What should you
do if someone tells you they are thinking about suicide?
If someone tells you they are thinking about suicide, you should
take their distress seriously, listen nonjudgmentally, and help
them get to a professional for evaluation and treatment. People
consider suicide when they are hopeless and unable to see alternative
solutions to problems. Suicidal behavior is most often related to
a mental disorder (depression) or to alcohol or other substance
abuse. Suicidal behavior is also more likely to occur when people
experience stressful events (major losses, incarceration). If someone
is in imminent danger of harming himself or herself, do not leave
the person alone. You may need to take emergency steps to get help,
such as calling 911. When someone is in a suicidal crisis, it is
important to limit access to firearms or other lethal means of committing
suicide.
<Back to Top> What are the most common methods of suicide?
Firearms are the most commonly used method of suicide
for men and women, accounting for 60 percent of all suicides. Nearly
80 percent of all firearm suicides are committed by white males.
The second most common method for men is hanging; for women, the
second most common method is self-poisoning including drug overdose.
The presence of a firearm in the home has been found to be an independent,
additional risk factor for suicide. Thus, when a family member or
health care provider is faced with an individual at risk for suicide,
they should make sure that firearms are removed from the home.
Why do men commit suicide more often
than women do?
More than four times as many men as women die by suicide; but women
attempt suicide more often during their lives than do men, and women
report higher rates of depression. Men and women use different suicide
methods. Women in all countries are more likely to ingest poisons
than men. In countries where the poisons are highly lethal and/or
where treatment resources scarce, rescue is rare and hence female
suicides outnumber males.
There is a common perception that suicide rates are highest among
the young. However, it is the elderly, particularly older white
males that have the highest rates. And among white males 65 and
older, risk goes up with age. White men 85 and older have a suicide
rate that is six times that of the overall national rate. Some older
persons are less likely to survive attempts because they are less
likely to recuperate. Over 70 percent of older suicide victims have
been to their primary care physician within the month of their death,
many did not tell their doctors they were depressed nor did the
doctor detect it. This has led to research efforts to determine
how to best improve physicians? abilities to detect and treat depression
in older adults.
Impulsiveness is the tendency to act without thinking through a
plan or its consequences. It is a symptom of a number of mental
disorders, and therefore, it has been linked to suicidal behavior
usually through its association with mental disorders and/or substance
abuse. The mental disorders with impulsiveness most linked to suicide
include borderline personality disorder among young females, conduct
disorder among young males and antisocial behavior in adult males,
and alcohol and substance abuse among young and middle-aged males.
Impulsiveness appears to have a lesser role in older adult suicides.
Attention deficit hyperactivity disorder that has impulsiveness
as a characteristic is not a strong risk factor for suicide by itself.
Impulsiveness has been linked with aggressive and violent behaviors
including homicide and suicide. However, impulsiveness without aggression
or violence present has also been found to contribute to risk for
suicide.
Some right-to-die advocacy groups promote the idea that suicide,
including assisted suicide, can be a rational decision. Others have
argued that suicide is never a rational decision and that it is
the result of depression, anxiety, and fear of being dependent or
a burden. Surveys of terminally ill persons indicate that very few
consider taking their own life, and when they do, it is in the context
of depression. Attitude surveys suggest that assisted suicide is
more acceptable by the public and health providers for the old who
are ill or disabled, compared to the young who are ill or disabled.
At this time, there is limited research on the frequency with which
persons with terminal illness have depression and suicidal ideation,
whether they would consider assisted suicide, the characteristics
of such persons, and the context of their depression and suicidal
thoughts, such as family stress, or availability of palliative care.
Neither is it yet clear what effect other factors such as the availability
of social support, access to care, and pain relief may have on end-of-life
preferences. This public debate will be better informed after such
research is conducted.
What biological factors increase
risk for suicide?
Researchers believe that both depression and suicidal behavior can
be linked to decreased serotonin in the brain. Low levels of a serotonin
metabolite, 5-HIAA, have been detected in cerebral spinal fluid
in persons who have attempted suicide, as well as by postmortem
studies examining certain brain regions of suicide victims. One
of the goals of understanding the biology of suicidal behavior is
to improve treatments. Scientists have learned that serotonin receptors
in the brain increase their activity in persons with major depression
and suicidality, which explains why medications that desensitize
or down-regulate these receptors (such as the serotonin reuptake
inhibitors, or SSRIs) have been found effective in treating depression.
Currently, studies are underway to examine to what extent medications
like SSRIs can reduce suicidal behavior.
There is growing evidence that familial and genetic factors contribute
to the risk for suicidal behavior. Major psychiatric illnesses,
including bipolar disorder, major depression, schizophrenia, alcoholism
and substance abuse, and certain personality disorders, which run
in families, increase the risk for suicidal behavior. This does
not mean that suicidal behavior is inevitable for individuals with
this family history; it simply means that such persons may be more
vulnerable and should take steps to reduce their risk, such as getting
evaluation and treatment at the first sign of mental illness.
Although the majority of people who have depression do not die by
suicide, having major depression does increase suicide risk compared
to people without depression. The risk of death by suicide may,
in part, be related to the severity of the depression. New data
on depression that has followed people over long periods of time
suggests that about 2 percent of those people ever treated for depression
in an outpatient setting will die by suicide. Among those ever treated
for depression in an inpatient hospital setting, the rate of death
by suicide is twice as high (4 percent). Those treated for depression
as inpatients following suicide ideation or suicide attempts are
about three times as likely to die by suicide (6 percent) as those
who were only treated as outpatients. There are also dramatic gender
differences in lifetime risk of suicide in depression. Whereas about
7 percent of men with a lifetime history of depression will die
by suicide, only 1 percent of women with a lifetime history of depression
will die by suicide.
Another way about thinking of suicide risk and depression is to
examine the lives of people who have died by suicide and see what
proportion of them were depressed. From that perspective, it is
estimated that about 60 percent of people who commit suicide have
had a mood disorder (e.g., major depression, bipolar disorder, dysthymia).
Younger persons who kill themselves often have a substance abuse
disorder in addition to being depressed.
Does alcohol and other drug abuse
increase the risk for suicide?
A number of recent national surveys have helped shed light on the
relationship between alcohol and other drug use and suicidal behavior.
A review of minimum-age drinking laws and suicides among youths
age 18 to 20 found that lower minimum-age drinking laws was associated
with higher youth suicide rates. In a large study following adults
who drink alcohol, suicide ideation was reported among persons with
depression. In another survey, persons who reported that they had
made a suicide attempt during their lifetime were more likely to
have had a depressive disorder, and many also had an alcohol and/or
substance abuse disorder. In a study of all nontraffic injury deaths
associated with alcohol intoxication, over 20 percent were suicides.
In studies that examine risk factors among people who have completed
suicide, substance use and abuse occurs more frequently among youth
and adults, compared to older persons. For particular groups at
risk, such as American Indians and Alaskan Natives, depression and
alcohol use and abuse are the most common risk factors for completed
suicide. Alcohol and substance abuse problems contribute to suicidal
behavior in several ways. Persons who are dependent on substances
often have a number of other risk factors for suicide. In addition
to being depressed, they are also likely to have social and financial
problems. Substance use and abuse can be common among persons prone
to be impulsive, and among persons who engage in many types of high
risk behaviors that result in self-harm. Fortunately, there are
a number of effective prevention efforts that reduce risk for substance
abuse in youth, and there are effective treatments for alcohol and
substance use problems. Researchers are currently testing treatments
specifically for persons with substance abuse problems who are also
suicidal, or have attempted suicide in the past.
What does "suicide contagion"
mean, and what can be done to prevent it?
Suicide contagion is the exposure to suicide or suicidal behaviors
within one's family, one's peer group, or through media reports
of suicide and can result in an increase in suicide and suicidal
behaviors. Direct and indirect exposure to suicidal behavior has
been shown to precede an increase in suicidal behavior in persons
at risk for suicide, especially in adolescents and young adults.
The risk for suicide contagion as a result of media reporting can
be minimized by factual and concise media reports of suicide. Reports
of suicide should not be repetitive, as prolonged exposure can increase
the likelihood of suicide contagion. Suicide is the result of many
complex factors; therefore media coverage should not report oversimplified
explanations such as recent negative life events or acute stressors.
Reports should not divulge detailed descriptions of the method used
to avoid possible duplication. Reports should not glorify the victim
and should not imply that suicide was effective in achieving a personal
goal such as gaining media attention. In addition, information such
as hotlines or emergency contacts should be provided for those at
risk for suicide.
Following exposure to suicide or suicidal behaviors within one's
family or peer group, suicide risk can be minimized by having family
members, friends, peers, and colleagues of the victim evaluated
by a mental health professional. Persons deemed at risk for suicide
should then be referred for additional mental health services.
At the current time there is no definitive measure to predict suicide
or suicidal behavior. Researchers have identified factors that place
individuals at higher risk for suicide, but very few persons with
these risk factors will actually commit suicide. Risk factors include
mental illness, substance abuse, previous suicide attempts, family
history of suicide, history of being sexually abused, and impulsive
or aggressive tendencies. Suicide is a relatively rare event and
it is therefore difficult to predict which persons with these risk
factors will ultimately commit suicide.
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