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Suicide

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See also: List of suicide crisis lines

Suicide is when a person chooses to kill themselves.[1] When someone kills themselves, people say that they have "committed suicide" "completed suicide" or "died by suicide”, however using a variation of death by suicide is best practice. When a person thinks about killing themselves, the person is described as suicidal.

Suicide
Classification and external resources
The Suicide by Édouard Manet 1877–1881
ICD-10X60.–X84.
ICD-9E950
MedlinePlus001554
eMedicinearticle/288598
MeSHF01.145.126.980.875

When people start having thoughts about killing themselves, it is a medical emergency. They should get a suicide risk assessment as soon as possible. They should not be left alone.

There are many reasons why a person might think about suicide. Most people who are suicidal have some type of mental condition or illness. They may have a chronic condition, which means it has been going on for a long time. But it may be an acute condition –, which means the first symptoms of mental illness happened rather quickly.

Depression is the mental illness that most often causes a person to have suicidal thoughts. Depression may also be a symptom of other mental or medical disorders.

Depression, which can lead to suicidal thoughts, has many possible causes. For example, it may also be caused by stress, and difficult events in a person's life, like losing a job or getting sick. Other causes of suicidal thoughts are bullying and inceldom.

Suicide is one of the top three causes of death for young people aged 14–35 years-old. It is the second most common and the second leading cause of death for college students. Every 3 seconds, a person somewhere in the world tries to kill themselves. Every 40 seconds, someone dies by suicide. For every suicide, at least six other people are seriously affected.(WHO 2000)

Although depression is the main factor in suicide, it is also treatable and suicide is often preventable.

Risk factors

 
Examples of suicide risk and protective factors.
Source: 2012 National Strategy for Suicide Prevention

There are many risk factors for suicide. However, it is important to remember that risk factors are not the same as causes. Risk factors do not cause suicide or suicidal thoughts. They only make it more likely that some people with those risk factors may become suicidal. If a person has a risk factor, that does not mean they are going to become suicidal.

Mental disorders

Most people who die by suicide have a mental disorder. Different studies found different rates, between 85%-95%. Depressive disorders account for about 80 percent of these numbers; schizophrenia, ten percent; and dementia and delirium about five percent.

Among people who have a mental disorder, 25% also have alcohol abuse issues. People who abuse alcohol have a 50% greater risk of suicide compared to those who do not.[2]

While acts of self-harm are not considered suicide attempts, a person who self-harms may be more likely to die by suicide.[3]

Emotions

  • Hopelessness: Feeling like there is no chance that things will get better. Hopelessness is very common in people who die by suicide.[4]
  • Perceived burdensomeness: When a person feels like they are a burden to others (like they just cause problems for other people). Suicidal people often feel hopeless at the same time.[5]
  • Loneliness: Feeling alone. Sometimes people actually are alone; sometimes they just feel lonely. People are more likely to feel suicidal if:[6][7][8]
    • They do not have people to support them, such as family and friends
    • They feel like they do not belong or fit in with other people
    • They live alone

Substance abuse

Substance abuse is the second most common reason for suicide and feeling suicidal. Only two serious mental illnesses - depression and bipolar disorder - cause more harm.[9] A person is at greater risk for suicide whether they have been using drugs for a long time or just a short time.[10] When a drug abuser is also sufffering from great sadness or grief, suicide is even more common.[11]

More than half of suicides are at least partly due to alcohol or drug use. About one-fourth of people who die by suicide have a substance use disorder (sick with drug addiction or alcoholism). In teenagers and youth, the percent is even higher.

Problem gambling

Problem gamblers have more suicidal ideation and make more suicide attempts compared to the general population.[12][13][14] (Problem gambling is gambling that causes major problems in a person's life.)

If a person becomes a problem gambler earlier in life, they have a higher risk of suicide for the rest of their life. Gambling-related suicide attempts are usually made by older people with gambling problems.[15][16] Substance use[17][18] and mental disorders increase the risk of suicide even more in people with problem gambling.

Medical conditions

There is a link between suicidality and medical conditions, including chronic pain,[19] mild brain injury, (MBI) or traumatic brain injury (TBI).[20][21] People with these conditions had a higher rate of suicide that was not caused by depression or alcohol abuse. People with more than one medical condition had an even higher risk of suicide.[22][23]

Problems with sleeping, such as insomnia[24] and sleep apnea, may be risk factors for depression and suicide. In some people, the sleep problem itself, not depression, may be what increases their risk for depression.[25]

People being treated for mood disorders should be checked by a doctor. This should include a physical examination and blood tests. This can make sure the person's mood disorder is not caused by a medical problem. Many medical conditions can cause problems with mood and thinking.[26] Seeing a doctor will also help make sure that it is safe to prescribe medications for the person's mood disorder.[26]

Biology

 
Brain immaturity

The human brain does not mature until the ages of 20-25. This clip shows the changes in grey matter between the ages of 5-20. Brain immaturity may have an influence on youth suicide.[27]

Some mental disorders that are risk factors for suicide may be partly caused by problems in the brain and body.[28][29]

  • Serotonin is an important brain neurotransmitter (a chemical messenger). Some studies have found that people who tried to kill themselves had low levels of serotonin in their brains. People who died by suicide had the lowest levels.[30][31] Low serotonin levels are a risk factor for suicide, even if a person has never had depression.[32][33][34]
  • Brain-derived neurotrophic factor (BDNF):[35] This is a protein that helps nerves grow. Problems with how BDNF works may help cause several mood disorders linked with suicidal behavior, including major depressive disorder.[36][37] Studies of suicide victims have shown very low levels of BDNF in the hippocampus and prefrontal cortex, even in people who had no mental illness.[38][39]

Even if they have the same risk factors, some people are at a higher risk for suicide than others. This is partly because of genetic inheritance. Genetics causes about 30–50% of the difference in suicide risk among different people.[40][41][41] For example, a person whose parent died by suicide is much more likely to try to kill themselves.[42][43] Epigenetics may also affect suicide risk.[44][45][46]

Media coverage

How the media shows news stories of suicide may have a negative effect[47] and trigger the possibility of copycat suicides (this is called the Werther effect).[48][49] This risk is greater in teenagers and young adults.[50][51][52]

The opposite of the Werther effect is the Papageno effect. This means that the media can help make suicide less likely if they cover good ways of dealing with stress and difficult things in life.[53]

Others

A person is also more likely to die by suicide if:

Protective factors

Protective factors make it less likely that a person will die by suicide. They help protect a person from the risk of suicide. They can also help protect a suicidal person from the effects of suicidal thinking.

Protective factors can be internal, such as a person's personal strengths and beliefs. For example:[61]

  • Having skills like good ways of dealing with stress and solving problems
  • Having religious or cultural beliefs that say life is important
  • Having reasons for living[62]

Protective factors can also be external, such as a person's relationships and life situation. These factors can include:[61]

  • Having strong connections with family and friends, who are supportive
  • Not being able to get items which are very deadly if used for a suicide attempt (like a gun)
  • Having someone who helps the person get the treatment and help they need
  • Being able to easily get good care and treatment for mental, physical, and substance abuse disorders

Protective factors are as important to identify as risk factors. Just as risk factors can be reduced, protective factors can be increased.

Prevention

Main page: Suicide prevention

Suicide prevention tries to decrease the number of suicides by using protective measures. Some prevention strategies make it harder for people to get the most common things used to commit suicide. This includes taking away guns, poisons, and drugs.

Studies have shown that good treatment of depression, alcohol abuse, and drug abuse can decrease the number of suicides. So does follow-up contact with those who have made a suicide attempt.[63]

In many countries, people who are at high risk of hurting themselves can check themselves into a hospital emergency department. In some countries or states, a doctor, judge, or police officer can force a person to go to the hospital if they seem suicidal, even if the person does not want to go. The person will be watched closely at the hospital to make sure they do not hurt themselves. A doctor or mental health professional will decide whether the person needs to go to a psychiatric hospital.

"SOS Signs of Suicide" is a suicide prevention program used in secondary schools for students between 13 and 17 years old. The program educations students about suicide, and tests them for suicide risk. Students who have done this program make less suicide attempts than students who have not done the program.[64]

Suicide hotlines and crisis intervention centers help students who are at high risk. They help people who have suicidal thoughts.[65]

A suicide risk assessment looks at how likely a person is to attempt suicide. A good assessment can help prevent a suicide. It is also the first step in coming up with a treatment plan. Even though suicide risk assessments are very important, they are usually not done. Many mental health care workers have little or no training in how to do a suicide risk assessment.[66][67]

Epidemiology

 
United States suicide rates in 2009.
 
World suicide rates in 2009. Grey areas are those where there is little or no data.

Worldwide suicide rates have increased by 60% in the past 45 years, mainly in the developing countries. As of 2006:[68]

  • Suicide was the tenth leading cause of death in the world
  • About a million people died of suicide every year (this means that 16 out of every 100,000 people in the world died from suicide every year)
  • A person completed suicide every 40 seconds

According to 2007 information, suicides happen twice as often as homicides in the United States. Suicide is the 11th leading cause of death in the country, ahead of liver disease and Parkinson's disease.[69]

Suicide rates vary a great deal across the world. Lithuania has the highest suicide rate.

30% of deaths by suicide are by people who are intoxicated.(Source: SAMSHA)

Methods

 
Death rates of suicide methods in the United States

The most common ways of death by suicide are not the same in every country. In different areas, they include hanging, pesticide poisoning, and firearms.[70]

A 2008 report compared 56 countries, using information from the World Health Organization. It found that:

  • Hanging was the most common method in most of the countries.[71] 53% of men who committed suicide, and 39% of women, used hanging.[72]
  • Worldwide, 30% of people who die by suicide use pesticides. This method was most common in the Pacific area, where over half of people who died by suicide used pesticides. It was least common in Europe, where only 4% used this method.[73]
  • In the United States 52% of suicides involve the use of firearms.[74]
  • In the United States, asphyxiation and poisoning are also common. About 40% of suicides in the United States used one of these methods.

Other people in the world die by suicide by:

Sometimes, suicidal people do something that will make another person kill them. For example, a suicidal person might point a gun at a police officer, so the police officer will shoot the person in self-defense. This is commonly called "suicide by cop."

Views of suicide

Modern medicine treats suicide as a mental health issue. When a person starts having many thoughts about killing themselves, it is considered a medical emergency.

The Abrahamic religions (like Christianity, Judaism, and Islam) think that life is sacred. They believe that when a person kills themselves, they are murdering what God has made. For this reason, many followers of Abrahamic religions thinks that when a person dies by suicide, they will go to Hell.

The Dharmic and Taoist religions (like Buddhism, Hinduism, Jainism, Taoism, Confucianism, and Shinto) believe that someone who does by suicide will be reincarnated in the next life with a less enlightened soul. However, many people of these religions are more likely to die by suicide because they believe that there will be a next life. They think that by dying by suicide, they may have a better chance in the next life.

Suicide as a weapon

There are several famous examples of suicide attacks in history. The Kamikazes were one example. They were Japanese fighter pilots during World War II, who would try to kill American soldiers by crashing their planes into American ships. By crashing their planes, they would kill themselves as well.

The September 11, 2001 terrorist attacks on the United States were also done by suicide attackers. They flew planes into the World Trade Center buildings and the Pentagon.[75]

Related pages

References

  1. ↑ The word suicide comes from the Latin words sui caedere, which means "to kill oneself".
  2. ↑ Benjamin James Sadock, M.D., Virginia Alcott Sadock: Kapalan and Sadock's Concise Textbook of Clinical Psychiatry. Lippincott Williams & Wilkins; Third edition (2008) ISBN 0781787467
  3. ↑ Whitlock J, Knox KL (July 2007). "The relationship between self-injurious behavior and suicide in a young adult population". Arch Pediatr Adolesc Med. 161 (7): 634–40. doi:10.1001/archpedi.161.7.634. PMID 17606825.
  4. ↑ American Psychiatric Association: American Psychiatric Association Practice Guidelines for the Treatment of Psychiatric Disorders: Compendium 2006. American Psychiatric Publishing; 1 edition (2006) pp.1410-1411 ISBN 0890423857
  5. ↑ Jahn DR, Cukrowicz KC, Linton K, Prabhu F (March 2011). "The mediating effect of perceived burdensomeness on the relation between depressive symptoms and suicide ideation in a community sample of older adults". Aging Ment Health. 15 (2): 214–20. doi:10.1080/13607863.2010.501064. PMID 20967639.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  6. ↑ You, S. (2010). "Social connections and suicidal thoughts and behavior". Psychology of Addictive Behaviors. 25 (1): 180–184. doi:10.1037/a0020936. PMC 3066301. PMID 21142333. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  7. ↑ Stravynski A, Boyer R (2001). "Loneliness in relation to suicide ideation and parasuicide: a population-wide study". Suicide Life Threat Behav. 31 (1): 32–40. PMID 11326767.
  8. ↑ Vanderhorst RK, McLaren S (November 2005). "Social relationships as predictors of depression and suicidal ideation in older adults". Aging Ment Health. 9 (6): 517–25. doi:10.1080/13607860500193062. PMID 16214699.
  9. ↑ D., PhD Frank, Jerome; Levin, Jerome D; S., PhD Piccirilli, Richard; Perrotto, Richard S; Culkin, Joseph (28 Sep 2001). Introduction to chemical dependency counseling. Northvale, NJ: Jason Aronson. pp. 150–152. ISBN 978-0-7657-0289-0.
  10. ↑ Giner L, Carballo JJ, Guija JA,; et al. (2007). "Psychological autopsy studies: the role of alcohol use in adolescent and young adult suicides". Int J Adolesc Med Health. 19 (1): 99–113. PMID 17458329.{{cite journal}}: CS1 maint: extra punctuation (link) CS1 maint: multiple names: authors list (link)
  11. ↑ Fadem, Barbara (1 Dec 2003). Behavioral science in medicine. Philadelphia: Lippincott Williams Wilkins. p. 217. ISBN 978-0-7817-3669-5.
  12. ↑ Moreyra, P., Ibanez A., Saiz-Ruiz J., Nissenson K., Blanco C. (2000). "Review of the phenomenology, etiology and treatment of pathological gambling". German Journal of Psychiatry. 3: 37–52.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  13. ↑ Pallanti, Stefano; Rossi, Nicolò Baldini; Hollander, Eric (2006). "11. Pathological Gambling". In Hollander, Eric; Stein, Dan J. (eds.). Clinical manual of impulse-control disorders. American Psychiatric Pub. pp. 251–289. ISBN 978-1-58562-136-1.
  14. ↑ Volberg, R.A. (2002). "The epidemiology of pathological gambling". Psychiatric Annals. 32: 171–8.
  15. ↑ Kaminer Y, Burleson JA, Jadamec A (September 2002). "Gambling behavior in adolescent substance abuse". Subst Abus. 23 (3): 191–8. doi:10.1080/08897070209511489. PMID 12444352.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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  19. ↑ Ilgen MA, Zivin K, McCammon RJ, Valenstein M (2008). "Pain and suicidal thoughts, plans and attempts in the United States". Gen Hosp Psychiatry. 30 (6): 521–7. doi:10.1016/j.genhosppsych.2008.09.003. PMC 2601576. PMID 19061678.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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  21. ↑ Teasdale TW, Engberg AW (October 2001). "Suicide after traumatic brain injury: a population study". J. Neurol. Neurosurg. Psychiatr. 71 (4): 436–40. doi:10.1136/jnnp.71.4.436. PMC 1763534. PMID 11561024.
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  29. ↑ Phillips J, Murray P, Kirk P., The biology of disease; pp.5-9 ISBN 978-0-632-05404-6
  30. ↑ David M. Stoff, Elizabeth J. Susman: Developmental psychobiology of aggression; Cambridge University Press (2005) ISBN 0-521-82601-2
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  35. ↑ BDNF brain-derived neurotrophic factor [ Homo sapiens ]Gene ID: 627, updated on 9-Sep-2012:[2]
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  45. ↑ Trygve Tollefsbol: Handbook of Epigenetics: The New Molecular and Medical Genetics. p.562: Elsevier Science;(2010);ISBN 0-12-375709-6
  46. ↑ Arturas Petronis: Brain, Behavior and Epigenetics, p.61 Springer (2011);ISBN 3-642-17425-6
  47. ↑ Niederkrotenthaler T, Herberth A, Sonneck G (2007). "[The "Werther-effect": legend or reality?]". Neuropsychiatr (in German). 21 (4): 284–90. PMID 18082110.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unrecognized language (link)
  48. ↑ Stack S (April 2003). "Media coverage as a risk factor in suicide". J Epidemiol Community Health. 57 (4): 238–40. doi:10.1136/jech.57.4.238. PMC 1732435. PMID 12646535.
  49. ↑ O'Carroll PW, Potter LB (April 1994). "Suicide contagion and the reporting of suicide: recommendations from a national workshop. United States Department of Health and Human Services". MMWR Recomm Rep. 43 (RR–6): 9–17. PMID 8015544.
  50. ↑ Thomas H. Ollendick, Carolyn S. Schroeder: Encyclopedia of clinical child and pediatric psychology, p.61; Springer;(2003) ISBN 0-306-47490-5
  51. ↑ Marion Crook: Out of the darkness: teens and suicide p.56 Arsenal Pulp Press (2004) ISBN 1-55152-141-5
  52. ↑ Stack S (April 2005). "Suicide in the media: a quantitative review of studies based on non-fictional stories". Suicide Life Threat Behav. 35 (2): 121–33. doi:10.1521/suli.35.2.121.62877. PMID 15843330.
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  54. ↑ Teasdale TW, Engberg AW (October 2001). "Suicide after traumatic brain injury: a population study". J. Neurol. Neurosurg. Psychiatr. 71 (4): 436–40. doi:10.1136/jnnp.71.4.436. PMC 1763534. PMID 11561024.
  55. ↑ Simpson G, Tate R (December 2007). "Suicidality in people surviving a traumatic brain injury: prevalence, risk factors and implications for clinical management". Brain Inj. 21 (13–14): 1335–51. doi:10.1080/02699050701785542. PMID 18066936.
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  58. ↑ "Child Protection and Child Outcomes: Measuring the Effects of Foster Care" (PDF). Retrieved 2011-11-01.
  59. ↑ Koch, Wendy (2007-07-03). "Study: Troubled homes better than foster care". Usatoday.Com. Retrieved 2011-11-01.
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  62. ↑ Malone KM1, Oquendo MA, Haas GL, Ellis SP, | display-authors = etal Protective factors against suicidal acts in major depression: reasons for living. Am J Psychiatry. 2000 Jul;157(7):1084-8. PMID 10873915
  63. ↑ "WHO - Suicide data". WHO.
  64. ↑ SAMSHA"S National Registry of Evidence-based Programs and Practices. SOS Signs of Suicide [3]
  65. ↑ Nolen-Hoeksema, Susan.Abnormal Psychology, 6e. McGraw-Hill, 2014. pg. 210. ISBN 1308211503
  66. ↑ Schmitz WM Jr1, Allen MH, Feldman BN, Gutin NJ, | display-authors = etal Suicide Life Threat Behav. 2012 Jun;42(3):292-304. doi: 10.1111/j.1943-278X.2012.00090.x. Epub 2012 Apr 11.Preventing suicide through improved training in suicide risk assessment and care: an American Association of Suicidology Task Force report addressing serious gaps in U.S. mental health training. PMID 22494118
  67. ↑ Roberts A R., Monferrari I, Yeager, KR, Avoiding Malpractice Lawsuits by Following Risk Assessment and Suicide Prevention Guidelines [4]
  68. ↑ "Suicide prevention". WHO Sites: Mental Health. World Health Organization. February 16, 2006. Retrieved 2008-09-16.
  69. ↑ "2007 Data" (PDF). Suicide Prevention. Suicidology.org. 2007. Retrieved 2011-01-13.
  70. ↑ Ajdacic-Gross V; Weiss MG; Ring M; et al. (September 2008). "Methods of suicide: international suicide patterns derived from the WHO mortality database". Bull. World Health Organ. 86 (9): 726–32. doi:10.2471/BLT.07.043489. PMC 2649482. PMID 18797649. {{cite journal}}: Unknown parameter |author-separator= ignored (help)
  71. ↑ Ajdacic-Gross, Vladeta, et al. "Methods of suicide: international suicide patterns derived from the WHO mortality database"PDF (267 KB). Bulletin of the World Health Organization 86 (9): 726–732. September 2008. Accessed 2 August 2011. Archived 2 August 2011. See html version.
    • The data can be seen here.
  72. ↑ O'Connor, Rory C.; Platt, Stephen; Gordon, Jacki, eds. (1 June 2011). International Handbook of Suicide Prevention: Research, Policy and Practice. John Wiley and Sons. p. 34. ISBN 978-1-119-99856-3.
  73. ↑ Gunnell D, Eddleston M, Phillips MR, Konradsen F (2007). "The global distribution of fatal pesticide self-poisoning: systematic review". BMC Public Health. 7: 357. doi:10.1186/1471-2458-7-357. PMC 2262093. PMID 18154668.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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  75. ↑ Editors, History com. "9/11 Attacks". HISTORY. {{cite web}}: |last= has generic name (help)

Other websites

Help for suicidal people

Learn more about suicide and how to get help for yourself or others

Hotlines

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