Suicidal behavior of persons with mental disability: review of literature

Suicidal behavior (SB) that includes thoughts, expressions, preparation for suicide and attempts to take one’s own life, in patients with mental retardation (MR) is not sufficiently studied and described in the scientific literature. Most experts believe that the prevalence of suicidal activity among patients with MR is lower (38.7 per 100 000) than among other patients with mental disorders (MD) (126.7-310.5) and healthy people (52.3). However, perhaps due to the small attention paid to research on SB, the difficulties in collecting such information among the mentally retarded (the lack of diagnostic tools for SB for people with low intellectual coefficient and a decrease in their communication skills). Other scientists, on the contrary, speak of a higher suicidal activity among them due to social maladaptation, lack of skills to solve psychological problems, the presence of anti-vital experiences and the impulsiveness of actions. It has been established that the incidence of SB is inversely proportional to the degree of MR, but even with moderate and severe mental impairment (Down's disease), cases of suicidal activity have been described. Many suicides with mental retardation do not have clear boundaries between suicide and parasuicide, self-destructive behavior. Of the methods of SB, “passive” (potentially less fatal) predominate: poisoning (about 30%), using cutting objects (about 30%), dangerous self-harming behavior. Among the causes of SB among MR, family factors, stresses (crisis conditions), episodes of violence (verbal, physical and sexual), lack of social support, loneliness are most often discussed. At the same time, comorbid MDs (4-11 times more often) are one of the main factors of SB, especially psychoses, depressive, personality and anxiety disorders, sleep disturbances, the use of psychoactive substances in combination with MR. Epilepsy (convulsive syndrome) is much more common in patients with MR (12.4-22.2%) than among the general population. Such comorbidity is also accompanied by increased mortality from suicide. SB among mentally retarded children and adolescents remains an underestimated problem, and violations of intellectual abilities and young children are regarded in some cases as a (cognitive) barrier (“anti-suicidal barrier”) to commit suicide. However, the several times higher (24 times) mortality rate of mothers of such intellectually inferior children can be a trigger factor in the commission of SB among MR. The places of detention, which contain a relatively high proportion of MR (up to 5%), contribute to various manifestations of SB among these patients. The issues of diagnosis, prevention and care of MR for patients with SB are currently only being developed. Treatment includes educational, behavioral (psycho-psychological) and psychopharmacotherapeutic interventions, psychotherapeutic techniques adapt. In order to prevent SB, it is proposed to pay attention primarily to patients with intellectual development disorders from the high-risk group.