According to Yager and Feinstein (2017), individuals diagnosed with the following conditions are more likely to think about, plan, attempt, or complete suicide:

major depressive disorder, bipolar disorder (especially rapid cycling), severe anxiety disorders such as panic disorder, schizophrenia, posttraumatic stress disorder, substance use disorders, personality disorders, eating disorders, chronic pain, and medical conditions such as chronic pulmonary disease.

01.

Chronic Illness and Pain

In a nationally representative sample of American adolescents ages 13-17, Dean-Boucher et al. (2019) discovered that teens who were diagnosed with asthma, dermatological conditions, allergies, headache, or back and neck pain were more likely to experience suicidal ideation. In addition, teens diagnosed with heart conditions were at greater risk for plans and attempts.

With a sample of almost 800 U.S. adult patients going through rehabilitation for pain or a physical injury, Fishbain et al. (2012) found that patients with chronic pain compared to patients with acute pain have a preference for death over disability that is strongly associated with passive (ideation and no plan), active (ideation and plan), and historical suicidality (history of suicidal ideation).

In another article, Fishbain et al. (2016) carried out a study where they identified strong correlations between self-perceived burdensomeness and various types of suicidality in acute pain patients (APPs) and chronic pain patients (CPPs). This relationship was especially significant for CPPs, as perceiving themselves as burdens seemed highly correlated with a wish to die, active suicidal ideation, planning suicide, having a history a suicide attempts, and a preference for death over disability.

After conducting a systematic literature review, Levine and Horesh (2020) concluded that individuals with fibromyalgia are more likely to experience suicidal ideation and behaviors compared to the general population. In addition, those with fibromyalgia (FM) have a greater chance of having co-occurring mental or other physical health conditions that can individually increase the risk of suicidality, such as substance abuse. In their own study, Triñanes et al. (2014) revealed that those who suffer with FM are at higher risk for suicidal ideation if they also experience depression or anxiety, or if the symptoms of the FM itself greatly interfere with daily living.

In a literature review, Pederson et al. (2017) point out that people with "invisible illnesses" which cause chronic pain such as FM, postural orthostatic tachycardia syndrome (also known as POTS), complex regional pain syndrome, and myalgic encephalomyelitis are often blamed for the occurrence or worsening of their symptoms by medical professionals. The authors plead for social workers who have clients with any of these conditions to have a more compassionate approach that addresses and validates their physical and mental health concerns. Evidence-based treatments which seem to address both the physical and mental components of such illnesses included dialectical behavior therapy (DBT) and collaborative assessment and management of suicidality (CAMS).

02.

Mood Disorders, Anxiety, and Schizophrenia

According to their systematic literature review, Köhler and colleagues (2018) noted that individuals with chronic depression not only began having symptoms earlier than those with non-chronic depression or major depressive disorder but also presented with more psychiatric co-occurring conditions and increased rates of suicidal ideation.

In a longitudinal study of 10 to 26-year-olds who had completed pediatric anxiety treatment some time between the ages of 3 and 11, Keeton et al. (2018) determined that early intervention in the form of cognitive behavioral therapy (CBT), medication, or CBT plus medication seemed to mitigate the likelihood that children with anxiety experienced chronic depression or suicidality in the future. The authors also mention the need for healthcare providers to pay attention to subclinical depressive symptoms and help children cope with adverse experiences as a way to potentially prevent later development of mood disorders, chronic depression, and suicidality.

Ducasse et al. (2017) studied affect lability, or the way affect changes over time, in a sample of euthymic and mildly depressed patients with bipolar disorder. In their results, they found that those with high affect lability were more likely to indicate suicidal ideation during a two-year follow-up compared to the other individuals with bipolar disorder. When looking at specific mood shifts, the researchers discovered that the individuals in this subgroup who more often switched between neutral and elation, neutral and anger, and anxious and depressive affect were more likely to indicate suicidal ideation during the follow-up.

Six months after discharge from inpatient hospitalization, a sample pool of adolescents who fit the criteria for a depressive disorder; had a history of suicidal ideation or attempt; and had any non-suicidal self-injury, substance use disorder, and/or history of a previous suicide attempt were assessed for suicidal ideation at a 6-month follow-up. Wolff and colleagues (2018) identified that adolescents who struggled with chronic ideation also experienced more difficulties in emotion regulation compared to the group of participants whose ideation lessened over time.

Individuals diagnosed with schizophrenia are especially more likely to attempt or complete suicide if they are in the early stages of the disorder. Ventriglio et al. (2016) noted that precipitating factors for suicide risk in this population include previous suicide attempts, lack of social support and social dysfunction, substance abuse, and the personality traits of perfectionism and insightfulness. They also said that specific psychotic symptoms are associated with this risk such as paranoid delusions, negative symptoms, and command hallucinations.

03.

History of Trauma and Traumatic Brain Injury (TBI)

According to Chalfin and Kallivayalil (2017), developmental trauma and suicidality are linked due to the abuser's reinforcement of negative self-talk and therefore encouragement of self-destructive thoughts. When someone who experienced trauma from a caregiver or other trusted adult throughout their childhood has suicidal thoughts, this mindset is said to be a type of memory regarding their experience with the abuser.

Matthew and Gedzior (2016) conducted a case study on an Army veteran inpatient who had suffered traumatic brain injury from being assaulted after his time in the military. These physicians identified his experience of symptoms that also fulfilled the criteria of posttraumatic stress disorder. They also found that with the veteran's experience of recurrent severe depression, anxiety, and visual and auditory hallucinations, he also suffered from flashbacks and intrusive memories, for instance. They concluded that his "fight or flight" response was on replay to the extreme, overworking the sympathetic nervous system and triggering chronic suicidal thoughts.

Kim et al. (2013) studied the connection between childhood adversity and future severity of depressive symptoms such as suicidal ideation among a sample of individuals with depression. It was found that those who experienced childhood physical and/or sexual abuse from parents seemed prone to more severe depressive and anxiety symptoms, more stressful life events (SLEs), and more severe suicidal ideation. The authors also reported that individuals who experienced physical abuse seemed to have poorer subjective quality of life, higher perceived stress, and an increased chance of needing medication adjustment or augmentation after trying an antidepressant for the first time.

04.

Borderline Personality Disorder

Individuals with borderline personality disorder (BPD) comprise one of the populations most at risk for chronic suicidal ideation. According to researchers, common behaviors among this population of individuals such as non-suicidal self-injury and suicidal thought and actions seem to serve a similar purpose: to decrease mental pain. These behaviors are thought to decrease aversive tension (chaotic dysphoric states), provide a "way out" of the pain, and help individuals feel like they have control over their emotional state, albeit temporarily. Thus, these behaviors are characterized as negative reinforcement according to a reinforcement model of suicidality (Hennings, 2020).

According to Marsha Linehan's biosocial theory, borderline personality disorder is largely characterized by emotion dysregulation. Borderline personality is also associated with chronic suicidality. Southward and Cheavens (2020) developed two studies that looked at differences in emotion regulation across those with BPD, MDD, and healthy controls. They saw that the use of adaptive coping skills was similar between the the BPD and MDD group but still lower than the healthy control group. What seemed to differentiate the individuals with BPD from the other groups was an increased use of maladaptive coping skills and poorer execution of learned coping skills.

According to their literature review, Yager and Feinstein (2017) found that therapies such as the CAMS, CBT, dialectical behavior therapy (DBT), problem-solving therapy, metallization-based treatment (MBT), psychodynamic interpersonal therapy, and transference-focused therapy (TBT) seem to benefit outpatient individuals with BPD but not those with depressive or schizophrenia spectrum disorders.

05.

Substance Use Disorders

Riquino et al. (2018) reviewed the interconnectedness of chronic pain, opioid misuse, and emotional dysregulation. Emotional dysregulation prompted by chronic pain and opioid use as prescribed for treatment of the chronic pain can lead to negative thoughts and feelings which then feed into opioid cravings and/or suicidal ideation. Subsequent opioid misuse and/or suicidality can arise and result in a temporary decrease in negative mood or increase in positive mood, therefore reinforcing continuation of the cycle. The authors noted that individuals with chronic pain who take prescription opioids long-term are at greater risk for these consequences. They also concluded that this cycle highlights the importance of interventions focused on improving emotion regulation among chronic pain patients who take opioids.

In their article, Conner et al. (2014) discussed the relationship between suicidality and alcohol use, whether it be alcohol use disorder (AUD) or acute use of alcohol (AUA). After conducting a literature review on previous research, it was deduced that AUD is one of the riskiest psychological conditions when it comes to suicidal thoughts and behaviors. AUA is sometimes associated with suicidal acts, whether it provides psychological or physical self-soothing that makes it easier for one to take the actions to end their life, or if the alcohol is consumed along with pills or other substances, thus forming a lethal combination. Also in their review of the literature, the authors also noticed that high levels of AUA has been connected to more violent suicide attempts such as death by hanging or firearms.

06.

Other Conditions and Factors

Conditions

Obsessive Compulsive Disorder- Raines et al. (2014) conducted a study with a participant pool of 80 adults to look at the relationship between specific features of OCD and suicidal ideation and behaviors. Such features included anxiety sensitivity, which is defined as a fear of experiencing anxiety, and the obsessive dimension of the disorder. Not only was it determined that the obsessive dimension of OCD is associated with increase risk of suicidality, but that cognitive concerns related to anxiety sensitivity, such as a fear of losing control over one's thoughts, was a moderating variable in this relationship.
Insomnia- Winsper and Tang (2014) reviewed the literature regarding the link between insomnia and suicidality. In their review, they concluded that there are significant direct and indirect connections between the two. This link is especially noticeable among individuals diagnosed with clinical depression or anxiety. The authors also looked at specific features of BPD and chronic pain which may contribute to suicidality in populations with those conditions. It was hypothesized that emotional dysregulation and impulsivity, both typical features of BPD, mediated the relationship between insomnia and suicidality. It was also hypothesized that catastrophizing and a sense of defeat were mediating factors among those with chronic pain.

Cultural and Social Factors

In their longitudinal study with a large adolescent sample, Brunstein Klomek et al. (2019) uncovered a bidirectional relationship between all types of bullying and depression. Teens who reported one incident of victimization were at considered more at risk for future suicidal ideation and attempts if it was physical. Chronic victimization, which was characterized by at least two incidents of victimization that occurred by the second interval of assessment in the longitudinal study, seemed to increase the risk for depression. Chronic relational victimization was associated with a higher risk of future suicidal ideation, and chronic physical victimization was associated with a higher risk of future suicide attempts.

Hatchel et al. (2019) sought to uncover main risk factors for suicidal ideation and attempts among adolescents who identified as LGBTQ. In a sample of 4,867 high school students across 20 different schools, 713 identified as LGBTQ. Within this subsample, rates of suicidal ideation and attempts were higher than among cisgender heterosexual teens. The authors identified that a combination of negative help-seeking beliefs and symptoms of depression strongly predicted suicidal ideation, and negative perceptions of help-seeking alone predicted suicide attempts. In addition, it was discovered that the strongest factors which predicted both ideation and attempts included peer victimization, severe depressive symptoms, and drug use.

Shaw et al. (2019) conducted a qualitative, phenomenological study looking at the experiences of people who identify as Alaska Native or American Indian that have struggled with chronic suicidal ideation. From 2012-2017 Alaska was one of the top two states with the highest rate of suicide, and the suicide rate among Alaska Native and American Indian populations in Alaska is about 3-4 times the national rate in the United States. In their interviews with the study participants, Shaw and colleagues noticed that some of the main protective factors were positive social connections and access to mental health services. They highlighted that social stigma has been a recurrent barrier preventing people from actively seeking mental health help. They also saw that individuals who looked for help sooner and found supportive treatment providers had shorter-term and less severe suicidality.

"Life doesn't make any sense without interdependence. We need each other, and the sooner we learn that, the better for us all."

-Erik Erikson