Stressful life events in suicide attempts and completed suicides

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:

  1. natural and man-made disasters
  2. combat, war and refugee experiences
  3. sexual and interpersonal violence
  4. witnessing or perpetrating violence
  5. 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:

  1. suicide ideation
  2. suicide attempt
  3. suicide planning in those with ideation
  4. suicide attempt in those with a suicide plan
  5. 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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  • LauraNP

    Very good summary. I had a client who stated he would kill himself if he was ever diagnosed with Alzheimers. About 10 years after he said that (and it was documented in his chart), he was diagnosed with Alzheimers and he killed himself. Every suicidal statement needs to be explored and analyzed thoroughly.

    • Bill

      Thanks for sharing a personal story on this topic. The stress associated with a new serious medical illness can be severe. Medical professionals are in a key position to assess how well their patients are coping with their illnesses.

  • gzuckier

    one might hypothesize that a significant factor, though probably not the most significant, in the rate of completed suicide might be easy and quick access to loaded, unlocked firearms; probably handguns more than long guns. however, were one to hypothesize that, one would come afoul of the NRA and other such defenders of our liberty and probably lose one’s grant.