Suicide and attempted suicide are complex behaviors, and a large number of proximal and distal risk factors have been identified (Hawton and van Heeringen, 2009). These risk factors can be categorized in explanatory models, which may help to understand suicidal individuals and facilitate the assessment of suicide risk. Early models have identified key determinants operating during the development of disorders or behavioral problems. For example, psychologists have developed schema models that focused on cognitive characteristics of, for example, depression, anxiety, and personality disorders. This conceptual approach and the empirical research motivated by such models have led to significant insights into these disorders (Ingram and Luxton, 2005). Stress has also been identified as a key determinant of psychopathology, so that a variety of models have featured stress as a primary determinant. Such models suggest that severe enough negative events can precipitate disorders even without reference to individual biological or psychological characteristics. The stress model of suicidal behavior is an example of such models. It is based on the observation that stressful life events are commonly recognized as triggers of suicidal behavior. A variety of explanatory models, including those applied by lay people, have indeed featured stress as a primary determinant of suicidal behavior. Such models indicate that negative life events if severe enough can precipitate suicidal behavior even without the existence of individual predisposing psychological or biological characteristics. Until recently, most studies of suicidal behavior were based on such early models and thus restricted to one domain of possible risk factors, for example, social, psychiatric, or psychological. As pointed out by Mann et al. (1999), such studies are too narrowly focused to estimate the relative importance of different types as risk factors or their interrelationship. A model of suicidal behavior has to take into account proximal and distal risk factors and their potential interaction (Hawton and van Heeringen, 2009). Stress models of suicidal behavior can indeed not explain the observations that even extreme stress does not lead to suicidal behaviors in all exposed individuals. Such observations have led to the recognition that the development of suicidal behavior involves a vulnerability or diathesis as a distal risk factor, which predisposes individuals to such behavior when stress is encountered. This chapter will review the scientific literature on the stress–diathesis model of suicidal behavior. Preceding this review, general issues regarding the origins, definitions, and components of stress–diathesis models will be addressed. The concluding discussion will point at the advantages of using stress–diathesis models for treating and preventing suicide risk and address issues with regard to future research.
自杀及自杀未遂是复杂的行为，人们已识别出大量的近端和远端风险因素（霍顿和范黑林根，2009年）。这些风险因素可在解释模型中进行分类，这可能有助于理解有自杀倾向的个体并促进对自杀风险的评估。早期模型已识别出在疾病或行为问题发展过程中起作用的关键决定因素。例如，心理学家已开发出模式模型，这些模型聚焦于如抑郁症、焦虑症和人格障碍等的认知特征。这种概念方法以及受此类模型推动的实证研究已使人们对这些疾病有了重要的认识（英格拉姆和卢克斯顿，2005年）。压力也已被确定为精神病理学的关键决定因素，因此各种模型都将压力作为主要决定因素。此类模型表明，即使不考虑个体的生物学或心理学特征，足够严重的负面事件也可能引发疾病。自杀行为的压力模型就是此类模型的一个例子。它基于这样的观察结果：有压力的生活事件通常被认为是自杀行为的触发因素。各种解释模型，包括非专业人士应用的模型，确实都将压力作为自杀行为的主要决定因素。此类模型表明，即使不存在个体易感性的心理或生物学特征，足够严重的负面生活事件也可能引发自杀行为。直到最近，大多数关于自杀行为的研究都基于此类早期模型，因此局限于可能的风险因素的一个领域，例如社会、精神或心理领域。正如曼恩等人（1999年）所指出的，此类研究关注范围过窄，无法估计不同类型作为风险因素的相对重要性或它们之间的相互关系。自杀行为模型必须考虑近端和远端风险因素及其潜在的相互作用（霍顿和范黑林根，2009年）。自杀行为的压力模型确实无法解释这样的观察结果：即使是极端压力也不会导致所有暴露个体出现自杀行为。此类观察结果已使人们认识到，自杀行为的发展涉及一种易感性或素质作为远端风险因素，当个体遇到压力时，这种因素会使他们易于出现此类行为。本章将综述关于自杀行为的压力 - 素质模型的科学文献。在进行这一综述之前，将讨论与压力 - 素质模型的起源、定义和组成部分相关的一般问题。最后的讨论将指出使用压力 - 素质模型治疗和预防自杀风险的优势，并探讨未来研究的相关问题。
