Suicide

Overview
Suicide is the act of killing yourself on purpose. Suicide affects males and females of all ages and from all socioeconomic classes. Typically, people who attempt suicide are expressing significant emotional distress.
Many suicides occur during an acute crisis. Often, a person who believes suicide is an option does not see solutions for the immediate crisis or realize that the pain and distress will pass. In that moment, suicide seems to be the only option. Intervention may be the only way to help the person understand the crisis is temporary and other options are available.

Females attempt suicide two to three times as often as males. However, males are four times more likely to complete suicide. Suicide by firearm is the most common method of suicide for both men and women. The suicide rate among American adolescents has quadrupled since 1952, making suicide the third leading cause of death in teenagers and young adults ages 15 to 24. White males over age 85 have the highest rates of suicide. Elder suicide attempts are generally more lethal than suicide attempts by younger adults, often occurring through covert measures such as self-inflicted falls or refusing to eat or take medication.


Suicide and children
For children, psychiatric illness, limited social skills, irritability, aggression, poor concentration and a preoccupation with death increase the risk of suicide. Children who attempt suicide tend to jump off high structures, run out in traffic, poison themselves or hang themselves. Among the few children who attempt suicide, boys are more likely to complete suicide than girls.

Suicide and adolescents
Suicide is a leading cause of death for adolescents ages 13 to 18. For adolescents, suicide is often considered a solution to an environmental or psychological problem. Adolescents often experience hostility at themselves or want to seek revenge on others by hurting themselves. Homosexual and bisexual high school students report higher rates of suicide thoughts or attempts than heterosexual students. However, it's difficult to determine if there is an increase in completed suicides for homosexual and bisexual youth.

Suicide and seniors
Older adults have fewer suicide attempts, but more completed suicides -- often due to more lethal methods of suicide and a decreased ability to recover from or survive a suicide attempt. In fact, Caucasian men age 85 and older have the highest suicide rate in the United States. For older adults, suicide attempts are often planned, rather than impulsive. Factors such as bereavement, real or perceived losses, and the presence of a physical illness increase the risk of suicide. Up to an estimated 90 percent of older adults who complete suicide have a diagnosed psychiatric condition, such as depression or substance abuse. Appropriate treatment and compliance with treatment plans may positively affect suicide rates for older adults.

Motives for suicide
Suicide attempts are often a cry for help or the only way some people believe their pain can end -- they are not simply harmless bids for attention. Typically, there are three motives for suicide.
Cessation: The person wants to stop his or her conscious experience forever with death.
Interruption: The person wants to interrupt his or her conscious experience for a while in an attempt to feel relief.
Appeal: The person uses suicide as an attempt to create an emotional or behavioral change in another person.

Risk factors
The vast majority of people who complete suicide have at least some risk factors. Keep in mind, however, individual risk factors alone are not necessarily indicative of suicide. Be aware that these factors can indicate many concerns. Suicidal thoughts or behavior needs careful, thorough evaluation. Do not make a determination based on these risk factors alone.
The risk of suicide is higher for people affected by the following psychiatric conditions:

mood disorders, such as major depression
substance abuse, especially alcohol intoxication or cocaine use
schizophrenia
anxiety disorders, particularly those that accompany a panic disorder
personality disorders, such as borderline personality disorder
post-traumatic stress disorder
impulsive disorder
Married people with children have the lowest rates of suicide. Groups of people at higher risk for suicide include those who are separated, divorced or widowed, as well as those who never married. Other high-risk populations include elderly adults, adolescents, those who abuse alcohol or drugs, those who have a chronic illness, those who have a history of prior suicide attempts or a family history of suicide, and those who have experienced the suicide of a friend, co-worker, colleague or role model.

Additional suicide risk factors include living in a rural area or an area with noticeable seasonal changes. Contemplating homicide when a suicidal plan is in place also increases the risk.

Although suicidal behavior is not a typical response to stress, recent stressful events may also present a risk for some people. Examples include:

the sudden appearance of stress or increased stress
irrevocable losses (such as being diagnosed with a serious medical condition)
the failure to perform a major life role resulting in humiliation (such as being fired or failing a class)
losing a loved one or losing personal possessions
facing a severe financial or legal crisis
losing status in the family, community or profession
being threatened with exposure of a particular issue or concern that would cause humiliation or embarrassment
having a friend, co-worker, colleague or role model who committed suicide
breaking up with a significant other or partner

Characteristics
Physical characteristics of a suicidal person may include having a chronic physical illness, a disease that may affect mood or thoughts (such as multiple sclerosis, AIDS, cancer or lupus), a severe sleep disturbance or reduced functioning of serotonin (a natural chemical that constricts blood vessels). Sometimes taking a particular medication that affects mood or thoughts may be a factor.
Psychological characteristics may include depressed mood, despair, extreme pessimism, a sense of hopelessness, anxiety, or peacefulness and composure following a period of distress. Some people experience hallucinations, such as voices telling them to hurt themselves. Social characteristics include an increase in aggressive or impulsive behavior, as well as talking about wanting to die or making suicidal threats.


Characteristics of suicide survivors
A suicide survivor is anyone who is profoundly affected by a suicide and experiences grief surrounding the loss. Survivors often feel guilty, shocked and emotionally and physically numb. They may feel anger toward the person who has died, another family member, a therapist or themselves. Survivors may feel relieved if the suicide followed a history of self-destructive behavior and mental anguish. Survivors often search for understanding of the death, sometimes hoping to find an external person or situation to blame.

Coping
There is always another option to suicide, and seeking help is an act of courage and strength. Professional treatment for a suicidal person may include medical help at an emergency room, inpatient hospitalization, support groups, and individual, group or family counseling. Medications may be prescribed for a diagnosed mental illness. Support groups and counseling can also be helpful for friends and family members of people who have attempted or completed suicide.

When a friend or loved one is suicidal
Listen. Always take remarks about wanting to commit suicide seriously. Be open and willing to hear what the person has to say without giving advice or offering a solution to the problem.

Be nonjudgmental. Do not debate whether suicide is right or wrong or whether feelings are good or bad. Be willing to talk frankly about the person's desire to commit suicide.

Don't give up. Remind your friend or loved one of your support and unconditional care.

Normalize. Remind the person that many people have experienced suicidal thoughts, especially in the midst of stress, grief, loss or disappointments.

Be direct. Share your concerns and observations. Provide options for getting additional support.

Don't be sworn to secrecy. Remind the person that you need support to help him or her get help.

Take action. Do not leave a suicidal person alone. Remove potential weapons or means of suicide, such as guns, knives or stockpiled pills. An assessment by a mental health professional or doctor in an emergency room or counseling clinic is needed immediately to help determine which services are most appropriate for the suicidal person.

Follow up. Check in with the person to find out how treatment is going.


Self-help suggestions for suicide survivors
Maintain contact with other people, and share your feelings of loss and pain with your family and friends. Understand that other loved ones may be grieving in their own way. Remember that the stigma of suicide can isolate suicide survivors. Seek comfort and support from those you trust. Know that it is normal and common to feel guilty for a while before you can accept that you are not to blame for the suicide. It is normal to feel anger toward the person who has committed suicide for taking himself or herself away from loved ones. Acknowledge the difficulty in anniversaries, birthdays and holidays and take special care of yourself during these times. Finally, remember that it's important to not only go on with life, but also to enjoy life again.