Suicide

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Suicide
Classification and external resources

Suicide affects everyone.
ICD-10 X60.–X84.
ICD-9 E950
MedlinePlus 001554
eMedicine article/288598
MeSH F01.145.126.980.875

Suicide is when a person chooses to kill himself or herself. The word suicide is from the Latin words sui caedere, which means "to kill oneself". In English, when someone kills himself, people say that he has "committed suicide," or "suicided." Doctors consider suicide attempts to be a symptom of a serious depression. Suicide is a crime in some places,[1] and it is considered a sin in many religions.[2][3][4][5]

Contents

Risk factors [change]

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

Mental disorders [change]

Many people who commit suicide have a mental disorder, the rates vary according to study between 85%-95%. Depressive disorders account for about 80% of these numbers, schizophrenia 10% and dementia and delirium about 5%. Among those who have a mental disorder, 25% also have alcohol abuse issues. People who abuse alcohol have a 50% greater risk of suicide comapred to those who do not.[6]

While acts of self-harm are not considered as suicide attempts, the presence of self-harming behavior may increase the risk of suicide.[7]

Emotions [change]

Hopelessness: the feeling that there is no prospect of improvement in one's situation---is a strong indicator of suicide.[8]

Perceived burdensomeness: when a person feels that they are a burden to others such as one's family, is often coupled with hopelessness[9]

Loneliness: whether a person just feels lonely or they actually are alone. A lack of social support such as family and friends, a feeling of not belonging or fitting in, and living alone.[10][11][12]

Substance abuse [change]

Substance abuse is the second most common risk factor for suicide after major depressive disorder and bipolar disorder.[13] Both chronic substance misuse as well as acute substance abuse are associated with suicide.[14] When combined with personal grief, the risk of suicide is greatly increased.[15] More than 50% of suicides have some relation to alcohol or drug use and up to 25% of suicides are committed by drug addicts and alcoholics, among adolescents, it is as high as 70%.

Substance abused Effects related to suicide
Alcohol Alcohol misuse is associated with a number of mental health disorders, and alcoholics have a very high suicide rate. Suicide from alcoholism is more common in older adults.[16] It has been found that drinking 6 drinks or more per day results in a sixfold increased risk of suicide.[17][18] High rates of major depressive disorder occur in heavy drinkers and heavy drinking itself can cause major depressive disorder in a lot of alcoholics.[19]
Benzodiazepines Chronic use or abuse of prescribed benzodiazepines like Xanax, is associated with depression as well as increased suicide risk.[20][21] Depressed adolescents who were taking benzodiazepines were found to have a greatly increased risk of self harm or suicide.[22]
Cigarettes There have been many studies showing a link between smoking, thinking about suicide and suicide attempts.[23][24] In studies conducted among 50,000 nurses,and 300,000 male U.S. Army soldiers, those smoking between 1 to 24 cigarettes per day had twice the suicide risk; 25 cigarettes or more, 4 times the suicide risk, as compared with those who had never smoked.[25][26][27]
Cocaine Misuse of drugs such as cocaine often has a link with suicide. The time when the effects of a drug wear off is called "crash" or withdrawal phase. During this phase, many people feel bad. Suicide is most likely to occur during this phase in chronic cocaine-dependent users. Using more than one drug is more often linked with suicide in younger adults.
Crystal meth Crystal meth use has a strong link with depression and suicide as well as a range of other adverse effects on physical and mental health.[28]
Heroin Deaths among heroin users attributed to suicide range from 3% to 35%. Overall, heroin users are 14 times more likely than their non-using peers to die from suicide.[29]

Problem gambling [change]

Problem gambling is often associated with increased suicidal ideation and attempts compared to the general population.[30][31][32]

Early onset of problem gambling increases the lifetime risk of suicide, with gambling-related suicide attempts usually made by older people with gambling problems.[33] [34]Substance use[35][36] and mental disorders increase the risk of suicide in people with problem gambling.

Medical conditions [change]

There is a link between suicidality and medical conditions, including chronic pain,[37] mild brain injury, (MBI) or traumatic brain injury (TBI).[38][39] The feelings of wanting to commit suicide lasted even after adjusting for depressive illness and alcohol abuse. In patients with more than one medical condition the risk was higher.[40][41]

Problems with sleeping, such as insomnia[42] and sleep apnea may be risk factors for depression and suicide. In some instances the sleep disturbance itself may be the risk factor independent of depression.[43]

Many medical conditions can cause psychiatric symptoms. The major medical conditions which may cause psychiatric symptoms in order of frequency were infectious, pulmonary,[44] thyroid, diabetic, hematopoietic, hepatic and CNS diseases.[45] Conservative estimates are that 10% of all psychological symptoms may be due to undiagnosed medical conditions,[46] with the results of one study suggesting that about 50% of individuals with a serious mental illness "have general medical conditions that are largely undiagnosed and untreated and may cause or exacerbate psychiatric symptoms".[47][48]


Biology [change]

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.[49]

Some mental disorders identified as risk factors for suicide often may have an underlying biological basis.[50][51]

  • Serotonin is a vital brain neurotransmitter; in those who have attempted suicide it has been found that they have lower serotonin levels, and people who have completed suicide have the lowest levels.[52][53]This has been found to be a risk factor for suicide independent of a history of a major depression "indicating that it is involved in the predisposition to suicide in many psychiatric disorders."[54][55][56]

Genetic inheritance accounts for roughly 30–50% of the variance in suicide risk between individuals.[69][70][70] Having a parent who has committed suicide is a strong predictor of suicide attempts.[71][72] Epigenetics, the study of changes in genetic expression in response to environmental factors which do not alter the underlying DNA, may also play a role in determining suicide risk.[73][74][75]

Media coverage [change]

How the media presents depictions of suicide may have a negative effect[76] and trigger the possibility of copycat suicides, also known as the Werther effect.[77][78] This risk is greater in teenagers and young adults who may often romantacize death.[79][80][81] The opposite of the Werther effect is the Papageno effect in which coverage of effective coping mechanisms and coping in adverse circumstances, may have protective effects.[82]

Others [change]

There are a number of other risk factors, availability of a means to commit the act, family history of suicide, previous head injury,[83][84]unemployment, poverty, homelessness, and discrimination,[85] a history of childhood physical or sexual abuse,[86] or having spent time in foster care.[87][88][89]

Methods [change]

The most common methods of suicide in the United States.

The leading methods of suicide are not the same in every country. The leading methods in different regions include hanging, pesticide poisoning, and firearms.[90] A 2008 review of 56 countries based on WHO mortality data found that hanging was the most common method in most of the countries,[91] accounting for 53% of the male suicides and 39% of the female suicides.[92] Worldwide 30% of suicides are from pesticides. The use of this method however varies markedly from 4% in Europe to more than 50% in the Pacific region.[93] In the United States 52% of suicides involve the use of firearms.[94] Asphyxiation (such as with a suicide bag) and poisoning are fairly common as well. Together they comprised about 40% of U.S. suicides. Other methods of suicide include blunt force trauma (jumping from a building or bridge, self-defenestrating, stepping in front of a train, or car collision. Exsanguination or bloodletting, intentional drowning, self-immolation, electrocution, and intentional starvation are other suicide methods. Individuals may also intentionally provoke another person into administering lethal action against them, as in suicide by cop.

Prevention [change]

Main page: Suicide prevention
Suicide prevention poster

Warning Signs of Suicide
ƒ * Talking about wanting to die;
* Looking for a way to kill oneself;
* Talking about feeling hopeless or having no purpose;
* Talking about feeling trapped or being in unbearable pain;
* Talking about being a burden to others;
* Increasing the use of alcohol or drugs;
* Acting anxious, agitated, or reckless;
* Sleeping too little or too much;
* Withdrawing or feeling isolated;
* Showing rage or talking about seeking revenge;
* Displaying extreme mood swings.
The more of these signs a person shows, the greater the risk of suicide. Warning signs are associated with suicide but may not be what causes a suicide.

What To Do
Do not leave the person alone; ƒ Remove any objects that could be used in a suicide attempt; ƒ Call a suicide prevention crisis line; and ƒ Take the person to an emergency room or seek help from a medical or mental health professional.
Source: 2012 National Strategy for Suicide Prevention: A report of the U.S. Surgeon General and of the National Action Alliance for Suicide Prevention

Suicide prevention is a term used for efforts to reduce the incidence of suicide in society and on an individual basis through preventive measures. Various strategies restrict access to the most common methods of suicide, such as firearms or toxic substances like pesticides, and have proved to be effective in reducing suicide rates. Studies have shown that adequate prevention, diagnosis and treatment of depression and alcohol and substance abuse can reduce suicide rates, as does follow-up contact with those who have made a suicide attempt.[95]

The Best Practices Registry (BPR) For Suicide Prevention is a list of treatment programs maintained by the American Association of Suicide Prevention. The Section I list are evidence-based programs: treatments which have been shown to work in reducing suicidality. Section II programs do not have enough evidence yet to show how well they work.[96][97]

In many countries, people who are at imminent risk of hurting themselves or others, can check themselves into a hospital emergency department; this may also be done on an involuntary basis on the referral of various persons acting in an official capacity such as the police.

The person will be placed on suicide watch until an emergency physician or mental health professional decides whether inpatient care at a mental health care facility is needed, and may hold the person for a period of usually three days. A court hearing may be held to determine the individual's competence. In most states, a psychiatrist may hold the person for a specific time period without a court order. If the psychiatrist determines the person to be a threat to himself or others, the person may be admitted involuntarily to a psychiatric treatment facility. After this time the person must be discharged or appear in front of a judge.[98]

Screening [change]

In approximately 75% of completed suicides the individuals had seen a physician within the year before their death, including 45% to 66% within the prior month. Approximately 33% to 41% of those who completed suicide had contact with mental health services in the prior year, including 20% within the prior month. These studies suggest an increased need for effective screening.[99][100][101][102][103]There are various self-report questionnaire's to help identify those at risk.[104]

Treatment [change]

There are treatments to lower the risk of suicide by treating the conditions some people may have which is causing them to think about suicide. These treatments may be medical treatment if a medical problem is causing or contributing to their problems,[105] taking medicine,[106] and talk therapy.[107]

Low-dose lithium with minimal side effects works in lowering the risk of suicide in those with both major depressive disorder and bipolar disorder.[108][109][110]

There are evidence-based talk therapies available to reduce suicidal ideation such as dialectical behaviour therapy (DBT) which has been shown to work in reducing suicidality in different groups, such as college students.[111][112] Cognitive Behavior Therapy for Suicide Prevention (CBT-SP) is a form of DBT adapted for adolescents at high risk for repeated suicide attempts.[113]

Epidemiology [change]

Worldwide suicide rates have increased by 60% in the past 45 years, mainly in the developing countries and is currently the tenth leading cause of death with about a million people dying by suicide annually, a global mortality rate of 16 suicides per 100,000 people, or a suicide every 40 seconds.[114] According to 2007 data, suicides in the U.S. outnumber homicides by nearly 2 to 1. Suicide ranks as the 11th leading cause of death in the country, ahead of liver disease and Parkinson's disease.[115]

Views of suicide [change]

Medical [change]

Modern medicine treats suicide as a mental health issue. When a person starts having many thoughts about killing his or her self, it is considered a medical emergency. Psychologists say that people who are planning to kill themselves should tell someone immediately. This is especially important if the person already has found a way of killing themselves. People who are depressed are considered a "high-risk" group for suicide. Suicide hotlines are available. Using these hotlines, people can tell someone about their thoughts and plans of suicide. People at the hotline may then find a way to solve these problems, so that the caller has no need to kill themselves. Self-esteem is also considered important to prevent suicide by World Health Organization.[116]

Cultural [change]

In the Warring States Period and the Edo period of Japan, samurai who disgraced their honour chose to end their own lives by harakiri (hara means stomach and kiri means cut) or seppuku.

The cut is usually performed diagonally from the top corner of the hand that the samurai uses to write with, and it has long been considered an honourable form of death (even when done to punish dishonour). Though obviously such a wound would be fatal, seppuku was not always technically suicide because the samurai's assistant (the kaishaku) would stand by to kill the samurai by decapitating them to end the suffering, sometimes as soon as the first incision into the abdomen was made.

Religion [change]

The Abrahamic religions, (like Christianity, Judaism, and Islam) think that life is sacred. They believe that by killing yourself, you are murdering what God has made, which is bad. For this reason, a person who commits suicide is believed to go to hell by many followers of Abrahamic religions.

The Dharmic and Taoist religions (like Buddhism, Hinduism, Jainism, Taoism, Confucianism, and Shinto) while having their differences, agree largely on their views to suicide. These people do not believe suicide is a good thing because they believe that someone who commits suicide will be reincarnated in the next life with a less enlightened soul. However, many people of these religions are more likely to commit suicide because they believe that there will be a next life.[source?] They think that by committing suicide, they may have a better chance in the next life.[source?]

Suicide as a weapon [change]

Suicide is sometimes used as a form of killing other people.[117][118][119] In a suicide attack, a person attacks other people in a way that is going to cause himself to be killed too. For example, a "suicide bomber" may carry a bomb or tape the bomb to his body, and then get close to the people he is trying to kill. He will then make the bomb go off while he is still holding it, so that the other people are killed or injured, but he is also killed in the blast.

There are a few very famous examples of suicide attacks in history. The Kamikazes were one example. They were Japanese fighter pilots during WWII, who would try to kill American soldiers (but would also kill themselves in the process) by crashing their planes into American ships. The September 11, 2001 terrorist attacks on the United States were also done by suicide attackers, who flew planes into the World Trade Center buildings and the Pentagon. [120]

Related pages [change]

References [change]

Wikimedia Commons has media related to: Suicide
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  72. ↑ Qin P, Agerbo E, Mortensen PB (October 2002). "Suicide risk in relation to family history of completed suicide and psychiatric disorders: a nested case-control study based on longitudinal registers". Lancet 360 (9340): 1126–30. doi:10.1016/S0140-6736(02)11197-4. PMID 12387960.
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  87. ↑ "Child Protection and Child Outcomes: Measuring the Effects of Foster Care" (PDF). http://www.mit.edu/~jjdoyle/doyle_fosterlt_march07_aer.pdf. Retrieved 2011-11-01.
  88. ↑ Koch, Wendy (2007-07-03). "Study: Troubled homes better than foster care". Usatoday.Com. http://www.usatoday.com/news/nation/2007-07-02-foster-study_N.htm. Retrieved 2011-11-01.
  89. ↑ Lawrence, CR; Carlson, EA; Egeland, B (2006). "The impact of foster care on development". Development and Psychopathology 18 (1): 57–76. doi:10.1017/S0954579406060044. PMID 16478552.
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  92. ↑ 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. pp. 34. ISBN 978-1-119-99856-3. http://books.google.com/books?id=3fDGLWQtwFkC&pg=PA34.
  93. ↑ 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.
  94. ↑ "U.S. Suicide Statistics (2005)". http://www.suicide.org/suicide-statistics.html. Retrieved 2008-03-24.
  95. ↑ World Health Organization: Suicide prevention (SUPRE)
  96. ↑ Best Practices Registry (BPR) For Suicide Prevention
  97. ↑ Rodgers PL, Sudak HS, Silverman MM, Litts DA (April 2007). "Evidence-based practices project for suicide prevention". Suicide Life Threat Behav 37 (2): 154–64. doi:10.1521/suli.2007.37.2.154. PMID 17521269.
  98. ↑ Giannini, A. James; Slaby, Andrew Edmund; Giannini, Matthew C. (1982). Handbook of overdose and detoxification emergencies. New Hyde Park, N.Y.: Medical Examination Pub. Co. ISBN 0-87488-182-X.
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  100. ↑ González HM, Vega WA, Williams DR, Tarraf W, West BT, Neighbors HW (January 2010). "Depression Care in the United States: Too Little for Too Few". Archives of General Psychiatry 67 (1): 37–46. doi:10.1001/archgenpsychiatry.2009.168. PMC 2887749. PMID 20048221.
  101. ↑ Luoma JB, Martin CE, Pearson JL (June 2002). "Contact with mental health and primary care providers before suicide: a review of the evidence". The American Journal of Psychiatry 159 (6): 909–16. doi:10.1176/appi.ajp.159.6.909. PMID 12042175.
  102. ↑ Lee HC, Lin HC, Liu TC, Lin SY (June 2008). "Contact of mental and nonmental health care providers prior to suicide in Taiwan: a population-based study". Canadian Journal of Psychiatry 53 (6): 377–83. PMID 18616858.
  103. ↑ Pirkis J, Burgess P (December 1998). "Suicide and recency of health care contacts. A systematic review". The British journal of psychiatry : the journal of mental science 173 (6): 462–74. doi:10.1192/bjp.173.6.462. PMID 9926074.
  104. ↑ Rory C. O'Connor, Stephen Platt, Jacki Gordon: International Handbook of Suicide Prevention: Research, Policy and Practice, p. 510 [4]
  105. ↑ Randolph B. Schiffer, Stephen M. Rao, Barry S. Fogel, Neuropsychiatry: Neuropsychiatry of suicide, pp. 706-713, (2003)ISBN 0781726557
  106. ↑ Cipriani A, Pretty H, Hawton K, Geddes JR (October 2005). "Lithium in the prevention of suicidal behavior and all-cause mortality in patients with mood disorders: a systematic review of randomized trials". Am J Psychiatry 162 (10): 1805–19. doi:10.1176/appi.ajp.162.10.1805. PMID 16199826.
  107. ↑ Linehan MM, Comtois KA, Murray AM, et al. (July 2006). "Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder". Arch. Gen. Psychiatry 63 (7): 757–66. doi:10.1001/archpsyc.63.7.757. PMID 16818865.
  108. ↑ Baldessarini RJ, Tondo L, Davis P, et al. Decreased risk of suicides and attempts during long-term lithium treatment: a meta-analytic review. Bipolar Disord. 2006 Oct;8(5 Pt 2):625-39. PMID 17042835
  109. ↑ Coppen A (2000). "Lithium in unipolar depression and the prevention of suicide". J Clin Psychiatry 61 Suppl 9: 52–6. PMID 10826662.
  110. ↑ American Psychiatric Association: American Psychiatric Association Practice Guidelines for the Treatment of Psychiatric Disorders: Compendium American Psychiatric Publishing; 1 edition (2006) p.1326 ISBN 0890423857
  111. ↑ Canadian Agency for Drugs nd technology in Health: Dialectical Behaviour Therapy in Adolescents for Suicide Prevention: Systematic Review of Clinical-Effectiveness, CADTH Technology Overviews, Volume 1, Issue 1, March 2010 [5]
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  113. ↑ Stanley B, Brown G, Brent DA et al. (October 2009). "Cognitive-behavioral therapy for suicide prevention (CBT-SP): treatment model, feasibility, and acceptability". J Am Acad Child Adolesc Psychiatry 48 (10): 1005–13. doi:10.1097/CHI.0b013e3181b5dbfe. PMC 2888910. PMID 19730273. http://linkinghub.elsevier.com/retrieve/pii/S0890-8567(09)60165-9.
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  116. ↑ Preventing Suicide, A resource for teacher and other school staff, 2000
  117. ↑ VIRGINIA WHEELER (2010-04-06). "9 dead in suicide attack on U.S. HQ". The Sun. http://www.thesun.co.uk/sol/homepage/news/2921371/9-dead-in-suicide-attack-on-US-HQ-in-Peshawar-Pakistan.html. Retrieved 2010-04-06.
  118. ↑ Reuters (2010-04-06). "Policemen die in Ingushetia suicide bomb". Reuters. http://www.irishtimes.com/newspaper/world/2010/0406/1224267753121.html. Retrieved 2010-04-06.
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  120. ↑ http://www.history.com/topics/9-11-attacks

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