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Suicide... |
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Suicide... |
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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.
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.
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.
With
regard to completed suicide, there are no national statistics for suicide rates
among gay, lesbian or bisexual (GLB) persons. Sexual orientation is not a
question on the death certificate, and to determine whether rates are higher for
GLB persons, we would need to know the proportion of the U.S. population that
considers themselves gay, lesbian or bisexual. Sexual orientation is a personal
characteristic that people can, and often do choose to hide, so that in
psychological autopsy studies of suicide victims where risk factors are
examined, it is difficult to know for certain the victim?s sexual orientation.
This is particularly a problem when considering GLB youth who may be less
certain of their sexual orientation and less open. In the few studies examining
risk factors for suicide where sexual orientation was assessed, the risk for gay
or lesbian persons did not appear any greater than among heterosexuals, once
mental and substance abuse disorders were taken into account.
With
regard to suicide attempts, several state and national studies have reported
that high school students who report to be homosexually and bisexually active
have higher rates of suicide thoughts and attempts in the past year compared to
youth with heterosexual experience. Experts have not been in complete agreement
about the best way to measure reports of adolescent suicide attempts, or sexual
orientation, so the data are subject to question. But they do agree that efforts
should focus on how to help GLB youth grow up to be healthy and successful
despite the obstacles that they face. Because school based suicide awareness
programs have not proven effective for youth in general, and in some cases have
caused increased distress in vulnerable youth, they are not likely to be helpful
for GLB youth either. Because young people should not be exposed to programs
that do not work, and certainly not to programs that increase risk, more
research is needed to develop safe and effective programs.
Historically,
African Americans have had much lower rates of suicides compared to white
Americans. However, beginning in the 1980s, the rates for African American male
youth began to rise at a much faster rate than their white counterparts. The
most recent trends suggest a decrease in suicide across all gender and racial
groups, but health policy experts remain concerned about the increase in suicide
by firearms for all young males. Whether African American male youth are more
likely to engage in ?victim-precipitated homicide? by deliberately getting in
the line of fire of either gang or law enforcement activity, remains an
important research question, as such deaths are not typically classified as
suicides.
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.
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.
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.
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.
* Information provided by the National Institute of Mental Health