Understanding Suicidality: Suicide risk, sex differences and views of suicide attempters

Abstract: Better understanding of suicidality may improve treatment and care of suicide attempters. This thesis aims at understanding suicidality by investigating suicide risk, sex differences and views of suicide attempters. Suicide risk factors (prospectively determined) differed between the sexes: Older age and high suicidal intent were female risk factors, whereas previous attempts and using a violent method were male risk factors. Major depression was a risk factor for both sexes, underlining the importance of adequate treatment of depression. Suicide attempters? views on causes and motives for attempted suicide were investigated using as well quantitative as qualitative methods. Men attributed more importance to economic problems and unemployment, whereas women more often affirmed loneliness, psychiatric symptoms and interpersonal problems. Most patients affirmed several contributing problems, and the background factors were recurrently described to interact in vicious circles. Escaping from emotional pain was the most common and fundamental motive for attempted suicide. Punishing/manipulating motives were seldom reported. More than one pathway to attempted suicide was described. Two types of acute suicidal states of mind were described: one distinguished by confusion, panic, and desperation, and another characterised by ?tunnel vision? and ?turned off? emotions. In this situation one neither wanted nor could seek help. Suicide attempters suggested that improvements of the professional help offered, as well as improvements of their own capabilities to deal with problems and seek help before it is perceived as too late might prevent suicide attempts. Trying to understand suicidality from the perspective of suicidal individuals seems clinically valuable.