suicide

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Suicide

 

Definition

Suicide is defined as the intentional taking of one's own life. Prior to the late nineteenth century, suicide was legally defined as a criminal act in most Western countries. In the social climate of the early 2000s, however, suicidal behavior is most commonly regarded and responded to as a psychiatric emergency.

Description

Suicide is considered a major public health problem around the world as well as a personal tragedy. According to the National Institute of Mental Health (NIMH), suicide was the eleventh leading cause of death in the United States in 2000, and the third leading cause of death for people between the ages of 15 and 24. About 10.6 out of every 100,000 persons in the United States and Canada die by their own hands. There are five suicide victims for every three homicide deaths in North America as of the early 2000s. There are over 30,000 suicides per year in the United States, or about 86 per day; and each day about 1900 people attempt suicide.
The demographics of suicide vary considerably within Canada and the United States, due in part to differences among age groups and racial groups, and between men and women. Adult males are three to five times more likely to commit suicide than females, but females are more likely to attempt suicide. Most suicides occur in persons below the age of 40; however, elderly Caucasians are the sector of the population with the highest suicide rate. Americans over the age of 65 accounted for 18 percent of deaths by suicide in the United States in 2000. Geographical location is an additional factor; according to the Centers for Disease Control and Prevention (CDC), suicide rates in the United States are slightly higher than the national average in the western states, and somewhat lower than average in the East and the Midwest.
Race is also a factor in the demographics of suicide. Between 1979 and 1992, Native Americans had a suicide rate 1.5 times the national average, with young males between 15 and 24 accounting for 64% of Native American deaths by suicide. Asian American women have the highest suicide rate among all women over the age of 65. And between 1980 and 1996 the suicide rate more than doubled for black males between the ages of 15 and 19.

Causes & symptoms

Causes

Suicide is a complex act that represents the end result of a combination of factors in any individual. These factors include biological vulnerabilities, life history, occupation, present social circumstances, and the availability of means for committing suicide. While these factors do not "cause" suicide in the strict sense, some people are at greater risk of self-harm than others. Risk factors for suicide include:
  • Male sex.
  • Age over 75.
  • A family history of suicide.
  • A history of previous suicide attempts.
  • A history of abuse in childhood.
  • A local cluster of recent suicides or a local landmark associated with suicides. Examples of the latter include the Golden Gate Bridge in San Francisco; Sydney Harbor Bridge in Australia; St. Peter's Basilica in Rome; the Eiffel Tower in Paris; Prince Edward Viaduct in Toronto; and Mount Mihara, a volcano in Japan.
  • Recent stressful events: separation or divorce, job loss, bankruptcy, upsetting medical diagnosis, death of spouse.
  • Medical illness. Persons in treatment for such serious or incurable diseases as AIDS, Parkinson's disease, and certain types of cancer are at increased risk of suicide.
  • Employment as a police officer, firefighter, physician, dentist, or member of another high-stress occupation.
  • Presence of firearms in the house. Death by firearms is the most common method for women as well as men as of the early 2000s. In 2001, 55% of reported suicides in the United States were committed with guns.
  • Alcohol or substance abuse. Mood-altering substances are a factor in suicide because they weaken a person's impulse control.
  • Presence of a psychiatric illness. Over 90% of Americans who commit suicide have a significant mental illness. Major depression accounts for 60% (especially in the elderly), followed by schizophrenia, alcoholism, substance abuse, borderline personality disorder, Huntington's disease, and epilepsy. The lifetime mortality due to suicide in psychiatric patients is 15% for major depression; 20% for bipolar disorder; 18% for alcoholism; 10% for schizophrenia; and 5-10% for borderline and certain other personality disorders.
Neurobiological factors may also influence a person's risk of suicide. Post-mortem studies of the brains of suicide victims indicate that the part of the brain associated with aggression and other impulsive behaviors (the frontal cortex) has a significantly lower level of serotonin, a neurotransmitter associated with mood disorders. Low serotonin levels are correlated with major depression. In addition, suicide victims have higher than normal levels of cortisol, a hormone produced in stressful situations, in the tissues of their central nervous system. Other research has indicated that abuse in childhood may have permanent effects on the level of serotonin in the brain, possibly "resetting" the level abnormally low. In addition, twin studies have suggested that there may be a genetic susceptibility to both suicidal ideation and suicide attempts which cannot be explained by inheritance of common psychiatric disorders.
Some psychiatrists propose psychodynamic explanations of suicide. According to one such theory, suicide is "murder in the 180th degree" that is, the suicidal person really wants to kill someone else but turns the anger against the self instead. Another version of this idea is that the suicidal person has incorporated the image of an abusive parent or other relative in their own psyche and then tries to eliminate the abuser by killing the self.

Diagnosis

When a person consults a doctor because they are thinking of committing suicide, or they are taken to a doctor's office or emergency room after a suicide attempt, the doctor will evaluate the patient's potential for acting on their thoughts or making another attempt. The physician's assessment will be based on several different sources of information:
  • The patient's history, including a history of previous attempts or a family history of suicide.
  • A clinical interview in which the physician will ask whether the patient is presently thinking of suicide; whether they have made actual plans to do so; whether they have thought about the means; and what they think their suicide will accomplish. These questions help in evaluating the seriousness of the patient's intentions.
  • A suicide note, if any.
  • Information from friends, relatives, or first responders who may have accompanied the patient.
  • Short self-administered psychiatric tests that screen people for depression and suicidal ideation. The most commonly used screeners are the Beck Depression Inventory (BDI), the Depression Screening Questionnaire, and the Hamilton Depression Rating Scale.
  • The doctor's own instinctive reaction to the patient's mood, appearance, vocal tone, and similar factors.

Treatment of attempted suicide

Suicide attempts range from well-planned attempts involving a highly lethal method (guns, certain types of poison, jumping from high places, throwing oneself in front of trains or subway cars) that fail by good fortune to impulsive or poorly planned attempts using a less lethal method (medication overdoses, cutting the wrists). Suicide attempts at the less lethal end of the spectrum are sometimes referred to as suicide gestures or pseudocide. These terms should not be taken to indicate that suicide gestures are only forms of attention-seeking; they should rather be understood as evidence of serious emotional and mental distress.
A suicide attempt of any kind is treated as a psychiatric emergency by the police and other rescue personnel. Treatment in a hospital emergency room includes a complete psychiatric evaluation; a mental status examination; blood or urine tests if alcohol or drug abuse is suspected; and a detailed assessment of the patient's personal circumstances (occupation, living situation, family or friends nearby, etc.). The patient will be kept under observation while decisions are made about the need for hospitalization.
A person who has attempted suicide can be legally hospitalized against his or her will if he or she seems to be a danger to the self or others. The doctor will base decisions about hospitalization on the severity of the patient's depression; the availability of friends, relatives, or other social support; and the presence of other suicide risk factors, including a history of previous suicide attempts, substance abuse, and psychosis (loss of contact with reality, often marked by delusions and hallucinations). If the attempt is judged to be a nonlethal suicide gesture, the patient may be released after the psychiatric assessment is completed. According to CDC figures, 132,353 Americans were hospitalized in 2002 following suicide attempts while 116,639 were released following emergency room treatment.

Related issues

Survivors of suicide

One group of people that is often overlooked in discussions of suicide is the friends and family left behind by the suicide. It is estimated that each person who kills him- or herself leaves six survivors to deal with the aftermath; thus there are at least 4.5 million survivors of suicide in the United States. In addition to the grief that ordinarily accompanies death, survivors of suicide often struggle with feelings of guilt and shame as well. They often benefit from group or individual psychotherapy in order to work through such issues as wondering whether they could have prevented the suicide or whether they are likely to commit suicide themselves. The American Foundation for Suicide Prevention (AFSP) has a number of online resources available for survivors of suicide.

Assisted suicide

One question that has been raised in developed countries as the average life expectancy increases is the legalization of assisted suicide for persons suffering from a painful terminal illness. Physician-assisted suicide has become a topic of concern since it was legalized in the Netherlands in 2001 and in the state of Oregon in 1997. It is important to distinguish between physician-assisted suicide and euthanasia, or "mercy killing.". Assisted suicide, which is often called "self-deliverance" in Britain, refers to a person's bringing about his or her own death with the help of another person. Because the other person is often a physician, the act is often called "doctor-assisted suicide." Euthanasia strictly speaking means that the physician or other person is the one who performs the last act that causes death. For example, if a physician injects a patient with a lethal overdose of a pain-killing medication, he or she is performing euthanasia. If the physician leaves the patient with a loaded syringe and the patient injects himself or herself with it, the act is an assisted suicide. As of early 2005 assisted suicide is illegal everywhere in the United States except for Oregon, and euthanasia is illegal in all fifty states.

Media treatment of suicide

The Centers for Disease Control and Prevention (CDC) sponsored a national workshop in April 1994 that addressed the connection between sensationalized media treatments of suicide and the rising rate of suicide among American youth. The CDC and the American Association of Suicidology subsequently adopted a set of guidelines for media coverage of suicide intended to reduce the risk of suicide by contagion.
The CDC guidelines point out that the following types of reporting may increase the risk of "copycat" suicides:
  • Presenting oversimplified explanations of suicide, when in fact many factors usually contribute to a person's decision to take their own life.
  • Excessive or repetitive local news coverage.
  • Sensationalizing the suicide by inclusion of morbid details or dramatic photographs.
  • Giving "how-to" descriptions of the method of suicide.
  • Describing suicide as an effective coping strategy or as a way to achieve certain goals.
  • Glorifying the act of suicide or the person who commits suicide.

Alternative treatment

Some alternative treatments may help to prevent suicide by preventing or relieving depression. Meditation practice or religious faith and worship have been shown to lower a person's risk of suicide. In addition, any activity that brings people together in groups and encourages them to form friendships helps to lower the risk of suicide, as people with strong social networks are less likely to give up on life.

Prognosis

The prognosis for a person who has attempted suicide is generally favorable, although further research needs to be done. A 1978 follow-up study of 515 people who had attempted suicide between 1937 and 1971 reported that 94% were either still alive or had died of natural causes. This finding has been taken to indicate that suicidal behavior is more likely to be a passing response to an acute crisis than a reflection of a permanent state of mind.

Prevention

One reason that suicide is such a tragedy is that most self-inflicted deaths are potentially preventable. Many suicidal people change their minds if they can be helped through their immediate crisis; Dr. Richard Seiden, a specialist in treating survivors of suicide attempts, puts the high-risk period at 90 days after the crisis. Some potential suicides change their minds during the actual attempt; for example, a number of people who survived jumping off the Golden Gate Bridge told interviewers afterward that they regretted their action even as they were falling and that they were grateful they survived.
Brain research is another important aspect of suicide prevention. Since major depression is the single most common psychiatric diagnosis in suicidal people, earlier and more effective recognition of depression is a necessary preventive measure. Known biological markers for an increased risk of suicide can now be correlated with personality profiles linked to suicidal behavior under stress to help identify individuals at risk. In addition, brain imaging studies using positron emission tomography (PET) are presently in use to detect abnormal patterns of serotonin uptake in specific regions of the brain. Genetic studies are also yielding new information about inherited predispositions to suicide.
Another major preventive measure is education of clinicians, media people, and the general public. In 2002 the CDC, the National Institutes of Health (NIH), and several other government agencies joined together to form the National Strategy for Suicide Prevention, or NSSP. Education of the general public includes a growing number of medical and government websites posting information about suicide, publications available for downloading, lists of books for further reading, tips for identifying symptoms of depressed and suicidal thinking, and advice about helping friends or loved ones who may be at risk. Many of these websites also have direct connections to suicide hotlines.
The National Institute of Mental Health (NIMH) recommends the following action steps for anyone dealing with a suicidal person:
  • Make sure that someone is with them at all times; do not leave them alone even for a short period of time.
  • Persuade them to call their family doctor or the nearest hospital emergency room.
  • Call 911 yourself.
  • Keep the person away from firearms, drugs, or other potential means of suicide.

Key terms

Assisted suicide — A form of self-inflicted death in which a person voluntarily brings about his or her own death with the help of another, usually a physician, relative, or friend.
Cortisol — A hormone released by the cortex (outer portion) of the adrenal gland when a person is under stress. Cortisol levels are now considered a biological marker of suicide risk.
Euthanasia — The act of putting a person or animal to death painlessly or allowing them to die by withholding medical services, usually because of a painful and incurable disease. Mercy killing is another term for euthanasia.
Frontal cortex — The part of the human brain associated with aggressiveness and impulse control. Abnormalities in the frontal cortex are associated with an increased risk of suicide.
Psychodynamic — A type of explanation of human behavior that regards it as the outcome of interactions between conscious and unconscious factors.
Serotonin — A chemical that occurs in the blood and nervous tissue and functions to transmit signals across the gaps between neurons in the central nervous system. Abnormally low levels of serotonin are associated with depression and an increased risk of suicide.
Suicide gesture — Attempted suicide characterized by a low-lethality method, low level of intent or planning, and little physical damage. Pseudocide is another term for a suicide gesture.

Resources

Books

Alvarez, A. The Savage God: A Study of Suicide. New York: Random House, Inc., 1972. A now-classic study of suicide written for general readers. The author includes a historical overview of suicide along with accounts of his own suicide attempt and the suicide of his friend, the poet Sylvia Plath.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision. Washington, DC: American Psychiatric Association, 2000.
"Depression." In The Merck Manual of Geriatrics, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 2004.
"Psychiatric Emergencies." In The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 2004.
"Suicidal Behavior." In The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 2004.
"Suicide in Children and Adolescents." In The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

Periodicals

Friend, Tad "Letter from California: Jumpers." New Yorker, 10 November 2003. 〈http://newyorker.com/printable/?fact/031013fa_fact〉. A journalist's account of the Golden Gate Bridge in San Francisco, the world's leading location for suicide.
Fu, Q., A. C. Heath, K. K. Bucholz, et al. "A Twin Study of Genetic and Environmental Influences on Suicidality in Men." Psychology in Medicine 32 (January 2002): 11-24.
Plunkett, A., B. O'Toole, H. Swanston, et al. "Suicide Risk Following Child Sexual Abuse." Ambulatory Pediatrics 1 (September-October 2001): 262-266.
Soreff, Stephen, MD. "Suicide." eMedicine, 3 September 2004. http://www.emedicine.com/med/topic3004.htm.

Organizations

American Academy of Child and Adolescent Psychiatry. 3615 Wisconsin Avenue, NW, Washington, DC 20016-3007. (202) 966-7300. Fax: (202) 966-2891. http://www.aacap.org..
American Association of Suicidology. Suite 408, 4201 Connecticut Avenue, NW, Washington, DC 20008. (202) 237-2280. Fax: (202) 237-2282. http://www.suicidology.org.
American Foundation for Suicide Prevention (AFSP). 120 Wall Street, 22nd Floor, New York, NY 10005. (888) 333-2377 or (212)
Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC). Mailstop K60, 4770 Buford Highway, Atlanta, GA 30341-3724. (770) 488-4362. Fax: (770) 488-4349. 〈http://www.cdc.gov/ncipc.htm〉.
National Institute of Mental Health (NIMH). 6001 Executive Boulevard, Room 8184, MSC 9663, Bethesda, MD 20892-9663. (301) 443-4513 or (886) 615-NIMH. www.nimh.nih.gov.

Other

American Academy of Child and Adolescent Psychiatry (AACAP). Teen Suicide. AACAP Facts for Families #10. Washington, DC: AACAP, 2004.
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. "Suicide Contagion and the Reporting of Suicide: Recommendations from a National Workshop." Morbidity and Mortality Weekly Report 43 (22 April 1994): 9-18. http://www.cdc.gov/mmwr/preview/mmwrhtml/00031539.htm.
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Suicide: Fact Sheet. http://www.cdc.gov/ncipc/factsheets/suifacts.htm.
National Institute of Mental Health (NIMH). In Harm's Way: Suicide in America. NIH Publication No. 03-4594. Bethesda, MD: NIMH, 2003. http://www.nimh.nih.gov/publicat/NIMHharmsway.pdf.
National Suicide Hotline: (800) 273-TALK (1-800-273-8255).

suicide

 [soo´i-sīd]
the taking of one's own life; also any person who voluntarily and intentionally takes his or her own life. Legally, a death suspected of being due to violence that is self-inflicted is not termed a suicide unless there is positive evidence of the victim's intent to destroy himself or herself, or the method of death is such that a verdict of suicide is inevitable. This means that many deaths that would be termed suicide according to medicopsychological criteria are reported as accidental or from undetermined cause. The difficulty of positively identifying a death as suicide is further complicated by the complexities of determining true intent and the psychological motivation one may have had for ending one's own life.



Incidence: Statistical evidence of the actual suicide rate for a specific population is difficult to compile because of the ambiguity of the term, a lack of criteria by which a death may be judged suicidal, and a lack of agreement among those reporting deaths as to what does, indeed, constitute a suicide. Existing data are as follows: Suicide is the eighth leading cause of death for males and the 19th leading cause for females. It is the third leading cause of death among persons 15 to 24 years of age, according to the national institutes of mental health. The group with the highest suicide rate is white men over age 85. Other high-risk groups include the elderly, the sick, and the mentally ill. There is a tendency of suicides to occur in families, but there is no evidence of a genetically determined suicidal behavior pattern. There are also seasonal fluctuations in suicide rates, with the highest number occurring in the spring.

The American Foundation for Suicide Prevention (AFSP) has developed a policy for the prevention of suicide. It includes as essential components of suicide prevention the following measures: educating professionals in recognition and treatment of individuals at risk; educating society that such individuals are suffering from a medical condition that must be recognized and treated rather than stigmatized, and that effective treatments are available; and educating survivors of suicide attempts about the resources available to them. Other recommendations include: improved methods of detecting individuals at highest risk for completed suicide; improved treatment interventions for high risk patients; responsible gun control legislation; education of media and mental health professionals in order to reduce inaccurate or sensational media coverage of suicide; and improvement of palliative care for seriously or terminally ill patients (including through education and legislation) so that suicide does not seem to be their only option. Depression screening should be a routine assessment for every clinician. Research is essential in developing, testing, and implementing treatment approaches to patients at risk for suicide, as well as developing prevention strategies that have been shown to be effective or appear likely to be effective.
assisted suicide suicide with the help of another person, such as when an incurably ill patient intentionally ingests a toxic substance or an overdose of a medication that was prescribed; the choice to die must always be made by the patient. See also euthanasia.

su·i·cide

(sū'i-sīd),
1. The act of taking one's own life.
2. A person who commits such an act.
[L. sui, self, + caedo, to kill]

suicide

/su·i·cide/ (soo´ĭ-sīd) the taking of one's own life.

suicide

(so͞o′ĭ-sīd′)
n.
1. The act or an instance of intentionally killing oneself.
2. One who commits suicide.
intr.v. sui·cided, sui·ciding, sui·cides
To kill oneself; commit suicide.

suicide

[so̅o̅′isīd]
Etymology: L, sui, of oneself, caedere, to kill
1 the intentional taking of one's own life.
2
Usage notes: (informal)
the ruin or destruction of one's own interests.
3 a person who commits or attempts self-destruction. Early signs of suicidal intent include depression; expressions of guilt, tension, and agitation; insomnia; loss of weight and appetite; neglect of personal appearance; giving away of personal or valued possessions; and direct or indirect threats to commit suicide.
adjective Referring to suicide. While suicidal is etymologically correct, it is often substituted by the noun, removing the need for the speaker to determine the actor’s frame of mind
noun The act of killing oneself
verb To complete suicide; the long form, ‘to commit suicide’, is much more common

suicide

Public health The killing of oneself; at least 1% of any population consider suicide annually; many consult a non-psychiatric physician in the 6 months before suicide Age Peaks in adolescence and college–age 15-25; more frequent in adolescent drug abusers Manner–♂ Firearms 46%, hanging 22%, gas 16%, poison 10%; ♀ Poison 41%, strangulation 17%, gas 15%, drowning 10%, firearms 8.5%–suicide by firearms is increasingly popular in ♀Physician rates Highest of all professionals; ♀ physicians are up to 3 times more likely to autodestruct than other ♀ professionals Risk factors Mental illness, especially depression, schizophrenia; 15% of those with affective disorders die by suicide; 10-15% of alcoholics kill themselves, accounting for14 of all suicides; other 'at-risk' conditions include AIDS, cancer, spinal cord injuries, seizure disorders and Huntington's disease;12 are unmarried, whites are 2-fold more common than blacks Incidence 28,000/yr–US, where it is the 8th leading COD, 12/105; from 1950 to 1980, ♂ rate ↑ 305%; ♀ ↑ 67%; from 1955 to 1977, suicides jumped 230% in the
15-24 age group; suicide is attempted more often in ♀, but more often successful in ♂–♂:♀ ratio, 4:1 Success rate Suicide attempt:success ratio, 5:1; North America has seasonal peaks in March, September; most occur at home; bodies are often discovered by family or friends. See Assisted suicide, Cluster suicide, Multishot suicide.

su·i·cide

(sū'i-sīd)
1. The act of taking one's own life.
2. A person who commits such an act.
3. biowarfare The act of taking one's own life to harm or kill one's perceived enemies (e.g., suicide bombing).
[L. sui, self, + caedo, to kill]

suicide

Intentional self-killing. Depression is the commonest cause of suicide and severely depressed people are always at risk. Suicide is also common among alcoholics, people with SCHIZOPHRENIA and people with severe personality disorders.

su·i·cide

(sū'i-sīd)
1. The act of taking one's own life.
2. A person who commits such an act.
[L. sui, self, + caedo, to kill]

suicide,

n the intentional taking of one's own life.

Patient discussion about suicide

Q. SUICIDE what is suicidal behavior/is it a psychiatric disorders?

A. Thank you also from me Lixurion. You make a huge difference in our lives.

Q. Should they still be having suicidal thoughts? Hi there, if someone who has been diagnosed as a rapid - cycling bipolar is on Epival, should they still be having suicidal thoughts and is there anything else that could be added in terms of medication to stabilize them?

A. Seek help right away when suicidal thoughts begin to creep in. It is important to pay attention to them right at the beginning and seek help right away so they dont get too bad. Like the others said there are a lot of medications that can be very helpful. My partner is also a rapid cycler and is on and antidepressant, a mood stabilizer, an anti psychotic and an anti anxiety medication which is working well/ However like the rest she needs enough sleep and enough excercise to keep her stable

Q. How do I know if someone’s planning to commit suicide? A guy I know is acting weird lately…saying some scary stuff about dying. How can I know he is not joking? And how can I stop him?

A. it shouldn't be your goal to stop him or prevent him as you say. you can't be with this individual 24/7.. if you are there for him and give him your ear to listen it will go much farther to prevent him than nething else you could do. as we learn in the psych field a very simple, effective way to discern suicidal intent is to talk w/ them and in the course of the conversation look right at them and say "it sounds like you're thinking about killing yourself". don't hesitate to call a healthcare professional to explain the situation. you don't have to give your name or his name for them to give u advice

More discussions about suicide