Risk factors for suicide better identified

The risk factors for suicide are better identified through collective expertise of INSERM, making prevention of this behavior a public health priority in France.
Mental disorders: a significant risk factor
With nearly 11,000 deaths each year, France is one of the most affected by suicide industrialized countries. As part of their prevention programs, some countries such as Finland and Canada have integrated method of "psychological autopsy" to highlight certain risk factors that may lead to committing suicide. The technique is to reconstruct the psychological, social and medical history of a deceased person by suicide from gathering information from its surroundings.

At the request of the Directorate General of Health, Inserm convened a group of experts who conducted a review of international knowledge.

In France, the number of suicides represents about 2% of annual deaths. It is the second leading cause of death among 15-44 after traffic accidents and first in the 30-39 age group.

In 1999, the last year for which the prevalence is known, the rate in the general population were 26.1 / 100,000 for men and 9.4 for women. Moreover, there are strong geographic disparities, with an emphasis on the prevalence of suicide in areas north-west of France.

Suicide attempts are, in turn, at least 10 times more common than successful outputs and suicide gestures are often repeated.

Suicide and attempted suicide have often been described as distinct phenomena. However, it appears more and more as they are not independent of one another. History of suicide attempts are the best predictor of later completed suicide, experts said.

Numerous epidemiological investigations have established character that most suicides intervened in the context of mental disorder.

Very quickly analyzes consecutive series have confirmed the prevalence of mental disorders in suicidal behavior for at least 90% of cases, regardless of age or sex, compared to 10-30% in controls met . All problems are represented, major depression appears to play a leading role. As for the co-morbidity between mental disorders and substance abuse, it was around 38%.

Studies show that after 60 years the risk factors in men and women converge. Unipolar major depression was found in 77% of cases of an Irish investigation. Hardware problems (financial, ruptures) take up less space than younger. However, the feeling of loss of a loved one or an idea (that the family will always be there to support them), along with a history of suicidal behavior, as well as low social support, can cause major depressive episodes may lead to suicide.

Regarding studies on youth suicide (children and adolescents), it is found, as in adults, a high prevalence of mental disorders, but antisocial behavior (difficulty in submitting to discipline and / or non-compliance of law), as well as adverse events in life are present. A strong correlation has been reported with depression, bipolar disorder, alcohol abuse and also to various substances.

Biomarkers
The psychological autopsy can also benefit from the knowledge on biological markers of suicide.

There seems to be a part of the activity of three neurobiological systems in the pathophysiology of suicidal behavior:

- Malfunction of the serotonergic system that would be associated with disturbances of regulation of anxiety, impulsivity and aggression contributing risk factors known trait-dependent,

- Hyperactivity of the hypothalamic-pituitary-adrenal

- Excessive activity of the noradrenergic system

These two systems seem to participate in the reaction to stressful events and contribute to states dependent factors.

"From these data, we can hypothesize that the neurobiological dysfunctions could encourage the emergence of suicidal behavior disrupted by modulation of basic neuropsychological functions," wrote experts.