Inpatient Psychiatry, James J. Peters VA Medical Center, Bronx, NY, USA.
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
QJM. 2024 Jun 4;117(5):313-316. doi: 10.1093/qjmed/hcad279.
Globally, hundreds of thousands of people die by suicide every year. Suicides are usually associated with psychiatric illness. However, considerable evidence suggests that a significant number of individuals who die by suicide do not have diagnosable psychiatric disorders. The goal of this article is to attract attention to an overlooked issue of suicide in persons with no psychiatric disorders and to discuss some aspects of this issue. Research on identification and prevention of suicidal behavior in people with no psychiatric disorders is very limited. The available data indicate that suicides in individuals without psychiatric disorders are related to life stressors, lack of social support, and certain personality traits such as impulsivity. Suicide risk may be increased in military veterans with no psychiatric disorders. Many physical disorders, especially conditions associated with pain increase suicide risk in individuals with no diagnosable psychiatric disorders. Developmental, genetic and physical factors may play a role in the psychobiology of suicide in people with no psychiatric conditions. Promoting resilience may reduce suicide risk in the general population. Clinicians who work with medical or surgical patients need to have sufficient training in suicide prevention. Possibly, shifting some suicide prevention resources from individuals who are regarded as high-risk suicide patients to the general population may reduce suicide rates. Public education and better awareness about suicide may reduce suicide deaths among people with no psychiatric disorders.
全球每年有数十万人自杀身亡。自杀通常与精神疾病有关。然而,大量证据表明,相当数量的自杀者没有可诊断的精神障碍。本文的目的是引起人们对无精神障碍者自杀这一被忽视问题的关注,并讨论这一问题的某些方面。对无精神障碍者自杀行为的识别和预防的研究非常有限。现有数据表明,无精神障碍者的自杀与生活应激源、缺乏社会支持以及冲动等某些人格特征有关。无精神障碍的退伍军人的自杀风险可能会增加。许多身体疾病,尤其是与疼痛相关的疾病,会增加无精神障碍者的自杀风险。发展、遗传和生理因素可能在无精神障碍者的自杀心理生物学中起作用。增强适应力可能会降低普通人群的自杀风险。与内科或外科患者合作的临床医生需要接受充分的预防自杀培训。可能将一些自杀预防资源从被认为是高风险自杀患者转移到普通人群,可能会降低自杀率。公众教育和对自杀的更好认识可能会降低无精神障碍者的自杀死亡人数。