Risk Factors for Suicide, Presuicidal Syndrome, Crisis Intervention

1. Overview & Epidemiology

• Suicide = intentional, self-inflicted death — a human-specific behaviour with biological, psychological and social roots. Identification of the potentially suicidal patient is considered the most difficult task in psychiatry (Frecska, DE lecture).
• A complex, multicausal phenomenon: not a "normal" response to stress, nor a simple linear consequence of mental illness. Suicide and attempts are very rare in the absence of a current major mental disorder (Rihmer).

Hungarian / European epidemiology (exam context)

• Hungary historically has one of the highest suicide rates in the world. Debrecen lecture figures: ~24 / 100,000 completed suicides, M : F ≈ 3 : 1, ~3% of all mortality.
• Method (Hungary): ~50% by hanging, ~25% by overdose.
• Attempts ≈ 10× completed suicides — and there are many repeaters.
• ~2/3 of completers are unmarried. Rate is ~5× higher above age 70.
• Geography within Hungary: SE > NW, urban > rural.
• Suicide mortality in the high-baseline countries (incl. Hungary, Austria, Finland) declined substantially 1980–2000, attributed in part to wider antidepressant (SSRI-era) use and better treatment of mood disorders (Rihmer).
• EU/global gradients: Europe & North America > South/Central America, Asia > Arab countries. Lowest among Catholic, Muslim, Jewish populations; highest among Protestants (orthodoxy of belief probably matters more than denomination).

Sex, age and method

• Men complete ~3× more suicides; women attempt ~4× more. Men use more violent/lethal methods (the "gender paradox").
• Except for the 15–24 age group, completed suicide increases with age; men peak after ~45, women after ~55 (so completed-suicide rate does not fall with age — see 4.180).
• Suicide is the 2nd most common cause of death in young males (after accidents/homicide) — 4.183.
• The class distribution is V-shaped (lowest in the middle class) — 4.183.
• Physicians carry ~2× the general-population risk; female physicians especially elevated.

Examiner pearl: Hungary is the textbook "high baseline" country. Quote ~24/100,000, M:F 3:1, hanging as the leading method, and the post-1980s decline tied to better depression treatment.

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