The DOI matches its Crossref record; 116 of the 116 references it cites were found in a registry or an index.
Toward a Clinical Model of Suicidal Behavior in Psychiatric Patients
Abstract
OBJECTIVE: Risk factors for suicide attempts have rarely been studied comprehensively in more than one psychiatric disorder, preventing estimation of the relative importance and the generalizability of different putative risk factors across psychiatric diagnoses. The authors conducted a study of suicide attempts in patients with mood disorders, psychoses, and other diagnoses. Their goal was to determine the generalizability and relative importance of risk factors for suicidal acts across diagnostic boundaries and to develop a hypothetical, explanatory, and predictive model of suicidal behavior that can subsequently be tested in a prospective study. METHOD: Following admission to a university psychiatric hospital, 347 consecutive patients who were 14-72 years old (51% were male and 68% were Caucasian) were recruited for study. Structured clinical interviews generated axis I and axis II diagnoses. Lifetime suicidal acts, traits of aggression and impulsivity, objective and subjective severity of acute psychopathology, developmental and family history, and past substance abuse or alcoholism were assessed. RESULTS: Objective severity of current depression or psychosis did not distinguish the 184 patients who had attempted suicide from those who had never attempted suicide. However, higher scores on subjective depression, higher scores on suicidal ideation, and fewer reasons for living were reported by suicide attempters. Rates of lifetime aggression and impulsivity were also greater in attempters. Comorbid borderline personality disorder, smoking, past substance use disorder or alcoholism, family history of suicidal acts, head injury, and childhood abuse history were more frequent in suicide attempters. CONCLUSIONS: The authors propose a stress-diathesis model in which the risk for suicidal acts is determined not merely by a psychiatric illness (the stressor) but also by a diathesis. This diathesis may be reflected in tendencies to experience more suicidal ideation and to be more impulsive and, therefore, more likely to act on suicidal feelings. Prospective studies are proposed to test this model.
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“The antisuicidal effect estimated here is larger than the effect on mood episodes, 27 28 raising the possibility of a specific effect.33”
From Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis (2013) · cites this paper as [33]
In the citing paper
“Numerous reports of associations between suicidal behavior and a range of neurobiological parameters have emerged from studies of mixed age and younger adult samples (52).”
From Suicide in older adults (2011) · cites this paper as [52]
In the citing paper
“First, suicidal behavior is found in many psychiatric disorders and not just in mood disorders and borderline personality disorder, where it is part of the diagnostic symptom list.”
From A brain-centric model of suicidal behavior (2020) · cites this paper as [13]
In the citing paper
“The stress-diathesis model (13, 14) depicts suicidal behavior as a consequence of an interaction between acute stressors or proximal risk factors and a diathesis or distal factors (Figure 1).”
From A brain-centric model of suicidal behavior (2020) · cites this paper as [13]
In the citing paper
“Second, only a minority of psychiatric patients make suicide attempts, and the presence or absence of suicidal behavior is not simply determined by the presence of a psychiatric illness or the overall severity of illness (12-14).”
From A brain-centric model of suicidal behavior (2020) · cites this paper as [13]
In the citing paper
“Suicidal behavior risk is moderated by a set of psychopathological and cognitive traits that are different from the psychopathology of associated psychiatric illnesses.”
From A brain-centric model of suicidal behavior (2020) · cites this paper as [13]
In the citing paper
“Second, only a minority of psychiatric patients make suicide attempts, and the presence or absence of suicidal behavior is not simply determined by the presence of a psychiatric illness or the overall severity of illness (12-14).”
From A brain-centric model of suicidal behavior (2020) · cites this paper as [13]
In the citing paper
“A stress-diathesis psychological model explains suicide risk as a combination of stressors in vulnerable persons.”
From Suicide (2020) · cites this paper as [31]
In the citing paper
“Individual vulnerability is considered to express itself in suicidal ideation under stress and is magnified by impulsivity and aggression, which increase the likelihood of acting on suicidal ideas.31”
From Suicide (2020) · cites this paper as [31]
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“However, the fact that avoidant attachment predicted suicide attempt, whereas social adjustment was a better predictor of major depression, supported the view that depression and suicidal behavior were distinct phenomena with some shared variance (Mann et al. 1999).”
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Dimensions of suicidal behavior according to patient reports
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“In spite of these facts, suicide research has only recently started to receive attention (Jamison 1999; Mann et al. 1999; U. S. Public Health Service 2001).”
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“Several risk factors that increase risk of suicidal behavior include depressed mood (Arsenault-Lapierre et al., 2004; Mann et al., 1999; Schwartz-Lifshitz et al., 2012; Yoshimasu et al., 2008), personality disorders with impulsive behavioral traits (Chesin et al.”
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“Suicidal ideation is seen as a early indicator of evaluating suicide risk which is different from suicide attempts (Mann et al., 1999; Klonsky et al., 2016).”
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“Interrater agreement and intraclass coefficients were good to excellent (22).”
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“result in actual suicidal behavior (Mann et al., 1999; van Heeringen, 2012; van Heeringen and Mann, 2014).”
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“It is logical to hypothesize that impulsivity and suicidal behavior are correlated, because impulsive individuals might be more likely to enact a suicidal ideation [20].”
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“Beside the genetic liability, the interplay of neurobiological, behavioral, developmental, and clinical factors contributes to the diathesis of suicidal behavior (17, 30).”
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“According to the stress-vulnerability hypotheses for depression and suicidality (Monroe and Simons, 1991; Mann et al., 1999; Wasserman, 2001), the socio-demographic variables (Group 1 variables) act independently on two groups of proximal factors, namely a set of E.”
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Psychiatric Emergencies in the Elderly Population
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“Risk for suicidal behavior differs markedly among individuals; factors such as demographic differences, personality traits, and psychiatric disorder all contribute to individual differences in risk [1,2].”
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Brown, V. M., Wilson, J., Hallquist, M. N., Szanto, K., & Dombrovski, A. Y. (2020) · Neuropsychopharmacology · doi:10.1038/s41386-020-0632-0 · Cited by 48
“Both impaired value-based decision-making in the laboratory [2] and selfreported impulsivity [3] are associated with suicidal behavior.”
BackgroundZhang, B., Fu, W., Guo, Y., Chen, Y., Jiang, C., Li, X., & He, K. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.09.091 · Cited by 47
Leeman, R. F., Grant, J. E., & Potenza, M. N. (2009) · Behavioral Sciences & the Law · doi:10.1002/bsl.855 · Cited by 50
Auerbach, R. P., Pagliaccio, D., & Kirshenbaum, J. S. (2022) · Current topics in behavioral neurosciences · doi:10.1007/7854_2022_358 · Cited by 51
Ashrafioun, L., Pigeon, W. R., Conner, K. R., Leong, S. H., & Oslin, D. W. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.09.014 · Cited by 48
“Indeed, previous work has suggested that those using substances are at particular risk for suicide attempts given that it contributes to increased impulsivity (Mann et al., 1999; Nock et al., 2010).”
BackgroundSuicidal Behavior and Attitudes Among Medical Students in the United Arab Emirates
Amiri, L., Voracek, M., Yousef, S., Galadari, A., Yammahi, S., Sadeghi, M. R., Eskin, M., & Dervic, K. (2012) · Crisis · doi:10.1027/0227-5910/a000170 · Cited by 55
Factors related to suicide attempts among individuals with major depressive disorder
Patumanond, J., Ruengorn, C., Sanichwankul, Niwatananum, Mahatnirunkul, & Pumpaisalchai (2012) · International Journal of General Medicine · doi:10.2147/ijgm.s30874 · Cited by 47
Association Between the Menses and Suicide Attempts: A Replication Study
Baca‐García, E., Díaz-Sastre, C., Ceverino, A., Sáiz-Ruiz, J., DÍAZ, F. J., & de León, J. (2003) · Psychosomatic Medicine · doi:10.1097/01.psy.0000058375.50240.f6 · Cited by 48
“Mann JJ.”
BackgroundInfluentialBlasco-Fontecilla, H., Delgado‐Gómez, D., Legido, T., de León, J., Pérez-Rodríguez, M. M., & Baca‐García, E. (2012) · Archives of Suicide Research · doi:10.1080/13811118.2012.640616 · Cited by 47
Do depression and anxiety converge or diverge in their association with suicidality?
Eikelenboom, M., Smit, J. H., Beekman, A. T. F., & Penninx, B. W. J. H. (2012) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2012.01.025 · Cited by 50
Reweighing the Ethical Tradeoffs in the Involuntary Hospitalization of Suicidal Patients
Borecky, A., Thomsen, C., & Dubov, A. (2019) · The American Journal of Bioethics · doi:10.1080/15265161.2019.1654557 · Cited by 51
“Diverse explanations for suicide exist in the literature, ranging from biological predisposition (Mann et al. 1999), to reaction to humiliation, helplessness, hopelessness, and guilt (Beck et al.”
BackgroundNegative Life Events Associated With Deliberate Self-Harm in an African Population in Uganda
Kinyanda, E., Hjelmeland, H., & Musisi, S. (2005) · Crisis · doi:10.1027/0227-5910.26.1.4 · Cited by 47
Resting-state amplitude of low-frequency fluctuation is associated with suicidal ideation
Lan, M. J., Rizk, M. M., Pantazatos, S. P., Rubin‐Falcone, H., Miller, J. M., Sublette, M. E., Oquendo, M. A., Keilp, J. G., & Mann, J. J. (2019) · Depression and Anxiety · doi:10.1002/da.22888 · Cited by 48
Self-citationPaashaus, L., Forkmann, T., Glaesmer, H., Juckel, G., Rath, D., Schönfelder, A., & Teismann, T. (2021) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2580 · Cited by 46
Çetin, Ö., & Eker, S. S. (2011) · Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry · doi:10.5455/cap.20110327 · Cited by 47
Grit and Perseverance in Suicidal Behavior and Non-Suicidal Self-Injury
Anestis, M. D., & Selby, E. A. (2015) · Death Studies · doi:10.1080/07481187.2014.946629 · Cited by 46
Watkins, H., & Meyer, T. D. (2013) · Bipolar Disorders · doi:10.1111/bdi.12090 · Cited by 50
“For example, Mann and colleagues (25) propose a stress-vulnerability model of suicidality suggesting that it is not just stressors (e.”
BackgroundRacial Disparities in Risk and Protective Factors for Suicide
Davidson, C. L., & Wingate, L. R. (2011) · Journal of Black Psychology · doi:10.1177/0095798410397543 · Cited by 49
Suicide attempters classification: Toward predictive models of suicidal behavior
Delgado‐Gómez, D., Blasco-Fontecilla, H., Sukno, F. M., Ramos-Plasencia, M. S., & Baca‐García, E. (2012) · Neurocomputing · doi:10.1016/j.neucom.2011.08.033 · Cited by 46
“[12], aggressiveness [13], depression [14], personality disorders (PD) [15] and drug use [16] are associated with an increased risk of suicide.”
BackgroundPathways to High-Lethality Suicide Attempts in Individuals with Borderline Personality Disorder
Chesin, M. S., Jeglic, E. L., & Stanley, B. (2010) · Archives of Suicide Research · doi:10.1080/13811118.2010.524054 · Cited by 44
“Since Mann's seminal paper (Mann, Waternaux, Haas et al, 1999 ), support for a stress-diathesis model of suicidal behavior has grown (Caraballo, Akamnonu, & Oquendo, 2008).”
BackgroundSuicidality and divalproex sodium: analysis of controlled studies in multiple indications
Redden, L., Pritchett, Y., Robieson, W., Kovacs, X., Garofalo, M. E., Tracy, K. A., & Saltarelli, M. (2011) · Annals of General Psychiatry · doi:10.1186/1744-859x-10-1 · Cited by 47
“It is important to note that when interpreting research regarding suicidality it is not possible to predict whether an event of lesser severity such as suicidal ideation will ultimately lead to suicide [21-23].”
BackgroundPharmacogenomics of Suicidal Events
Brent, D. A., Melhem, N., & Turecki, G. (2010) · Pharmacogenomics · doi:10.2217/pgs.10.64 · Cited by 47
Clinical and genetic factors associated with suicide in mood disorder patients
Antypa, N., Souery, D., Tomasini, M., Albani, D., Fusco, F., Mendlewicz, J., & Serretti, A. (2015) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-015-0658-1 · Cited by 46
on behalf of the UNIVERSAL study group., Blasco, M. J., Castellví, P., Almenara, J., Lagares, C., Roca, M., Sesé, A., Piqueras, J. A., Soto‐Sanz, V., Marín, J. R., et al. (2016) · BMC Psychiatry · doi:10.1186/s12888-016-0820-y · Cited by 52
Paul, E. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.08.059 · Cited by 51
“Diathesis-stress models of suicide risk specify several underlying vulnerabilities (Bridge et al., 2006; Brodsky, 2016; Mann et al., 1999) which may interact with recent stressful life events to increase the likelihood of transitioning to a suicide attempt.”
BackgroundStålenheim, E. G. (2001) · European Psychiatry · doi:10.1016/s0924-9338(01)00595-8 · Cited by 46
A proposed model of the development of suicidal ideations
Gvion, Y., Horesh, N., Levi‐Belz, Y., & Apter, A. (2014) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2014.09.019 · Cited by 51
“Impulsivity has also been singled out as a key factor facilitating the transition from suicidal thoughts to attempts [23,24].”
BackgroundBränström, R., Stormbom, I., Bergendal, M., & Pachankis, J. E. (2022) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12830 · Cited by 58
“Second, this study assessed a comprehensive set of risk factors for suicidality, thereby permitting a simultaneous test of key components of four theories of suicidality: the clinical model (Mann et al., 1999), interpersonal model (Van Orden et al.”
BackgroundMethodResultInfluentialBeing in want of control: Experiences of being on the road to, and making, a suicide attempt
Pavulans, K. S., Bolmsjö, I., Edberg, A., & Öjehagen, A. (2012) · International Journal of Qualitative Studies on Health and Well-Being · doi:10.3402/qhw.v7i0.16228 · Cited by 44
“The central role of impulsiveness in suicidal acts is supported by previous studies (Dougherty et al., 2004; Mann et al., 1999).”
Lineberry, T., & O'Connor, S. S. (2012) · Mayo Clinic proceedings · doi:10.1016/j.mayocp.2012.07.002 · Cited by 50
“Impulsive” suicide attempts: What do we really mean?
May, A. M., & Klonsky, E. D. (2015) · Personality Disorders Theory Research and Treatment · doi:10.1037/per0000160 · Cited by 54
Cognitive, Emotional, Temperament, and Personality Trait Correlates of Suicidal Behavior
Giner, L., Blasco-Fontecilla, H., Vega, D., & Courtet, P. (2016) · Current Psychiatry Reports · doi:10.1007/s11920-016-0742-x · Cited by 48
Bakhiyi, C. L., Jaussent, I., Béziat, S., Cohen, R. F., Genty, C., Kahn, J., Leboyer, M., Vaou, P. L., Guillaume, S., & Courtet, P. (2017) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2016.12.022 · Cited by 45
“According to the stress-diathesis model of suicidal behavior (Mann et al., 1999; Oquendo et al., 2004), suicide might be the result of the interaction between environmental stressors or psychiatric disorders and trait-dependent vulnerability to suicidal behavior.”
BackgroundResearch on the pathophysiology, treatment, and prevention of suicide: practical and ethical issues
Nugent, A. C., Ballard, E. D., Park, L. T., & Zarate, C. A. (2019) · BMC Psychiatry · doi:10.1186/s12888-019-2301-6 · Cited by 55
Zhao, K., Zhou, S., Shi, X., Chen, J., Zhang, Y., Fan, K., Zhang, X., Wang, W., & Tang, W. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02791-x · Cited by 45
“Earlier studies have indicated that current major episode of depression [6], gender [7], age, education level, chronic diseases [8], the disturbance of metabolism [9], alcohol dependence [10], smoking [11], among others, are risk factors for suicide attempts.”
Background
Metadata
- Authors
- Mann, J. J., Waternaux, C., Haas, G. L., & Malone, K. M.
- Affiliations
- New York State Psychiatric Institute (US)
- Venue
- American Journal of Psychiatry
- Published
- 1999-02-01
- Volume
- 156
- Issue
- 2
- Pages
- 181-189
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2157574219
- Cited by
- 1,791
- References
- 115
- Citations by year
- 2026: 44 · 2025: 62 · 2024: 45 · 2023: 52 · 2022: 55 · 2021: 70 · 2020: 71 · 2019: 69 · 2018: 82 · 2017: 80 · 2016: 99 · 2015: 76 · 2014: 104 · 2013: 91 · 2012: 102
- FWCI
- 41.72
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (MH48514, MH46745, MH48492, R01MH048492, R01MH048514)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- suicide attempts, suicide risk factors, suicidal behavior, diathesis-stress model, suicidal ideation, impulsivity, aggression, depression severity, psychosis severity, borderline personality disorder, substance use disorders, alcoholism, family history of suicide, childhood abuse, traumatic brain injury, smoking, psychiatric inpatients
- MeSH terms
- Adolescent, Adult, Aged, Mental Disorders, Child Abuse, Female, Craniocerebral Trauma, Humans, Impulsive Behavior, Life Change Events, Male, Middle Aged, Models, Psychological, Personality Disorders, Personality Inventory, Psychiatric Status Rating Scales, Risk Factors, Severity of Illness Index, Sex Factors, Suicide, Attempted, Comorbidity, Chi-Square Distribution, Substance-Related Disorders
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