Suicide is when a person intentionally ends his or her life. Over the ages society has had differing views regarding this act—from acceptance, in that this is a choice, to considering it as a sin. Currently it is felt that suicide is rather complex resulting from social stressors, psychology, and biological factors. In the United States, approximately 30,000 people kill themselves every year, while it is believed that a much larger number of people attempt suicide. Suicide is the ninth overall cause of death in this country.
There are many factors that are felt to be associated with risk to attempt and complete suicide. These include gender, age, marital status, psychiatric illness, substance abuse, occupation, physical health, and history of suicide attempts. Men kill themselves three times as often as women, whereas women attempt four times as often as men. It is felt that the reason for this may be related to the methods employed. Men attempting suicide commonly use more lethal methods, such as guns and hanging. Women tend to overdose more frequently in their attempts. However, new studies indicate that women are using firearms more often than they had previously.
Age is another associated factor and suicide rates increase with age. Suicides peak for men after the age of 45, while that of women is at 55 years. Younger people tend to attempt suicide more often and are less likely to succeed than older people as a trend. Currently, the suicide rate is rising most rapidly in younger people and is specific to men 18-24 years old. People who are married have a lower risk of suicide and this is reinforced if they are parents. Occupation plays a role as well in the risk for suicide. Unemployment is a risk factor for suicide as are high-stress professions, such as medicine.
Medical illness can be a large factor in suicide. When people have chronic medical problems that impact their quality of life, the risk for killing themselves increases. In the treatment of some medical illnesses, the medications used can result in a mood disorder such as depression, which again can place people at higher risk. Psychiatric illnesses are another risk factor for suicide. It is estimated that almost 95% of people who kill themselves have a mental illness. The predominant ones are the depressive disorders with 80% of suicides having this class of illness. People with these types of disorders who kill themselves are usually in a depressive episode. It is noted that they will kill themselves either at the beginning or the end of a depressive period. Along with mental illness is comorbid substance abuse, which is seen commonly. People with schizophrenia are also at risk for suicide and account for 10% of the people with mental illness who kill themselves. This group of people has the onset of their illness during early adulthood, and those who commit suicide usually do so within the first few years after diagnosis. People with alcohol dependence are at risk and it is estimated that 15% will kill themselves. Approximately 80% of those alcohol-dependent people who commit suicide are males. Many of the people with mental illness have other factors in common—significant social isolation, feeling hopeless, and unemployment—that in and of themselves are risk factors for suicide.
It is felt that perhaps the best predictor for suicide is a past suicide attempt. Some data show that up to 40% of people with depression who kill themselves have attempted suicide in the past. Further studies have been examining the intent to die associated with prior attempts. It is believed that this will show that people who attempt suicide with a high intent to die will be at higher risk of completed suicide.
Warning signs of suicide are felt to be seen in approximately 80% of people who succeed at this. These signs can be the person telling others about their thoughts, preoccupation with death, or discussing feeling hopeless. Much attention has also been drawn to the evaluation of art—paintings, songs, and poetry that revolve around the topic of death. Another common warning sign is when people give away their valued personal belongings. While it is frequently thought that asking about suicide will plant this idea onto an otherwise nonsuicidal person, research suggests that this is not the case. On the other hand, asking about suicidal thoughts many times can aid in finding treatment for an underlying depression and thus prevent a suicide. It is felt that most suicides are preventable as suicidal thoughts are usually temporary and secondary to a depressed mood.
Over the years many different theories have been proposed to explain why people commit suicide. As mentioned previously, depression plays a large role, but there are various possible causes for depression. The French sociologist Emile Durkheim hypothesized that both social and cultural influences play a role in depression. He described multiple types of suicide where integration in a social group, or lack thereof, can result in one killing himself or herself. Psychological factors have been examined as possible explanations to suicide. For example, Sigmund Freud felt that suicide was a result of an earlier repressed wish to kill someone else. Recent media coverage of famous people who commit suicide has brought speculation that this can cause others, specifically adolescents, to kill themselves. Currently there are no data to support this thought.
Biological factors have also been investigated. Genetics is a known risk factor and suicide runs in families. One study in an Amish population in Pennsylvania found 26 suicides in just 4 families. However, in this study, the family members all had psychiatric illnesses. Because of this, it is felt that suicide itself may not be genetically inherited, but rather the psychiatric illness is hereditary and this is what puts a person at higher risk. Neurobiochemistry also appears to play a role in suicide. In a study of people who killed themselves by violent means, it was found that there was a lower serotonin level in their brains compared to depressed people who did not commit suicide. Serotonin is a neuro-chemical believed to be one of the main chemicals involved in depression.
It is felt that suicide is many times preventable as it is usually secondary to fleeting thoughts while in a depressive episode. In the 1950s, most communities in the United States started suicide hotlines; however, these are only helpful to those who call. People in the community, such as teachers and police, are educated in how to recognize the risk factors for suicide. Many times when someone is suicidal and intent on killing themselves, psychiatric hospitalization is appropriate. Suicide has a large impact on the people who were close to the person who ended his/her life. These people, left behind, can blame themselves and may not want to talk about the event secondary to the social stigma attached to suicide. There are many support groups for families who have lived through a suicide, which can be useful in coping with this tragedy.
- American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.