Suicide - Frequently Asked Questions
What should you do if someone tells you they are thinking about suicide?
If someone tells you they are thinking about suicide, you
should take their distress seriously, listen nonjudgmentally, and help them get
to a professional for evaluation and treatment. People consider suicide when they are hopeless and unable to
see alternative solutions to problems.
Suicidal behavior is most often related to a mental disorder
(depression) or to alcohol or other substance abuse. Suicidal behavior is also more likely to occur when people
experience stressful events (major losses, incarceration). If someone is in imminent danger of harming
himself or herself, do not leave the person alone. You may need to take emergency steps to get help, such as calling
911. When someone is in a suicidal
crisis, it is important to limit access to firearms or other lethal means of
committing suicide.
What are the most common methods of suicide?
Firearms are the most commonly used method of suicide for
men and women, accounting for 60 percent of all suicides. Nearly 80 percent of all firearm suicides
are committed by white males. The
second most common method for men is hanging; for women, the second most common
method is self-poisoning including drug overdose. The presence of a firearm in the home has been found to be an
independent, additional risk factor for suicide. Thus, when a family member or health care provider is faced with
an individual at risk for suicide, they should make sure that firearms are
removed from the home.
Why do men commit suicide more often than women do?
More than four times as
many men as women die by suicide; but women attempt suicide more often during their lives than do men, and women report higher rates of depression. Men and women use different suicide methods. Women in all countries are more likely to ingest poisons than men. In countries where the poisons are highly lethal and/or where treatment resources scarce, rescue is rare and hence female suicides outnumber males.
Who is at highest risk for suicide in the U.S.?
There is a common perception that suicide rates are highest
among the young. However, it is the elderly, particularly older white males that have the highest rates. And among white males 65 and older, risk goes up with age. White men 85 and older
have a suicide rate that is six times that of the overall national rate. Some older persons are less likely to survive attempts because they are less likely to recuperate. Over 70 percent of older suicide victims have been to their primary care physician within the month of their death, many did not tell their doctors they were depressed nor did the doctor detect it. This has led to research efforts to determine how to best improve physicians' abilities to detect and treat depression in older adults.
Are gay and lesbian youth at high risk for suicide?
With regard to completed suicide, there are no national statistics for suicide rates among gay, lesbian or bisexual (GLB) persons. Sexual orientation is not a question on the death certificate, and to determine whether rates are higher for GLB persons, we would need to know the proportion of the U.S. population that considers themselves gay, lesbian or bisexual. Sexual orientation is a personal characteristic that people can, and often do choose to hide, so that in psychological autopsy studies of suicide victims where risk factors are examined, it is difficult to know for certain the victim's sexual
orientation. This is particularly a problem when considering GLB youth who may be less certain of their sexual orientation and less open. In the few
studies examining risk factors for suicide where sexual orientation was assessed, the risk for gay or lesbian persons did not appear any greater than
among heterosexuals, once mental and substance abuse disorders were taken into account.
With regard to suicide
attempts, several state and national studies have reported that high school
students who report to be homosexually and bisexually active have higher rates
of suicide thoughts and attempts in the past year compared to youth with
heterosexual experience. Experts have
not been in complete agreement about the best way to measure reports of adolescent
suicide attempts, or sexual orientation, so the data are subject to
question. But they do agree that
efforts should focus on how to help GLB youth grow up to be healthy and
successful despite the obstacles that they face. Because school based suicide awareness programs have not proven
effective for youth in general, and in some cases have caused increased
distress in vulnerable youth, they are not likely to be helpful for GLB youth
either. Because young people should not
be exposed to programs that do not work, and certainly not to programs that
increase risk, more research is needed to develop safe and effective programs.
Are African American youth at great risk for suicide?
Historically, African Americans have had much lower rates of
suicides compared to white Americans.
However, beginning in the 1980s, the rates for African American male
youth began to rise at a much faster rate than their white counterparts. The most recent trends suggest a decrease in
suicide across all gender and racial groups, but health policy experts remain
concerned about the increase in suicide by firearms for all young males. Whether African American male youth are more
likely to engage in "victim-precipitated homicide" by deliberately getting in
the line of fire of either gang or law enforcement activity, remains an
important research question, as such deaths are not typically classified as
suicides.
Is suicide related to impulsiveness?
Impulsiveness is the tendency to act without thinking
through a plan or its consequences. It
is a symptom of a number of mental disorders, and therefore, it has been linked to
suicidal behavior usually through its association with mental disorders and/or
substance abuse. The mental disorders
with impulsiveness most linked to suicide include borderline personality
disorder among young females, conduct disorder among young males and antisocial
behavior in adult males, and alcohol and substance abuse among young and
middle-aged males. Impulsiveness
appears to have a lesser role in older adult suicides. Attention deficit hyperactivity disorder
that has impulsiveness as a characteristic is not a strong risk factor for
suicide by itself. Impulsiveness has
been linked with aggressive and violent behaviors including homicide and
suicide. However, impulsiveness without
aggression or violence present has also been found to contribute to risk for
suicide.
Is there such a thing as "rational" suicide?
Some right-to-die advocacy groups promote the idea that
suicide, including assisted suicide, can be a rational decision. Others have argued that suicide is never a
rational decision and that it is the result of depression, anxiety and fear of
being dependent or a burden. Surveys of terminally ill persons indicate that
very few consider taking their own life, and when they do, it is in the context
of depression. Attitude surveys suggest
that assisted suicide is more acceptable by the public and health providers for
the old who are ill or disabled, compared to the young who are ill or disabled. At this time,
there is limited research on the frequency with which persons with terminal
illness have depression and suicidal ideation, whether they would consider
assisted suicide, the characteristics of such persons, and the context of their
depression and suicidal thoughts, such as family stress, or availability of
palliative care. Neither is it yet
clear what effect other factors such as the availability of social support,
access to care, and pain relief may have on end-of-life preferences. This public debate will be better informed
after such research is conducted.
What biological factors increase risk for suicide?
Researchers believe that both depression and suicidal behavior
can be linked to decreased serotonin in the brain. Low levels of a serotonin metabolite, 5-HIAA, have been detected
in cerebral spinal fluid in persons who have attempted suicide, as well as by
postmortem studies examining certain brain regions of suicide victims. One of the goals of understanding the
biology of suicidal behavior is to improve treatments. Scientists have learned that serotonin
receptors in the brain increase their activity in persons with major depression
and suicidality, which explains why medications that desensitize or
down-regulate these receptors (such as the serotonin reuptake inhibitors, or
SSRIs) have been found effective in treating depression. Currently, studies are underway to examine
to what extent medications like SSRIs can reduce suicidal behavior.
Can the risk for suicide be inherited?
There is growing evidence that familial and genetic factors
contribute to the risk for suicidal behavior.
Major psychiatric illnesses, including bipolar disorder, major
depression, schizophrenia, alcoholism and substance abuse, and certain
personality disorders, which run in families, increase the risk for suicidal
behavior. This does not mean that
suicidal behavior is inevitable for individuals with this family history; it
simply means that such persons may be more vulnerable and should take steps to
reduce their risk, such as getting evaluation and treatment at the first sign
of mental illness.
Does depression increase the risk for suicide?
Although the majority of people who have depression do not die by suicide, having major depression does increase suicide risk compared to people without depression. The risk of death by suicide may, in part, be related to the severity of the depression. New data on depression that has followed people over long periods of time suggests that about 2% of those people ever treated for depression in an outpatient setting will die by suicide. Among those ever treated for depression in an inpatient hospital setting, the rate of death by suicide is twice as high (4%). Those treated for depression as inpatients following suicide ideation or suicide attempts are about three times as likely to die by suicide (6%) as those who were only treated as outpatients. There are also dramatic gender differences in lifetime risk of suicide in depression. Whereas about 7% of men with a lifetime history of depression will die by suicide, only 1% of women with a lifetime history of depression will die by suicide.
Another way about thinking of suicide risk and depression is to examine the lives of people who have died by suicide and see what proportion of them were depressed. From that perspective, it is estimated that about 60% of people who commit suicide have had a mood disorder (e.g., major depression, bipolar disorder, dysthymia). Younger persons who kill themselves often have a substance abuse disorder in addition to being depressed.
Does alcohol and other drug abuse increase the risk for suicide?
A number of recent national surveys have helped shed light on the
relationship between alcohol and other drug use and suicidal behavior. A review of minimum-age drinking laws and
suicides among youths age 18 to 20 found that lower minimum-age drinking laws
was associated with higher youth suicide rates. In a large study following adults who drink alcohol, suicide
ideation was reported among persons with depression. In another survey, persons who reported that they had made a
suicide attempt during their lifetime were more likely to have had a depressive
disorder, and many also had an alcohol and/or substance abuse disorder. In a study of all nontraffic injury deaths
associated with alcohol intoxication, over 20 percent were suicides.
In studies that examine risk factors among people who have completed
suicide, substance use and abuse occurs more frequently among youth and adults,
compared to older persons. For
particular groups at risk, such as American Indians and Alaskan Natives,
depression and alcohol use and abuse are the most common risk factors for
completed suicide. Alcohol and
substance abuse problems contribute to suicidal behavior in several ways. Persons who are dependent on substances
often have a number of other risk factors for suicide. In addition to being depressed, they are
also likely to have social and financial problems. Substance use and abuse can be common among persons prone to be
impulsive, and among persons who engage in many types of high risk behaviors
that result in self-harm. Fortunately,
there are a number of effective prevention efforts that reduce risk for
substance abuse in youth, and there are effective treatments for alcohol and
substance use problems. Researchers are
currently testing treatments specifically for persons with substance abuse
problems who are also suicidal, or have attempted suicide in the past.
What does "suicide contagion" mean, and what can be done to prevent it?
Suicide contagion is the
exposure to suicide or suicidal behaviors within one's family, one's peer group,
or through media reports of suicide and can result in an increase in suicide
and suicidal behaviors. Direct and
indirect exposure to suicidal behavior has been shown to precede an increase in
suicidal behavior in persons at risk for suicide, especially in adolescents and
young adults.
The risk for suicide
contagion as a result of media reporting can be minimized by factual and
concise media reports of suicide.
Reports of suicide should not be repetitive, as prolonged exposure can
increase the likelihood of suicide contagion.
Suicide is the result of many complex factors; therefore media coverage
should not report oversimplified explanations such as recent negative life
events or acute stressors. Reports
should not divulge detailed descriptions of the method used to avoid possible
duplication. Reports should not glorify
the victim and should not imply that suicide was effective in achieving a
personal goal such as gaining media attention.
In addition, information such as hotlines or emergency contacts should
be provided for those at risk for suicide.
Following exposure to
suicide or suicidal behaviors within one's family or peer group, suicide risk
can be minimized by having family
members, friends, peers, and colleagues of the victim evaluated by a mental
health professional. Persons deemed at
risk for suicide should then be referred for additional mental health services.
Is it possible to predict suicide?
At the current time
there is no definitive measure to predict suicide or suicidal behavior.
Researchers have identified factors that place individuals at higher risk for
suicide, but very few persons with these risk factors will actually commit
suicide. Risk factors include mental
illness, substance abuse, previous suicide attempts, family history of suicide,
history of being sexually abused, and impulsive or aggressive tendencies. Suicide is a relatively rare event and it is
therefore difficult to predict which persons with these risk factors will
ultimately commit suicide.
Source: National Institute of Mental Health (NIMH)
December 1999
Updated: January 03, 2000
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