Factors associated with suicide ideation in adults.

The study considers numerous factors potentially related to suicide ideation in adults, including life stress, stress perceptions, social support, personality, alcohol use, chronic conditions, distress symptoms and sociodemographic background. Using data from a health survey of 825 adult residents in the urban Reykjavik area of Iceland, the study finds that financial hardship, legal stress, family difficulties, stress perceptions and low material support are significantly related to thoughts of committing suicide. Multiple chronic conditions, frequent alcohol use and various forms of distress (e.g. depression, anxiety, hopelessness, pain) are also related to suicide ideation. Furthermore, low self-esteem and external locus of control (low sense of mastery) are both associated with suicidal thoughts. No significant relationships were found between sociodemographic background and suicide ideation. The meaning of the results, and their implications for continued theoretical and clinical work in this area, are discussed. Suicide research has primarily focused on completed suicides (e.g. Durkheim [1897] 1951; Fisher et al. 1993; Henry and Short 1954; Lester 1974; Pritchard 1996) or suicide attempts (e.g. Diekstra 1982; Maris 1981; Slap et al. 1989; Smith and Crawford 1986; Stack and Wasserman 1995). Relatively few studies have focused on thoughts of own death or suicide, or suicide planning. Nevertheless, there is a growing understanding that ideation and planning are important steps in a process of suicide, characterised by a stepwise hierarchy of actions with an underlying gradient of severity (Beck 1986; Bonner and Rich 1987; Diekstra 1993; Smith and Crawford 1986). Ideation precedes planning, which may result in an attempt leading to death. If nonfatal, the attempt may increase the likelihood of subsequent ideation, planning and attempt (see paths a-e in Fig. 1). It should therefore be of theoretical as well as clinical value to consider the risk factors associated with suicide ideation and planning.