Skip to main content


Suicide and Suicidal Behavior

Article metrics


Suicidal behavior is a major public health problem. As it has for decades, suicide remains one of the leading causes of death in the western world. This paper reviews the literature and the latest developments on the research and knowledge of suicide behavior and death from suicide.

The keywords: suicide, psychopathology, mental pain, impulsivity, aggression and communication difficulties were entered into databases: PubMed, PsychLit and ProQuest. Significant articles were scrutinized for relevant information.

According to WHO estimates for the year 2020, approximately 1.53 million people will die from suicide, and ten to 20 times more people will attempt suicide worldwide. These estimates represent on average one death every 20 seconds and one attempt every one to two seconds. Although of low predictive value, the presence of psychopathology is probably the single most important predictor of suicide. Accordingly, approximately 90 percent of suicide cases meet criteria for a psychiatric disorder, particularly major depression, substance use disorders, cluster B personality disorders and schizophrenia. Other more transient factors that reflect an imminent risk of suicide crisis and therefore require immediate intervention include unbearable mental pain and related experiences of depression and hopelessness. Problems with help-seeking, social communication and self-disclosure also pose a suicide risk, as do personality traits of aggression and impulsivity. All these factors are highly correlated with suicidal behavior across psychiatric samples and nosological borders.

Although suicidal behavior has been well studied, empirically and clinically, the definition of the different subtypes and phenotypes of suicidal behaviors and mechanisms underlying some of the risk factors (such as aggression, impulsivity, suicide intent) remain unclear. Reducing the increasing trend of suicide rates among the most vulnerable populations will require further research. Hopefully this review will contribute to the understanding of this phenomenon and to the development of preventive initiatives


  1. 1.

    Durkheim E. Suicide: A Study in Sociology. Spoulding JA, (translator). Simpson G, (editor). New York, NY: Free Press; 1897/1951.

  2. 2.

    Barraclough BM, Pallis DJ. Depression followed by suicide: a comparison of depressed suicides with living depressives. Psychol Med. 1975;5:55–61.

  3. 3.

    Beck AT, Steer RA, Kovacs M, Garrison B. Hopelessness and eventual suicide: a 10 year prospective study of patients hospitalized with suicidal ideation. Am J Psychiatry. 1985;142:559–63.

  4. 4.

    Fawcett J, Scheftner W, Clark D, Hedeker D, Gibbons R, Coryell W. Clinical predictors of suicide in patients with major affective disorders: a controlled prospective study. Am J Psychiatry. 1987;144:35–40.

  5. 5.

    Nock MK, Borges G, Bromet EJ, Alonso J, Angermeyer M, Beautrais A, et al. Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. Br J Psychiatry. 2008;192:98–105.

  6. 6.

    Shneidman ES. The Definition of Suicide. New York, NY and London: John Wiley and sons; 1985.

  7. 7.

    De Leo D, Burgis S, Bertolote JM, Kerkhof AJ, Bille-Brahe U. Definitions of suicidal behavior: lessons learned from the WHO/EURO multicentre study. Crisis. 2006;27:4–15.

  8. 8.

    O’Carroll PW, Berman AL, Maris RW, Moscicki EK, Tanney BL, Silverman MM. Beyond the tower of Babel: a nomenclature for suicidology. Suicide Life Threat Behav. 1996;26:237–52.

  9. 9.

    Silverman MM, Berman AL, Sanddal ND, O’Carroll PW, Joiner TE. Rebuilding the Tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. Part 1: Background, rationale, and methodology. Suicide Life Threat Behav. 2007; 37:248–63.

  10. 10.

    Silverman MM, Berman AL, Sanddal ND, O’Carroll PW, Joiner TE. Rebuilding the Tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors: Part 2: Suicide-related ideations, communications and behaviors. Suicide Life Threat Behav. 2007;37:264–77.

  11. 11.

    Heilbron N, Compton JS, Daniel SS, Goldston DB. The problematic label of suicide gesture: alternativesfor clinical research and practice. Prof Psychol Res Pr. 2010;41:221–7.

  12. 12.

    Van Orden KA, Witte TK, Cukrowicz KC, Braithwaite SR, Selby EA, Joiner TE Jr. The Interpersonal theory of suicide. Psychol Rev. 2010;117:575–600.

  13. 13.

    Apter A. Clinical aspects of suicidal behavior relevant to genetics. Eur Psychiatry. 2010;25:257–9.

  14. 14.

    Levi Y, Horesh N, Fischel T, Treves I, Or E, Apter A. Mental pain and its communication in medically serious suicide attempts: an “impossible situation” J Affect Disord. 2008;111:244–50.

  15. 15.

    World Health Organization. Suicide Prevention (SUPRE). WHO: 2007. Available from URL: (accessed 23 August 2012).

  16. 16.

    Center for Disease Control. Deaths, percent of total deaths, and death rates for the 15 leading causes of death: United States and each State, 2003. CDC: 2006. Available from URL: (accessed 23 August 2012).

  17. 17.

    Kung HC, Hoyert DL, Xu JQ, Murphy SL. Deaths: Final data for 2005. In: National Vital Statistics Reports, Volume 56. Hyattsville, MD: National Center for Health Statistics; 2008.

  18. 18.

    Cutcliffe JR. Research endeavours into suicide: a need to shift the emphasis. Br J Nurs. 2003;12:92–9.

  19. 19.

    Black DW, Bell S, Hulbert J, Nasrallah A. The importance of Axis II in patients with major depression. J Affect Disord. 1988;14:115–22.

  20. 20.

    Diaconu G, Turecki, G. Family history of suicidal behavior predicts impulsive-aggressive behavior levels in psychiatric outpatients. J Affect Disord. 2009;113:172–8.

  21. 21.

    Bertolote JM, Fleishman, A. A global perspective in the epidemiology of suicide. Suicidologi. 2002;7:6–8.

  22. 22.

    Vijayakumar L, Nagaraj K, Pirkis J, Whiteford H. Suicide in developing countries 1: frequency, distribution, and association with socioeconomic indicators. Crisis. 2005;26:104–11.

  23. 23.

    Nock MK, Borges G, Bromet EJ, Cha CB, Kessler RC, Lee S. Suicide and suicidal behavior. Epidemiol Rev. 2008;30:133–54.

  24. 24.

    Moscicki EK. Epidemiology of suicide. In: The Harvard Medical School Guide to Suicide Assessment and Intervention. Jacobs DG, (editor). Jossey-Bass; 1999, pp. 40–51.

  25. 25.

    Kessler RC, Berglund P, Borges G, Nock MK, Wang PS. Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990–1992 to 2001–2003. JAMA. 2005;293:2487–95.

  26. 26.

    Weissman MM, Bland RC, Canino GJ, Greenwald S, Hwu HG, Joyce PR, et al. Prevalence of suicide ideation and suicide attempts in nine countries. Psychol Med. 1999;29:9–17.

  27. 27.

    World Health Association. The WHO World Mental Health Surveys: Global Perspectives on the Epidemiology of Mental Disorders. Kessler RC, Ustun TB, (editors). Cambridge University Press; 2008.

  28. 28.

    World Bank. World Development Indicators 2003. The World Bank, 2003.

  29. 29.

    Gvion Y, Apter A. Aggression, impulsivity and suicide behavior: a review of the literature. Suicide Life Threat Behav. 2011;15:93–112.

  30. 30.

    Groholt B. & Ekeberg O. Prognosis after adolescent suicide attempt: mental health, psychiatric treatment, and suicide attempts in a nine-year follow-up study. Institute for Psychiatry at the University of Oslo. Suicide Life Threat Behav. 2009;39:125–36.

  31. 31.

    Renaud J, Berlim MT, McGirr A, Tousignant M, Turecki G. Current psychiatric morbidity, aggression/impulsivity, and personality dimensions in child and adolescent suicide: a case-control study. J Affect Disord. 2008;105:221–8.

  32. 32.

    Beautrais A. Suicide and serious suicide attempts in youth. A multiple-group comparison study. Am J Psychiatry. 2003;160:1093–9.

  33. 33.

    Becker DF, Grilo CM. Prediction of suicidality and violence in hospitalized adolescents: comparisons by sex. Can J Psychiatry. 2007;52:572–81.

  34. 34.

    Zhang J, Xiao S, Zhou L. Mental disorders and suicide among young rural Chinese: a case-control psychological autopsy study. Am J Psychiatry. 2010;167:773–81.

  35. 35.

    Kerkhof AJFM. Attempted suicide: Patterns and trends. In: The international handbook of suicide and attempted suicide. Hawton K, van Heeringen K. (editors). Chichester Wiley; 2000.

  36. 36.

    Symond CS, Taylor S, Tippins V, Tirkington D. Violent self-harm in schizophrenia. Suicide Life Threat Behav. 2006;36:44–9.

  37. 37.

    Soloff PH, Lis JA, Kelly T, Cornelius J, Ulrich R. Risk factors for suicidal behavior in borderline personality disorder. Am J Psychiatry. 1994;151:1316–23.

  38. 38.

    Brodsky BS, Groves SA, Oquendo MA, Mann JJ, Stanley B. Interpersonal precipitants and suicide attempts in borderline personality disorder. Suicide Life Threat Behav. 2006;36:313–22.

  39. 39.

    American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fourth edition, text revision: DSM-IV-TR. Washington, DC: APA; 2000.

  40. 40.

    Linehan MM, Cochran BN, Kehrer CA. Dialectical behavior therapy for borderline personality disorder. In: Clinical handbook of psychological disorders: A step-by-step treatment manual (3rd ed.). Barlow DH, (editor). New York, NY: Guilford; 2001, pp. 470–522.

  41. 41.

    Bergman B, Brismar B. Hormone levels and personality traits in abusive and suicidal male alcoholics. Alcohol Clin Exp Res. 1994;18:311–6.

  42. 42.

    Mezzich AC, Giancola PR, Tarter RE, Lu S, Parks SM, Barrett CM. Violence, suicidality, and alcohol/drug use involvement in adolescent females with psychoactive substance use disorder and controls. Alcohol Clin Exp Res. 1997;21:1300–7.

  43. 43.

    Suominen K, Isometsä E, Henriksson M, Ostamo A, Lönnqvist J. Hopelessness, impulsiveness and intent among suicide attempters with major depression, alcohol dependence or both. Acta Psychiatr Scand. 1997;96:142–9.

  44. 44.

    Wojnar M, Ilgen MA, Czyz E, Strobbe S, Klimkiewicz A, Jakubczyk A, et al. Impulsive and non-impulsive suicide attempts in patients treated for alcohol dependence. J Affect Disord. 2009;115:131–9.

  45. 45.

    Pompili M, Innamorati M, Lester D, Akiskal HS, Rihmer Z, del Casale A, et al. Substance abuse, temperament and suicide risk: evidence from a case-control study. J Addict Dis. 2009;28:13–20.

  46. 46.

    Arsenault-Lapierre G, Kim, C, Turecki G. Psychiatric diagnoses in 3275 suicides: a meta-analysis. BMC Psychiatry. 2004;4:37.

  47. 47.

    Cavanagh JT, Carson AJ, Sharpe M, Lawrie SM. Psychological autopsy studies of suicide: a systematic review. Psychol Med. 2003;33:395–405.

  48. 48.

    Conner KR, Swogger MT, Houston RJ. A test of reactive aggression-suicidal behavior hypotheses: Is there a case for proactive aggression? J Abnorm Psychol. 2009;118:235–40.

  49. 49.

    Romanov K, Hatakka M, Keskinen E, Laaksonen H, Kaprio J, Rose RJ, Koskenvuo M. Self-reported hostility and suicidal acts, accidents, and accidental deaths: a prospective study of 21,443 adults aged 25–59. Psychosom Med. 1994;56:328–36.

  50. 50.

    Mann JJ, Currier D. Biological predictors of suicidal behavior in mood disorders. In: Oxford Textbook of Suicide Prevention. A Global Perspective. Wasserman D, Wasserman C, (editors). Oxford University Press; 2009, pp. 335–41.

  51. 51.

    Mann JJ, Malone KM. Cerebrospinal fluid amines and higher lethality suicide attempts in depressed inpatients. Biol Psychiatry. 1997;41:162–71.

  52. 52.

    Ninan PT, van Kammen DP, Scheinin M, Linnoila M, Bunney WE Jr, Goodwin FK. CSF 5-hydroxyindoleacetic acid levels in suicidal schizophrenic patients. Am J Psychiatry. 1984;141:566–9.

  53. 53.

    Doihara C, Kawanishi C, Yamada T, Sato R, Hasegawa H, Furuno T, et al. Trait aggression in suicide attempters: a pilot study. Psychiatry Clin Neurosci. 2008;62:352–4.

  54. 54.

    Black DW, Bell S, Hulbert J, Nasrallah A. The importance of Axis II in patients with major depression. J Affect Disord. 1988;14:115–22.

  55. 55.

    McGlashan TH. Borderline personality disorder and unipolar affective disorder. J Nerv Ment Dis. 1987;175:467–73.

  56. 56.

    Dumais A, Lesage AD, Lalovic A, Séguin M, Tousignant M, Chawky N, Turecki G. Is violent method of suicide a behavioral marker of lifetime aggression? Am J Psychiatry. 2005;162:1375–8.

  57. 57.

    Conner KR, Duberstein PR, Conwell Y, Seidlitz L, Caine ED. Psychological vulnerability to completed suicide: a review of empirical studies. Suicide Life Threat Behav. 2001;31:367–85.

  58. 58.

    Soloff PH, Fabio A, Kelly TM, Malone KM, Mann JJ. High-lethality status in patients with borderline personality disorder. J Pers Disord. 2005;19:386–99.

  59. 59.

    Linehan MM. A social behavioral analysis of suicide and parasuicide: implications for clinical assessment and treatment. In: Depression: Behavioral and Directive Intervention Strategies. Glazer HG, Clarkin JF (editors). New York, NY: Garland Press; 1981, pp.229–94.

  60. 60.

    Linehan MM. Suicidal people. One population or two? In: Psychobiology of Suicidal Behaviour. Mann JJ, Stanely M, (editors). New York, NY: Annals of the New York Academy of Sciences; 1986, pp.16–33.

  61. 61.

    Becker DF, Grilo CM. Prediction of suicidality and violence in hospitalized adolescents: comparisons by sex. Can J Psychiatry. 2007;52:572–80.

  62. 62.

    Vermeiren R, Schwab-Stone M, Ruchkin VV, King RA, Van Heeringen C, Deboutte D. Suicidal behavior and violence in male adolescents: a school-based study. J Am Acad Child Adolesc Psychiatry. 2003;42:41–8.

  63. 63.

    Apter A, Gothelf D, Orbach I, Weizman R, Ratzoni G, Har-Even D, Tyano S. Correlation of suicidal and violent behavior in different diagnostic categories in hospitalized adolescent patients. J Am Acad Child Adolesc Psychiatry. 1995;34:912–8.

  64. 64.

    Plutchik R, van Praag HM. Suicide, impulsivity, and antisocial behavior. In: Handbook of Antisocial Behavior. Stoff DM, Breiling J, Maser JD, (editors). New York, NY: Wiley; 1997, pp.101–8.

  65. 65.

    Lambert SF, Copeland-Linder N, Ialongo, NS. Longitudinal associations’ between community violence exposure and suicidality. J Adolesc Health. 2008;43:380–6.

  66. 66.

    Rutz W, Rihmer Z. Suicide in men. suicide prevention for the male person. In: Oxford Textbook of Suicide Prevention. A Global Perspective. Wasserman D, Wasserman C, (editors). Oxford University Press; 2009, pp.249–55.

  67. 67.

    Wasserman D, Varnik A. Eklund G. Male suicides and alcohol consumption in the former USSR. Acta Psychiatr Scand. 1994;89:306–13.

  68. 68.

    Evenden J. Impulsivity: a discussion of clinical and experimental findings. J Psychopharmacol. 1999;13:180–192.

  69. 69.

    Whiteside SP, Lynam DR. Understanding the role of impulsivity and externalizing psychopathology in alcohol abuse: application of the UPPS Impulsive Behavior Scale. Exp Clin Psychopharmacol. 2003;11:210–7.

  70. 70.

    Horesh N, Rolnick T, Iancu I, Dannon P, Lepkifker E, Apter A, Kotler M. Anger, impulsivity, and suicide risk. Psychother Psychosom. 1997;66:92–6.

  71. 71.

    Horesh N, Gothelf D, Ofek H, Weizman T, Apter A. Impulsivity as a correlate of suicidal behavior in adolescent psychiatric inpatients. Crisis. 1999;20:8–14.

  72. 72.

    Wu CS, Liao SC, Lin KM, Tseng MM, Wu EC, Liu SK. Multidimensional assessments of impulsivity in subjects with history of suicidal attempts. Compr Psychiatry. 2009;50:315–21.

  73. 73.

    Giegling I, Olgiati P, Hartmann AM, Calati R, Möller HJ, Rujescu D, Serretti A. Personality and attempted suicide. Analysis of anger, aggression and impulsivity. J Psychiatr Res. 2009;43:1262–71.

  74. 74.

    Soloff PH, Lynch KG, Kelly TM, Malone KM, Mann JJ. Characteristics of suicide attempts of patients with major depressive episode and borderline personality disorder: a comparative study. Am J Psychiatry. 2000;157:601–8.

  75. 75.

    Zouk H, Tousignant M, Seguin M, Lesage A, Turecki G. Characterization of impulsivity in suicide completers: a clinical, behavioral and psychosocial dimensions. J Affect Disord. 2006;92:195–204.

  76. 76.

    Anestis MD, Selby EA, Joiner TE. The role of urgency in maladaptive behaviors. Behav Res Ther. 2007;45:3018–29.

  77. 77.

    Dougherty DM, Mathias CW, Marsh DM, Papageorgiou TD, Swann AC, Moeller FG. Laboratory-measured behavioral impulsivity relates to suicide. Suicide Life Threat Behav. 2004;34:374–85.

  78. 78.

    Baca-García E, Diaz-Sastre C, Basurte E, Prieto R, Ceverino A, Saiz-Ruiz J, de Leon J. A prospective study of the paradoxical relationship between impulsivity and lethality of suicide attempts. J Clin Psychiatry. 2001;62:560–4.

  79. 79.

    Dumais A, Lesage AD, Lalovic A, Séguin M, Tousignant M, Chawky N, Turecki G. Is violent method of suicide a behavioral marker of lifetime aggression? Am J Psychiatry. 2005;162:1375–8.

  80. 80.

    Maser JD, Akiskal HS, Schettler P, Scheftner W, Mueller T, Endicott J, et al. Can temperament identify affectively ill patients who engage in lethal or near lethal suicide behavior? A 14-year prospective study. Suicide Life Threat Behav. 2002;32:10–32.

  81. 81.

    Swann AC, Dougherty DM, Pazzaglia PJ, Pham M, Steinberg JL, Moeller FG. Increased impulsivity associated with severity of suicide attempt history in patients with bipolar disorder. Am J Psychiatry. 2005;162:1680–7.

  82. 82.

    Baca-Garcia E, Diaz-Sastre C, García Resa E, Blasco H, Braquehais Conesa D, Oquendo MA, et al. Suicide attempts and impulsivity. Eur Arch Psychiatry Clin Neurosci. 2005;255:152–6.

  83. 83.

    Beck AT, Beck R, Kovacs M. Classification of suicidal behaviors: quantifying intent and medical lethality. Am J Psychiatry. 1975;132:285–7.

  84. 84.

    Beck AT, Schuyler D, Herman I. Development of Suicide Intent Scales. In: The Prediction of Suicide. Beck AT, Resnick HLP, Lettieri D, (editors). Bowie, MD: Charles Press Publishers; 1974, pp. 45–56.

  85. 85.

    Hjelmeland H, Nordvik H, Bille-Brahe U, De Leo D, Kerkhof JF, Lönnqvist J, et al. A cross-cultural study of suicide intent in parasuicide patients. Suicide Life Threat Behav. 2000;30:295–303.

  86. 86.

    Freedenthal S. Assessing the wish to die: a 30-year review of the suicide intent scale. Arch Suicide Res. 2008;12:277–98.

  87. 87.

    Williams CL, Davidson JA, Montgomery I. Impulsive suicidal behavior. J Clin Psychol. 1980;36:90–4.

  88. 88.

    Dorpat TL, Ripley HS. A study of suicide in the Seattle area. Compr Psychiatry. 1960;1:349–59.

  89. 89.

    Li XY, Philips MR, Wang YP, et al. The comparison of impulsive and non-impulsive attempted suicide. Chinese J Psychiatry 2003;29:27–31. [in Chinese]

  90. 90.

    Brent DA. Correlates of the medical lethality of suicide attempts in children and adolescents. J Am Acad Child Adolesc Psychiatry. 1987;26:87–91.

  91. 91.

    Simon OR, Swann AC, Powell KE, Potter LB, Kresnow MJ, O’Carroll PW. Characteristics of impulsive suicide attempts and attempters. Suicide Life Threat Behav. 2001;32(1 Suppl):49–59.

  92. 92.

    Hawton K. Suicidal Behavior in Children and Adolescents. Newbury Park, CA: Sage; 1986.

  93. 93.

    Brent DA, Johnson B, Bartle S, Bridge J, Rather C, Matta J, et al. Personality disorder, tendency to impulsive violence and suicidal behavior in adolescents. J Am Acad Child Adolesc Psychiatry. 1993;32:69–75.

  94. 94.

    Brent DA, Bridge J, Johnson BA, Connolly J. Suicidal behavior runs in families. A controlled family study of adolescent suicide victims. Arch Gen Psychiatry. 1996;53:1145–52.

  95. 95.

    Carballo JJ, Oquendo MA, Giner L, Zalsman G, Roche AM, Sher L. Impulsive-aggressive traits and suicidal adolescents and young adults with alcoholism. Int J Adolesc Med Health. 2006;18:15–9.

  96. 96.

    Renaud J, Berlim MT, McGirr A, Tousignant M, Turecki G. Current psychiatric morbidity, aggression/impulsivity, and personality dimensions in child and adolescent suicide: a case-control study. J Affect Disord. 2008;105:221–8.

  97. 97.

    McGirr A, Renaud J, Bureau A, Seguin M, Lesage A, Turecki G. Impulsive-aggressive behaviors and completed suicide across the life cycle: a predisposition for younger age of suicide. Psychol Med. 2008;38:407–17.

  98. 98.

    Coccaro EF, Bergeman CS, Kavoussi RJ, Seroczynski AD. Heritability of aggression and irritability: A twin study of the Buss-Durkee Aggression Scales in adult male subjects. Biol Psychiatry. 1997;41:273–84.

  99. 99.

    Seroczynski AD, Bergeman CS, Coccaro EF. Etiology of the impulsivity/aggression relationship: Genes or environment? Psychiatry Res. 1999; 86:41–57.

  100. 100.

    Fulwiler C, Grossman H, Forbes C, Ruthazer R. Early-onset substance abuse and community violence by out-patients wuth chronic mental illness. Psychiatr Serv. 1997;48:1181–5.

  101. 101.

    Malone KM, Oquendo MA, Haas GL, Ellis SP, Li S, Mann JJ. Protective factors against suicidal acts in major depression: reasons for living. Am J Psychiatry. 2000;157:1084–8.

  102. 102.

    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;166:1124–34.

  103. 103.

    Conner KR, Swogger MT, Houston RJ. A test of reactive aggression- suicidalbehavior hypotheses: is there a case for proactive aggression? J Abnorm Psychol. 2009;118:235–40.

  104. 104.

    Michaelis BH, Goldberg JF, Davis GP, Singer TM, Garno JL, Wenze SJ. Dimensions of impulsivity and aggression associated with suicide attempts among bipolar patients: a preliminary study. Suicide Life Threat Behav. 2004;34:172–6.

  105. 105.

    Shneidman ES. Suicide as Psychache: A Clinical Approach to Self-Destructive Behavior. Northvale, NJ: Jason Aronson; 1993.

  106. 106.

    Orbach I, Mikulincer M, Sirota P, Gilboa-Schechtman E. Mental pain: a multidimensional operationalization and definition. Suicide Life Threat Behav. 2003;33:219–30.

  107. 107.

    Brown MZ, Comtois KA, Linehan MM. Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorder. J Abnorm Psychol. 2002;111:198–202.

  108. 108.

    Joiner TE, Van Orden KA, Witte TK, Selby EA, Ribiero J, Lewis R, et al. Acquired capability for suicidal behavior and its interaction with burdensomeness and belongingness to predict suicide attempts. J Abn Psych 2009;118:6.

  109. 109.

    Frattaroli J. Experimental disclosure and its moderators: a meta-analysis. Psychol.Bull. 2006;132:823.

  110. 110.

    Frisina PG, Borod JC, Lepore SJ. A meta-analysis of the effects of written emotional disclosure on the health outcomes of clinical populations. J Nerv Ment Dis. 2004;192:629–34.

  111. 111.

    Dervic K, Brent DA, Oquendo MA. Completed suicide in childhood. Psychiatr Clin North Am. 2008;31:271–91.

  112. 112.

    Dejong TM, Overholser JC, Stockmeier CA. Apples to oranges? A direct comparison between suicide attempters and suicide completers. J Affect Disord. 2010;124:90–7.

  113. 113.

    Joiner TE. Why People Die by Suicide. Cambridge, MA: Harvard University Press; 2005.

  114. 114.

    Witte TK, Merrill KA, Stellrecht NE, Bernert RA, Hollar DL, Schatschneider C, Joiner TE Jr. Impulsive youth suicide attempters are not necessarily all that impulsive. J Affect Disord. 2008;107:107–16.

  115. 115.

    Speckens AE, Hawton K. Social problem solving in adolescents with suicidal behavior: a systematic review. Suicide Life Threat Behav 2005;35:365–87.

  116. 116.

    Stanley B, Brown G, Brent DA, Wells K, Poling K, Curry J, et al. Cognitive-behavioral therapy for suicide prevention (CBT-SP): treatment model, feasibility, and acceptability. J Am Acad Child Adolesc Psychiatry. 2009;48:1005–13.

  117. 117.

    Vitiello B, Brent DA, Greenhill LL, Emslie G, Wells K, Walkup JT, et al. Depressive symptoms and clinical status during the Treatment of Adolescent Suicide Attempters (TASA) Study. J Am Acad Child Adolesc Psychiatry. 2009;48:997–1004.

  118. 118.

    Jessor RF. In: Adolescents and Risk: Behaviors, Functions, and Protective Factors (English translation). Bonino S, Cattelino E, Ciairano S, (editors). New York, NY: Springer; 2005, pp. 5–51.

  119. 119.

    Williams JMG. Cry of Pain: Understanding Suicide and Self-Harm. London: Penguin Books; 1997.

Download references

Author information

Correspondence to Yari Gvion PhD.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Gvion, Y., Apter, A. Suicide and Suicidal Behavior. Public Health Rev 34, 9 (2012) doi:10.1007/BF03391677

Download citation


  • suicide
  • suicidal behavior
  • impulsivity
  • aggression
  • mental pain
  • communication difficulties