The Suicide File

[Cary Polachek]

Suicideis the act of intentionally causing one's own death.[9] Mental disorders (including depression, bipolar disorder, schizophrenia, personality disorders, anxiety disorders, attention deficit hyperactivity disorder, and cognitive disengagement syndrome), physical disorders (such as chronic fatigue syndrome), and substance abuse (including alcoholism and the use of and withdrawal from benzodiazepines) are risk factors.[2][3][5][10]

Some suicides are impulsive acts due to stress (such as from financial or academic difficulties), relationship problems (such as breakups or divorces), or harassment and bullying.[2][11][12] Those who have previously attempted suicide are at a higher risk for future attempts.[2] Effective suicide prevention efforts include limiting access to methods of suicide such as firearms, drugs, and poisons; treating mental disorders and substance abuse; careful media reporting about suicide; improving economic conditions;[2][13] and dialectical behaviour therapy (DBT).[14] Although crisis hotlines are common resources, their effectiveness has not been well studied.[15][16]

Suicides resulted in 828,000 deaths globally in 2015, an increase from 712,000 deaths in 1990.[17][18][inconsistent] This makes suicide the 10th leading cause of death worldwide.[3][6] Approximately 1.5% of all deaths worldwide are by suicide.[8] In a given year, this is roughly 12 per 100,000 people.[6] Rates of suicide are generally higher among men than women, ranging from 1.5 times higher in the developing world to 3.5 times higher in the developed world.[1] Suicide is generally most common among those over the age of 70; however, in certain countries, those aged between 15 and 30 are at the highest risk.[1] Europe had the highest rates of suicide by region in 2015.[19] There are an estimated 10 to 20 million non-fatal attempted suicides every year.[20] Non-fatal suicide attempts may lead to injury and long-term disabilities.[21] In the Western world, attempts are more common among young people and women.[21] The most commonly adopted method of suicide varies from country to country and is partly related to the availability of effective means.[22]

Views on suicide have been influenced by broad existential themes such as religion, honor, and the meaning of life.[23][24] The Abrahamic religions traditionally consider suicide as an offense towards God due to belief in the sanctity of life.[25] During the samurai era in Japan, a form of suicide known as seppuku (腹切り, harakiri) was respected as a means of making up for failure or as a form of protest.[26] Similarly, a ritual fast unto death, known as Vatakkiruttal (Tamil: வடக்கரத்தல், Vaṭakkiruttal, 'fasting facing north'), was a Tamil ritual suicide in ancient India during the Sangam age.[27] Suicide and attempted suicide, while previously illegal, are no longer so in most Western countries.[28] It remains a criminal offense in some countries.[29] In the 20th and 21st centuries, suicide has been used on rare occasions as a form of protest;or as both a military and terrorist tactic while or after murdering others.[30] Suicide is often seen as a major catastrophe causing significant grief to the deceased's relatives, friends and community members, and it is viewed negatively almost everywhere around the world.[31][32][33]

Suicide, derived from Latin suicidium, is "the act of taking one's own life".[9][34] Attempted suicide or non-fatal suicidal behavior amounts to self-injury with at least some desire to end one's life that does not result in death.[35][36] Assisted suicide occurs when one individual helps another bring about their own death indirectly via providing either advice or the means to the end.[37] This is in contrast to euthanasia, where another person takes a more active role in bringing about a person's death.[37]

Suicidal ideation is thoughts of ending one's life but not taking any active efforts to do so.[35] It may or may not involve exact planning or intent.[36] Suicidality is defined as "the risk of suicide, usually indicated by suicidal ideation or intent, especially as evident in the presence of a well-elaborated suicidal plan."[38]

In 2011, in an article calling for changing the language used around suicide entitled "Suicide and language: Why we shouldn't use the 'C' word," the Centre for Suicide Prevention in Canada found that the normal verb in scholarly research and journalism for the act of suicide was commit, and argued for destigmatizing terminology related to suicide.[41][42] The American Psychological Association lists "committed suicide" as a term to avoid because it "frame[s] suicide as a crime".[43] Some advocacy groups recommend using the terms took his/her own life, died by suicide, or killed him/herself instead of committed suicide.[44][45][46] The Associated Press Stylebook recommends avoiding "committed suicide" except in direct quotes from authorities.[47] The Guardian and Observer style guides deprecate the use of "committed",[48] as does CNN.[49] Opponents of commit argue that it implies that suicide is criminal, sinful, or morally wrong.[50]

Factors that affect the risk of suicide include mental disorders, drug misuse, psychological states, cultural, family and social situations, genetics, experiences of trauma or loss, and nihilism.[59][60][16] Mental disorders and substance misuse frequently co-exist.[61] Other risk factors include having previously attempted suicide,[21] the ready availability of a means to take one's life, a family history of suicide, or the presence of traumatic brain injury.[62] For example, suicide rates have been found to be greater in households with firearms than those without them.[63]

Socio-economic problems such as unemployment, poverty, homelessness, and discrimination may trigger suicidal thoughts.[64][65] Suicide might be rarer in societies with high social cohesion and moral objections against suicide.[36] Genetics appears to account for between 38% and 55% of suicidal behaviors.[66] Suicides may also occur as a local cluster of cases.[67]

Most research does not distinguish between risk factors that lead to thinking about suicide and risk factors that lead to suicide attempts.[68][69] Risks for suicide attempt, rather than just thoughts of suicide, include a high pain tolerance and a reduced fear of death.[70]

A previous history of suicide attempts is the most accurate predictor of death by suicide.[21] Approximately 20% of suicides have had a previous attempt. Of those who have attempted suicide, 1% die by suicide within a year[21] and more than 5% die by suicide within 10 years.[71]

Others estimate that about half of people who die by suicide could be diagnosed with a personality disorder, with borderline personality disorder being the most common.[81] About 5% of people with schizophrenia die of suicide.[82] Eating disorders are another high risk condition.[71] Around 22% to 50% of people with gender dysphoria have attempted suicide, however this greatly varies by region.[83][84][85][86][87]

Substance misuse is the second most common risk factor for suicide after major depression and bipolar disorder.[91] Both chronic substance misuse as well as acute intoxication are associated.[61][92] When combined with personal grief, such as bereavement, the risk is further increased.[92] Substance misuse is also associated with mental health disorders.[61]

The misuse of cocaine and methamphetamine has a high correlation with suicide.[61][97] In those who use cocaine, the risk is greatest during the withdrawal phase.[98] Those who used inhalants are also at significant risk with around 20% attempting suicide at some point and more than 65% considering it.[61] Smoking cigarettes is associated with risk of suicide.[99] There is little evidence as to why this association exists; however, it has been hypothesized that those who are predisposed to smoking are also predisposed to suicide, that smoking causes health problems which subsequently make people want to end their life, and that smoking affects brain chemistry causing a propensity for suicide.[99] Cannabis, however, does not appear to independently increase the risk.[61]

There is an association between suicidality and physical health problems such as[71] chronic pain,[103] traumatic brain injury,[104] cancer,[105] chronic fatigue syndrome,[106] kidney failure (requiring hemodialysis), HIV, and systemic lupus erythematosus.[71] The diagnosis of cancer approximately doubles the subsequent frequency of suicide.[105] The prevalence of increased suicidality persisted after adjusting for depressive illness and alcohol abuse. Among people with more than one medical condition the frequency was particularly high. In Japan, health problems are listed as the primary justification for suicide.[107]

Sleep disturbances, such as insomnia[108] and sleep apnea, are risk factors for depression and suicide. In some instances, the sleep disturbances may be a risk factor independent of depression.[109] A number of other medical conditions may present with symptoms similar to mood disorders, including hypothyroidism, Alzheimer's, brain tumors, systemic lupus erythematosus, and adverse effects from a number of medications (such as beta blockers and steroids).[21]

A number of psychological factors increase the risk of suicide including: hopelessness, loss of pleasure in life, depression, anxiousness, agitation, rigid thinking, rumination, thought suppression, and poor coping skills.[76][110][111] A poor ability to solve problems, the loss of abilities one used to have, and poor impulse control also play a role.[76][112] In older adults, the perception of being a burden to others is important.[113] Those who have never married are also at greater risk.[21] Recent life stresses, such as a loss of a family member or friend or the loss of a job, might be a contributing factor.[76][67]

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