What drives a person to attempt suicide?

Understanding the Drivers of Suicidal Behavior

Suicidal behavior fundamentally arises from the intersection of psychiatric illness (present in over 90% of cases) and an overwhelming sense of psychological pain that the person perceives as intolerable and inescapable. 1

Primary Psychiatric Drivers

The overwhelming majority of individuals who attempt or complete suicide suffer from an underlying mental health disorder:

• Depression is the most common driver, present in 50-79% of youth attempting suicide and doubling the odds of suicide attempts in adults 1
• Mood disorders (including major depressive disorder, bipolar disorder, mixed states, or rapid cycling) are strongly associated with suicidal behavior in both children and adults 1
• Anxiety disorders independently increase risk, particularly panic attacks in females and separation anxiety in adolescents 1, 2
• Substance abuse significantly amplifies suicide risk, especially in teenagers aged 16 and older 1
• Comorbid conditions (depression plus substance abuse, or mood disorders with psychotic features) create particularly high-risk scenarios 1

Psychological Pain and Cognitive Distortions

Beyond psychiatric diagnosis, specific psychological states drive suicidal intent:

• Hopelessness is a critical cognitive distortion that accompanies depression and serves as both a risk factor and predictor of treatment dropout 1
• Motivating feelings include the wish to escape an intolerable situation, to rejoin a dead relative, to gain attention, to effect change in relationships, or to seek revenge 1
• Social isolation and perceived burdensomeness—the belief that others would be better off without them—fuel suicidal thinking 3
• Dysregulated impulse control combined with intense psychological pain creates a lethal combination 4

Environmental and Social Precipitants

Stressful life events often trigger suicidal behavior in vulnerable individuals:

• Interpersonal crises such as loss of romantic relationships, family discord, or disciplinary troubles frequently precede suicide attempts 1
• History of abuse: Physical or sexual abuse increases suicide risk even when controlling for other factors, with 15-20% of female attempters having abuse history 1
• Family psychopathology, including family history of suicidal behavior, bipolar illness, or substance abuse, increases risk 1
• Social marginalization: Gay, lesbian, and bisexual youth face 2-7 fold increased risk due to multiple stressors including victimization, family conflict, and substance abuse 1

The Balance Between Life and Death

Suicide intent involves a dynamic balance between the wish to die and the wish to live. 1 When psychological pain becomes unbearable and the person perceives no alternative solutions, the balance tips toward death:

• Some individuals view suicide as the "only viable solution" to end unendurable pain 5
• The intent may be to truly die, or it may serve other functions like communicating distress or attempting to control overwhelming feelings 1, 6
• Critical pitfall: Never dismiss suicidal statements as "manipulative" or "attention-seeking"—these may represent the only way a patient can ask for help 3

Protective Factors That Counter Suicidal Drive

Understanding what prevents suicide is equally important:

• Future orientation—having plans and goals for the future—protects against suicide 2
• Firm religious beliefs are well-established protective factors 2
• Social connection: Living with family, having work responsibilities, and maintaining social support provide purpose and reduce risk 2

Age and Demographic Variations

Risk factors and presentations vary by developmental stage:

• In children ≤12 years: Disruptive disorders increase suicidal ideation risk 1
• In adolescents: Substance use, separation anxiety, and peer relationship problems become more prominent 1
• In older adults: Social isolation, spousal bereavement, physical illness, and functional impairment add to psychiatric risk 1
• Males have 5.5:1 higher completion rates than females, though females attempt more frequently 1

The Role of Impulsivity and Planning

The degree of planning reveals important information about risk:

• Impulsive attempts often occur in the context of brief adjustment reactions, typically following interpersonal disputes 1
• Planned attempts with steps taken to avoid discovery, use of lethal methods beyond ingestion/cutting, and persistent wish to die signal higher risk 1
• Inappropriate coping styles such as catastrophizing or impulsivity increase vulnerability 1

Neurobiological Underpinnings

Emerging research identifies biological factors:

• Serotonergic system dysfunction underlies both dysregulated impulse control and propensity to psychological pain 4
• Genetic factors contribute to risk, particularly in families with history of suicidal behavior or bipolar illness 1

The clinical imperative is recognizing that suicidal behavior represents an attempt to redress unfulfilled psychological needs—reducing the sense of frustration or satisfying frustrated needs can lower the risk below the lethal threshold. 7