Neuroscientific Glance at Suicide

​​Might be thought-provoking for you to hear that most suicide attempters have at least one mental health condition. There is a great consensus that one of the most common underlying conditions which lead to suicide is depression (Lutz et al., 2017). Nine out of ten people who attempt suicide have at least one mental condition, and this rate surges up in the case of co-morbidities (Arsenault-Lapierre et al., 2004; Hegerl et al., 2016; Holmstrand et al., 2015). Pessimistic mood, isolation, hopelessness, avoidance and anhedonia can be valuable signs for getting preliminary support at this stage. Researchers have found that suicidal behaviour might be triggered in the presence of psychosis, alcoholism, personality disorders, and many affective disorders (Lutz et al., 2017).

 

The risk factors of suicide show an immense variety, which means having a mental condition is not the only predictive element. For instance, males choose more lethal ways to attempt suicide, therefore just being a male makes someone more likely to die from suicide in comparison to a female with the same degree of intention (Hegerl et al., 2016). Besides that, both lower and higher testosterone levels may also be the cause of suicidal behaviour in men (Lengvenyte et al., 2021). Having stressful life events, severe health conditions, emotional break-ups, unemployments and early traumatic events can also lead to suicidality; howbeit, having a close family member who took his/her own life might leave a huge impact (Fazel et al., 2020). Interestingly, children and adolescents who have lost their mom to suicide are more likely to attempt suicide than the children and adolescents who have lost their dad instead. The risks are higher and even more devastating for moms if their children die by suicide (Fazel et al., 2020). Here the biopsychosocial model provides more detailed depiction of suicide risk (see Figure 1).

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In terms of genetics, abnormal serotonin regulation is one of the most cardinal features of the suicidal brain. Arango et al. (2003) studied the different genetic aspects of serotonin processing in people with suicidal ideation and attempt. They have shown that both depressed and suicidal individuals had fewer serotonin transporter (5-HTT) sites in the prefrontal cortex, which is meant to elucidate poorer serotonergic activity (Underwood et al., 2018). The scarcity of serotonin might lead to low, anxious and depressed mood. Many scientific studies have demystified the incredible similarities between feeling depressed and suicidal. Although the suicidal brain has several unique features, Arango et al. (2003) claim that there is no specific gene to help us identify suicide at a glimpse. Instead, all the genetic components should be combined to distinguish suicidal risk accurately. Moreover, poor response inhibition and decision-making along with differences in default mode network, prefrontal and insular cortices are typical in the suicidal brain (see Figure 2; Lengvenyte et al., 2021). The insular cortex is particularly vital in suicide research. It communicates with emotion centres such as the amygdala and cingulate cortex, which may play a role in evoking harmful stimuli (Hwang et al., 2010; Lengvenyte et al., 2021; Peng et al., 2014). Thereby, the level of insular activity is important in estimating the lethality of suicidal attempts (Rizk et al., 2019). Further, Jollant et al. (2018) have unveiled that diminished caudate nucleus and putamen volume may indicate violent suicide attempts. Over and above, deterioration in the frontal grey matter volume is one the most prevalent finding of suicide attempts (Domínguez-Baleón et al., 2018; Hwang et al., 2010). Malfunctioning in the prefrontal region causes weakened abilities in decision-making, risk-reward assessment and social assessment. Jollant et al. (2008) have found that people who have attempted suicide in the past are more fragile towards social disapproval and more susceptible to follow negative emotions. After a while, such maladaptive ways to process psychological distress may eventually be the antecedent of suicidal behaviour (Meerwijk et al., 2013). There seem to be plenty of conditions in which suicide can be an issue, but they are unfortunately beyond the scope of this editorial. 

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When it comes to supporting people with persistent suicidal ideation, psychotherapeutic (Cognitive Behavioral Therapy, Dialectical Behavioral Therapy) and psychopharmacological interventions (Lithium, Clozapine, Ketamine, Selective Serotonin Reuptake Inhibitors, Buprenorphine) seem to be utile. In particular, people who receive CBT are estimated to become 50% to 60% more resilient to any suicidal attempt in the future (Barredo et al., 2021). Despite there are other interventions, such as; electroconvulsive therapy or transcranial magnetic stimulation, the two aforementioned interventions remain as most effective. Researchers also believe that it would be better to focus on depression first in the presence of multiple co-morbidities (Hegerl et al., 2016).

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Unfortunately, suicide rates are not recorded properly in low-income and developing countries. With whopping high rates, suicide is most commonly seen in Lesotho, Guyana, Eswatini; but sociocultural factors seem to matter as much as the country by itself. Fortunately, there are plenty of organisations in modern countries for people who are in need of psychological support. For example, the Department of Health and Social Care in the UK recently announced that they will provide a 5 million pounds fund to prevent suicide this year. Lastly, several organisations are providing help over the phone whilst dropping the suicide rates in the UK. So please do not hesitate to contact these organisations if you are in need.

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•‘111’, Option 2, is the NHS First Response Service for mental health crises and support.

•‘National Suicide Prevention Helpline UK’ – 24/7: Call 0800 689 5652.

•‘Campaign Against Living Miserably (CALM)’ – 5PM to midnight: Call 0800 58 58 58.

•‘Shout’ – 24/7 for texting: Text SHOUT to 85258

•‘Papyrus’ – 24/7, under 35s : Call 0800 068 4141, Text 07860039967 – https://www.papyrus-uk.org/

•‘Samaritans’ – 24/7: Call 116 123 – https://www.samaritans.org/

•‘Silence of Suicide’ – 8pm until Midnight, Monday to Friday: Call 0808 115 1505

•'Grassroots' – https://www.prevent-suicide.org.uk/about/contact/

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References available, email to learn more at info@erayertugrul.com