status can also be triggers for a suicidal crisis. this is also the case for a range of acute and chronic health problems, such as pain syndromes, or diagnoses of conditions like hiv or cancer.: 18, 25, 41–42 mental state certain clinical mental state features are predictive of suicide. an affective state of hopelessness, in other words a sense that nothing will ever get better, is a powerful predictive feature. high risk is also associated with a state of severe anger and hostility, or with agitation, anxiety, fearfulness, or apprehension.: 17, 38 research domain criteria symptom burdens, particularly the positive and negative valence domains, are associated with time varying risk of suicide. specific psychotic symptoms, such as grandiose delusions, delusions of thought insertion and mind reading are thought to indicate a higher likelihood of suicidal behavior. command hallucinations are often considered indicative of suicide risk, but the empirical evidence for this is equivocal. another psychiatric illness that is a high risk of suicide is schizophrenia. the risk is particularly higher in younger patients who have insight into the serious effect the illness is likely to have on their lives. the primary and necessary mental state federico sanchez called idiozimia (from idios "self" and zimia "loss"), followed by suicidal thoughts, hopelessness, loss of will power, hippocampal damage due to stress hormones, and finally either the activation of a suicidal belief system, or in the case of panic or anxiety attacks the switching over to an anger attack, are the converging reasons for a suicide to occur. suicidal ideation main article: suicidal ideation suicidal ideation refers to the thoughts that a person has about suicide. assessment of suicidal ideation includes assessment of the extent of preoccupation with thoughts of suicide (for example continuous or specific thoughts), specific plans, and the person's reasons and motivation to attempt suicide. planning assessment of suicide risk includes an assessment of the degree of planning, the potential or perceived lethality of the suicide method that the person is considering, and whether the person has access to the means to carry out these plans (such as access to a firearm). a suicide plan may include the following elements: timing, availability of method, setting, and actions made towards carrying out the plan (such as obtaining medicines, poisons, rope or a weapon), choosing and inspecting a setting, and rehearsing the plan. the more detailed and specific the suicide plan, the greater the level of risk. the presence of a suicide note generally suggests more premeditation and greater suicidal intent. the assessment would always include an exploration of the timing and content of any suicide note and a discussion of its meaning with the person who wrote it.: 46 motivation to die suicide risk assessment includes an assessment of the person's reasons for wanting to die from suicide. some are due to overwhelming emotions or others can have a deep philosophical belief. the causes are highly varied. other motivations for suicide suicide is not motivated only by a wish to die. other motivations for suicide include being motivated to end the suffering psychologically and a person suffering from a terminal illness may intend to die from suicide as a means of managing physical pain and/or their way of dealing with possible future atrophy or death.: 440 reasons to live balanced against reasons to die are the suicidal person's reasons to live, and an assessment would include an enquiry into the person's reasons for living and plans for the future.: 44 past suicidal acts there are people who die from suicide the first time they have suicidal thoughts and there are many who have suicidal thoughts and never attempt or die from suicide. suicide risk and mental illness all major mental disorders carry an increased risk of suicide.: 1037 however, 90% of suicides can be traced to depression, linked either to manic-depression (bipolar), major depression (unipolar), schizophrenia or personality disorders, particularly borderline personality disorder. comorbity of mental disorders increases suicide risk, especially anxiety or panic attacks. anorexia nervosa has a particularly strong association with suicide: the rate of suicide is forty times greater than the general population.: 1037 the lifetime risk of suicide was 18% in one study, and in another study 27% of all deaths related to anorexia nervosa were due to suicide.: 847 the long-term suicide rate for people with schizophrenia was estimated to be between 10 and 22% based upon longitudinal studies that extrapolated 10 years of illness for lifetime, but a more recent meta-analysis has estimated that 4.9% of people with schizophrenia will die from suicide during their lifetimes, usually near the illness onset.: 614 risk factors for suicide among people with schizophrenia include a history of previous suicide attempts, the degree of illness severity, comorbid depression or post-psychotic depression, social isolation, and male gender. the risk is higher for the paranoid subtype of schizophrenia, and is highest in the time immediately after discharge from hospital. while the lifetime suicide risk for mood disorders in general is around 1%, long-term follow-up studies of people who have been hospitalized for severe depression show a suicide risk of up to 13%. people with severe depression are 20 times more likely and people with bipolar disorder are 15 times more likely to die from suicide than members of the general population.: 722 depressed people with agitation, severe insomnia, anxiety symptoms, and co-morbid anxiety disorders are particularly at-risk. antidepressants have been linked with suicide as healy (2009) stated that people on antidepressant have the tendency to die from suicide after 10–14 days of commencement of antidepressant. people with a diagnosis of a personality disorder, particularly borderline, antisocial or narcissistic personality disorders, are at a high risk of suicide. in this group, elevated suicide risk is associated with younger age, comorbid drug addiction and major mood disorders, a history of childhood sexual abuse, impulsive and antisocial personality traits, and recent reduction of psychiatric care, such as recent discharge from hospital. while some people with personality disorders may make manipulative or contingent suicide threats, the threat is likely to be non-contingent when the person is silent, passive, withdrawn, hopeless, and making few demands. a history of excessive alcohol use is common among people who die from suicide, and alcohol intoxication at the time of the suicide attempt is a common pattern.: 48 meta analytic research conducted in 2015 indicates that a person with co-occurring alcohol use disorder and major depression is more likely to ideate, attempt, and complete suicide than those with individual disorders. theoretical models