Introduction
- Suicide is a global concern to nurses and other health-care
providers.1
- Suicidal behavior is a leading cause of death and disability
worldwide.2
- Suicidal ideation refers to thinking about or formulating
plans for suicide. Suicidal ideation is closely associated with
both suicidal attempts and deaths, serving as a significant risk
factor for future suicide attempts.3
- Theoretical models are used to explain how the individual
progresses from suicidal ideation to a suicide attempt.1
- The problem of suicide has puzzled philosophers throughout
the history and a person’s decision to live or die is a
“fundamental question of philosophy”.4
Important Theories
- Sigmond Freud proposed that suicide
resulted from anger at a loved one directed inward.5 He
conceptualized that in response to the experience of a loss, the
individual internalizes the lost object as a way of holding on
to it. The outcome of maintaining the loss is twofold: it helps
to ease the grieving, and it provides an alternative target for
hostility toward the lost object.6
- Cognitive model of suicidal behavior –
Aron Beck explains that two types of cognitive disturbances
observed in suicidal people, trait cognitive disturbances and
“state” cognitive disturbances. Hopelessness is more often
associated with suicidality. Cognitive therapy is effective in
reducing suicidal behaviors.7,8
- Durkheim proposed that dysregulation of social force results
in suicide.9
- Durkheim proposed four types of suicide- egoistic, anomic,
altruistic, and fatalistic suicide.9
- Durkheim viewed egoistic suicide as a consequence of the
deterioration of social and familial bonds.9
- He considered anomic suicide to disillusionment and
disappointment.10
- He considered social integration as a protective strategy
against suicide risk factors.10
- Durkheim’s theory does not give attention to individual
factors.11
- Shneidman’s theory of suicide (psychache theory) focused on
individual factors, with “psychache”—psychological and emotional
pain that reaches intolerable intensity –as the primary factor
causing suicide.12
- Thomas Joiner's Interpersonal Theory of Suicide (IPTS) states
that the need to belong is the need central to the development
of suicidal desire.13
- The most dangerous form of suicidal desire is caused by the
simultaneous presence of two interpersonal constructs—thwarted
belongingness and perceived burdensomeness.11
- Thwarted Belongingness – when the “the need to belong” is not
met social isolation develops and it is the strongest and most
reliable predictors of suicide ideation.11
- Perceived Burdensomeness - elevated likelihood of developing
perceptions of burdensomeness on others is associated with
suicide.11
- Thwarted belongingness and perceived burdensomeness are
presumed to be distinct, but related constructs.11
- Interpersonal theory of suicide states that when
individuals experience intractable feelings of perceived
burdensomeness and thwarted belongingness and that near-lethal
or lethal suicidal behavior occurs in the presence of suicidal
desire and capability for suicide.14
- The three-step theory of suicide - explains suicide in terms
of four factors: pain, hopelessness, connection, and capability
for suicide.15
- According to a stress-diathesis psychological model, in
vulnerable individuals, a combination of stressors can increase
the chance of suicide.16
- Integrated motivational–volitional (IMV) – IMV is a
second-generation suicide model, that describes a tri-partite
biopsychosocial framework in which suicidal ideation and
behaviour may emerge (pre-motivational phase), the factors that
lead to the emergence of suicidal ideation (motivational phase)
and the factors that govern the transition from suicidal
ideation to suicide attempts/death by suicide (volitional
phase).17
- The fluid vulnerability theory of suicide indicates the
strong likelihood that multiple pathways can lead to suicidal
behavior.18
- The fluid vulnerability theory emphasizes the dynamic nature
of suicide risk across cognitive, emotional, behavioral, and
physiological domains.19
References
- Keefner TP, Stenvig T. Rethinking Suicide Risk With a New
Generation of Suicide Theories. Res Theory Nurs Pract. 2020 Nov
1;34(4):389–408.
- Klonsky ED, May AM, Saffer BY. Suicide, Suicide Attempts, and
Suicidal Ideation. Annu Rev Clin Psychol. 2016;12:307–30.
- Harmer B, Lee S, Rizvi A, Saadabadi A. Suicidal Ideation. In:
StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing; 2024 [cited 2024 May 24]. Available from:
http://www.ncbi.nlm.nih.gov/books/NBK565877/
- Millner AJ, Robinaugh DJ, Nock MK. Advancing the
Understanding of Suicide: The Need for Formal Theory and
Rigorous Descriptive Research. Trends Cogn Sci. 2020
Sep;24(9):704–16.
- Yakeley J, Burbridge-James W. Psychodynamic approaches
to suicide and self-harm. BJPsych Adv. 2018 Jan;24(1):37–45.
- Haddad SK, Neiderhiser JM, Spotts EL, Ganiban J, Lichtenstein
P, Reiss D. DEPRESSION AND INTERNALLY DIRECTED AGGRESSION:
GENETIC AND ENVIRONMENTAL CONTRIBUTIONS. J Am Psychoanal Assoc.
2008 Jun;56(2):515–50.
- Wenzel A, Beck AT. A cognitive model of suicidal
behavior: Theory and treatment. Appl Prev Psychol. 2008 Oct
1;12(4):189–201.
- Suicide I of M (US) C on P and P of A and A. COGNITIVE
APPROACHES TO SUICIDE. In: Suicide Prevention and Intervention:
Summary of a Workshop [Internet]. National Academies Press (US);
2001 [cited 2024 May 24]. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK223847/
- Durkheim E. Le Suicide: Etude de socologie. Paris: F. Alcan;
1897.
- Kushner HI, Sterk CE. The Limits of Social Capital: Durkheim,
Suicide, and Social Cohesion. Am J Public Health. 2005
Jul;95(7):1139–43.
- Van Orden KA, Witte TK, Cukrowicz KC, Braithwaite S, Selby
EA, Joiner TE. The Interpersonal Theory of Suicide. Psychol Rev.
2010 Apr;117(2):575–600.
- Shneidman ES. A psychological approach to suicide. VandenBos,
Gary R; 1987.
- Joiner T. Why People Die by Suicide. Harvard University
Press; 2005. 304 p.
- Chu C, Buchman-Schmitt JM, Stanley IH, Hom MA, Tucker RP,
Hagan CR, et al. The Interpersonal Theory of Suicide: A
Systematic Review and Meta-Analysis of a Decade of
Cross-National Research. Psychol Bull. 2017 Dec;143(12):1313–45.
- Klonsky ED, Pachkowski MC, Shahnaz A, May AM. The three-step
theory of suicide: Description, evidence, and some useful points
of clarification. Prev Med. 2021 Nov;152(Pt 1):106549.
- Fazel S, Runeson B. Suicide. N Engl J Med. 2020 Jan
16;382(3):266–74.
- O’Connor RC, Kirtley OJ. The integrated
motivational–volitional model of suicidal behaviour. Philos
Trans R Soc B Biol Sci. 2018 Sep 5;373(1754):20170268.
- Bryan CJ, Butner JE, May AM, Rugo KF, Harris J, Oakey DN, et
al. Nonlinear change processes and the emergence of suicidal
behavior: a conceptual model based on the fluid vulnerability
theory of suicide. New Ideas Psychol. 2020
Apr;57:10.1016/j.newideapsych.2019.100758.
- Rugo-Cook KF, Kerig PK, Crowell SE, Bryan CJ. Fluid
vulnerability theory as a framework for understanding the
association between posttraumatic stress disorder and suicide: A
narrative review. J Trauma Stress. 2021 Dec;34(6):1080–98.
This page was last updated on: 24/05/2024