Understanding the relationship between mental illness and suicide and the implications for suicide prevention

Résumé

Although the presence of a mental disorder is highly associated with suicide in developed countries, there is little research on the mechanisms that explain why people with a mental disorder are at greater risk of suicide. We describe alternative explanatory models of the relationship between mental disorders and suicide and their implications for prevention activities: 1. Suicide and mental disorders have a common aetiology; 2. Some mental disorders are alternatives to suicide; 3. Suicide is a direct consequence of mental disorders; 4. Suicide is the result of the consequences of living with a mental disorder; 5. Suicide results from treatment, it is “iatrogenic” or related to inadequate, inappropriate or incomplete treatment. Implications of each model for suicide prevention are discussed. For example, if a major explanation is that living with mental disorders leads to increased exposure to well known and easily identified risk factors, this suggests the need for greater focus of prevention activities on improving the lives of persons with mental disorders. We challenge the simple conclusion that, because mental disorders and suicide may be highly associated, therefore treating mental disorders is the best suicide prevention strategy. We suggest that understanding why people with a mental disorder are at more risk of suicide can help us to understand why only a minority of people with mental disorder complete suicide as well as how to prevent suicide in persons with mental disorders. SANTÉ-MENTALE FACTEUR-RISQUE MODÈLE THÉORIE PSYCHOPATHOLOGIE ÉVÉNEMENT-VIE ÉTIOLOGIE CRISE-SUICIDAIRE VULNÉRABILITÉ INTERVENTION-CRISE