Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

The suicidal process: age of onset and severity of suicidal behaviour

Abstract

Purpose

The concept of the suicidal process implies a progression from behaviour of relatively low intent to completed suicide. Evidence from the literature has given rise to the speculation that the age of onset of an early form of the suicidal process may be associated with the ultimate seriousness of suicidal behaviour. This study was designed to test the hypothesis that early onset of the first stage of the suicidal process, a wish to die, is associated with increases in the ultimate position along the suicidal process dimension.

Methods

Questions on the appearance and timing of suicidal process components (a death wish, ideation, plan, or attempt) were embedded in a telephone survey on mental health and addictions in the workforce. Records of those that had experienced suicidal behaviour were examined for the effects on the age of onset of the first death wish as a function of the level of severity of suicidal behaviour, gender, and depression.

Results

The findings showed that increases in suicidal intent were associated with lowered age of the first death wish. This pattern held true for depressed and non-depressed persons alike.

Conclusions

The results support the notion that the early onset of a supposed precursor of suicidal behaviour, a death wish in this case, adds to its ability to portend more serious problem levels in later stages of life. Furthermore, mood operates independently in its association with the timing of such suicidal behaviour, suggesting that the effect of a relatively youthful appearance of a wish to die cannot be explained by early onset depression.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2

Notes

  1. 1.

    A death wish, by definition, does not include thoughts of suicide and thus it is not clear that it should be discussed as suicidal behaviour. However, it will be retained as such since, at worst, it is prodromal to suicidal behaviour and contemporary convention has it firmly planted in the suicidal process.

References

  1. 1.

    Angst J, Degonda M, Ernst C (1992) The Zurich study: XV. Suicide attempts in a cohort from age 20 to 30. Eur Arch Psychiatry Clin Neurosci 242:135–141

  2. 2.

    Mościcki EK (1989) Epidemiologic surveys as tools for studying suicidal behavior: a review. Suicide Life Threat Behav 19:131–146

  3. 3.

    Portzky G, Audenaert K, van Heeringen K (2005) Adjustment disorder and the course of the suicidal process in adolescents. J Affect Disord 87:265–270

  4. 4.

    Runeson BS, Beskow J, Waern M (1996) The suicidal process in suicides among young people. Acta Psychiatr Scand 93:35–42

  5. 5.

    van Heeringen K, Hawton K, Williams JMG (2000) Pathways to suicide: an integrative approach. In: Hawton K, van Heeringen K (eds) The international handbook of suicide and attempted suicide. Wiley, New York, pp 223–234

  6. 6.

    Kovacs M, Feinberg T, Crouse-Novak M, Paulauskas S, Pollock M, Finkelstein R (1984) Depressive disorders in childhood. II. A longitudinal study of the risk for a subsequent major depression. Arch Gen Psychiatry 41:643–649

  7. 7.

    Kandel DB, Davies M (1986) Adult sequelae of adolescent depressive symptoms. Arch Gen Psychiatry 43:255–262

  8. 8.

    Rao U, Ryan ND, Birmaher B, Dahl RE, Williamson DE, Kaufman J, Rao R, Nelson B (1995) Unipolar depression in adolescents: clinical outcome in adulthood. J Am Acad Child Adolesc Psychiatry 34:566–578

  9. 9.

    Bland RC, Newman SC, Orn H (1986) Recurrent and nonrecurrent depression: a family study. Arch Gen Psychiatry 43:1085–1089

  10. 10.

    Weissman MM, Wickramaratne P, Merikangas KR, Leckman JK, Prusoff BA, Caruso KA, Kidd KK, Gammon GD (1984) Onset of major depression in early adulthood: increased familial loading and specificity. Arch Gen Psychiatry 41:1136–1143

  11. 11.

    Weissman MM, Merikangas KR, Wickramaratne P, Kidd KK, Prusoff BA, Leckman JK, Pauls DL (1986) Understanding the clinical heterogeneity of major depression using family data. Arch Gen Psychiatry 43:430–434

  12. 12.

    Thompson AH (2008) Younger onset of depression is associated with greater suicidal intent. Soc Psychiatry Psychiatr Epidemiol 43:538–544

  13. 13.

    Wyder M, De Leo D (2007) Behind impulsive suicide attempts: indications from a community study. J Affect Disord 104:167–173

  14. 14.

    Bertolote JM, Fleishmann A, De Leo D, Bolhari J, Botega N, de Silva D, Thanh HTThi, Phillips M, Schlebusch L, Varnik A, Vijayakumar L, Wasserman D (2005) Suicide attempts, plans, and ideation in culturally diverse sites: the WHO SUPRE-MISS community survey. Psychol Med 35:1457–1465

  15. 15.

    Fortune S, Stewart A, Yadav V, Hawton K (2007) Suicide in adolescents: using life charts to understand the suicidal process. J Affect Dis 100:199–210

  16. 16.

    Kessler RC, Merikangas KR (2004) The national comorbidity survey replication (NCS-R): background and aims. Int J Methods Psychiatr Res 13(2):60–68

  17. 17.

    Kessler RC (2006) National comorbidity survey: replication (NCS-R), 2001–2003 [Computer file]. Conducted by Harvard Medical School, Department of Health Care Policy/University of Michigan, Survey Research Center. ICPSR04438-v1. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [producer and distributor], 2006-06-07. http://www.hcp.med.harvard.edu/ncs/. Accessed 13 Oct 13 2006

  18. 18.

    Robins LN, Helzer JE, Croughan J, Williams JBW, Spitzer RL (1981) NIMH diagnostic interview schedule. NIMH Division of Biometry and Epidemiology, National Institute of Mental Health, Washington

  19. 19.

    Shneidman ES, Farberow NL (1961) Statistical comparisons between committed and attempted suicides. In: Farberow NL, Schneidman ES (eds) The cry for help. McGraw-Hill, New York, pp 19–47

  20. 20.

    Kuo W, Gallo JJ, Tien AY (2001) Incidence of suicidal ideation and attempts in adults: the 13-year follow-up of a community sample in Baltimore, Maryland. Psychol Med 31:1181–1191

  21. 21.

    Thomas HV, Crawford M, Meltzer H, Lewis G (2002) Thinking life is not worth living. Soc Psychiatry Psychiatr Epidemiol 37:351–356

  22. 22.

    Vilhjalmsson R, Kristjansdottir G, Sveinbjarnardottir E (1998) Factors associated with suicide ideation in adults. Soc Psychiatry Psychiatr Epidemiol 33:97–103

  23. 23.

    Thompson AH, Jacobs P, Dewa CS (2011) The Alberta survey of addictive behaviours and mental health in the workforce: 2009. Institute of Health Economics, Edmonton

  24. 24.

    Paykel ES, Myers JK, Lindenthal JJ, Tanner J (1974) Suicidal feelings in the general population: a prevalence study. Br J Psychiatry 124:460–469

  25. 25.

    Sheehan DV, Lecrubier L, Harnett-Sheehan K, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 22(Suppl 20):22–33

  26. 26.

    Weissman MM, Bland RC, Canino GJ, Greenwald S, Hwu HG, Joyce PR, Karam EG, Lee CK, Lellouch J, Lepine JP, Newman SC, Rubio-Stipek M, Wells JE, Wickramaratne PJ, Wittchen HU, Yeh EK (1999) Prevalence of suicide ideation and suicide attempts in nine countries. Psychol Med 29:9–17

  27. 27.

    Welch SS (2001) A review of the literature on the epidemiology of parasuicide in the general population. Psychiatr Serv 52:368–375

  28. 28.

    Thompson AH (2010) The suicidal process and self-esteem. Crisis 31:311–316

  29. 29.

    De Leo D, Cerin E, Spathonis K, Burgis S (2005) Lifetime risk of suicide ideation and attempts in an Australian community: prevalence, suicidal process, and help-seeking behaviour. J Affect Disord 86:215–224

  30. 30.

    Kessler RC, Borges G, Walters EE (1999) Prevalence of risk factors for lifetime suicide attempts in the National Comorbidity Survey. Arch Gen Psychiatry 56:617–626

  31. 31.

    Mościcki EK, O’Carroll P, Rae DS, Locke BZ, Roy A, Regier DA (1988) Suicide attempts in the Epidemiologic Catchment Area Study. Yale J Biol Med 61:259–268

  32. 32.

    Rancans E, Lapins J, Salander Renberg E, Jacobsson L (2003) Self-reported suicidal and help-seeking behaviours in the general population in Latvia. Soc Psychiatry Psychiatr Epidemiol 38:18–26

  33. 33.

    Mayes LC, Suchman NE (2006) Developmental pathways to substance abuse. In: Cicchetti D, Cohen D (eds) Developmental psychopathology, vol 3. John Wiley and Sons, New York, pp 599–619

  34. 34.

    Wolfe DA, Mash EJ (2005) Behavioral and emotional disorders in adolescents: nature assessment and treatment. The Guildford Press, New York

  35. 35.

    Oman RF, Vesely S, Aspy CB, McLeroy K, Rodine S, Marshall L (2004) The potential protective effect of youth assets on adolescent alcohol and drug use. Am J Public Health 94:1425–1430

  36. 36.

    Fergusson DM, Lynskey MT (1998) Conduct problems in childhood and psychosocial outcomes in young adulthood: a prospective study. J Emot Behav Disord 6:2–18

  37. 37.

    Seligman MEP (1989) Research in clinical psychology: why is there so much depression today? In: Cohen IS (ed) The G. Stanley Hall lecture series 9. American Psychological Association, Washington, DC, pp 65–96

  38. 38.

    Cross-National Collaborative Group (1992) The changing rate of major depression: cross-national comparisons. JAMA 268:3098–3105

  39. 39.

    Li CY, Sung FC (1999) A review of the healthy worker effect in occupational epidemiology. Occup Med 49(4):225–229

  40. 40.

    Bland RC, Stebelsky G, Orn H, Newman SC (1988) Psychiatric disorders and unemployment in Edmonton. Acta Psychiatr Scand 77(Suppl 338):72–80

  41. 41.

    Mishara B (1999) Conceptions of death and suicide in children ages 6–12 and their implications for suicide prevention. Suicide Life-Threat Behav 29(2):105–118

  42. 42.

    Gliatto MF, Rai AK (1999) Evaluation and treatment of patients with suicidal ideation. American Family Physician 57(6, March 15), pp 1500–1513. http://www.aafp.org/afp/990315ap/1500.html/. Accessed 27 Apr 2011

  43. 43.

    McAuliffe CM (2002) Suicidal ideation as an articulation of intent: a focus for suicide prevention? Arch Suicide Res 6:325–338

Download references

Acknowledgments

Data collection for the base study that included the questions used here was conducted under the terms of a contract between the Addiction and Mental Health section of Alberta Health Services (the sponsor) and the Institute of Health Economics, Edmonton, Canada. Interviewing and data assembly were completed by a private research firm, Malatest and Associates. We wish to thank the members of the project’s Advisory Committee for their much-appreciated input.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Correspondence to Angus H. Thompson.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Thompson, A.H., Dewa, C.S. & Phare, S. The suicidal process: age of onset and severity of suicidal behaviour. Soc Psychiatry Psychiatr Epidemiol 47, 1263–1269 (2012). https://doi.org/10.1007/s00127-011-0434-0

Download citation

Keywords

  • Suicide
  • Depression
  • Age
  • Onset
  • Suicidal process