The suicidal process: Age of onset and severity of suicidal behavior

Purpose: The concept of the suicidal process implies a progression from behaviour of relatively low intent to completed suicide. Evidence from the literature has given rise to the speculation that the age of onset of an early form of the suicidal process may be associated with the ultimate seriousness of suicidal behaviour. This study was designed to test the hypothesis that early onset of the first stage of the suicidal process, a wish to die, is associated with increases in the ultimate position along the suicidal process dimension. Methods: Questions on the appearance and timing of suicidal process components (a death wish, ideation, plan, or attempt) were embedded in a telephone survey on mental health and addictions in the workforce. Records of those that had experienced suicidal behaviour were examined for the effects on the age of onset of the first death wish as a function of the level of severity of suicidal behaviour, gender, and depression. Results: The findings showed that increases in suicidal intent were associated with lowered age of the first death wish. This pattern held true for depressed and nondepressed persons alike. Conclusions: The results support the notion that the early onset of a supposed precursor of suicidal behaviour, a death wish in this case, adds to its ability to portend more serious problem levels in later stages of life. Furthermore, mood operates independently in its association with the timing of such suicidal behaviour, suggesting that the effect of a relatively youthful appearance of a wish to die cannot be explained by early onset depression.