A Novel Therapy for People Who Attempt Suicide and Why We Need New Models of Suicide

Konrad Michel, Ladislav Valach, Anja Gysin-Maillart, Konrad Michel, Ladislav Valach, Anja Gysin-Maillart

Abstract

This paper presents a model of suicidal behaviour based on suicide as a goal-directed action, and its implications. An action theoretical model has guided the authors in the development of a brief therapy for individuals who attempt suicide (ASSIP-Attempted Suicide Short Intervention Program). Key elements are an early therapeutic alliance, narrative interviewing, psychoeducation, a joint case conceptualization, safety planning, and regular letters over 24 months. In a randomized controlled trial, ASSIP was highly effective in reducing the risk of suicide reattempts. The therapeutic elements in this treatment are described and possible implications for future directions in clinical suicide prevention discussed.

Keywords: action theory; attempted suicide; narrative interview; psychotherapy; suicide; suicide prevention.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The treatment model of ASSIP, illustrating that safety strategies can switch off the suicidal mode at various stages in the development of the suicidal mode.

References

    1. Maris R. Pathways to Suicide: A Survey of Self-Destructive Behaviors. The Johns Hopkins University Press; Baltimore, MD, USA: 1981.
    1. Durkheim E. Le suicide: Etude de Sociologie (Suicide: A Sociological Study) Félix Alcan; Paris, France: 1897.
    1. Mann J.J., McBride P.A., Brown R.P., Linnoila M., Leon A.C., DeMeo M., Mieczkowski T., Myers J.E., Stanley M. Relationship between central and peripheral serotonin indexes in depressed and suicidal psychiatric inpatients. Arch. Gen. Psychiatry. 1992;49:442–446.
    1. Rihmer Z. Suicide risk in mood disorders. Curr. Opin. Psychiatry. 2007;20:17–22. doi: 10.1097/YCO.0b013e3280106868.
    1. Borges G., Nock M.K., Haro Abad J.M., Hwang I., Sampson N.A., Alonso J., Andrade L.H., Angermeyer M.C., Beautrais A., Bromet E., et al. Twelve-month prevalence of and risk factors for suicide attempts in the world health organization world mental health surveys. J. Clin. Psychiatry. 2010;71:1617–1628. doi: 10.4088/JCP.08m04967blu.
    1. De Leo D. Why are we not getting any closer to preventing suicide? Br. J. Psychiatry. 2002;181:372–374. doi: 10.1192/bjp.181.5.372.
    1. Bertolote J.M., Fleischmann A., De Leo D., Wasserman D. Suicide and mental disorders: Do we know enough? Br. J. Psychiatry. 2003;183:382–383. doi: 10.1192/bjp.183.5.382.
    1. Kapusta N.D., Niederkrotenthaler T., Etzersdorfer E., Voracek M., Dervic K., Jandl-Jager E., Sonneck G. Influence of psychotherapist density and antidepressant sales on suicide rates. Acta Psychiatr. Scand. 2009;119:236–242. doi: 10.1111/j.1600-0447.2008.01314.x.
    1. Pacchiarotti I., Bond D.J., Baldessarini R.J., Nolen W.A., Grunze H., Licht R.W., Post R.M., Berk M., Goodwin G.M., Sachs G.S., et al. The international society for bipolar disorders (ISBD) task force report on antidepressant use in bipolar disorders. Am. J. Psychiatry. 2013;170:1249–1262. doi: 10.1176/appi.ajp.2013.13020185.
    1. Van Praag H.M. A stubborn behaviour: The failure of antidepressants to reduce suicide rates. World J. Biol. Psychiatry. 2003;4:184–191. doi: 10.1080/15622970310029917.
    1. Cipriani A., Hawton K., Stockton S., Geddes J.R. Lithium in the prevention of suicide in mood disorders: Updated systematic review and meta-analysis. BMJ. 2013;346:f3646. doi: 10.1136/bmj.f3646.
    1. De Leo D. Suicide prevention is far more than a psychiatric business. World Psychiatry. 2004;3:155–156.
    1. Jobes D.A. Collaborating to prevent suicide: A clinical-research perspective. Suicide Life Threat. Behav. 2000;30:8–17.
    1. Linehan M.M. Suicide intervention research: A field in desperate need of development. Suicide Life Threat. Behav. 2008;38:483–485. doi: 10.1521/suli.2008.38.5.483.
    1. Hjelmeland H., Knizek B.L. Why we need qualitative research in suicidology. Suicide Life Threat. Behav. 2010;40:74–80. doi: 10.1521/suli.2010.40.1.74.
    1. Brown G.K., Ten Have T., Henriques G.R., Xie S.X., Hollander J.E., Beck A.T. Cognitive therapy for the prevention of suicide attempts: A randomized controlled trial. JAMA. 2005;294:563–570. doi: 10.1001/jama.294.5.563.
    1. Rudd M.D., Bryan C.J., Wertenberger E.G., Peterson A.L., Young-McCaughan S., Mintz J., Williams S.R., Arne K.A., Breitbach J., Delano K., et al. Brief cognitive-behavioral therapy effects on post-treatment suicide attempts in a military sample: Results of a randomized clinical trial with 2-year follow-up. Am. J. Psychiatry. 2015;172:441–449. doi: 10.1176/appi.ajp.2014.14070843.
    1. Linehan M.M., Armstrong H.E., Suarez A., Allmon D., Heard H.L. Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Arch. Gen. Psychiatry. 1991;48:1060–1064. doi: 10.1001/archpsyc.1991.01810360024003.
    1. Jobes D.A. The collaborative assessment and management of suicidality (CAMS): An evolving evidence-based clinical approach to suicidal risk. Suicide Life Threat. Behav. 2012;42:640–653. doi: 10.1111/j.1943-278X.2012.00119.x.
    1. Zalsman G., Hawton K., Wasserman D., van Heeringen K., Arensman E., Sarchiapone M., Carli V., Hoschl C., Barzilay R., Balazs J., et al. Suicide prevention strategies revisited: 10-Year systematic review. Lancet Psychiatry. 2016;3:646–659. doi: 10.1016/S2215-0366(16)30030-X.
    1. Hetrick S.E., Robinson J., Spittal M.J., Carter G. Effective psychological and psychosocial approaches to reduce repetition of self-harm: A systematic review, meta-analysis and meta-regression. BMJ Open. 2016;6:e011024. doi: 10.1136/bmjopen-2016-011024.
    1. Michel K., Dey P., Valach L. Suicide as goal-directed action. In: Heeringen K.V., editor. Understanding Suicidal Behaviour: The Suicidal Process Approach to Research and Treatment. Wiley & Sons; Chichester, UK: 2001.
    1. Downs M.F., Eisenberg D. Help seeking and treatment use among suicidal college students. J. Am. Coll. Health. 2012;60:104–114. doi: 10.1080/07448481.2011.619611.
    1. Michel K., Valach L., Waeber V. Understanding deliberate self-harm: The patients’ views. Crisis. 1994;15:172–178.
    1. Renaud J., Berlim M.T., Seguin M., McGirr A., Tousignant M., Turecki G. Recent and lifetime utilization of health care services by children and adolescent suicide victims: A case-control study. J. Affect. Disord. 2009;117:168–173. doi: 10.1016/j.jad.2009.01.004.
    1. Isometsä E.T., Heikkinen M.E., Marttunen M.J., Henriksson M.M., Aro H.M., Lönnqvist J.K. The last appointment before suicide: Is suicide intent communicated? Am. J. Psychiatry. 1995;152:919–922.
    1. Pirkis J., Burgess P. Suicide and recency of health care contacts. A systematic review. Br. J. Psychiatry. 1998;173:462–474. doi: 10.1192/bjp.173.6.462.
    1. Wolk-Wasserman D. Contacts of suicidal neurotic and prepsychotic/psychotic patients and their significant others with public care institutions before the suicide attempt. Acta Psychiatr. Scand. 1987;75:358–372. doi: 10.1111/j.1600-0447.1987.tb02803.x.
    1. Apter A., Horesh N., Gothelf D., Graffi H., Lepkifker E. Relationship between self-disclosure and serious suicidal behavior. Compr. Psychiatry. 2001;42:70–75. doi: 10.1053/comp.2001.19748.
    1. Murphy G.E. The physician’s responsibility for suicide. II. Errors of omission. Ann. Intern. Med. 1975;82:305–309.
    1. Shea S. The delicate art of eliciting suicidal ideation. Psychiatr. Ann. 2004;34:374–400. doi: 10.3928/0048-5713-20040501-19.
    1. Michel K. Suicide and suicide prevention. Could the physician do more? Results of a questionnaire of relatives of suicide attempters and suicide victims. Schweiz. Med. Wochenschr. 1986;116:770–774.
    1. Kurz A., Möller H.J. Help-seeking behavior and compliance of suicidal patients. Psychiatr. Prax. 1984;11:6–13.
    1. Fawcett J., Scheftner W.A., Fogg L. Predictive factors of post-discharge follow-up care among adolescent suicide attempters. Acta Psychiatr. Scand. 2001;104:31–36.
    1. Monti K., Cedereke M., Ojehagen A. Treatment attendance and suicidal behavior 1 month and 3 months after a suicide attempt: A comparison between two samples. Arch. Suicide Res. 2003;7:167–174. doi: 10.1080/13811110301581.
    1. Treolar A.J., Pinfold T.J. Deliberate self-harm: An assessment of patients’ attitudes to the care they receive. Crisis. 1993;14:83–89.
    1. Michel K., Valach L. Suicide as goal-directed action. Arch. Suicide Res. 1997;3:213–221. doi: 10.1080/13811119708258273.
    1. Gollwitzer P.M. The volitional benefits of planning. In: Gollwitzer P.M., Bargh J.A., editors. The Psychology of Action. Linking Cognition and Motivation to Behavior. The Guilford Press; New York, NY, USA: 1996.
    1. Valach L., Michel K., Young R.A., Dey P. Attempted suicide stories: Suicide career, suicide project and suicide action. In: Valach L., Young R.A., Lynam M.J., editors. Action Theory Primer for Applied Research in the Social Sciences. Praeger; Westport, CT, USA: 2002. pp. 153–171.
    1. Maltsberger J.T. The descent into suicide. Int. J. Psychoanal. 2004;85:653–668. doi: 10.1516/3C96-URET-TLWX-6LWU.
    1. Tornblom A.W., Werbart A., Rydelius P.A. Shame behind the masks: The parents’ perspective on their sons’ suicide. Arch. Suicide Res. 2013;17:242–261. doi: 10.1080/13811118.2013.805644.
    1. Valach L., Michel K., Young R.A. Suicide as a distorted goal-directed process: Wanting to die, killing, and being killed. J. Nerv. Ment. Dis. 2016;204:812–819. doi: 10.1097/NMD.0000000000000528.
    1. Adler H.M. The history of the present illness as treatment: Who’s listening, and why does it matter? J. Am. Board Fam. Pract. 1997;10:28–35.
    1. Valach L., Young R.A., Lynam M.J. Action Theory: A Primer for Applied Research in the Social Sciences. Praeger; Westport, CT, USA: 2002.
    1. Alexander L.B., Luborsky L. The penn helping alliance scales. In: Greenberg L.S., Pinsoff W.M., editors. The Psychotherapeutic Process: A Research Handbook. Guilford Press; New York, NY, USA: 1986. pp. 325–366.
    1. Michel K., Dey P., Stadler K., Valach L. Therapist sensitivity towards emotional life-career issues and the working alliance with suicide attempters. Arch. Suicide Res. 2004;8:203–213. doi: 10.1080/13811110490436792.
    1. The Aeschi Working Group Meeting the Suicidal Person. [(accessed on 27 February 2017)]. Available online:
    1. Michel K., Maltsberger J.T., Jobes D.A., Leenaars A.A., Orbach I., Stadler K., Dey P., Young R.A., Valach L. Discovering the truth in attempted suicide. Am. J. Psychother. 2002;56:424–437.
    1. Horvath A.O., Symonds B.D. Relation between working alliance and outcome in psychotherapy: A meta-analysis. J. Couns. Psychol. 1991;38:139–149. doi: 10.1037/0022-0167.38.2.139.
    1. Saltzman C., Luetgert M.J., Roth C.H., Creaser J., Howard L. Formation of a therapeutic relationship: Experiences during the initial phase of psychotherapy as predictors of treatment duration and outcome. J. Consult. Clin. Psychol. 1976;44:546–555. doi: 10.1037/0022-006X.44.4.546.
    1. Zuroff D.C., Blatt S.J., Sotsky S.M., Krupnick J.L., Martin D.J., Sanislow C.A., III, Simmens S. Relation of therapeutic alliance and perfectionism to outcome in brief outpatient treatment of depression. J. Consult. Clin. Psychol. 2000;68:114. doi: 10.1037/0022-006X.68.1.114.
    1. Allen J.G., Fonagy P., Bateman A. Mentalizing in Clinical Practice. American Psychiatric Publishing; Washington, DC, USA: 2008.
    1. Hermans H.J., Hermans-Jansen E. Self-Narratives. Guilford; New York, NY, USA: 1995.
    1. Young R.A., Valach L., Dillabough J.-A., Dover C., Matthes G. Career research from an action perspective: The self-confrontation procedure. Career Dev. Q. 1994;43:185–196. doi: 10.1002/j.2161-0045.1994.tb00857.x.
    1. Valach L., Michel K., Dey P., Young R.A. Self-confrontation interview with suicide attempters. Couns. Psychol. Q. 2002;15:1–22. doi: 10.1080/09515070110101487.
    1. Michel K., Gysin-Maillart A. ASSIP—Attempted Suicide Short Intervention Program. A Manual for Clinicians. Hogrefe Publishing; Göttingen, Germany: 2015.
    1. National Institute of Mental Health and the Research Prioritization Task Force . A Prioritized Research Agenda for Suicide Prevention: An Action Plan to Save Lives. National Action Alliance for Suicide Prevention; Rockville, MD, USA: 2014.
    1. Lizardi D., Stanley B. Treatment engagement: A neglected aspect in the psychiatric care of suicidal patients. Psychiatr. Serv. 2010;61:1183–1191. doi: 10.1176/ps.2010.61.12.1183.
    1. Runeson B.S. Suicide after parasuicide. BMJ. 2002;325:1125–1126. doi: 10.1136/bmj.325.7373.1125/a.
    1. Hawton K., Zahl D., Weatherall R. Suicide following deliberate self-harm: Long-term follow-up of patients who presented to a general hospital. Br. J. Psychiatry. 2003;182:537–542. doi: 10.1192/bjp.182.6.537.
    1. Owens D., Horrocks J., House A. Fatal and non-fatal repetition of self-harm systematic review. Br. J. Psychiatry. 2002;181:193–199. doi: 10.1192/bjp.181.3.193.
    1. Yang B., Lester D. Recalculating the economic cost of suicide. Death Stud. 2006;31:351–361. doi: 10.1080/07481180601187209.
    1. Lewis G., Hawton K., Jones P. Strategies for preventing suicide. Br. J. Psychiatry. 1997;171:351–354. doi: 10.1192/bjp.171.4.351.
    1. Arensman E., Townsend E., Hawton K., Bremner S., Feldman E., Goldney R., Gunnell D., Hazell P., Van Heeringen K., House A., et al. Psychosocial and pharmacological treatment of patients following deliberate self-harm: The methodological issues involved in evaluating effectiveness. Suicide Life Threat. Behav. 2001;31:169–180. doi: 10.1521/suli.31.2.169.21516.
    1. Orbach I. Therapeutic empathy with the suicidal wish: Principles of therapy with suicidal individuals. Am. J. Psychother. 2001;55:166–184.
    1. Gysin-Maillart A., Schwab S., Soravia L., Megert M., Michel K. A novel brief therapy for patients who attempt suicide: A 24-months follow-up randomized controlled study of the attempted suicide short intervention program (ASSIP) PLoS Med. 2016;13:e1001968. doi: 10.1371/journal.pmed.1001968.
    1. Allen J. Mentalizing suicidal states. In: Michel K., Jobes D.A., editors. Building a Therapeutic Alliance with the Suicidal Patient. American Psychological Association APA Books; Washington, DC, USA: 2011. p. 83.
    1. Arnow B.A., Steidtmann D. Harnessing the potential of the therapeutic alliance. World Psychiatry. 2014;13:238–240. doi: 10.1002/wps.20147.
    1. Colom F. Keeping therapies simple: Psychoeducation in the prevention of relapse in affective disorders. Br. J. Psychiatry. 2011;198:338. doi: 10.1192/bjp.bp.110.090209.
    1. Rudd M.D. Cognitive therapy for suicidality: An integrative, comprehensive, and practical approach to conceptualization. J. Contemp. Psychother. 2004;34:59–72. doi: 10.1023/B:JOCP.0000010913.66296.21.
    1. Michel K., Jobes D.A. Building a Therapeutic Alliance with the Suicidal Patient. American Psychological Association APA Books; Washington, DC, USA: 2011.
    1. Michel K. Therapeutic alliance and the therapist. In: O’Connor R.C., Pirkis J., editors. The International Handbook of Suicide Prevention. John Wiley & Sons Ltd.; Chichester, UK: 2016. pp. 346–361.
    1. Jobes D.A. Managing Suicidal Risk: A Collaborative Approach. Guilford Press; New York, NY, USA: 2006.
    1. Gysin-Maillart A.C., Soravia L.M., Gemperli A., Michel K. Suicide ideation is related to therapeutic alliance in a brief therapy for attempted suicide. Arch. Suicide Res. 2016;21:113–126. doi: 10.1080/13811118.2016.1162242.
    1. Angus L., Levitt H., Hardtke K. The narrative processes coding system: Research applications and implications for psychotherapy practice. J. Clin. Psychol. 1999;55:1255–1270. doi: 10.1002/(SICI)1097-4679(199910)55:10<1255::AID-JCLP7>;2-F.
    1. Epstein S., Lipson A., Holstein C., Huh E. Irrational reactions to negative outcomes: Evidence for two conceptual systems. J. Pers. Soc. Psychol. 1992;62:328–339. doi: 10.1037/0022-3514.62.2.328.
    1. Stanovich K.E., West R.F. Individual differences in reasoning: Implications for the rationality debate? Behav. Brain Sci. 2000;23:645–665. doi: 10.1017/S0140525X00003435.
    1. Kahneman D. Thinking Fast and Slow. Farrar, Strauss and Giroux; New York, NY, USA: 2011.
    1. Botvinick M.M., Cohen J.D., Carter C.S. Conflict monitoring and anterior cingulate cortex: An update. Trends Cogn. Sci. 2004;8:539–546. doi: 10.1016/j.tics.2004.10.003.
    1. Orbach I. Dissociation, physical pain, and suicide: A hypothesis. Suicide Life Threat. Behav. 1994;24:68–79.
    1. Orbach I. Suicide and the suicidal body. Suicide Life Threat. Behav. 2003;33:1–8. doi: 10.1521/suli.33.1.1.22786.
    1. Beck A.T. Beyond belief: A theory of modes, personality, and psychopathology. In: Salkovskis P., editor. Frontiers of Cognitive Therapy. Guilford Press; New York, NY, USA: 1996. pp. 1–25.
    1. Reisch T., Seifritz E., Esposito F., Wiest R., Valach L., Michel K. An fmri study on mental pain and suicidal behavior. J. Affect. Disord. 2010;126:321–325. doi: 10.1016/j.jad.2010.03.005.
    1. Michel K. Neurobiology and patient-oriented models of suicide—A contradiction? In: Michel K., Jobes D.A., editors. Building a Therapeutic Alliance with the Suicidal Patient. American Psychological Association APA Books; Washington, DC, USA: 2011. pp. 183–201.
    1. Stanley B., Brown G.K. Safety planning intervention: A brief intervention to mitigate suicide risk. Cogn. Behav. Pract. 2012;19:256–264. doi: 10.1016/j.cbpra.2011.01.001.
    1. Carter G.L., Clover K., Whyte I.M., Dawson A.H., D’Este C. Postcards from the edge project: Randomised controlled trial of an intervention using postcards to reduce repetition of hospital treated deliberate self poisoning. BMJ. 2005;331:805–807. doi: 10.1136/bmj.38579.455266.E0.
    1. Carter G.L., Clover K., Whyte I.M., Dawson A.H., D’Este C. Postcards from the edge: 5-Year outcomes of a randomised controlled trial for hospital-treated self-poisoning. Br. J. Psychiatry. 2013;202:372–380. doi: 10.1192/bjp.bp.112.112664.
    1. Motto J.A., Bostrom A.G. A randomized controlled trial of postcrisis suicide prevention. Psychiatr. Serv. 2001;52:828–833. doi: 10.1176/appi.ps.52.6.828.
    1. Beautrais A.L., Gibb S.J., Faulkner A., Fergusson D.M., Mulder R.T. Postcard intervention for repeat self-harm: Randomised controlled trial. Br. J. Psychiatry. 2010;197:55–60. doi: 10.1192/bjp.bp.109.075754.
    1. Bennewith O., Evans J., Donovan J., Paramasivan S., Owen-Smith A., Hollingworth W., Davies R., O’Connor S., Hawton K., Kapur N., et al. A contact-based intervention for people recently discharged from inpatient psychiatric care: A pilot study. Arch. Suicide Res. 2014;18:131–143. doi: 10.1080/13811118.2013.838196.
    1. Hepp U., Wittmann L., Schnyder U., Michel K. Psychological and psychosocial interventions after attempted suicide: An overview of treatment studies. Crisis. 2004;25:108–117. doi: 10.1027/0227-5910.25.3.108.
    1. Bowlby J. A Secure Base. Clinical Applications of Attachment Theory. Routledge; London, UK: 1988.
    1. O’Connor R., Platt S., Gordon J. Achievements and Challenges in Suicidology: Conclusions and Future Directions. In: O’Connor R., Platt S., Gordon J., editors. International Handbook of Suicide Prevention. John Wiley & Sons; Chichester, UK: 2011. pp. 625–642.
    1. Kessler R.C., Borges G., Walters E.E. Prevalence of and risk factors for lifetime suicide attempts in the national comorbidity survey. Arch. Gen. Psychiatry. 1999;56:617–626. doi: 10.1001/archpsyc.56.7.617.
    1. Rutz W., von Knorring L., Pihlgren H., Rihmer Z., Walinder J. Prevention of male suicides: Lessons from gotland study. Lancet. 1995;345:524. doi: 10.1016/S0140-6736(95)90622-3.
    1. Rogers J.R., Soyka K.M. “One size fits all”: An existential-constructivist perspective on the crisis intervention approach with suicidal individuals. J. Contemp. Psychother. 2004;34:7–22. doi: 10.1023/B:JOCP.0000010910.74165.3a.
    1. Sabo A.N., Rand B. The Real World Guide to Psychotherapy Practice. Harvard University Press; Cambridge, MA, USA: 2000. The relational aspects of psychopharmacology; pp. 34–59.
    1. Jollant F., Bellivier F., Leboyer M., Astruc B., Torres S., Verdier R., Castelnau D., Malafosse A., Courtet P. Impaired decision making in suicide attempters. Am. J. Psychiatry. 2005;162:304–310. doi: 10.1176/appi.ajp.162.2.304.
    1. Jollant F., Lawrence N.S., Olie E., O’Daly O., Malafosse A., Courtet P., Phillips M.L. Decreased activation of lateral orbitofrontal cortex during risky choices under uncertainty is associated with disadvantageous decision-making and suicidal behavior. Neuroimage. 2010;51:1275–1281. doi: 10.1016/j.neuroimage.2010.03.027.
    1. Maltsberger J.T. Confusions of the body, the self, and others in suicidal states. In: Leenaars A.A., editor. Suicidology: Essays in Honour of Edwin S. Shneidman. Jason Aronson Inc.; Northvale, NJ, USA: 1993. pp. 148–171.
    1. Hines K. The Kevin Hines Story. [(accessed on 27 February 2017)]. Available online:
    1. Fleischmann A., Bertolote J.M., Wasserman D., De Leo D., Bolhari J., Botega N.J., De Silva D., Phillips M., Vijayakumar L., Varnik A., et al. Effectiveness of brief intervention and contact for suicide attempters: A randomized controlled trial in five countries. Bull. World Health Organ. 2008;86:703–709. doi: 10.2471/BLT.07.046995.
    1. Sinclair J., Green J. Understanding resolution of deliberate self harm: Qualitative interview study of patients’ experiences. BMJ. 2005;330:1112. doi: 10.1136/bmj.38441.503333.8F.
    1. Angst J., Angst F., Gerber-Werder R., Gamma A. Suicide in 406 mood-disorder patients with and without long-term medication: A 40 to 44 years’ follow-up. Arch. Suicide Res. 2005;9:279–300. doi: 10.1080/13811110590929488.
    1. Lytle M.C., Silenzio V.M., Caine E.D. Are there still too few suicides to generate public outrage? JAMA Psychiatry. 2016;73:1003–1004. doi: 10.1001/jamapsychiatry.2016.1736.
    1. Mann J.J. Neurobiology of suicidal behaviour. Nat. Rev. Neurosci. 2003;4:819–828. doi: 10.1038/nrn1220.
    1. Jollant F., Lawrence N.L., Olie E., Guillaume S., Courtet P. The suicidal mind and brain: A review of neuropsychological and neuroimaging studies. World J. Biol. Psychiatry. 2011;12:319–339. doi: 10.3109/15622975.2011.556200.
    1. Turecki G., Ernst C., Jollant F., Labonte B., Mechawar N. The neurodevelopmental origins of suicidal behavior. Trends Neurosci. 2012;35:14–23. doi: 10.1016/j.tins.2011.11.008.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj