["Suicidal intentions": literature review and perspectives].

Abstract

Fifteen years ago, Baechler presented his "strategic theory of suicide". Following a viewpoint initiated at the end of the 1950's by Stengel and Cook, he proposed the more accomplished theoretical development of suicidal functions. We propose a critical review of international empiric literature following this approach.
We carried out a bibliographic research on PsychINFO(®) databank, crossing terms of suicide attempt, deliberate self-harm and parasuicide, to reasons, motivations, functions, intentions. Thirty-one articles were selected. They cover a period ranging from 1971 to 2008, and from Europe to the USA.
Few studies have been conducted in France, but international literature has grown since 1970, and some questionnaires have been created: e.g. the Motives for Parasuicide Questionnaire (MPQ, Kerkhof et al., 1993 [28]) and the Reasons for Attempting Suicide Questionnaire (RASQ, Holden et al., 1998 [24]). The first intentions mentioned are internal perturbations type: to get relief, to escape, cannot endure situation or thoughts any longer, loss of control. They are often blended with interpersonal intentions: to make people understand what they felt, to seek help, to make things easier for others, while more aggressive, punitive or manipulative functions are seldom reported. Women report more reasons than men, but do not differ in their pattern of intentions. Suicide attempters report varying desire to die across studies. Some inconsistent distinctions can be made from age and gender but few from subjects' suicidal history.
One can wonder if subject's answers are really honest, particularly in regards to social desirability. Links between internal perturbations and suicidal intent, hopelessness, and depression are logically found, which aims to give evidence that, at least for this dimension, subjects give true answers, but which also point out the redundant aspect of some items of the suicidant functions scales (e.g. "to die"). Today, it turns out that this kind of research should be managed in France, by creating tools and questionnaires, validating existing ones and, internationally, by taking into account gender, age, and subjects' suicidal history to obtain more clear results.
So far, to our knowledge, this kind of review has never been conducted. Suicidal functions appear to be a rich and relevant approach to better understand suicide attempts, notably in a "suicidal crisis" perspective. In the future, some links with coping strategies and cathartic effect of the attempts could be made. We also point out that it could be relevant for psychotherapeutic care.