Understanding suicide

Understanding Suicide

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Suicide is when people direct violence at themselves with the intent to end their lives, and they die as a result of their actions. Suicide is a leading cause of death in the United States.

A suicide attempt is when people harm themselves with the intent to end their lives, but they do not die as a result of their actions. Many more people survive suicide attempts than die, but they often have serious injuries. However, a suicide attempt does not always result in a physical injury.

Understanding suicide

How does suicide affect health?

People who attempt suicide and survive may experience serious injuries, such as broken bones, brain damage, or organ failure. These injuries may have long-term effects on their health. People who survive suicide attempts may also have depression and other mental health problems.

Suicide also affects the health of others and the community. When people die by suicide, their family and friends often experience shock, anger, guilt, and depression. The medical costs and lost wages associated with suicide also take their toll on the community.

Who is at risk for suicide?

There is no single cause of suicide. Several factors can increase a person’s risk for attempting or dying by suicide. However, having these risk factors does not always mean that suicide will occur. Risk factors for suicide include:

• Previous suicide attempt(s)

• History of depression or other mental illness

• Alcohol or drug abuse

• Family history of suicide or violence

• Physical illness

• Feeling alone Suicide affects everyone, but some groups are at higher risk than others.

Men are about four times more likely than women to die from suicide. However, women are more likely to express suicidal thoughts and to make nonfatal attempts than men. The prevalence of suicidal thoughts, suicide planning, and suicide attempts is significantly higher among young adults aged 18-29 years than it is among adults aged ≥30 years. Other groups with higher rates of suicidal behavior include American Indian and Alaska Natives, rural populations, and active or retired military personnel.

Risk factors

Depression

Kielholz reported risk factors associated with suicide in patients suffering from depression. These risk factors are described below, with special emphasis on those possibly requiring particular attention. According to a survey done using the psychological autopsy method, 70–90% of those who committed suicide had evidence of some mental disorder when alive, and 60–70% were depressed. Reportedly, one in six patients who fall under the category of major depression as set forth in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSMIV), of the American Psychiatric Association, dies as a result of suicide. Thus, the suicide rate among patients suffering from depression is at least several dozen times higher than that of the general population.

Patients with severe depression who meet the diagnostic criteria for melancholia are at particularly high risk of suicide. Caution is also necessary in dealing with patients who are not seriously ill but have prolonged illnesses with repeated exacerbations. Rapid cyclers, who alternate between hypomanic and depressive phases within a short period of time, and patients who present a mixed clinical picture in the convalescent stage are also at high risk of suicide.

Symptoms that require particular caution include persistent insomnia and extreme psychomotor retardation and anxiety/irritability. Early morning waking is observed in most depressed patients, and suicide attempts are often made at that time; thus, the highest priority should be given to treating insomnia.

Patients who are aware of feelings of despair, hopelessness, and worthlessness also require special attention. Certain researchers attach great importance to patients’ feelings of despair as a predictor of future suicide.

The suicide rate in patients suffering from depression associated with delusions is extremely high. Depressed patients suffering from hypochondriacal delusion, delusion of self-guilt, or delusion of poverty have a fivefold higher suicide rate than those without such delusions.

Some patients who have not yet reached the hypochondriacal delusion stage may dwell on somatic symptoms. It is not rare for somatic symptoms to be the most prominent feature of the patient’s clinical picture, while other depressive symptoms remain relatively obscure. Such patients are apt to focus exclusively on their somatic symptoms and visit primary care physicians other than psychiatrists.

Elderly patients in particular often complain of somatic symptoms, rather than reporting depressed feelings. The leading cause of suicide in the elderly is physical illness. Although some highly suicidal patients may have a malignant disease with a poor prognosis, the presence of a number of somatic symptoms, no one of which is particularly severe, should also be regarded as a risk factor for suicide.

Association with Drinking

When alcohol dependence is concomitant with depression, the risk of suicide increases. Even if the diagnostic criteria for alcohol dependence are not met, many who attempt suicide are under the influence of alcohol when the attempt is made. The direct effects of alcohol include blunting of judgment and facilitation of the tendency toward suicidal behavior.

Since alcohol may provide temporary relief from some depressive symptoms, alcohol consumption may increase gradually without a patient’s conscious awareness. Among patients suffering from depression, non-drinkers may begin imbibing or those with low alcohol consumption may increase their intake. Even though patients seem to experience some improvement of symptoms while under the influence of alcohol, the original depressive symptoms actually tend to worsen in the long term, because alcohol essentially depresses the central nervous system. Considering the risk of suicide, patients should abstain from drinking alcohol while being treated for depression.

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Anxiety disorders

Studies have shown a consistent correlation between anxiety disorders and suicide attempts in males, while a weaker association has been found in females. Trait anxiety appears to be relatively independent of depression in its effect on the risk of suicidal behaviour, which suggests that the anxiety of adolescents at risk for suicidal behaviour should be assessed and treated. Psychosomatic symptoms are also often present in young persons tormented by suicidal thoughts.

Eating disorders

Owing to dissatisfaction with their bodies, many children and adolescents try to lose weight and are concerned about what they should and should not eat. Between 1% and 2% of teenage girls suffer from either anorexia or bulimia. Anorexic girls very frequently also succumb to depression, and suicide risk among anorexic girls is 20 times that for young people in general. Recent findings show that boys, too, can suffer from anorexia and bulimia.

Psychotic disorders

Although few children and adolescents suffer from severe psychiatric disorders such as schizophrenia or manic-depressive disorder, suicide risk is very high in those affected. Most psychotic young people are, in fact, characterized by several risk factors, such as drinking problems, excessive smoking and drug abuse.

Previous suicide attempts

A history of single or recurrent suicide attempts, with or without the above-mentioned psychiatric disorders, is an important risk factor for suicidal behaviour.

Cultural and sociodemographic factors

Low socioeconomic status, poor education and unemployment in the family are risk factors. Indigenous people and immigrants may be assigned to this group, since they often experience not only emotional and linguistic difficulties but also the lack of social networks. In many cases, these factors are combined with the psychological impact of torture, war injuries and isolation.

These cultural factors are also linked with low participation in society’s customary activities, as well as with conflict between various group values. Specifically, this conflict is a powerful factor for girls born or brought up in a new and freer country, but who retain strong roots in their parents’ even stronger conservative culture.

Each individual young person’s growth is intertwined with collective cultural tradition. Children and adolescents who lack cultural roots have marked identity problems and lack a model for conflict resolution. In some stressful situations, they may resort to self-destructive behaviour such as a suicide attempt or suicide

Family pattern and negative life events during childhood

Destructive family patterns and traumatic events in early childhood affect young people’s lives thereafter, especially when they have been unable to cope with the trauma. Aspects of family dysfunction and instability and negative life events often found in suicidal children and adolescents are:

• Parental psychopathology, with the presence of affective and other psychiatric disorders;

• Alcohol and substance abuse, or antisocial behaviour in the family;

• A family history of suicide and suicide attempts;

• A violent and abusive family (including physical and sexual abuse of the child);

• Poor care provided by parents/guardians, with poor communication within the family;

• Frequent quarrels between parents/guardians, with tension and aggression;

• Divorce, separation or death of parents/guardians;

• Frequent moves to a different residential area;

• Very high or very low expectations on the part of parents/guardians;

• Parents’/guardians’ inadequate or excessive authority;

• Parents’/guardians’ lack of time to observe and deal with the child’s emotional distress, and a negative emotional environment featuring rejection or neglect;

• Family rigidity;

• Adoptive or foster family.

These family patterns often, but by no means always, characterize cases of children and adolescents who attempt or commit suicide. Evidence suggests that young suicidal people often come from families with more than one problem in which risks are cumulative. Since they are loyal to their parents and sometimes unwilling, or forbidden, to reveal family secrets, they frequently refrain from seeking help outside the family.

How can we prevent suicide?

Suicide is a significant public health problem, and there is a lot to learn about how to prevent it. One strategy is to learn about the warning signs of suicide, which can include individuals talking about wanting to hurt themselves, increasing substance use, and having changes in their mood, diet, or sleeping patterns. When these warning signs appear, quickly connecting the person to supportive services is critical. Promoting opportunities and settings that strengthen connections among people, families, and communities is another suicide prevention goal.

Step 1:  Define the problem. Before we can prevent suicide, we need to know how big the problem is, where it occurs, and who it affects. You can learn about a problem by gathering and studying data. These data are critical because they helps know where prevention is most needed.

Step 2:  Identify risk and protective factors. It is not enough to know that suicide affects certain people in certain areas. You also need to know why. You can conduct and supports research to answer this question. You can then develop programs to reduce or get rid of risk factors and to increase protective factors.

Step 3:  Develop and test prevention strategies Using information gathered in research

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