The role of stressful life events in suicide attempts and completed suicides has been a key area of study in the epidemiology of mental disorders. Although suicidal behavior often occurs in the context of acute and chronic stressor, this does not prove a causal link. We all could probably report serious life stressors throughout out lives and these could be interpreted as a reason for suicidal behavior. So these associations could simply be a coincidence and not have anything to do with suicidal behavior.
A recent analysis of the WHO (World Health Organization) World Mental Health Surveys attempts to shed some light on this issue. This study focused on traumatic life events, a subset of life stressors that are associated with the development of PTSD. The traumatic events studied included:
- natural and man-made disasters
- combat, war and refugee experiences
- sexual and interpersonal violence
- witnessing or perpetrating violence
- death or trauma to a loved one
These more serious stressful life events provide a opportunity focus on events everyone would agree as significant. The authors then looked at five lifetime categories related to suicide:
- suicide ideation
- suicide attempt
- suicide planning in those with ideation
- suicide attempt in those with a suicide plan
- suicide attempt in those without a plan
The most common traumatic events reported by respondents across the 20 country survey included: death of a loved one (30.5%), followed by witnessing violence (21.8%), interpersonal violence (18.8%), accidents (17.7%), exposure to war (16.2%) and trauma to a loved one (12.5%).
The authors of the study perform complex analysis of the individual and cumulative effects of traumatic events. The key findings summarized by these analyses include:
- experiencing interpersonal or sexual violence appeared to have the strongest effect on suicidal ideation and suicide attempt
- suicidal ideation and attempts had a dose-response effect with traumatic experiences–the more number of experiences, the higher the risk although this effect plateaued after experiencing about 4 events
- traumatic effects had limited effect on the progression from suicidal ideation to a suicide attempt
- effects of traumatic events occurred across low-, middle- and high income countries
- it was estimated that elimination of traumatic life events could reduce population suicide ideation by 15% and suicide attempts by 22%
The study was not able to analyze the effect on the most important variable–completed suicide. This would add significant weight to attributing a link between traumatic life events. Nevertheless, this study provides additional insight into stressful life events and suicide ideation and plan. Traumatic events appear to be important although playing a relatively minor role. Presence of a serious mental disorder, i.e. major depression, bipolar disorder, substance abuse, schizophrenia, severe personality disorder continues to be the most important risk factor for suicide.
William Yates is a family physician who blogs at Brain Posts.
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