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Classification and external resources

Suicide can happen to anyone, it affects everyone, and it is preventable.[1][2]
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 comes 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." When a person thinks about killing themselves this kind of thinking is called suicidal ideation and the person is said to be suicidal. When a person starts having thoughts about killing his or her self, it is considered a medical emergency and they should receive a suicide risk assessment as soon as possible.

There are many reasons that can cause a person to think about committing suicide or actually making an attempt kill to themselves. Most people who are suicidal have some type of mental illness and/or a medical condition which can cause the symptoms of a mental illness. They may have a chronic condition - which means it has been going on for a long time - or it may be an acute condition - which means the first symptoms of mental illness happened rather fast.

Depression is the mental illness that most often causes a person to have suicidal thoughts. Depression may also be a symptom of another mental or medical disorder or both. Diseases or medical conditions which have signs and symptoms that are the same or similar to other diseases or medical conditions are called differential diagnoses.

Depression which leads to suicidal thoughts can also be caused by stress and events in a person's life like losing a job, having an physical illness or being a victim of a crime or natural disaster. Feelings of loneliness caused by not having family or friends can be risk factors for suicide, there are also many others.

Every 3 seconds a person somewhere in the world attempts to kill themselves and every 40 seconds some commits suicide. Suicide is one of the top three causes of death for young people aged 15–35 years-old and the second leading cause of death for college students. For every suicide at least six other people are seriously affected.(WHO 2000).

While depression is the main factor in suicide it is also treatable and suicide is preventable.

Risk factors[change | edit source]

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

Mental disorders[change | edit source]

Most 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 compared to those who do not.[3]

While acts of self-harm are not considered as suicide attempts, the presence of self-harming behavior may increase the risk of suicide.[4]

Emotions[change | edit source]

Hopelessness: the feeling that there is no prospect of improvement in one's situation---is a strong indicator of suicide.[5]

Perceived burdensomeness: when a person feels that they are a burden to others such as one's family, is often coupled with hopelessness[6]

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.[7][8][9]

Substance abuse[change | edit source]

Substance abuse is the second most common risk factor for suicide after major depressive disorder and bipolar disorder.[10] Both chronic substance misuse as well as acute substance abuse are associated with suicide.[11] When combined with personal grief, the risk of suicide is greatly increased.[12] 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.[13] It has been found that drinking 6 drinks or more per day results in a sixfold increased risk of suicide.[14][15] High rates of major depressive disorder occur in heavy drinkers and heavy drinking itself can cause major depressive disorder in a lot of alcoholics.[16]
Benzodiazepines Chronic use or abuse of prescribed benzodiazepines like Xanax, is associated with depression as well as increased suicide risk.[17][18] Depressed adolescents who were taking benzodiazepines were found to have a greatly increased risk of self harm or suicide.[19]
Cigarette smoking There have been many studies showing a link between smoking, thinking about suicide and suicide attempts.[20][21] 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.[22][23][24]
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.[25]
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.[26]

Problem gambling[change | edit source]

Problem gambling is often associated with increased suicidal ideation and attempts compared to the general population.[27][28][29]

Early onset of problem gambling increases the lifetime risk of suicide, with gambling-related suicide attempts usually made by older people with gambling problems.[30] [31]Substance use[32][33] and mental disorders increase the risk of suicide in people with problem gambling.

Medical conditions[change | edit source]

Hyperthyroidism (over active thyroid) is when the thyroid gland makes too much thyroid hormone.
Hypothyroidism (under active thyroid) is when the thyroid gland make too little thyroid hormone.
Hyperparathyroidism(over active parathyroid/s) is when one or more of the four parathyroid glands makes too much parathyroid hormone.
Hypoparathyroidism (under active parathyroid/s) is when one or more of the four parathyroid glands makes too little parathyroid hormone.

Disorders of either the thyroid or parathyroid glands can cause depression and other mood problems which may increase the risk of suicide.
These disorders, especially hypothyroidism should be considered as a possible cause in cases of depression especially when it is chronic and non-responsive.[34][35] [36]

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]

People being treated for mood disorders should receive a medical evaluation. This should include a physical examination and various laboratory tests. This is done to rule out mood disorders caused by medical conditions and also to insure safety if medications are prescribed for treatment.[44]Many medical conditions can cause psychiatric symptoms.

Biology[change | edit source]

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.[45]

Some mental disorders identified as risk factors for suicide often may have an underlying biological basis.[46][47]

  • 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.[48][49]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."[50][51][52]

Genetic inheritance accounts for roughly 30–50% of the variance in suicide risk between individuals.[58][59][59] Having a parent who has committed suicide is a strong predictor of suicide attempts.[60][61] 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.[62][63][64]

Media coverage[change | edit source]

How the media shows news stories of suicide may have a negative effect[65] and trigger the possibility of copycat suicides, also known as the Werther effect.[66][67] This risk is greater in teenagers and young adults who may often romantacize death.[68][69][70] 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.[71]

Others[change | edit source]

There are a number of other risk factors, availability of a means to commit the act, family history of suicide, previous head injury,[72][73]unemployment, poverty, homelessness, and discrimination,[74] a history of childhood physical or sexual abuse,[75] or having spent time in foster care.[76][77][78]

Protective factors[change | edit source]

Lowering suicide risk
Raise the protective factors, lower the risk factors.

Protective factors help the effects of suicidal thinking and the risk of a person dying by suicide. These factors can be internal, such as a a persons personal strengths and beliefs, or external such as their relationships and life situation. Protective factors are as important to identify as risk factors. Just as risk factors can be reduced protective factors can be increased. These factors can include:[79]

  • Personal strengths and skills such as handling stress, problem solving
  • Social support from strong connections with family and friends
  • Religious and cultural beliefs that that value life
  • Restricted access to highly lethal means of suicide
  • Having someone who helps them get the help they need
  • Easy access to quality care for mental, physical, and substance abuse disorders
  • Reasons for living[80]

Prevention[change | edit source]

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.[81]

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.[82]

"No harm" contract[change | edit source]

A "no harm" contract is supposed to be a suicide prevention contract. The suicidal patient signs a contract promising not to harm themselves. Despite their widespread use there is no evidence whatsoever that they work, and they may actually be harmful.[83][84][85]

Screening[change | edit source]

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.[86][87][88][89][90]

SOS Signs of Suicide is a suicide prevention program used in secondary schools for students between 13 to 17-years-old. The program uses both education about suicide and screening for suicide risk. There are fewer suicide attempts in students who have taken part in the program compared to those who have not.[91]

Suicide risk assessment[change | edit source]

Suicide Assessment Five-Step Evaluation and Triage

Suicide risk assessments should be conducted at first contact. (SAMHSA 2009)

Suicide risk assessment uses various methods to examine a person's potential to attempt suicide. An adequate assessment is critical to prevent the possibility of a completed suicide and is the first step in devising an adequate treatment plan. Despite the importance of a professional systematic (step-by-step) suicide risk assessment, they are usually not done.

Even though a suicide risk assessment is very important in helping save the life of a suicidal person, they are usually not done. Many mental health care workers have little or no training in how to do a suicide risk assessment.[92][93]
Suicide crisis lines are part of the suicide prevention efforts in many countries. This one is a nationwide number in the United States.

Treatment[change | edit source]

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,[94] taking medicine,[95] and talk therapy.[96]There are evidence-based (scientifically proven to work) talk therapies available to reduce suicidal ideation and suicide attempts. The Best Practices Registry (BPR) For Suicide Prevention is a list of treatment programs.[97][98]

Low-dose lithium with minimal side effects works in lowering suicidal thoughts and the risk of suicide in those with mood disorders. In addition to bipolar disorder, it works in major depressive disorder as well.[99][100][101]Lithium is the only psychotropic drug proven to reduce suicidal thoughts and suicide attempts - as much as a 14-fold decrease - and is a recommended by the American Psychiatric Association as a treatment for those at risk of suicide.[102]

Dialectical behavior therapy (DBT) has been shown to work in reducing suicidality in different groups, such as college students (in which suicide is the second leading cause of death).[103][104] Cognitive Behavior Therapy for Suicide Prevention (CBT-SP) is a form of DBT adapted for adolescents at high risk for repeated suicide attempts.[105]

Epidemiology[change | edit source]

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 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.[106]

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.[107] 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[change | edit source]

Death rates of suicide methods 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.[108] A 2008 review of 56 countries based on WHO mortality data found that hanging was the most common method in most of the countries,[109] accounting for 53% of the male suicides and 39% of the female suicides.[110] 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.[111] In the United States 52% of suicides involve the use of firearms.[112] 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.

Views of suicide[change | edit source]

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.

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) 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 | edit source]

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. [113]

Related pages[change | edit source]

Other websites[change | edit source]

References[change | edit source]

  1. International Handbook of Suicide Prevention: Research, Policy and Practice Eds. Rory C. O'Connor, Stephen Platt, Jacki Gordon Wiley; 1 edition (2011) ISBN 0470683848
  2. World Health Organization: Preventing Suicide a Resource for Primary Healthcare Workers (2000) p.5[1]
  3. 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
  4. 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.
  5. 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
  6. 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.
  7. You, S.; Van Orden, K. A.; Conner, K. R. (2010). "Social connections and suicidal thoughts and behavior". Psychology of Addictive Behaviors 25 (1): 180–184. doi:10.1037/a0020936. PMC 3066301. PMID 21142333.
  8. 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.
  9. 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.
  10. 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.
  11. 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.
  12. Fadem, Barbara (1 Dec 2003). Behavioral science in medicine. Philadelphia: Lippincott Williams Wilkins. p. 217. ISBN 978-0-7817-3669-5.
  13. Chignon JM, Cortes MJ, Martin P, Chabannes JP (July 1998). "[Attempted suicide and alcohol dependence: results of an epidemiologic survey]" (in French). Encephale 24 (4): 347–54. PMID 9809240.
  14. O'Donohue, William T.; R. Byrd, Michelle; Cummings, Nicholas A.; Henderson, Deborah P. (2005). Behavioral integrative care: treatments that work in the primary care setting. New York: Brunner-Routledge. p. 115. ISBN 978-0-415-94946-0.
  15. Ayd, Frank J (31 May 2000). Lexicon of psychiatry, neurology, and the neurosciences. Philadelphia: Lippincott-Williams Wilkins. p. 256. ISBN 978-0-7817-2468-5.
  16. Fergusson DM, Boden JM, Horwood LJ (March 2009). "Tests of causal links between alcohol abuse or dependence and major depression". Arch. Gen. Psychiatry 66 (3): 260–6. doi:10.1001/archgenpsychiatry.2008.543. PMID 19255375.
  17. Neutel CI, Patten SB (November 1997). "Risk of suicide attempts after benzodiazepine and/or antidepressant use". Ann Epidemiol 7 (8): 568–74. doi:10.1016/S1047-2797(97)00126-9. PMID 9408553.
  18. Taiminen TJ (January 1993). "Effect of psychopharmacotherapy on suicide risk in psychiatric inpatients". Acta Psychiatr Scand 87 (1): 45–7. doi:10.1111/j.1600-0447.1993.tb03328.x. PMID 8093823.
  19. Brent DA, Emslie GJ, Clarke GN et al. (April 2009). "Predictors of spontaneous and systematically assessed suicidal adverse events in the treatment of SSRI-resistant depression in adolescents (TORDIA) study". Am J Psychiatry 166 (4): 418–26. doi:10.1176/appi.ajp.2008.08070976. PMID 19223438.
  20. Iwasaki M, Akechi T, Uchitomi Y, Tsugane S (April 2005). "Cigarette Smoking and Completed Suicide among Middle-aged Men: A Population-based Cohort Study in Japan". Annals of Epidemiology 15 (4): 286–92. doi:10.1016/j.annepidem.2004.08.011. PMID 15780776.
  21. Miller M, Hemenway D, Rimm E (May 2000). "Cigarettes and suicide: a prospective study of 50,000 men". American journal of public health 90 (5): 768–73. doi:10.2105/AJPH.90.5.768. PMC 1446219. PMID 10800427.
  22. Hemenway D, Solnick SJ, Colditz GA (February 1993). "Smoking and suicide among nurses". American journal of public health 83 (2): 249–51. doi:10.2105/AJPH.83.2.249. PMC 1694571. PMID 8427332.
  23. Thomas Bronischa, Michael Höflerab, Roselind Liebac (May 2008). "Smoking predicts suicidality: Findings from a prospective community study". Journal of Affective Disorders 108 (1): 135–145. doi:10.1016/j.jad.2007.10.010. PMID 18023879.
  24. Miller M, Hemenway D, Bell NS, Yore MM, Amoroso PJ (June 2000). "Cigarette smoking and suicide: a prospective study of 300,000 male active-duty Army soldiers". American Journal of Epidemiology 151 (11): 1060–3. PMID 10873129.
  25. Darke, S.; Kaye, S.; McKetin, R.; Duflou, J. (May 2008). "Major physical and psychological harms of methamphetamine use". Drug Alcohol Rev 27 (3): 253–62. doi:10.1080/09595230801923702. PMID 18368606.
  26. Darke S, Ross J (November 2002). "Suicide among heroin users: rates, risk factors and methods". Addiction 97 (11): 1383–94. doi:10.1046/j.1360-0443.2002.00214.x. PMID 12410779.
  27. 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.
  28. Pallanti, Stefano; Rossi, Nicolò Baldini; Hollander, Eric (2006). "11. Pathological Gambling". In Hollander, Eric; Stein, Dan J.. Clinical manual of impulse-control disorders. American Psychiatric Pub. pp. 251–289. ISBN 978-1-58562-136-1.
  29. Volberg, R.A. (2002). "The epidemiology of pathological gambling". Psychiatric Annals 32: 171–8.
  30. 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.
  31. Kausch O (2003). "Suicide attempts among veterans seeking treatment for pathological gambling". Journal of Clinical Psychiatry 64 (9): 1031–8. doi:10.4088/JCP.v64n0908. PMID 14628978.
  32. Kausch O (2003). "Patterns of substance abuse among treatment-seeking pathological gamblers". Journal of Substance Abuse Treatment 25 (4): 263–70. doi:10.1016/S0740-5472(03)00117-X. PMID 14693255.
  33. Ladd, G. T., Petry N. M. (2003) A comparison of pathological gamblers with and without substance abuse treatment histories. Experimental and Clinical Psychopharmacology, 11, 202-9.
  34. Vyas,Ahuja. Textbook of Postgraduate Psychiatry (2 Vols.) Jaypee Brothers medical Publis; 2nd edition (2003) p.441 ISBN 8171796486
  35. Hurst K. Primary hyperparathyroidism as a secondary cause of depression. J Am Board Fam Med. 2010 Sep-Oct ;23(5):677-80. doi: 10.3122/jabfm.2010.05.090199.
  36. Weber T1, Eberle J, Messelhäuser U, Schiffmann L, et al. Parathyroidectomy, elevated depression scores, and suicidal ideation in patients with primary hyperparathyroidism: results of a prospective multicenter study. JAMA Surg. 2013 Feb ;148(2):109-15
  37. 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.
  38. Simpson GK, Tate RL (August 2007). "Preventing suicide after traumatic brain injury: implications for general practice". Med. J. Aust. 187 (4): 229–32. PMID 17708726.
  39. 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.
  40. Druss B, Pincus H (May 2000). "Suicidal ideation and suicide attempts in general medical illnesses". Arch. Intern. Med. 160 (10): 1522–6. doi:10.1001/archinte.160.10.1522. PMID 10826468.
  41. Braden JB, Sullivan MD (December 2008). "Suicidal thoughts and behavior among adults with self-reported pain conditions in the national comorbidity survey replication". J Pain 9 (12): 1106–15. doi:10.1016/j.jpain.2008.06.004. PMC 2614911. PMID 19038772.
  42. Ribeiro JD, Pease JL, Gutierrez PM, et al. (October 2011). "Sleep problems outperform depression and hopelessness as cross-sectional and longitudinal predictors of suicidal ideation and behavior in young adults in the military". J Affect Disord 136 (3): 743–50. doi:10.1016/j.jad.2011.09.049. PMID 22032872.
  43. Bernert RA, Joiner TE, Cukrowicz KC, Schmidt NB, Krakow B (September 2005). "Suicidality and sleep disturbances". Sleep 28 (9): 1135–41. PMID 16268383.
  44. Janis Cutler, Eric Marcus. Psychiatry Oxford University Press, USA; 2 edition (2010) p.82 ISBN 0195372743
  45. B.J. Casey, Rebecca M. Jones,a and Todd A. Hareb. The Adolescent Brain. Ann N Y Acad Sci. 2008 March; 1124: 111–126. doi: 10.1196/annals.1440.010 PMCID: PMC2475802 NIHMSID: NIHMS56148[2]
  46. Krishnan, V.; Nestler, E. (2008). "The molecular neurobiology of depression". Nature 455 (7215): 894–902. doi:10.1038/nature07455. PMC 2721780. PMID 18923511.
  47. Phillips J, Murray P, Kirk P., The biology of disease; pp.5-9 ISBN 978-0-632-05404-6
  48. David M. Stoff, Elizabeth J. Susman: Developmental psychobiology of aggression; Cambridge University Press (2005) ISBN 0-521-82601-2
  49. S. Hossein Fatemi, Paula J. Clayton:The medical basis of psychiatry. p.562 Springer(1994);, ISBN 978-1-58829-917-8
  50. J. John Mann, M.D., Neurobiological Aspects of Suicide
  51. Roberto Tatarelli, Maurizio Pompili, Paolo Girardi: Suicide in psychiatric disorders. p.266; Nova Science Pub Inc;(2007) ISBN 1-60021-738-9
  52. Alan F. Schatzberg: The American Psychiatric Publishing textbook of mood disorders. p.489; American Psychiatric Publishing; (2005) ISBN 1-58562-151-X
  53. BDNF brain-derived neurotrophic factor [ Homo sapiens ]Gene ID: 627, updated on 9-Sep-2012:[3]
  54. Castrén E, Rantamäki T. Dev The role of BDNF and its receptors in depression and antidepressant drug action: Reactivation of developmental plasticity. Neurobiol. 2010 Apr;70(5):289-97. PMID 20186711
  55. Molendijk ML, Bus BA, Spinhoven P, et al. Serum levels of brain-derived neurotrophic factor in major depressive disorder: state-trait issues, clinical features and pharmacological treatment. Mol Psychiatry. 2011 Nov;16(11):1088-95. doi: 10.1038/mp.2010.98. Epub 2010 Sep 21. PMID: 20856249
  56. Sher L. Brain-derived neurotrophic factor and suicidal behavior. QJM. 2011 May;104(5):455-8. PMID 21051476
  57. Alan F. Schatzberg, Charles B: The American Psychiatric Publishing Textbook of Psychopharmacology. pp-918-919. American Psychiatric Publishers Inc; 4 edition (2009) ISBN 1585623091
  58. Brezo J, Klempan T, Turecki G (June 2008). "The genetics of suicide: a critical review of molecular studies". Psychiatr. Clin. North Am. 31 (2): 179–203. doi:10.1016/j.psc.2008.01.008. PMID 18439443.
  59. 59.0 59.1 Goldsmith, Sara K. (2002). Reducing suicide: a national imperative. Washington, D.C: National Academies Press. p. 141. ISBN 0-309-08321-4.
  60. Agerbo E, Nordentoft M, Mortensen PB (July 2002). "Familial, psychiatric, and socioeconomic risk factors for suicide in young people: nested case-control study". BMJ 325 (7355): 74. PMC 117126. PMID 12114236.
  61. 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.
  62. Krishnan, V.; Nestler, E. (2009). "Epigenetics in Suicide and Depression". Biological Psychiatry 66 (9): 812–813. doi:10.1016/j.biopsych.2009.08.033. PMC 2770810. PMID 19833253.
  63. Trygve Tollefsbol: Handbook of Epigenetics: The New Molecular and Medical Genetics. p.562: Elsevier Science;(2010);ISBN 0-12-375709-6
  64. Arturas Petronis: Brain, Behavior and Epigenetics, p.61 Springer (2011);ISBN 3-642-17425-6
  65. Niederkrotenthaler T, Herberth A, Sonneck G (2007). "[The "Werther-effect": legend or reality?]" (in German). Neuropsychiatr 21 (4): 284–90. PMID 18082110.
  66. 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.
  67. 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.
  68. Thomas H. Ollendick, Carolyn S. Schroeder: Encyclopedia of clinical child and pediatric psychology, p.61; Springer;(2003) ISBN 0-306-47490-5
  69. Marion Crook: Out of the darkness: teens and suicide p.56 Arsenal Pulp Press (2004) ISBN 1-55152-141-5
  70. 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. PMID 15843330.
  71. Niederkrotenthaler T, Voracek M, Herberth A et al. (September 2010). "Role of media reports in completed and prevented suicide: Werther v. Papageno effects". Br J Psychiatry 197 (3): 234–43. doi:10.1192/bjp.bp.109.074633. PMID 20807970.
  72. 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.
  73. 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.
  74. Qin P, Agerbo E, Mortensen PB (April 2003). "Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial factors: a national register-based study of all suicides in Denmark, 1981–1997". Am J Psychiatry 160 (4): 765–72. doi:10.1176/appi.ajp.160.4.765. PMID 12668367.
  75. Dube SR, Anda RF, Felitti VJ, Chapman DP, Williamson DF, Giles WH (December 2001). "Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study". JAMA 286 (24): 3089–96. PMID 11754674.
  76. "Child Protection and Child Outcomes: Measuring the Effects of Foster Care" (PDF). Retrieved 2011-11-01.
  77. Koch, Wendy (2007-07-03). "Study: Troubled homes better than foster care". Usatoday.Com. Retrieved 2011-11-01.
  78. 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.
  79. Robert I. Simon: Preventing Patient Suicide: Clinical Assessment and Management American Psychiatric Publishing, Inc.; 1 edition (2010) pp.51-57 ISBN 1585629340
  80. Malone KM1, Oquendo MA, Haas GL, Ellis SP, et al. Protective factors against suicidal acts in major depression: reasons for living. Am J Psychiatry. 2000 Jul;157(7):1084-8. PMID 10873915
  81. World Health Organization: Suicide prevention (SUPRE)
  82. 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.
  83. Stanford EJ, Goetz RR, Bloom JD. The no harm contract in the emergency assessment of suicidal risk. J Clin Psychiatry. 1994;55:344-348.
  84. Fiedorowicz JG, Weldon K, Bergus G. Determining suicide risk (hint: a screen is not enough) J Fam Pract. 2010 May;59(5):256-60. PMID 20544044
  85. Goin, M, The “Suicide-Prevention Contract”: A Dangerous Myth. Psychiatric News. Volume 38 Number 14 page 3-38.[4]
  86. Depression and Suicide Andrew B. Medscape
  87. 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.
  88. 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.
  89. 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.
  90. 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.
  91. SAMSHA"S National Registry of Evidence-based Programs and Practices. SOS Signs of Suicide [5]
  92. Schmitz WM Jr1, Allen MH, Feldman BN, Gutin NJ, et al. 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
  93. Roberts A R., Monferrari I, Yeager, KR, Avoiding Malpractice Lawsuits by Following Risk Assessment and Suicide Prevention Guidelines[6]
  94. Randolph B. Schiffer, Stephen M. Rao, Barry S. Fogel, Neuropsychiatry: Neuropsychiatry of suicide, pp. 706-713, (2003)ISBN 0781726557
  95. 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.
  96. 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.
  97. Best Practices Registry (BPR) For Suicide Prevention
  98. 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.
  99. 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
  100. Coppen A (2000). "Lithium in unipolar depression and the prevention of suicide". J Clin Psychiatry 61 Suppl 9: 52–6. PMID 10826662.
  101. 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
  102. American Psychiatric Association Practice Guidelines for the Treatment of Psychiatric Disorders: Compendium 2006. American Psychiatric Publishing; 1 edition (2006) p.1375 ISBN 0890423857
  103. 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 [7]
  104. National Institute of Mental Health: Suicide in the U.S.: Statistics and Prevention [8]
  105. 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.
  106. "Suicide prevention". WHO Sites: Mental Health. World Health Organization. February 16, 2006. Retrieved 2008-09-16.
  107. "2007 Data" (PDF). Suicide Prevention. 2007. Retrieved 2011-01-13.
  108. 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.
  109. 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.
  110. 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.
  111. 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.
  112. "U.S. Suicide Statistics (2005)". Retrieved 2008-03-24.