Subscribe to RSS
DOI: 10.1055/s-0038-1627646
Depression und Suizidalität
Depression and suicidal behaviourPublication History
eingegangen am:
09 July 2015
angenommen am:
14 July 2015
Publication Date:
22 January 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00034916/201511/lookinside/thumbnails/10-1055-s-0038-1627646_de-1.jpg)
Zusammenfassung
Mit jährlich circa 10 000 Suiziden und circa 200 000 Suizidversuchen stellt suizidales Verhalten in Deutschland eine Herausforderung für das Gesundheits- und Versorgungssystem dar. Im vorliegenden Beitrag werden ausgewählte Aspekte wie Alters- und Geschlechtsunterschiede suizidaler Handlungen, Entstehungsmodelle und Präventionsansätze diskutiert. Hierbei wird die Frage aufgeworfen, ob psychosoziale Aspekte wie beispielsweise Stress oder Arbeitslosigkeit sowie körperliche Erkrankungen als kausale Faktoren für suizidales Verhalten überbewertet werden. Gute Belege liegen dafür vor, dass in Europa ein Großteil der Suizide und Suizidversuche vor dem Hintergrund psychiatrischer und insbesondere depressiver Erkrankungen erfolgt. Wegen dieser engen Assoziation ist eine verbesserte Versorgung und Behandlung depressiv Erkrankter ein zentraler Baustein in Suizidpräventionsprogrammen. Das Deutschland- und europaweit implementierte und evaluierte gemeindebasierte 4-Ebenen-Interventionsprogramm der Stiftung Deutsche Depressionshilfe kombiniert die Ziele einer optimierten Versorgung depressiv Erkrankter und der Prävention suizidaler Handlungen.
Summary
With approximately 10 000 suicides and 200 000 suicide attempts each year in Germany, suicidal behaviour poses a challenge to the health care system. In this article, specific aspects such as age and gender differences in suicidal behaviour, etiological considerations and prevention strategies are discussed. Thereby it is questioned whether psychosocial aspects, such as stress or unemployment as well as physical illness are overestimated as causal factors for suicidal behaviour. There is strong evidence that the majority of suicide attempts and completed suicides in Europe occurs in the context of psychiatric disorders, particularly depressive disorders. Due to this strong association, improved care and treatment of depressed individuals is a core component in suicide prevention programmes. The community-based 4-level intervention programme of the German Depression Foundation, that has been implemented and evaluated in Germany and Europe, combines the aims of an improved care of depressed patients and that of preventing suicidal behaviour.
-
Literatur
- 1 Statistisches Bundesamt. Todesursachenstatistik. 2014 www.gbe-bund.de Abgerufen am 8.12.2014.
- 2 Preventing suicide: A global imperative. Genf: Weltgesundheitsorganisation; 2014
- 3 Värnik P. Suicide in the world. Int J Environ Res Public Health 2012; 09: 760-71.
- 4 Freuchen A, Kjelsberg E, Lundervold AJ, Grøholt B. Differences between children and adolescents who commit suicide and their peers: A psychological autopsy of suicide victims compared to accident victims and a community sample. Child Adolesc Psychiatry Ment Health 2012; 06: 1.
- 5 Stillion JM, McDowell EE. Suicide across the life span: Premature exits. 2. Aufl. Washington, D.C: Taylor & Francis; 1996
- 6 Schrijvers DL, Bollen J, Sabbe Bernard G C. The gender paradox in suicidal behavior and its impact on the suicidal process. J Affect Disord 2012; 138: 19-26.
- 7 Cibis A, Mergl R, Bramesfeld A, Althaus D, Niklewski G, Schmidtke A. et al. Preference of lethal methods is not the only cause for higher suicide rates in males. J Affect Disord 2012; 136: 9-16.
- 8 Mergl R, Koburger N, Heinrichs K, Székely A, Monika TothDitta, James Coyne. et al. What are reasons for the large gender differences in the lethality of suicidal acts? An epidemiological analysis in four European countries. PLoS ONE 2015; 10: e0129062.
- 9 Arsenault-Lapierre G, Kim C, Turecki G. Psychiatric diagnoses in 3275 suicides: a meta-analysis. BMC Psychiatry 2004; 04: 37.
- 10 Cavanagh J T O, Carson AJ, Sharpe M, Lawrie SM. Psychological autopsy studies of suicide: a systematic review. Psychol Med 2003; 33: 395-405.
- 11 Lönnqvist J. Major psychiatric disorders in suicide and suicide attempters. In: Wasserman D, Wasserman C. (Hrsg.). Oxford Textbook of Suicidology and Suicide Prevention: A Global Perspective. New York: Oxford University Press Inc; 2009: 275-86.
- 12 Phillips MR, Shen Q, Liu X, Pritzker S, Streiner D, Conner K. et al. Assessing depressive symptoms in persons who die of suicide in mainland China. J Affect Disord 2007; 98: 73-82.
- 13 Beck AT, Brown G, Berchick RJ, Stewart BL, Steer RA. Relationship between hopelessness and ultimate suicide: A replication with psychiatric outpatients. FOC 2006; 04: 291-6.
- 14 Beck AT, Steer RA, Kovacs M, Garrison B. Hopelessness and eventual suicide: a 10-year prospective study of patients hospitalized with suicidal ideation. Am J Psychiatry 1985; 142: 559-63.
- 15 Bertolote JM, Fleischmann A, Leo deD, Wasserman D. Psychiatric diagnoses and suicide: revisiting the evidence. Crisis 2004; 25: 147-55.
- 16 Blair-West GW, Mellsop GW, Eyeson-Annan ML. Down-rating lifetime suicide risk in major depression. Acta Psychiatr Scand 1997; 95: 259-63.
- 17 Sokero TP, Melartin TK, Rytsälä HJ, Leskelä US, Lestelä-Mielonen PS, Isometsä ET. Prospective study of risk factors for attempted suicide among patients with DSM-IV major depressive disorder. Br J Psychiatry 2005; 186: 314-8.
- 18 Guze SB, Robins E. Suicide and primary affective disorders. Br J Psychiatry 1970; 117: 437-8.
- 19 Angst J, Angst F, Stassen HH. Suicide risk in patients with major depressive disorder. J Clin Psychiatry 1999; 60 Suppl 2: 57-62.
- 20 Beautrais AL, Joyce PR, Mulder RT, Fergusson DM, Deavoll BJ, Nightingale SK. Prevalence and comorbidity of mental disorders in persons making serious suicide attempts: a case-control study. Am J Psychiatry 1996; 153: 1009-14.
- 21 Sokero TP, Melartin TK, Rytsälä HJ, Leskelä US, Lestelä-Mielonen PS, Isometsä ET. Suicidal ideation and attempts among psychiatric patients with major depressive disorder. J Clin Psychiatry 2003; 64: 1094-100.
- 22 Durkheim É. Der Selbstmord. 1. Aufl. Frankfurt/ Main: Suhrkamp; 1983
- 23 Stuckler D, Basu S, Suhrcke M, Coutts A, McKee M. Effects of the 2008 recession on health: a first look at European data. Lancet 2011; 378: 124-5.
- 24 Chang S, Stuckler D, Yip P, Gunnell D. Impact of 2008 global economic crisis on suicide: time trend study in 54 countries. BMJ 2013; 347: f5239.
- 25 Nordt C, Warnke I, Seifritz E, Kawohl W. Modelling suicide and unemployment: a longitudinal analysis covering 63 countries, 2000–11. The Lancet Psychiatry 2015; 02: 239-45.
- 26 Mäkinen IH. Eastern European transition and suicide mortality. Soc Sci Med 2000; 51: 1405-20.
- 27 Karanikolos M, Mladovsky P, Cylus J, Thomson S, Basu S, Stuckler D. et al. Financial crisis, austerity, and health in Europe. Lancet 2013; 381: 1323-31.
- 28 Gusmão R, Quintão S, McDaid D, Arensman E, van Audenhove C, Coffey C. et al. Antidepressant utilization and suicide in Europe: An ecological multi-national study. PLoS ONE 2013; 08: e66455.
- 29 Webb RT, Kontopantelis E, Doran T, Qin P, Creed F, Kapur N. Suicide risk in primary care patients with major physical diseases: a case-control study. Arch Gen Psychiatry 2012; 69: 256-64.
- 30 Hegerl U, Mergl R. Depression and suicidality in COPD: understandable reaction or independent disorders?. Eur Respir J 2014; 44: 734-43.
- 31 Weltgesundheitsorganisation. Mental health action plan 2013−2020. 2013
- 32 Mann JJ, Apter A, Bertolote J, Beautrais A, Currier D, Haas A. et al. Suicide prevention strategies: a systematic review. JAMA 2005; 294: 2064-74.
- 33 Althaus D, Hegerl U. The evaluation of suicide prevention activities: state of the art. World J Biol Psychiatry 2003; 04: 156-65.
- 34 Hegerl U, Althaus D, Schmidtke A, Niklewski G. The alliance against depression: 2-year evaluation of a community-based intervention to reduce suicidality. Psychol Med 2006; 36: 1225-33.
- 35 Hegerl U, Mergl R, Havers I, Schmidtke A, Lehfeld H, Niklewski G. et al. Sustainable effects on suicidality were found for the Nuremberg alliance against depression. Eur Arch Psychiatry Clin Neurosci 2010; 260: 401-6.
- 36 Hegerl U, Rummel-Kluge C, Värnik A, Arensman E, Koburger N. Alliances against depression – A community based approach to target depression and to prevent suicidal behaviour. Neurosci Biobehav Rev 2013; 37: 2404-9.
- 37 Hegerl U, Wittenburg L, Arensman E, van Audenhove C, Coyne JC, McDaid D. et al. Optimizing suicide prevention programs and their implementation in Europe (OSPI Europe): an evidencebased multi-level approach. BMC Public Health 2009; 09: 428.
- 38 Hübner-Liebermann B, Neuner T, Hegerl U, Hajak G, Spiessl H. Reducing suicides through an alliance against depression?. Gen Hosp Psychiatry 2010; 32: 514-8.
- 39 Székely A, Konkolÿ BThege, Mergl R, Birkás E, Rózsa S, Purebl G. et al. How to decrease suicide rates in both genders? An effectiveness study of a community-based intervention (EAAD). PLoS ONE 2013; 08: e75081.
- 40 Bostwick JM, Pankratz VS. Affective disorders and suicide risk: a reexamination. Am J Psychiatry 2000; 157: 1925-32.
- 41 Yang G. et al. Understanding the unique characteristics of suicide in China: national psychological autopsy study. Biomed Environ Sci 2005; 18: 379-89.
- 42 Inskip HM, Harris EC, Barraclough B. Lifetime risk of suicide for affective disorder, alcoholism and schizophrenia. Br J Psychiatry 1998; 172: 35-7.