If you are feeling desperate, alone or helpless, or know someone who is
call 1-800-273-TALK (8255)
to talk to a counselor at the National Suicide Prevention Lifeline.
What Is Suicide?
Suicide is one of the top 10 causes of death in the United States, accounting for around 40,000 deaths per year and an estimated 1 million deaths worldwide. It leaves behind more unanswered questions than any other cause of death. Friends and family members are left in a wake of uncertainty, most never knowing what events led to their loved one’s death.
Suicide is the act of purposely ending one’s own life. How societies view suicide varies widely according to culture and religion. For example, many Western cultures, as well as mainstream Judaism, Islam, and Christianity tend to view killing oneself as quite negative. One myth about suicide that may be the result of this view is considering suicide (suicidal ideation) to always be the result of a mental illness. Some societies also treat a suicide attempt as if it were a crime. However, suicides are sometimes seen as understandable or even honorable in certain circumstances, as in protest to persecution (for example, a hunger strike), as part of battle or resistance (for example, suicide pilots of World War II, suicide bombers), or as a way of preserving the honor of a dishonored person (for example, killing oneself to preserve the honor or safety of family members).
More than 800,000 people worldwide committed suicide in 2012, with many more suicide attempts annually. That translates into someone dying by suicide every 40 seconds somewhere in the world. More than 39,000 people reportedly kill themselves each year in the United States, making it the 10th leading cause of death.
The true number of suicides is likely higher because some deaths that were thought to be an accident, like a single-car accident, overdose, or shooting, are not recognized as being a suicide.
The higher frequency of completed suicides in males versus females is consistent across the life span, but the ratio of men to women who complete suicide decreases from 3:1 in wealthier countries to closer to 1.5:1 in less wealthy countries. In the United States, boys 10-14 years of age commit suicide twice as often as their female peers. Teenage boys 15-19 years of age complete suicide five times as often as girls their age, and men 20-24 years of age commit suicide 10 times as often as women their age.
Gay, lesbian, transgender, and other sexual minority youth are more at risk for thinking about and attempting suicide than heterosexual teens.
There are trends regarding the means of committing suicide as well. For example, the frequency of hanging, carbon monoxide poisoning, or other forms of self-suffocation increased from 1992 to 2006, while committing suicide by a gun has decreased during that period of time and has remained unchanged from 2012-2013.
Suicide is the second leading cause of death for people 15-29 years of age. Teen suicide statistics for youths 15-19 years of age indicate that from 1950-1990, the frequency of suicides increased by 300% and from 1990-2003, that rate decreased by 35%. However, from 1999 through 2006, the rate of suicide increased by about 1% per year and by about 2% per year from 2006 through 2014, both in the 10-24 years and the 25-64 years old age groups.
While the rate of murder-suicide remains low, the devastation it creates makes it a concerning public-health issue.
The rates of suicide can vary with the time of year, as wells as with the time of day. For example, the number of suicides by train tends to peak soon after sunset and about 10 hours earlier each day. Although professionals like police officers and dentists are thought to be more vulnerable to suicide than others, important flaws have been found in the research upon which those claims are based.
As opposed to suicidal behavior, self-mutilation is defined as deliberately hurting oneself without meaning to cause one’s own death. Examples of self-mutilating behaviors include cutting any part of the body, usually of the wrists. Self-tattooing is also considered self-mutilation. Other self-injurious behaviors include self-burning, head banging, pinching, and scratching.
Physician-assisted suicide is defined as ending the life of a person who is terminally ill in a way that is either painless or minimally painful for the purpose of ending suffering of the individual. It is also called euthanasia and mercy killing. In 1997, the United States Supreme Court ruled against endorsing physician-assisted suicide as a constitutional right but allowed for individual states to enact laws that permit it to be done. As of 2016, California, Oregon, Washington, and Vermont were the only states with laws in effect that authorized physician-assisted suicide, but a number of other states are in the process of considering it. Physician-assisted suicide seems to be less offensive to people compared to assisted suicide that is done by a non-physician, although the acceptability of both means to end life tends to increase as people age and with the severity of medical illness and the number of times the person who desires their own death repeatedly asks for such assistance.
What Are The Risk Factors And Protective Factors For Suicide?
Ethnically, the highest suicide rates in the United States occur in non-Hispanic whites and in Native Americans. The lowest rates are in non-Hispanic blacks, Asians, Pacific Islanders, and Hispanics. Former Eastern Bloc countries currently have the highest suicide rates worldwide, while South America has the lowest. Geographical patterns of suicides are such that individuals who live in a rural area versus urban area and the western United States versus the eastern United States are at higher risk for killing themselves. The majority of suicide completions take place during the spring.
In most countries, women continue to attempt suicide more often, but men tend to complete suicide more often. Although the frequency of suicides for young adults has been increasing in recent years, elderly Caucasian males continue to have the highest rate of suicide completion. Other risk factors for taking one’s life include poor access to mental-health care, single marital status, unemployment, low income, mental illness, a history of being physically or sexually abused, a personal history of suicidal thoughts, threats or behaviors, or a family history of attempting suicide. A lack of access to mental-health care has also been identified as increasing the likelihood of suicide. The means of attempting suicide can have particular risk factors as well. For example, individuals who attempt suicide by jumping from a height like a bridge may be more likely to be single, unemployed, and psychotic, while those who use firearms may more often have a history of legal issues, alcoholism, and certain personality disorders.
Data regarding mental illnesses as risk factors indicate that depression, manic depression, schizophrenia, substance abuse, eating disorders, and severe anxiety increase the probability of suicide attempts and completions. Nine out of 10 people who commit suicide have a diagnosable mental-health problem and up to three out of four individuals who take their own life had a physical illness when they committed suicide. Behaviors that tend to be linked with suicide attempts and completions include impulsivity, violence against others, and self-mutilation, like slitting one’s wrists or other body parts, or burning oneself.
Over 90% of those who die by suicide have a mental illness at the time of their death – the most common mental illness that leads to suicide is untreated major depression. Other mental illnesses that may lead to suicide include bipolar disorder and schizophrenia.
It’s very rare for someone to die by suicide due to a single cause. Usually, there are several reasons that someone chooses to die by suicide.
Risk factors for adults who commit murder-suicide include male gender, older caregiver, access to firearms, separation or divorce, depression, and drug abuse or addiction.
In children and adolescents, bullying and being bullied seem to be associated with an increased risk of suicidal behaviors. Specifically regarding male teens who ultimately commit murder-suicide by school shootings, being bullied may play a significant role in putting them at risk for this outcome. Another risk factor that renders children and teens more at risk for suicide compared to adults is having someone they know commit suicide, which is called contagion or cluster formation.
Generally, the absence of mental illness and substance abuse, as well as the presence of a strong social support system, decrease the likelihood that a person will kill him- or herself. Having children who are younger than 18 years of age also tends to be a protective factor against mothers committing suicide.
What Are Some Common Motivations For Suicide?
Left in the wake of a suicide, many suicide survivors try to understand why a loved one chose to end his or her life. Here are some of the common reasons for a suicide:
Suicide is a solution. Suicide is many things, but it is neither random nor pointless. To those who choose to end their lives, suicide is seen as an answer to an unsolvable problem or a way out of a horrible dilemma. Suicide is (somehow) the preferred choice to another set of dreaded circumstances, emotional pain, or disability, which the person fears more than death.
Suicide is a way to cease consciousness. Those who die by suicide want to end their conscious experience, which, for them, has become an endless stream of distressing, preoccupying thoughts. Suicide offers total oblivion.
Suicide stemming from frustrated psychological needs. People who have high standards and expectations are extra vulnerable to suicide when progress toward goals is suddenly frustrated. People who attribute failure and disappointment to their own shortcomings may view themselves as worthless, unlovable, and incompetent. In adults, suicide is often related to work or interpersonal problems. In teenagers, suicide is often precipitated by family turmoil.
Suicide may be a way to end intolerable psychological pain. Excruciating negative emotions (i.e. sadness, shame, guilt, anger, and fear) from any circumstance frequently serve as the foundation for suicide.
Suicide stems from ambivalence. Most of those who contemplate suicide – including those successful in carrying out their suicidal plans -are ambivalent. They do want to die, yet they also wish they could find another solution to their dilemma.
Suicide may be a response to hopelessness and/or helplessness. A pessimistic expectation about the future is even more important than other types of negative emotions (anger, depression) in predicting suicide. A suicidal person is convinced that nothing whatsoever can improve the situation; that no one else can help.
Suicide as a plan. Suicidal thoughts and plans are like tunnel vision. The suicidal person is unable or unwilling to engage in any effective problem-solving behaviors and may see everything in all or nothing terms.
Someone who dies by suicide has often spoken of his or her suicidal ideations. There’s a harmful myth that those who really want to die by suicide do not talk about it. However, at least 80% of those who do end up killing themselves have spoken to others about their plans or have attempted suicide before.
Suicide as an escape. Suicide provides a way to escape from intolerable circumstances.
Those who die by suicide may lack coping skills. During crisis periods that precipitate suicidal thoughts, people tend to use the response patterns they’ve used all of their life.
What Are Some of the Common Warning Signs For Suicide?
Warning signs that a person is imminently planning to kill themselves may include making a will, getting his or her affairs in order, suddenly visiting friends or family members (one last time), buying instruments of suicide like a gun, hose, rope, pills, or other forms of medications, a sudden and significant decline or improvement in mood, or writing a suicide note. Contrary to popular belief, many people who complete suicide do not tell their therapist that they plan to kill themselves in the months before they do so. If they communicate their plan to anyone, it is more likely to be someone with whom they are personally close, like a friend or family member.
While it may seem otherwise, suicide is rarely a spur of the moment idea. The strongest signs that someone is going to commit suicide are verbal, such as, “I cannot go on,” “I can’t do this anymore,” “Nothing matters,” “I’m thinking of ending it all.”
While many people do not exhibit any symptoms of suicide, approximately 75% of those who die by suicide do exhibit warning signs of suicide. Always take any warning signs of suicide very, very seriously.
Here are some warning signs that someone you love may be feeling suicidal:
- Becoming depressed and acting sad most of the time
- Losing interest in activities
- Talking or writing about death or suicide
- Sudden and dramatic change in mood
- Sudden change in personality
- Feeling hopeless/helpless without a reason to live.
- Feeling a strong rage
- Feeling trapped in a situation
- Acting impulsively
- Giving away possessions
- Getting affairs in order
- Writing a will
- Withdrawing from family and friends
- Abusing drugs and/or alcohol
- Looking for ways to kill oneself
- Feeling hopeless
- Change in sleeping and eating habits
- Performing poorly at work or school
People who take their lives tend to suffer from severe anxiety or depression, symptoms of which may include moderate alcohol abuse, insomnia, severe agitation, loss of interest in activities they used to enjoy (anhedonia), hopelessness, and persistent thoughts about the possibility of something bad happening. Since suicidal behaviors are often quite impulsive, removing guns, medications, knives, and other instruments people often use to kill themselves from the immediate environment can allow the individual time to think more clearly and perhaps choose a more rational way of coping with their pain. It can also allow the person’s caregivers or loved ones time to intervene.
How Are Suicidal Thoughts And Behaviors Assessed?
The risk assessment for suicidal thoughts and behaviors performed by mental-health professionals often involves an evaluation of the presence, frequency, severity, and duration of suicidal feelings in the individuals they treat as part of a comprehensive evaluation of the person’s mental health. Therefore, in addition to asking questions about family mental-health history and about the symptoms of a variety of emotional problems (for example, anxiety, depression, mood swings, bizarre thoughts, substance abuse, eating disorders, and any history of being traumatized), practitioners frequently ask the people they evaluate about any past or present suicidal thoughts (ideations), dreams, intent, and plans. If the individual has ever attempted suicide, information about the circumstances surrounding the attempt, as well as the level of dangerousness of the method and the outcome of the attempt, may be explored. Any other history of violent behavior might be evaluated. The person’s current circumstances, like recent stressors (for example, end of a relationship, family problems), sources of support, and accessibility of weapons are often probed. What treatment the person may be receiving and how he or she has responded to treatment recently and in the past, are other issues mental-health professionals tend to explore during an evaluation.
Sometimes professionals assess suicide risk by using an assessment scale. One such scale is called the SAD PERSONS Scale, which identifies risk factors for suicide as follows:
- Sex (male)
- Age younger than 19 or older than 45 years of age
- Depression (severe enough to be considered clinically significant)
- Previous suicide attempt or received mental-health services of any kind
- Excessive alcohol or other drug use
- Rational thinking lost
- Separated, divorced, or widowed (or other ending of significant relationship)
- Organized suicide plan or serious attempt
- No or little social support
- Sickness or chronic medical illness
How Are Suicidal People Treated?
Those who treat people who attempt suicide adapt immediate treatment to the person’s individual needs. Those who have a responsive and intact family, good friendships, generally good social supports, and who have a history of being hopeful and have a desire to resolve conflicts may need only a brief crisis-oriented intervention. However, those who have made previous suicide attempts, have shown a high degree of intent to kill themselves, seem to be suffering from either severe depression or other mental illness, are abusing alcohol or other drugs, have trouble controlling their impulses, or have families who are unable or unwilling to commit to counseling are at higher risk and may need psychiatric hospitalization to prevent a repeat attempt in the days following the failed suicide by providing close monitoring (for example, suicide watch) and long-term outpatient mental-health services to recover from suicidal thoughts or actions.
Talk therapy (psychotherapy) that focuses on helping the person understand how their thoughts and behaviors affect each other (cognitive behavioral therapy) is an effective treatment for many people who struggle with thoughts of harming themselves. School intervention programs in which teens are given support and educated about the risk factors, symptoms, and ways to manage suicidal thoughts in themselves and how to engage adults when they or a peer expresses suicidal thinking have been found to decrease the number of times adolescents report attempting suicide.
Although concerns have been raised about the possibility that antidepressant medications increase the frequency of suicide attempts, mental-health professionals try to put those concerns in the context of the need to treat the severe emotional problems that are usually associated with attempting suicide and the fact that the number of suicides that are completed by mentally ill individuals seems to decrease with treatment. The effectiveness of medication treatment for depression in teens is supported by research, particularly when medication is combined with psychotherapy. In fact, concern has been expressed that the reduction of antidepressant prescribing since the U.S. Food and Drug Administration required that warning labels be placed on these medications may be related to the 18.2% increase in U.S. youth suicides from 2003-2004 after a decade of steady decrease. While the use of specific antidepressants has been associated with lower suicide rates in adolescents over the long term, uncommon short-term side effects of serotonergic antidepressants (for example, fluoxetine [Prozac], sertraline [Zoloft], paroxetine [Paxil], escitalopram [Lexapro], or vortioxetine [Trintellix]) may include an increase in suicide. Therefore, most practitioners consider antidepressant medication an important part of treating depression while closely monitoring their patients’ progress to prevent suicide.
Mood-stabilizing medications like lithium (Lithobid) — as well as medications that address bizarre thinking and/or severe anxiety, like clozapine (Clozaril), risperidone (Risperdal), and aripiprazole (Abilify) — have also been found to decrease the likelihood of individuals killing themselves
How Can People Cope With Suicidal Thoughts?
In the effort to cope with suicidal thoughts, silence is the enemy. Suggestions for helping people survive suicidal thinking include engaging the help of a doctor or other health professional, a spiritual advisor, or by immediately calling a suicide hotline or going to the closest emergency room or mental-health crisis center. In order to prevent acting on thoughts of suicide, it is often suggested that people who have experienced suicidal thinking keep a written or mental list of people to call in the event that suicidal thoughts come back. Other strategies include having someone hold all medications to prevent overdose, removing knives, guns, and other weapons from the home, scheduling stress-relieving activities every day, getting together with others to prevent isolation, writing down feelings, including positive ones, and avoiding the use of alcohol or other drugs.
Is It Possible To Prevent A Suicide Attempt?
For most, suicide prevention strategies include increasing access to health care, promoting mental health, avoidance of drug use, and restricting access to means to complete suicide. Responsible media reporting to raise mental-health and suicide awareness, as well as how to report suicides and other violence that occurs are other suicide-prevention strategies that are often used.
Suicide prevention measures for people at a higher risk, who have a mental health history following a psychiatric hospitalization usually involve professionals trying to implement a comprehensive outpatient treatment plan prior to the person being discharged. This is EXTREMELY important since many people fail to comply with outpatient therapy after leaving the hospital. It is often recommended that all firearms and other weapons be removed from the home, because the person may still find access to guns and other dangerous objects stored in their home, even if locked. It’s often recommended that sharp objects and potentially lethal medications be locked up as a result of the attempt.
Vigorous treatment of the underlying psychiatric disorder is important in decreasing short-term and long-term risk for suicide. Contracting with the person against suicide has not been shown to be especially effective in preventing suicidal behavior, but the technique may still be helpful in assessing risk, since hesitation or refusal to agree to refrain from harming oneself or to fail to agree to tell a specified person may indicate an intent to harm oneself. Contracting might also help the individual identify sources of support he or she can call upon if the suicidal thoughts recur
What is the prognosis for someone who has made a suicide attempt or threat?
While most people who attempt suicide do not ultimately die by suicide, those who have tried to kill themselves are at much higher risk of completing suicide compared to those who have never attempted to do so. People who attempt suicide have been found to be at risk for developing symptoms of post-traumatic stress disorder (PTSD), with the suicide attempt being the traumatic event. This has been found to be more likely the more serious the suicide attempt and the more steps the person took in an effort to avoid detection before their demise. Given the potentially fatal prognosis of attempting suicide, the need for treatment is all the more important.
How To Help A Suicidal Friend (Emergency Situation):
If your friend has an active plan (a set time and way they plan to suicide) for suicide, call 911. Don’t hesitate.
While waiting for 911 to respond, STAY WITH THE SUICIDAL FRIEND.
If your suicidal friend has plans to use a firearm for suicide – and owns the firearm – call the police.
When in doubt, CALL 911!
Before you leave the suicidal person, make sure that he or she is in professional hands that are able to handle the risk for suicide.
After the suicidal person has gotten help and is no longer at risk for a suicide, help the person make an appointment with a doctor or therapist to help with his or her problems.
Continue to follow up and check in with your suicidal friend as often as you can.
How to Help A Suicidal Friend (Non-Emergency):
If the suicide is not an eminent emergency, here are some tips for talking to a suicidal friend or loved one.
Listen, really listen to your suicidal friend rather than offer solutions and help. Let your suicidal loved one talk as much as he or she wants while listening closely to what he or she says.
When someone is feeling suicidal, they must talk about their feelings immediately. Sometimes, just letting those feelings out can help.
Don’t be judgmental and invalidate anything the suicidal person says or feels.
Offer encouragement – not platitudes – while listening to your suicidal loved one speak.
Be careful of your words – you don’t want to make the suicidal person feel any worse than he or she already does.
Allow for the expression of suicide and dark thoughts in ANY WAY they want. Allow your suicidal loved one to cry, yell, swear or scream – anything to let out that emotion.
Let them know that you do care about them very much and that you are very concerned about them. A suicidal person is very vulnerable.
If your suicidal loved one tells you to keep the suicidal intents a secret, don’t keep the secret. Saving a life is more important than honoring your friend’s privacy.
Talk openly about suicide – you need to know as much as you can about what’s going through your suicidal loved one’s mind. The more planning, the more risk that your suicidal loved one may actually go through with the suicide. Use the method form (Suicidal, method, means, when?) Ask things like this:
“Are you feeling so badly that you’re thinking about suicide?”
If yes, say, “Have you thought about how you’d commit suicide?”
If yes ask, “Do you have what you need to commit suicide?”
If yes, ask, “Have you thought about when you’d do it?”
If your suicidal loved one can answer all of those questions, CALL 911. THIS IS AN EMERGENCY SITUATION.
How Do I Handle A Suicidal Person Online?
If you see a suicidal person online, don’t presume they’re faking it. They’re reaching out – you should help if you can.
Start by sending the suicidal person to the National Suicide Prevention Hotline website.
Tell them to call the National Suicide Prevention Helpline: 1-800-273-TALK.
Please, if you are thinking about suicide, pick up the phone and call 1-800-SUICIDE.
Take any talk of suicide seriously.
Respond with compassion.
Encourage the suicidal person online to reach out for help from a friend, family member, therapist or others in his or her community.
If someone you see online says that he or she is about to kill him or herself or is in the process of attempting suicide, try to locate this person and call the local police.
Grief Following A Suicide:
The loss of someone you love to suicide is incredibly shocking and the grieving process is intense and prolonged and those left behind often feel abandoned.
Wondering if the death could have been prevented and questioning whether or not the death could have been prevented is incredibly common and incredibly guilt-inducing. There is research to support that people grieving a suicide feel more guilt than those who grieve any other death.
Sources of Support For Suicide:
I Am Alive: IMAlive is a live online network that uses instant messaging to respond to people in crisis. People need a safe place to go during moments of crisis and intense emotional pain.
National Suicide Prevention Lifeline– The National Suicide Prevention Lifeline 1-800-273-TALK (8255) is a 24-hour, toll-free, confidential suicide prevention hotline available to anyone in suicidal crisis or emotional distress. By dialing 1-800-273-TALK, the call is routed to the nearest crisis center in our national network of more than 140 crisis centers.
Befrienders Worldwide: Organization that works to provide emotional support to reduce suicide. They want to listen to people who are in distress. They do not judge or tell them what to do. They LISTEN. They can also help with bereavement and grieving that follows the death of a loved one through suicide.
Sources of Information about Suicide:
American Association of Suicidology: an educational organization that is devoted to understanding and preventing suicide. They are attempting to advance Suicidology as a science; encouraging, developing and disseminating scholarly work in suicidology. They encourage the development and application of strategies that reduce the incidence and prevalence of suicidal behaviors.
Suicide Awareness Voices Of Education (SAVE): an educational site that aims to educate the public about suicide, reduce the stigma of suicide, and serve as a resource for those touched by suicide. Many links to community resources, information about intervention strategies to prevent suicide, and all kinds of information about mental illnesses.
American Foundation for Suicide Prevention: a national not-for-profit organization dedicated to understanding and preventing suicide through research, education, and advocacy, and to reaching out to those with mental illness and those impacted by suicide.
Post last audited 8/2018