Interpersonal Loss
Much research has focussed on the impact of significant psychosocial stressors such as separation, loss divorce etc. Death of a loved one is a particular psychosocial risk because of the annual anniversary risk. Some studies have reported robust associations between early parental loss and increased risk for suicide in later life, whereas other studies have not been able to replicate this finding.
Abuse
Recent evidence suggests that early childhood abuse either physical or sexual may predispose to suicidal behavior in later life. The biologic mechanism described above (chronic excess cortisol inhibiting serotonin system development) has yet to be explored in humans.
Bullying
There have been several studies to date particularly in the adolescent psychological literature which have reported an association between bullying and suicidal behavior including suicide. School prevention programs are beginning to focus on addressing the problem of bullying as one of several mechanisms to introduce suicide prevention schemes.
These and other psychosocial stressors constitute a trigger mechanism as described above.
Life events
There seems to be an association between quantity (accumulation) of significant life events and increased risk for suicidal acts, particularly in the six months prior to a suicidal act. This is a particularly complex association however, as the quality and personal significance of the life event may be a significant contributory factor. Such events include separation, divorce, personal loss, financial loss, a significant health event and legal problems. These are just some examples.
Hopelessness
The intensity of the subjective experience of hopelessness is the most robust clinical predictor of eventual suicide in depressed patients. This observation is based on a number of clinical studies of depressed patients followed longitudinally for up to 10 years after initial assessment. Recent studies suggest that there may be two kinds of hopelessness “state hopelessness” and “trait hopelessness”. State hopelessness typically coincides with a depressive episode but resolves following successful treatment of the episode. Trait hopelessness on the other hand is a more enduring characteristic characterized by ongoing low-grade levels of hopelessness and despair and is considered a vulnerability factor for increased suicide risk. Cognitive Behavioral Therapy (CBT) is a psychological therapy which focuses particularly on modifying both trait and state hopelessness and is effective in resolving acute depressive episodes as well as contributing to relapse prevention, probably by impacting on trait hopelessness. Psychological therapies may be useful in reducing suicide risk but few have been scientifically tested. Dialectical Behavior Therapy (DBT) is an operational zed psychological therapy whose foundations are based largely on CBT. Early evidence suggests that this psychological therapy may reduce suicidal behavior particularly in subjects with Borderline Personality Disorder (see above).
Prisoners
Research suggests that prisoners are a particularly high-risk group. The risk is particularly high in prisoners on remand and in those within the first month of serving their sentence
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