Relationship Between Environmental Stressors, Mental Disorders and Suicide Risk

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.

References

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