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.
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.
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.
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.
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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.
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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.
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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
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