Disciplinary fragmentation and nosological and semantic controversies have obscured the impressive advances made in the area of depressive disorders during the past decade. This article is an attempt to translate data derived from psychodynamic, sociobehavioral, and neurobiologic research into a clinically meaningful framework. We review ten models of depression with special emphasis on newer models supported by empirical and experimental studies, and present a new model, which incorporates and synthesizes findings from different schools. Depressive illness is conceptualized as the feedback interaction of three sets of variables at chemical, experiential, and behavioral levels with the diencephalon serving as the field of action.

https://jamanetwork.com/journals/PSYCH/articlepdf/491325/archpsyc_32_3_001.pdf

Overview of recent research in depression. Integration of ten conceptual models into a comprehensive clinical frame.

General population survey data are used to disaggregate the associations of substance use disorders with suicide attempts in order to evaluate a number of hypotheses about the processes leading to these associations. Data are from the US National Comorbidity Survey (1990-1992). Discrete-time survival analysis is used to study the effects of retrospectively reported temporally prior substance use, abuse, and dependence in predicting first onset of suicidal behavior. Alcohol and drug use predict subsequent suicide attempts after controlling for sociodemographics and comorbid mental disorders. Previous use is not a significant predictor among current nonusers. Abuse and dependence are significant predictors among users for three of the 10 substances considered (alcohol, inhalants, and heroin). The number of substances used is more important than the types of substances used in predicting suicidal behavior. Disaggregation shows that the effects of use are largely on suicidal ideation and nonplanned attempts among ideators. In comparison, the effects of use on suicide plans and planned attempts among ideators are not significant. Clinicians need to be aware that current substance use, even in the absence of abuse or dependence, is a significant risk factor for unplanned suicide attempts among ideators.

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Associations of Substance Use, Abuse, and Dependence with Subsequent Suicidal Behavior

Although the suicide rate has been relatively stable in the United States and other countries over the last decade, there has been a marked increase in suicide attempts. A review of English language studies between 1960 and 1971 documents the increases, their magnitude and characteristics. The striking international consistencies in the age, sex, personality of the attempters, as well as the social context and method of attempts, indicates that self-destruction in the young is a major public health problem for the 70s requiring new approaches at the level of primary prevention.

The epidemiology of suicide attempts, 1960 to 1971.

Alcohol and suicidal behavior.

The death certificates and coroners' reports for all suicides, undetermined causes of death, and questionable accidents were obtained from the Pennsylvania Department of Vital Statistics for 10- to 19-year-old residents of Allegheny County, Pennsylvania, from 1960 to 1983. During the 24-year study period, 159 cases of definite suicide and 38 cases of likely suicide were noted. The suicide rate increased markedly among youth during the study period, particularly among white males aged 15 to 19 years, and was not due to changes in classification procedures over time. The suicide rate by firearms increased much faster than the suicide rate by other methods (2.5 vs 1.7-fold). The proportion of suicide victims who had detectable blood alcohol levels rose 3.6-fold from 12.9% in 1968 to 1972 to 46.0% in 1978 to 1983. Suicide victims who used firearms were 4.9 times more likely to have been drinking than were those who used other methods of suicide. The availability of firearms and the increased use of alcohol among youth may have made a significant contribution to the increase in the suicide rate among the young.

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=jama&articleId=366759&pdfFileName=jama_257_24_026.pdf

Alcohol, firearms, and suicide among youth. Temporal trends in Allegheny County, Pennsylvania, 1960 to 1983.

A total of 34 patients were admitted to the hospital with wounds inflicted in suicide attempts, 29 were alcoholics Of these, 26 were intoxicated at the time of the suicide attempt Two behavioral syndromes and a high incidence of amnesia and denial (42%) were identified Seven patients with an "abreactive" syndrome made their attempts after becoming abruptly intoxicated These attempts occurred in the context of an interpersonal interaction with manifest anger, aggression, and hyperactivity These patients seldom sustained severe injuries Eleven patients with a "depressive syndrome of chronic intoxication" made their attempts after two weeks or more of excessive drinking during which they had increasing depression in mood, motor retardation, and withdrawal While the majority of these patients inflicted potentially fatal injuries such depressions are detectable and these suicides are potentially preventable

Demmie G. Mayfield

Papers

Alcoholism, Alcohol Intoxication, and Suicide Attempts