Toward fine-grained phenotyping of suicidal behavior: the role of suicidal subtypes

Despite advances in the assessment and management of suicidal behavior (SB), suicide remains a leading cause of morbidity and mortality in the United States, and suicide rates have increased dramatically over the past 30 years.1 There is ample evidence that suicidal thoughts and behaviors are transdiagnostic phenomena that can arise even in the absence of other diagnosable mental health disorders.2 While attempts to elucidate a unified model of SB have identified genetic, neurobiological, and psychological factors that are associated with increased risk, these risk factors, or their combination, have only modest statistical and limited clinical utility.3 Thus, predicting who will engage in SB remains challenging. We assert that, rather than being a unified construct, SB likely represents a final common pathway of multiple separate pathological processes. Here, we hypothesize that the pattern of suicidal thinking helps distinguish at least two of these suicidal subtypes.