The number of deaths by suicide among mental health patients treated at home by crisis resolution home treatment teams (CRHT)*, has more than doubled in England in recent years, rising from an average of 80 in 2003-2004 to 163 in 2010-2011, according to new research published in The Lancet Psychiatry. In contrast, suicides on psychiatric wards fell by more than half, from 163 in 2003-2004 to 76 in 2010-2011.
In this Review, published to coincide with the launch of The Lancet Psychiatryjournal, Professor Rory O’Connor from the University of Glasgow and Professor Matthew K. Nock from Harvard University review the key psychological factors that may contribute to, or protect against, suicidal behaviour including personality differences, cognitive factors, and negative life events such as serious physical illness, as well as current psychological treatments. Evidence suggests that about 60% of people struggling with suicidal thoughts or behaviour do not receive any help, and, surprisingly, there is relatively little evidence for the effectiveness of treatments received by those who do. The authors conclude by calling for more research into novel psychological and psychosocial treatments.
In this Review, published to coincide with the launch of The Lancet Psychiatryjournal, Professor Kees van Heeringen from Ghent University in Belgium and John Mann from Columbia University in the USA discuss the stress-diathesis theory of suicide, in which a predisposition or diathesis interacts with stressful life experiences and acute psychiatric illness to cause suicidal behaviour. The theory explains why only a small minority of individuals are at risk of taking their own lives after exposure to such stressors.
The Lancet Psychiatry
The authors discuss the causes of the diathesis, or predisposition, to suicidal behaviour, which may include genetic effects and the long-term impact on the brain and behaviour of early life adversity (eg, physical and sexual abuse). Additionally, they outline various neurobiological factors that may play a role in this predisposition to suicidal behaviour. For example, post-mortem and neuroimaging studies have identified structural and functional changes in the brains of individuals with a history of suicidal behavior that may affect regulation of mood, response to stress and decision-making, and these include biochemical deficits in serotonin function and the hypothalamic pituitary adrenal axis (HPA) stress-response. The authors suggest that these abnormalities could be used in future to develop biomarkers that may help predict who is at risk of taking their own lives, and that may serve as a target for treatment.
People bereaved by the suicide of a partner and mothers losing an adult child to suicide run a significantly higher risk of suicide compared to people bereaved after sudden deaths from other causes. The psychological impact on other members of the family is also serious: children who lose a mother to suicide have an increased risk of depression, while people who lose a child to suicide have an increased likelihood of psychiatric admission for mental illness.