Abnormal Psychology

Mood Disorders and Suicide 239

In 2007, U.S. soldiers on active duty in Iraq and

Afghanistan attempted or committed suicide at

the highest level since records for military

personnel began to be kept in 1980 (Priest, 2008).

On average, fi ve soldiers attempted suicide every

day. Reasons for the high suicide rate include the

strain on family relationships caused by long and

repeated tours of duty, combat-related stress, and

legal and fi nancial problems. The Army’s suicide

prevention efforts include hiring additional men-

tal health providers and instituting a program to

teach junior Army leaders how to recognize signs

of suicide intention in their troops and how to then

intervene (Tyson, 2008).

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among those who commit suicide is fi ve to one in some Eastern European coun-

tries and up to ten to one in Puerto Rico (WHO, 1999). This pattern of more men

than women committing suicide is the rule, but there are exceptions. In India, the

suicide rate for men and women is about the same (Mayer & Ziaian, 2002). And

in China, particularly in rural areas, women are more likely to commit suicide

than men (Ji, Kleinman, & Becker, 2001; Jianlin, 2000; Phillips, Li, & Zhang,

2002). Several explanations have been proposed for China’s unique pattern. One

is that Chinese women use more lethal methods (such as ingesting insecticides)

than non-Chinese women do. In addition, medical facilities are widely scattered

in rural China, so even if a woman were found by a friend or family member

after she took the poison, there might not be enough time to get her to medi-

cal help (Phillips, 2001). Another explanation is that in rural China women are

viewed as far inferior to men, leading to a sense of greater frustration and hope-

lessness among some women (Qin & Mortensen, 2001).

What might explain the gender differences in suicide rates in general? One

possibility is that socially related protective factors may be more common or

effective among women; that is, women may have better support systems, greater

emotional awareness, and may be more willing to seek help (Canetto, 1992;

De Leo, 2002a).

FEEDBACK LOOPS IN ACTION: Suicide

Suicide can best be understood as arising from the confl uence of neurological,

psychological, and social factors. A neurological vulnerability, such as abnormal

neurotransmitter functioning, serves as the backdrop. Add to that the psycho-

logical factors: depression or feelings of hopelessness, beliefs about suicide, poor

coping skills, and perhaps impulsive or violent personality traits. In turn, these

factors affect, and are affected by, social and cultural forces—such as economic

realities, wars, cultural beliefs and norms about suicide, re-

ligion, stressful life events, and social support. The dynamic

balance among all these factors will infl uence the likelihood

of an individual’s suicidal ideation, plans, and behavior

(Sánchez, 2001; Wenzel et al., 2009). Figure 6.8 summa-

rizes the factors that may contribute to suicide, as well as

the feedback loops between them.

Preventing Suicide

Suicide prevention efforts can focus on immediate safety or

longer-term prevention. Immediate crisis intervention pro-

vides resources to help people when they are on the verge of

committing suicide; for example, suicide hotlines are avail-

able for people who are seriously contemplating killing them-

selves. Longer-term interventions can help those at increased

risk—people who have attempted suicide in the past. Preven-

tion can also encompass treating related disorders, such as substance abuse, which

in turn is associated with increased impulsivity and poor judgment. Such prevention

efforts can target all three types of factors: neurological, psychological, and social.

As we saw with the treatment of mood disorders, successfully changing one type of

factor leads to changes in the others.

However, it is diffi cult to gauge the success of suicide prevention efforts. In

the usual studies that evaluate treatments of DSM-IV-TR clinical disorders, po-

tential participants can be identifi ed through a clinical interview or questionnaire

and assigned to a treatment group or a control group. However, there are many

stumbling blocks in using similar research designs to evaluate suicide prevention

methods. It’s not clear, for instance, which participants should be included in a

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