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Purposely self-destructive conduct is often the final expression of thinking that has been distorted, narrowed, and made inflexible by prolonged and intolerable distress. The particular form that this distortion takes can often be accurately identified and reliably linked with an underlying mental disorder.
For example, major depressive episodes often lead to characteristic patterns of thinking in which the person has temporarily lost the capacity to imaginatively generate different courses of action in response to a situation. When reaching a conclusion, the depressed person often fails to examine all available information, makes noticeable errors in reasoning, and fails to check the conclusions that have been reached.
Among those who have schizophrenic or other psychotic disorders, thinking is highly influenced by inaccurate perceptions with unusual distortions that experienced clinicians quickly recognize. Those with borderline or similar personality disorders have creative but highly maladaptive ways of perceiving their world, interpreting what they experience, and reaching conclusions.
Adults with mental disorders characterized by significant cognitive distortions are at greater risk for suicidal conduct. (Children and adolescents having similar disorders are likely to face similarly elevated risks, but we aren't aware of studies that have demonstrated this.) Let's examine a study that vividly quantifies this elevated risk for adults.
This was a prospective study of 4,800 veterans who were admitted to the psychiatric inpatient unit of the Houston (Texas) Department of Veterans Affairs Medical Center. The veterans participated in a diagnostic evaluation that included a suicide risk assessment, and their status was tracked over the next 4-6 years. Diagnostic information about those who killed themselves were used to compute the suicidal death rates presented below. Remember that there are about 12 suicidal deaths per 100,000, per year, among all U.S. residents.
Overall, the veterans in this study had a rate of suicidal death (279 per 100,000) that is about 23 times greater than the risk among the general population (12 per 100,000). Those with the highest risk were white, non-married, male veterans, who had been admitted to an inpatient psychiatric unit, and had a diagnosis of a mood, schizophrenic, or substance use disorder. For those in this high-risk group, the rate of completed suicide during the 4-6 years of follow-up was 1,020 per 100,000.
Most individuals in this study were men, so results may not apply to women. All individuals were veterans, so results may not be applicable to non-veterans.
In explaining the limitations of suicide risk assessment, the author notes that "...by applying our ‘test’ for suicide, we correctly identified just over half of the 63 suicides, but at the cost of 1,206 false-positive identifications."
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