PDF herunterladen
Nervenheilkunde 2017; 36(04): 213-219
DOI: 10.1055/s-0038-1627007
Suizid
Schattauer GmbH

Die Einschätzung des Suizidrisikos

Forschungsstand und PerspektivenSuicide risk assessmentState of the art and future perspectives
W. P. Kaschka
1   Klinik für Psychiatrie und Psychotherapie I der Universität Ulm, Zentrum für Psychiatrie (ZfP) Südwürttemberg, Ravensburg-Weissenau
,
M. Jandl
2   Universitätsklinik für Psychiatrie und Psychotherapie, Universität Bern, Schweiz
,
J. Steyer
3   Zentrum für Psychiatrie (ZfP) Südwürttemberg, Ravensburg-Weissenau
,
S. Hodgkinson
1   Klinik für Psychiatrie und Psychotherapie I der Universität Ulm, Zentrum für Psychiatrie (ZfP) Südwürttemberg, Ravensburg-Weissenau
› Institutsangaben
Weitere Informationen

Publikationsverlauf

eingegangen am: 06. September 2016

angenommen am: 11. Oktober 2016

Publikationsdatum:
20. Januar 2018 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Zusammenfassung

Bei weltweit jährlich annähernd einer Million Todesfällen durch Suizid stellt suizidales Verhalten eine der größten Herausforderungen an die öffentlichen Gesundheitssysteme moderner Gesellschaften dar. Unter präventiven Gesichtspunkten kommt deshalb der Einschätzung des individuellen Suizidrisikos zu beliebigen Zeitpunkten erhebliche Bedeutung zu. Der vorliegende Beitrag gibt eine Übersicht über die enorme Komplexität dieses Problems, das nicht befriedigend gelöst wurde, und zeigt auf, dass ein integrierter Ansatz, der nicht nur klinische und psychosoziale, sondern auch aktuelle neurobiologische Erkenntnisse berücksichtigt, sich als vielversprechend erweist und Fortschritte – auch in präventiver Hinsicht – erwarten lässt.

Summary

Current epidemiological data reveal that suicide is a prominent cause of death worldwide with approximately one million victims per year and therefore represents a major challenge for the public health systems of modern societies. To improve our methods of suicide prevention, the reliable assessment of an individual person’s suicide risk at any point in time with sufficient sensitivity and specificity appears to be an important milestone, but this has not yet been achieved. The present contribution provides a review of the enormous complexity of the problem and suggests an integrated approach taking into account not only clinical and psychosocial aspects, but also recent neurobiological findings.

Schlüsselwörter

Suizidales Verhalten - Epidemiologie - Einschätzung des Suizidrisikos - Suizidprävention - Neurobiologie

Keywords

Suicidal behaviour - epidemiology - suicide risk assessment - suicide prevention - neurobiology
 

  • Literatur

  • 1 Afifi TO, Taillieu T, Zamorski MA, Turner S, Cheung K, Sareen J. Association of child abuse exposure with suicidal ideation, suicide plans, and suicide attempts in military personnel and the general population in Canada. JAMA Psychiatry 2016; 73: 229-238.
    CrossrefPubMedSuche in Google Scholar
  • 2 Altamura AC, Dell’Osso B, Berlin HA, Buoli M, Bassetti R, Mundo E. Duration of untreated illness and suicide in bipolar disorder: a naturalistic study. Eur Arch Psychiatry Clin Neurosci 2010; 260: 385-391.
    CrossrefPubMedSuche in Google Scholar
  • 3 Antypa N, Souery D, Tomasini M, Albani D, Fusco F, Mendlewicz J, Serretti A. Clinical and genetic factors associated with suicide in mood disorder patients. Eur Arch Psychiatry Clin Neurosci 2016; 266: 181-193.
    CrossrefPubMedSuche in Google Scholar
  • 4 Äsberg M, Traskman L, Thoren P. 5-HIAA in the cerebrospinal fluid. A biochemical suicide predictor? Arch Gen Psychiatry 1976; 33: 1193-1197.
    PubMedSuche in Google Scholar
  • 5 Äsberg M. Neurotransmitters and suicidal behavior. The evidence from cerebrospinal fluid studies. Ann NY Acad Sci 1997; 836: 158-181.
    CrossrefPubMedSuche in Google Scholar
  • 6 Batterham PJ, Christensen H, Calear AL. Anxiety symptoms as precursors of major depression and suicidal ideation. Depression and Anxiety 2013; 30: 908-916.
    PubMedSuche in Google Scholar
  • 7 Bernert RA, Turvey CL, Conwell Y, Joiner TE. Association of poor subjective sleep quality with risk for death by suicide during a 10-year period. A longitudinal, population-based study of late life. JAMA Psychiatry 2014; 71: 1129-1137.
    CrossrefPubMedSuche in Google Scholar
  • 8 Bernstein H-G, Tausch A, Wagner R, Steiner J, Seeleke P, Walter M, Dobrowolny H, Bogerts B. Disruption of glutamate-glutamine-GABA cycle significantly impacts on suicidal behaviour: survey of the literature and own findings on glutamine synthetase. CNS & Neurological Disorders – Drug Targets 2013; 12: 900-913.
    CrossrefPubMedSuche in Google Scholar
  • 9 Bolton JM, Gunnell D, Turecki G. Suicide risk assessment and intervention in people with mental illness. Br Med J 2015; 351: h4978.
    CrossrefPubMedSuche in Google Scholar
  • 10 Brent DA, Melhem NM, Oquendo M, Burke A, Birmaher B, Stanley B, Biernesser C, Keilp J, Kolko D, Ellis S, Porta G, Zelazny J, Iyengar S, Mann JJ. Familial pathways to early-onset suicide attempt. A 5.6-year prospective study. JAMA Psychiatry 2015; 72: 160-168.
    CrossrefPubMedSuche in Google Scholar
  • 11 Butler AM, Malone K. Attempted suicide v. nonsuicidal self-injury: behaviour, syndrome or diagnosis? Br J Psychiatry 2013; 202: 324-325.
    PubMedSuche in Google Scholar
  • 12 Christensen H, Cuijpers P, Reynolds III CF. Changing the direction of suicide prevention research. A necessity for true population impact. JAMA Psychiatry 2016; 73: 435-436.
    CrossrefPubMedSuche in Google Scholar
  • 13 Colom F, Vieta E, Daban C, Pacchiarotti I, Sánchez-Moreno J. Clinical and therapeutic implications of predominant polarity in bipolar disorder. J Affect Disord 2006; 93: 13-17.
    CrossrefPubMedSuche in Google Scholar
  • 14 Coryell W, Young EA. Clinical predictors of suicide in primary major depressive disorder. J Clin Psychiatry 2005; 66: 412-417.
    CrossrefPubMedSuche in Google Scholar
  • 15 Dazzi T, Gribble R, Wessely S, Fear NT. Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence?. Psychol Med 2014; 44: 3361-3363.
    CrossrefPubMedSuche in Google Scholar
  • 16 Döme P, Kapitány B, Ignits G, Rihmer Z. Season of birth is significantly associated with the risk of completed suicide. Biol Psychiatry 2010; 68: 148-155.
    CrossrefPubMedSuche in Google Scholar
  • 17 Dougall N, Lambert P, Maxwell M, Dawson A, Sinnott R, McCafferty S, Morris C, Clark D, Springbett A. Deaths by suicide and their relationship with general and psychiatric hospital discharge: 30-year record linkage study. Br J Psychiatry 2014; 204: 267-273.
    CrossrefPubMedSuche in Google Scholar
  • 18 Dwivedi Y. The neurobiological basis of suicide. Boca Raton: CRC Press; 2012
    Suche in Google Scholar
  • 19 Dwivedi Y. Serotonergic and noradrenergic neurotransmitter systems in suicide. In: Kaschka WP, Rujescu D. (eds.). Advances in Biological Psychiatry. Basle: Karger; 2016: 21-36.
    Suche in Google Scholar
  • 20 Egeland JA, Sussex JN. Suicide and family loading for affective disorders. J Am Med Ass 1985; 254: 915-918.
    CrossrefSuche in Google Scholar
  • 21 Finkelstein Y, Macdonald EM, Hollands S, Silvilotti MLA, Hutson JR, Mamdani MM, Koren G, Juurlink D. CDSERN Risk of suicide following deliberate self-poisoning. JAMA Psychiatry 2015; 72: 570-575.
    CrossrefPubMedSuche in Google Scholar
  • 22 Fountoulakis KN. et al. Relationship of suicide rates to economic variables in Europe: 2000–2011. Br J Psychiatry 2014; 205: 486-496.
    CrossrefPubMedSuche in Google Scholar
  • 23 Giegling I, Rujescu D. Genetics of suicidal behavior. In: Kaschka WP, Rujescu D. (eds.). Biological Aspects of Suicidal Behavior. Advances in Biological Psychiatry. Basle: Karger; 2016: 51-62.
    Suche in Google Scholar
  • 24 Green KL, Brown GK, Jager-Hyman S, Cha J, Steer RA, Beck AT. The predictive validity of the Beck Depression Inventory Suicide Item. J Clin Psychiatry 2015; 76: 1683-1686.
    CrossrefPubMedSuche in Google Scholar
  • 25 Hawgood J, De Leo D. Anxiety disorders and suicidal behaviour: an update. Curr Opin Psychiatry 2008; 21: 51-64.
    CrossrefPubMedSuche in Google Scholar
  • 26 Hodgkinson S, Jandl M, Kaschka WP. Increased levels of anxiety rather than depression are associated with the presentation of suicidal ideation in mildly-depressed women. Zur Publikation eingereicht
  • 27 Hodgkinson S, Steyer J, Kaschka WP, Jandl M. Electroencephalographic risk markers of suicidal behaviour. In: Kaschka WP, Rujescu D. (eds.). Biological aspects of suicidal behavior. Advances in Biological Psychiatry. Basle: Karger; 2016: 101-109.
    Suche in Google Scholar
  • 28 Holma KM, Melartin TK, Haukka J, Holma IAK, Sokero TP, Isometsä ET. Incidence and predictors of suicide attempts in DSM-IV major depressive disorder: a five-year prospective study. Am J Psychiatry 2010; 167: 801-808.
    CrossrefPubMedSuche in Google Scholar
  • 29 Høyer EH, Licht RW, Mortensen PB. Risk factors of suicide in inpatients and recently discharged patients with affective disorders. A case-control study. Eur Psychiat 2009; 24: 317-321.
    CrossrefPubMedSuche in Google Scholar
  • 30 Hunt IM, Kapur N, Webb R, Robinson J, Burns J, Shaw J, Appleby L. Suicide in recently discharged psychiatric patients: a case-control study. Psychol Med 2009; 39: 443-449.
    CrossrefPubMedSuche in Google Scholar
  • 31 Ilgen MA, Bohnert AS, Ignacio RV, McCarthy JF, Valenstein MM, Kim HM, Blow FC. Psychiatric diagnoses and risk of suicide in veterans. Arch Gen Psychiatry 2010; 67: 1152-1158.
    CrossrefPubMedSuche in Google Scholar
  • 32 Jandl M, Steyer J, Kaschka WP. Suicide risk markers in major depressive disorder: a study of electrodermal activity and event-related potentials. J Affect Disord 2010; 123: 138-149.
    CrossrefPubMedSuche in Google Scholar
  • 33 Kapur N, Cooper J, Connor RC, Hawton K. Nonsuicidal self-injury v. attempted suicide: new diagnosis or false dichotomy? Br J Psychiatry 2013; 202: 326-328.
    PubMedSuche in Google Scholar
  • 34 Kaschka WP, Rujescu D. (eds.). Biological aspects of suicidal behavior. Advances in Biological Psychiatry. Basle: Karger; 2016
    Suche in Google Scholar
  • 35 Kelleher I. et al. Psychotic symptoms and population risk for suicide attempt. A prospective cohort study. JAMA Psychiatry 2013; 70: 940-948.
    CrossrefPubMedSuche in Google Scholar
  • 36 Kessler RC. et al. Predicting suicides after psychiatric hospitalization in US army soldiers. The army study to assess risk and resilience in servicemembers (army STARRS). JAMA Psychiatry 2015; 72: 49-57.
    CrossrefPubMedSuche in Google Scholar
  • 37 Kim C, Jung SH, Kang DR, Kim HC, Moon KT, Hur NW, Shin DC, Suh I. Ambient particulate matter as a risk factor for suicide. Am J Psychiatry 2010; 167: 1100-1107.
    CrossrefPubMedSuche in Google Scholar
  • 38 Kim N, Mickelson JB, Brenner BE, Haws CA, Yurgelun-Todd DA, Renshaw PF. Altitude, gun ownership, rural areas, and suicide. Am J Psychiatry 2011; 168: 49-54.
    CrossrefPubMedSuche in Google Scholar
  • 39 King C, Senior J, Webb RT, Millar T, Piper M, Pearsall A, Humber N, Appleby L, Shaw J. Suicide by people in a community justice pathway: population-based nested case-control study. Br J Psychiatry 2015; 207: 175-176.
    CrossrefPubMedSuche in Google Scholar
  • 40 Kleiman EM, Liu RT. Prospective prediction of suicide in a nationally representative sample: religious service attendance as a protective factor. Br J Psychiatry 2014; 204: 262-266.
    CrossrefPubMedSuche in Google Scholar
  • 41 Koenig HG. Association of religious involvement and suicide. JAMA Psychiatry 2016; 73: 775-776.
    CrossrefPubMedSuche in Google Scholar
  • 42 Kohli MA. et al. Association of genetic variants in the neurotrophic receptor – encoding gene NTRK2 and a lifetime history of suicide attempts in depressed patients. Arch Gen Psychiatry 2010; 67: 348-359.
    CrossrefPubMedSuche in Google Scholar
  • 43 Krzyzanowska M, Steiner J, Karnecki K, Kaliszan M, Brisch R, Wiergowski M, Braun K, Jankowski Z, Gos T. Decreased ribosomal DNA transcription in dorsal raphe nucleus neurons differentiates between suicidal and non-suicidal death. Eur Arch Psychiatry Clin Neurosci 2016; 266: 217-224.
    CrossrefPubMedSuche in Google Scholar
  • 44 Le-Niculescu H. et al. Discovery and validation of blood biomarkers for suicidality. Mol Psychiatry 2013; 18: 1249-1264.
    CrossrefPubMedSuche in Google Scholar
  • 45 Levey DF. et al. Towards understanding and predicting suicidality in women: biomarkers and clinical risk assessment. Mol Psychiatry 2016; 1-18.
    PubMedSuche in Google Scholar
  • 46 Lindqvist D. et al. Interleukin-6 is elevated in the cerebrospinal fluid of suicide attempters and related to symptom severity. Biol Psychiatry 2009; 66: 287-292.
    CrossrefPubMedSuche in Google Scholar
  • 47 Logan J, Hall J, Karch D. Suicide categories by patterns of known risk factors. A latent class analysis. Arch Gen Psychiatry 2011; 68: 935-941.
    CrossrefPubMedSuche in Google Scholar
  • 48 Lukaschek K. et al. Determinants of completed railway suicides by psychiatric in-patients: case-control study. Br J Psychiatry 2014; 205: 398-406.
    CrossrefPubMedSuche in Google Scholar
  • 49 Lund-Sørensen H. et al. A nationwide cohort study of the association between hospitalization with infection and risk of death by suicide. JAMA Psychiatry 2016; 73: 912-919.
    CrossrefPubMedSuche in Google Scholar
  • 50 Lutz P-E. et al. Decreased expression of nociceptin/ orphanin FQ in the dorsal anterior cingulate cortex of suicides. Eur Neuropsychopharmacol 2015; 25: 2008-2014.
    CrossrefPubMedSuche in Google Scholar
  • 51 Maes M, De Meyer F, Thompson P, Peeters D, Cosyns P. Synchronized annual rhythms in violent suicide rate, ambient temperature and the lightdark span. Acta Psychiatr Scand 1994; 90: 391-396.
    CrossrefPubMedSuche in Google Scholar
  • 52 Mann JJ. Neurobiology of suicidal behaviour. Nat Rev Neurosci 2003; 04: 819-828.
    Suche in Google Scholar
  • 53 McGirr A, Alda M, Séguin M, Cabot S, Lesage A, Turecki G. Familial aggregation of suicide explained by cluster B traits: a three-group family study of suicide controlling for major depressive disorder. Am J Psychiatry 2009; 166: 1124-1134.
    CrossrefPubMedSuche in Google Scholar
  • 54 Mergl R. et al. Seasonality of suicide attempts: association with gender. Eur Arch Psychiatry Clin Neurosci 2010; 260: 393-400.
    CrossrefPubMedSuche in Google Scholar
  • 55 Milner A, Spittal MJ, Pirkis J, LaMontagne AD. Suicide by occupation: systematic review and meta-analysis. Br J Psych 2013; 203: 409-4016.
    CrossrefPubMedSuche in Google Scholar
  • 56 Mittendorfer-Rutz E, Rasmussen F, Wasserman D. Familial clustering of suicidal behaviour and psychopathology in young suicide attempters. A registerbased nested case control study. Soc. Psychiatry Psychiatr Epidemiol 2008; 43: 28-36.
    CrossrefPubMedSuche in Google Scholar
  • 57 Mulder R, Newton-Howes G, Coid JW. The futility of risk prediction in psychiatry. Br J Psychiatry 2016; 209: 271-272.
    CrossrefPubMedSuche in Google Scholar
  • 58 Nanri A. et al. Dietary patterns and suicide in Japanese adults: the Japan Public Health Center-based Prospective Study. Br J Psychiatry 2013; 203: 422-427.
    CrossrefPubMedSuche in Google Scholar
  • 59 Niculescu AB. et al. Understanding and predicting suicidality using a combined genomic and clinical risk assessment approach. Mol Psychiatry 2015; 20: 12166-1285.
    Suche in Google Scholar
  • 60 Niederkrotenthaler T. et al. Role of media reports in completed and prevented suicide: Werther v Papageno effects. Br J Psychiatry 2010; 197: 234-243.
    CrossrefPubMedSuche in Google Scholar
  • 61 O´Reilly D, Rosato M. Religion and the risk of suicide: longitudinal study of over 1 million people. Br J Psychiatry 2015; 206: 466-470.
    CrossrefPubMedSuche in Google Scholar
  • 62 Oquendo MA. et al. Toward a biosignature for suicide. Am J Psychiatry 2014; 171: 1259-1277.
    CrossrefPubMedSuche in Google Scholar
  • 63 Pabba M, Sibille E. GABA, depression and suicide. In: Kaschka WP, Rujescu D. (eds.). Biological aspects of suicidal behavior. In: Advances in Biological Psychiatry. Basle: Karger; 2016: 37-50.
    Suche in Google Scholar
  • 64 Pfennig A. et al. Hypothalamus-pituitary-adrenal system regulation and suicidal behaviour in depression. Biol Psychiatry 2005; 57: 336-342.
    CrossrefPubMedSuche in Google Scholar
  • 65 Pitman A. Romantic suicide. Br J Psychiatry 2015; 207: 122.
    CrossrefPubMedSuche in Google Scholar
  • 66 Pompili M, Gonda X, Serafini G, Innamorati M, Sher L, Amore M, Rihmer Z, Girardi P. Epidemiology of suicide in bipolar disorders: a systematic review of the literature. Bipolar Disorders 2013; 15: 457-490.
    CrossrefPubMedSuche in Google Scholar
  • 67 Pompili M. et al. Prädiktion des Suizidrisikos bei bipolar und unipolar depressiven Patienten. Nervenarzt 2009; 80: 315-323.
    CrossrefPubMedSuche in Google Scholar
  • 68 Postolache TT, Manalai P, Brenner LA, Brundin L. Inflammation and suicidal behavior. In: Kaschka WP, Rujescu D. (eds.). Biological aspects of suicidal behavior. In: Advances in Biological Psychiatry. Basle: Karger; 2016: 123-144.
    Suche in Google Scholar
  • 69 Reeves A, McKee M, Stuckler D. Economic suicides in the great recession in Europe and North America. Br J Psychiatry 2014; 205: 246-247.
    CrossrefPubMedSuche in Google Scholar
  • 70 Rivlin A, Hawton K, Marzano L, Fazel S. Psychiatric disorders in male prisoners who made nearlethal suicide attempts: case-control study. Br J Psychiatry 2010; 197: 313-319.
    CrossrefPubMedSuche in Google Scholar
  • 71 Roy A, Segal NL, Centerwall BS, Robinette CD. Suicide in twins. Arch Gen Psychiatry 1991; 48: 29-32.
    CrossrefPubMedSuche in Google Scholar
  • 72 Rujescu D, Kaschka IN, Kaschka WP. Challenges for future research and closing remarks. In: Kaschka WP, Rujescu D. (eds.): Biological Aspects of Suicidal Behavior. Advances in Biological Psychiatry. Basle: Karger; 2016: 161-163.
    Suche in Google Scholar
  • 73 Sareen J. et al. Anxiety disorders and risk for suicidal ideation and suicide attempts. A populationbased longitudinal study of adults. Arch Gen Psychiatry 2005; 62: 1249-1257.
    CrossrefPubMedSuche in Google Scholar
  • 74 Schmidtke A, Häfner H. The Werther effect after televison films: new evidence for an old hypothesis. Psychol Med 1988; 18: 665-676.
    CrossrefPubMedSuche in Google Scholar
  • 75 Schmitt J, Tuma T. “Wir müssen noch offener werden”. Der Spiegel 2010; 21: 63-65.
    Suche in Google Scholar
  • 76 Steck N, Egger M, Zwahlen M. Assisted and unassisted suicide in men and women: longitudinal study of the Swiss population. Br J Psychiatry 2016; 208: 484-490.
    CrossrefPubMedSuche in Google Scholar
  • 77 Steiner J, Gos T, Bogerts B, Bielau H, Drexhage HA, Bernstein H-G. Possible impact of microglial cells and the monocyte-macrophage system on suicidal behaviour. CNS & Neurological Disorders – Drug Targets 2013; 12: 971-979.
    CrossrefPubMedSuche in Google Scholar
  • 78 Sullivan GM. et al. Positron emission tomography quantification of Serotonin1A receptor binding in suicide attempters with major depressive disorder. JAMA Psychiatry 2015; 72: 169-178.
    CrossrefPubMedSuche in Google Scholar
  • 79 Turecki G. Epigenetics of suicidal behaviour. In: Kaschka WP, Rujescu D. (eds.). Biological aspects of suicidal behavior. Advances in Biological Psychiatry. Basle: Karger; 2016: 75-87.
    Suche in Google Scholar
  • 80 Ursano RJ. et al. Risk factors, methods, and timing of suicide attempts among US army soldiers. JAMA Psychiatry 2016; 73: 741-749.
    CrossrefPubMedSuche in Google Scholar
  • 81 VanderWeele TJ, Li S, Tsai AC, Kawachi I. Association between religious service attendance and lower suicide rates among US women. JAMA Psychiatry 2016; 73: 845-851.
    CrossrefPubMedSuche in Google Scholar
  • 82 Värnik P, Wassermann D. Global Suicide. In: Kaschka WP, Rujescu D. (eds.). Biological Aspects of Suicidal Behavior. Adances in Biological Psychiatry. Basel: Karger; 2016: 1-10.
    Suche in Google Scholar
  • 83 Vyssoki B, Kapusta ND, Praschak-Rieder N, Dorffner G, Willeit M. Direct effect of sunshine on suicide. JAMA Psychiatry 2014; 71: 1231-1237.
    CrossrefPubMedSuche in Google Scholar
  • 84 Webb RT, Qin P, Stevens H, Mortensen PB, Appleby L, Shaw J. National study of suicide in all people with a criminal justice history. Arch Gen Psychiatry 2011; 68: 591-599.
    CrossrefPubMedSuche in Google Scholar
  • 85 Wilkinson MD, Kelvin R, Roberts C, Dubicka B, Goodyer I. Clinical and psychosocial predictors of suicide attempts and nonsuicidal self-injury in the adolescent depression antidepressants and psychotherapy trial (ADAPT). Am J Psychiatry 2011; 168: 495-501.
    CrossrefPubMedSuche in Google Scholar
  • 86 Winther BMJohannsen. et al. All-cause mortality in women with severe postpartum psychiatric disorders. Am J Psychiatry 2016; 173: 635-642.
    CrossrefPubMedSuche in Google Scholar
  • 87 World Health Organization (WHO). Suicide prevention. A global challenge. www.who.int/men tal_health/suicide-prevention/exe_summary_english.pdf