Progression of suicidal ideation to suicidal behavior from a perspective of selected suicidological models

Abstract

In clinical practice suicidal ideation (SI) is one of the most commonly encountered symptoms in patients with mental disorders. Such encounter calls for diligent evaluation of suicidal risk. Although the risk factors are widely known, accurate estimation of suicidal risk remains one of the most difficult and most important tasks that clinicians face - especially considering recently collected data showing increase in suicide prevalence in Poland. More thorough estimation of suicidal risk in patients with SI requires taking under consideration not only suicidal risk factors but also factors that are more specific for progression of SI to suicidal behaviors (SB). The review presented in this paper consists of a range of suicidological theories that allow to select a number of groups of factors and mechanisms that are most specific for progression of SI to SB. These groups include: (1) transgression of fear of causing harm and pain to oneself, as well as disintegration of other protective barriers such as (2) decline of social integration with others, feeling of being alienated or abandoned, decline of sense of belongingness, lack of social support, (3) resignation from family and social obligations, (4) dismissing cultural or religious norms, (5) rejection of life goals, values and aspirations that were appreciated earlier, (6) narrowing down in perceived alternatives for suicide, i.e., "tunnel vision", feelings of helplessness and powerlessness, (7) devising in details and accepting simple suicidal plan, especially when such plan is being consolidated through rehearsals and as if "automatized", (8) impulsiveness, (9) accumulation of aggression that may be vented out as suicide, and finally (10) accessibility of means to commit suicide.

Suicidal and violent ideation in acute psychiatric inpatients: prevalence, co‐occurrence, and associated characteristics

“…In conclusion, it is evident that suicidal and violent ideation is common in mental health disorders. However, despite the persistent interest in the topic, including psychoanalytic perspectives (Berman et al, 2000; Menninger, 1996; Rodzinski et al, 2017) and contemporary examinations (Ammerman et al, 2015; Arango et al, 2002; Mann, 2002; Mann et al, 2001; Poldrack et al, 2018), we still do not know why they co‐occur so frequently. Future studies should continue to examine the complexity of their co‐occurrence using longitudinal data and further improve routines of systematic and clinical assessment.…”

Suicides among adults in Paraguay: An 18-year national exploratory study (2004–2022)

“…This may suggest a strong call to action for the health authorities in order to adopt urgent public policies for suicide prevention and decentralization of mental health care services through the country areas. Also, our findings may add knowledge regarding the national trend and factors allowing clinicians and researchers to develop suicide intervention and prevention strategies (Rodziński et al, 2017). Although our results are focused on suicide deaths, data collection from national suicide records confirmed that previous attempts were an important risk factors as discussed in the international literature (Fazel & Runeson, 2020).…”

Creencias actitudinales sobre el comportamiento suicida en profesionales de salud del área de emergencias de un Hospital público en Lima, Perú

“…Diversos estudios sugieren que las diferencias culturales, las creencias religiosas y adversidades económicas, laborales influyen en el incremento de las tasas de suicidio (6,7). Adicionalmente, en los países de medianos y altos ingresos, las tasas de suicidio masculino son más elevadas que las femeninas en una proporción de 4:1, lo que conlleva a considerarlo como un problema de salud pública a nivel mundial y sugieren establecer medias de prevención e intervenciones para la reducción de factores de riesgo (7,8).…”

“…Entre los factores de riesgo para el suicidio se encuentran el sexo masculino, la juventud, una menor educación, ser soltero, padecer una comorbilidad mental y, en algunos casos, se presenta en personas sin diagnóstico previo (8,12). También se considera como factor de riesgo la impulsividad, la conducta agresiva y el abuso de sustancias que incluyen el tabaquismo.…”