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People attempt suicide because they cannot bear their psychological pain and doubt it will ever get better, new research suggests.
Though that might sound intuitive, the new findings, published this month in the journal Suicide and Life-Threatening Behavior, contradict other hypotheses that suicide attempts are impulsive or a "cry for help."
"Our findings really converged on two motivations that applied to everyone who was in our study: unbearable psychological pain and hopelessness that things would ever get better," said study co-author E. David Klonsky, a psychologist at the University of British Columbia in Canada.
The findings could have implications for clinicians trying to identify which patients are most at risk for suicide, Klonsky said.
Past research has often focused on how demographics or genetics may play a role in suicide risk, Klonsky said. For instance, some research has shown that children with autism have a higher suicide risk, and recent studies have found a sharp rise in suicide among baby boomers. Depression is also linked to suicide. [Where is the suicide belt?]
But such broad generalizations don't provide useful guidance for clinicians to identify the patients who are most at risk.
To do so, researchers must first gain a better understanding of what makes people attempt suicide. Klonsky and psychology doctoral candidate Alexis May developed a questionnaire to understand suicide motivations, and then gave it to 120 people who had attempted suicide over the past three years in British Columbia.
Half of the people came from the general population and had a median age of 38 years, while the other half consisted of undergraduates with a median age of 21 years. Most had attempted suicide between one and three times, though at least one patient had made 15 attempts.
Overwhelmingly, people said they attempted suicide because of unbearable psychological distress they were hopeless would ever improve. Most had also been thinking about suicide for many years.
Contrary to the earlier theories, they did not show more impulsivity than the general population, and weren't likely to say the attempt was a cry for help.
The findings suggest that measures such as putting nets under bridges can prevent suicide not because they thwart an impulsive attempt at suicide. Instead, such impediments prevent suicide for a few minutes, hours or days — just enough time for people's mental states to incrementally improve until they can bear the pain a little longer and possibly get help, Klonsky said.
Yet there may be more to distinguishing those who think about suicide and those who attempt it. Other research has shown that people suffering from depression who do not attempt suicide may be just as unhappy and hopeless, but more scared of the idea than those who make attempts.
"Everything about our biology is to avoid pain, avoid injury, avoid death," Klonsky told LiveScience. "Even people who feel suicidal fortunately have a very hard time actually making an attempt."
But people who attempt suicide are less fearful of pain and death. People who have a history of cutting themselves, for instance, may be less afraid of attempting suicide than those who do not. Other research has shown that becoming habituated to the idea — by simply thinking often about it or by, for instance, walking along a high bridge while considering suicide — may also make people more likely to carry out an attempt, Klonsky said.
The new study also provides a tool to find those at risk because of psychological distress, hopelessness and a lack of fear of pain or death.
"We also think that a sense of connectedness to others — to family, to community, to friends — is an important protective factor that keeps people tied to life and wanting to live even if they have the hopelessness or the pain," Klonsky said.