"Shock waves of grief and denial are still sweeping through our family as we come to grips with what has happened." -Linkin Park band members

Chester Bennington's sudden death in July of this year took music fans worldwide by surprise. After the shock come the questions. Why did this happen to him? How could someone so successful and passionate about his career take his own life? What could have been done to stop it? Were there signs of severe depression or suicidality leading up to the incident?

What is suicidal behavior?

Among those in the mental health field, there is debate on how to categorize suicidal behavior. Some view it simply as a symptom, often of borderline personality disorder, major depressive disorder, bipolar disorder, or other psychiatric conditions. It is even associated with some physical conditions, such as Huntington's.

The simple assessment for suicidal behaviors, "Suicidal Behaviors Questionnaire (SBQ-R)" consists of four questions, each one targeting a different dimension of suicidality: lifetime suicide ideation and/or attempt, frequency of suicidal ideation over the past year, threat of suicide attempt, and self-reported likelihood of suicidal behavior in the future. As shown by even the brief assessment, there are various factors to consider when assessing for suicidality. Why or how someone is suicidal is not simple to answer.

Suicide Risk Factors

According to the CDC, the risk factors include:

• History of mental disorders, particularly clinical depression
• Isolation, a feeling of being cut off from other people
• Barriers to accessing mental health treatment
• Loss (relational, social, work, or financial)
• Unwillingness to seek help because of the stigma attached to mental health and substance abuse disorders or to suicidal thoughts

Suicide Protective Factors

Protective factors "protect" the individuals from suicidal thoughts and behavior. They are not studied as often as risk factors but are equally as important.

Protective Factors include:

• Effective clinical care for mental, physical, and substance abuse disorders
• Family and community support
• Support from ongoing medical and mental health care relationships
• Skills in problem-solving, conflict resolution, and nonviolent ways of handling disputes
• Cultural and religious beliefs that discourage suicide and support instincts for self-preservation

(U.S. Public Health Service 1999)

Suicide as a Disease

During the writing of the last Diagnostic and Statistical Manual (DSM-5), a proposal to have a "suicide behavior disorder" as a separate disorder was considered. Instead of being accepted, it was put on probation along with a list of other topics for further research.

Current research already supports suicidality as a separate condition, such as the similarities of the brain of those who have committed suicide (including structural changes in the prefrontal cortex and altered levels of the neurotransmitter serotonin), distinct from the brains of those with mood disorders who died naturally.

As a disease, there could be more focused research on the best treatment and medication approach for it. Maybe, the label "suicide behavior disorder" could help remove the stigma from the behaviors and help establish more public understanding.