Some are biological that genetic and neurotransmitters may play a role in risk for suicide. Some are clinical that mental disorders, particularly mood disorders, schizophrenia, anxiety disorders and certain personality disorders contribute to suicidal behaviors. Some are psychosocial that lack of social support and sense of isolation also increase the risk of suicide (Suicide Prevention Resource Center, n.d.). These factors are important to understand why people have suicidal behaviors. For example, the suicides in Hong Kong can be explained by clinical and psychosocial factors which range from psychiatric illness and a history of past suicide attempt to unemployment and the absence of social support (Shuiyuan et al., 2006). Among different risk factors, major depression is a significant one that it is both the strongest risk factors for attempted suicide in adults and youths. People suffered from depression are at a greater potential to attempt suicide.
Let’s define depression for the purposes of subsequent discussion. It is the most common mental disorder. Clinical depression is generally acknowledged to be more serious than just sadness or normal depressed feelings. It is characterized by a severely depressed mood that persists at least two weeks, with at least five defining features (Robert, James & Susan, 1996). For example, people with depression may experience a lack of interest and pleasure in daily activities, significant weight loss or gain, insomnia or excessive sleeping, lack of energy, etc. The depressed mood often leads to constant negative thinking and sometimes substance abuse. Extreme depression can culminate in its sufferers attempting or recurrent thoughts of death and committing suicide.
The increased risk of suicide by depression is caused by its association with suicidal ideation. This depression-suicidal ideation link has been documented in research studies conducted with Asian adolescents. In a study of Korean high school students (Rebecca & Vivien, 2006), depression was found to be the strongest and most consistent predictor of suicidal behaviors. Students who had high scores on depression were 5.31 times more likely to report suicidal ideas and 3.19 times more likely to attempt suicide, as compared to those with low scores. It shows that depressed people have a higher chance to think about suicide whether or not they intend to act on these thoughts. The risky people to commit suicide, however, are not those who are severely depressed because they often do not have the energy to harm themselves. It is when their depression lifts and they gain increased energy that they may be more likely to attempt suicide.
Nevertheless, the link between depression and suicide attempt is not solely a direct causal relationship, but in fact, it is a complication of depressive illness in combination with other risk factors to trigger the suicide attempt. To begin with, stressful life events combined with depression may lead to suicide. Those stressful events often precede a suicide attempt. They may include death of a relative, breakup, loss of a job, etc. They are rarely a sufficient cause of suicide, but they often act as precipitating factors in young people (PreventionLane, .n.d.).
On the other hand, sociodemographic factors are often associated with depression. The combination of them brings about suicide attempt. For example, females are strongly associated with depression that they are more predisposed to depression compared to males. Females are also strongly related to suicide attempt that they are more likely to attempt suicide than males that there are three female attempts for each male attempt (Chris, 2010). Intriguingly, it shows that gender, as a sociodemographic factor, has influences on depression and suicide attempt as well. In other words, it is the antecedent that triggers the happening of depression and suicide attempt. The effect of gender on depression and suicide attempt may stem from gender stereotypes and identity roles (Christina, 2004). There are different social expectations for males and females that females are encouraged to express their feelings while males are not, hence increase the chances of depression being triggered by social factors, such as loss of friends. So females are more likely to suffer from depression, which in turn, lead to subsequent suicide attempt.
Besides gender, age also has a significant relationship with depression and suicide attempt. People in two age groups are more vulnerable to depression and suicide attempt which are adolescent and elderly respectively. Their risks of suicide are very high, especially the adolescent. Suicide of adolescent has become a global issue that they are now the group at highest risk in a third of countries, in both developed and developing countries (World Health Organization, n.d.). While in Hong Kong, the trend of adolescent suicide is on the rise in recent years with an average annual growth of 10%, while the first 8 months in 2010, youth suicide figures have been comparable with the 2009 full year figures. So far this year, there were 26 young people under 25 years old committed suicide cases and 30 cases of suicide attempt were rescued (The Samaritan Befrienders Hong Kong, 2010). For the suicide attempt of adolescents, depression is the major risk factor. There are a couple of reasons why adolescents develop depression. It can be family problem because they don’t have a good relationship with the parents. It may be a reaction to a disturbing event, such as a breakup with a boyfriend or girlfriend or failure at school. There is also a personality predisposition to depression. Adolescents who have low self-esteem and feel little sense of control over negative events are particularly at risk to become depressed when they experience stressful events.
There are some more sociodemographic characteristics that are potential risk factors for depression and suicidal attempt, such as marital status, sexual orientation and employment status. Divorced people, homosexuals and unemployed people are both found to be strongly linked to depression and suicide. These factors, combined with gender and age are crucial to understand the problem of suicide deeply and find out the kind of people who are vulnerable to suicide attempt
From another perspective, comorbid disorders in depression are also associated with suicide attempt. In one study investigating comorbid disorder in depression (James et al., 2010), specific comorbid anxiety, personality, and substance use disorders are found to be strongly associated with suicide attempt. For anxiety disorder, it is panic disorder comorbidity in depression to have a threefold increase of suicide attempt when compared to depression without panic disorder. Posttraumatic stress disorder is another comorbidity that associated with suicide attempt. Moreover, personality disorder comorbidity in depression also highlights the risk of suicide attempt. Borderline avoidant, paranoid, and schizoid personality disorders comorbid with depression are all associated with higher rates of suicide attempt. Especially borderline personality disorder, it increased the odds of suicide attempt by seven times.
Among the comorbid disorders in depression, substance use disorders are worthy for further discussion because it is the most common comorbidity in depression. People turn to drugs to help them feel better when they feel depressed and overwhelmed with life. It is a way of self-medicating which can lead to substance abuse. The chemical balance in the brain of the people will be affected by substance abuse, intensifying feelings of depression and sadness (Suicide Awareness Voices of Education. n.d.). It will wind up as a vicious circle that substance abuse leads to increasingly severe depression. The depressed mood contributes to suicidal thoughts and suicidal attempt. Therefore, substance abuse disorder comorbidity in depression is indeed a high risk factor for suicide attempt. After depressed people resort to substance abuse, their odds of suicide attempt will increase over time because they will become more depressed.
Last but not the least, a history of past suicidal ideation and previous suicide attempts are also strong risk factors for suicide attempts. They are one of the most consistently identified risk factors for future suicide attempts in depression (Sokero et al., 2005). A male attempted suicide in the past is more than thirty times more likely to complete suicide, while a female with a past attempt has about three times the risk (PreventionLane, .n.d.).
The combination of depression and other risk factors contribute to suicide attempt. Some sociodemographic factors such as gender and age is significant in the development of depression, which in turn, prompt the onset of suicide attempt. Comorbid disorders in depression also increases the risk of suicide attempt. These factors will be helpful to