Table of Contents

Suicide is a complex human behavior with multiple determinants. These determinants can be organized as chronic predispositions (vulnerabilities, resiliencies, risk factors) and perisuicidal factors (triggers and protective factors). One prevailing integrative pathophysiological theory is the stress-diathesis model of John Mann from Columbia University (1). Environmental factors may contribute to both the stress as well as the diathesis component of this model.

Immediate environmental factors may involve availability of means to commit suicide, and circumstances which may prevent a suicidal act. However, effects of the environment on suicide risk factors precede our birth. For instance, the evolutionary environment, which acted on our ancestors. Through selection, it is likely that in many ways our neurocircuits, neuroendocrine connections, and overall regulatory processes are more adapted to the environment of our ancestors rather than to contemporaneous environment. We should also consider the prenatal environment, where the brain develops in utero. For instance, unknown environmental factors, such as a virus, may infect the mother and the embryo or fetus in utero, damaging the developing brain and possibly generating immune responses and aberrant restorative processes. This could cause abnormalities, which remain dormant until manifesting as mental illness years later during adolescence or young adulthood. Another important determinant is the perinatal environment involving factors related to delivery, and very early period of life. Also, the individual early formative years have a very solid, pronounced effect on later mental health and overall development.