Suicide

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Suicide
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]

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