media coverage of suicide is
connected to the increase—or decrease—in subsequent suicides,
particularly among adolescents (Sisask & Värnik, 2012). High volume,
prominent, repetitive coverage that glorifies, sensationalizes or
romanticizes suicide has been found to be associated with an increase in
suicides (Bohanna and Wang, 2012). There is also evidence that when
coverage includes detailed description of specific means used, the use
of that method may increase in the population as a whole (Yip, et al.,
2012).
In recent years, the internet has become a particular
concern because of its reach and potential to communicate information
about notorious suicides and those that occur among celebrities.
However, when media follows appropriate
reporting recommendations, studies show that the risk of
suicide contagion can be decreased (Bohanna and Wang, 2012).
Access to Lethal Methods of Suicide
There
is strong evidence that the availability and use of different methods
of suicide impacts suicide rates among different groups in the
population and different geographical areas of the world. In the U.S.,
the most common method of suicide is firearms, used in 51% of all
suicides. Currently, firearms are involved in 56% of male suicides and
30% of female suicides. Among U.S. women, the most common suicide method
involves poisonous substances, especially overdoses of medications.
Poisoning accounts for 37% of female suicides, compared to only 12% of
male suicides. Hanging or other means of suffocation are used in about
25% of both male and female suicides. The difference in death rates
among the most common suicide methods estimated at 80–90% for firearms
and 1.5–4% for overdoses—helps to account for the roughly 4: 1 ratio of
male-to-female suicides (Yip, et al., 2012). The greater availability of
firearms in rural parts of the country also contributes to higher
suicide rates in the more rural Western states.
Studies have shown
that many suicide attempts are unplanned and occur during an acute
period of ambivalence (Bohanna & Wang, 2012). Therefore,
restricting access to lethal methods is a key suicide prevention strategy.
Biological Factors
Postmortem
studies of the brains of people who have died by suicide have shown a
number of visible differences in the brains of people who died by
suicide, compare to those who died from other causes, suicide is a
result of a disease of the brain (Mann & Currier, 2012). The brain
systems that have been most frequently studied as factors in suicide are
the serotonergic system, adrenergic system and the
Hypothalamic-Pituitary Axis (HPA), which relate to mood, thinking and
stress response, respectively. This research has also identified
neurobiological impairments related to depression and other underlying
mental disorders, as well as to acute or prolonged stressors. One of the
key challenges of neurobiological studies is determining the
abnormalities in genes, brain structures or brain function that
differentiate depressed people who died by suicide from depressed people
who died by other causes.
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