Post by blackcrowheart on Jan 19, 2006 15:32:31 GMT -5
Preventing Suicide (mental health)
PREVENTING YOUTH SUICIDE
RESOURCE LINKS LOCATED AT END OF ARTICLE
Teen Suicide-Suicide is the 9th leading cause of death in the United
States, claiming about 29,000 lives each year. And suicide is the 3rd
leading cause of death in younger people age 15-24, with about 12 people
in this age group dying each day from suicide. In addition, there are
an estimated 8-25 attempted suicides to one completion; the ratio is
higher in women and youth and lower in men and the elderly.
Children who are going to commit suicide can be hard to identify, but
specific risk factors do exist and according the American Academy of
Pediatrics, they can include having a:
• history of depression • previous suicide attempt • family history of
psychiatric disorders, especially depression or suicidal behavior •
disruption in the family • chronic physical or psychiatric illness •
alcohol use and alcoholism • history of physical or sexual abuse
If someone tells you they are thinking about suicide, you should take
their distress seriously, listen non-judgmentally, 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. 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.
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.
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.
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.
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.
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.
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.
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. 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.
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.
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.
To help prevent suicide, follow these tips suggested by the Centers for
Disease Control and Prevention and the National Depressive and
Manic-Depressive Association.
For Individuals:
• Know that help is available. Call 1-800-SUICIDE or a local crisis
center to talk to a counselor if you feel suicidal. Express your
feelings to trusted friends or relatives.
• Avoid drugs and alcohol. Most deaths by suicide result from sudden,
uncontrolled impulses; drugs and alcohol contribute to such impulses.
Drugs and alcohol also interfere with the effectiveness of medications
prescribed for depressive disorders.
• Recognize the earliest warning signs of a suicidal episode. There are
often subtle warning signs your body will give you when an episode is
developing. As you learn to manage your illness, you will learn how to
be sensitive to these signs. This is a signal to treat yourself with the
utmost care, as opposed to becoming angry or disgusted with yourself.
• Write down your thoughts. Each day, write about your hopes for the
future and the people you value in your life. Read what you've written
when you need to remind yourself why your own life is important.
For Families and Friends:
• Be a good listener. If people express suicidal thoughts or feel
depressed, hopeless, or worthless, be supportive. You may encounter
negative reactions from the individual who believes that his or her
condition is hopeless and will never get better. Let them know you are
there for them and are willing to help them seek professional help.
Never issue challenges or dares.
• Many people find it awkward to put into words how another person's
life is important for their own well-being, but it is important to
stress that the person's life is important to you and to others.
Emphasize in specific terms the ways in which the person's suicide would
be devastating to you and to others.
• Express empathy and concern for people who express thoughts about
committing suicide. Suicidal ideation is frequently accompanied by a
self-absorbed, uncommunicative, and withdrawn state of mind. When you
try to help, the individual may be reluctant to discuss what he or she
is thinking. At such times, it is important to acknowledge the reality
of the individual's pain and hopelessness. If the person is not
comfortable talking with you, encourage him or her to talk with someone
else.
• Describe specific behaviors and events that trouble you. Noting
particular ways in which a person's behavior has changed may help to get
communication started.
• Familiarize yourself with suicide intervention resources such as
mental health centers, counseling centers, and hotlines.
• Restrict inappropriate access to firearms.
For Communities:
• Build support for families, communities, and neighborhoods.
• Ensure accessible and effective clinical care for mental, physical,
and substance abuse disorders.
• Expand suicide prevention efforts for youths, emphasizing nonviolent
handling of disputes, conflict resolution, and skill-building in problem
solving.
• Promote awareness of suicide intervention resources such as mental
health centers, counseling centers, and hotlines.
Suicide is the eighth leading cause of death for all Americans. Suicide
rates are the highest among people age 65 and older, and suicide is the
third leading cause of death for people ages 15 to 24. Among youths 10
to 14 years old, suicide rates increased 100 percent from 1980 to 1996.
Suicide affects many populations. From 1979 to 1992, suicide rates for
Native Americans (including American Indians and Native Alaskans) were
1.5 times the national rates. Young males ages 15 to 24 accounted for 64
percent of all suicides among Native Americans. Suicide rates are higher
than the national average for some groups of Asian Americans/Pacific
Islanders. In Hawaii, the suicide rate for this group is 4 percent
higher than the rate for the rest of the population. Asian American
women have the highest suicide rate among women age 65 and older. While
the suicide rate among young people is greatest among white males, from
1980 to 1996 the suicide rate increased most rapidly (and more than
doubled) among black males ages 15 to 19. Hispanic students were more
likely than white students to have reported a suicide attempt.
Nationwide in 1997, 21 percent of high school students had seriously
considered attempting suicide within the past year, and 8 percent had
attempted suicide within the past year. Although females are more likely
than males to attempt suicide, males are more likely to die in their
first attempt than females.
Nearly 60 percent of all suicides in the United States are committed
with a firearm. Because firearms are particularly lethal, these people
usually do not have another chance.
The people most at risk for committing suicide are those who have
several of the following characteristics:
• have attempted suicide in the past
• have a family history of suicide
• have a firearm in the home
• consume alcohol and/or abuse other substances
• are depressed (changes in sleeping patterns and appetite, feeling
worthless)
• have experienced violence (physical, sexual, domestic, or child abuse)
• are experiencing unusual stress due to adverse life events, such as
separation or divorce
• have spent time in jail or prison
• have a medical condition
• move frequently from one location to another
• experienced poor parent/child communication
• feel socially isolated
Resources:
www.fnyar.ca/
www.turtleisland.org/discussion/viewtopic.php?t=481/
www.mentalhealth.org/suicideprevention/fivews.asp/
www.keepkidshealthy.com/welcome/conditions/youth_suicide.html/
In an emergency, call 1-800-SUICIDE (1-800-784-2433), the national
suicide hotline.
American Association of Suicidology
Their web site, www.suicidology.org/, provides information on
current research, prevention, ways to help a suicidal person, and
surviving suicide. A list of crisis centers is also included. Their
phone number is 202-237-2280.
American Foundation for Suicide Prevention
Their web site, www.afsp.org/,provides research, education, and
current statistics regarding suicide; links to other suicide and mental
health sites are offered. Information and help is also available by
calling 1-888-333-AFSP (2377).
American Psychiatric Association
Call 1-800-852-8330 for information and referrals to psychiatrists in
your area. Or visit their web site at www.afsp.org/
American Psychological Association (APA)
APA's web site, www.apa.org/, provides information about who is
at risk, suicide warning signs, and steps toward suicide prevention.
Call APA at 1-800-964-2000 if you have questions about their web site or
any other mental health issues.
Boys Town
Boys Town is an organization that cares for troubled children—both boys
and girls—and for families in crisis. Their hotline staff is trained to
handle calls and questions about violence and suicide. Call
1-800-448-3000 (crisis hotline) or 1-800-545-5771. Or visit them on the
web at www.girlsandboystown.org/home.asp
Centers for Disease Control and Prevention
National Center for Injury Prevention and Control
Division of Violence Prevention
Visit their web site, www.cdc.gov/ncipc/ for links to suicide
statistics, the SafeUSA web site, and safety information. Or call
770-488-4362.
The Center for Mental Health Services
Visit their web site, www.mentalhealth.org/highlights/suicide to
learn more about Suicide Awareness Week, May 7-13, 2000.
National Alliance for the Mentally Ill (NAMI)
NAMI's toll-free number, 1-800-950-NAMI (6264), provides information
about family support and self-help groups. Their web site,
www.nami.org/, includes links to information about teen suicide,
child suicide, brain biology and suicide, as well as general suicide
information links.
National Depressive and Manic-Depressive Association (NDMDA)
Call NDMDA at 1-800-82-NDMDA (63632) for information on local patient
and support groups. Their web site, www.nami.org/ provides
information about biological causes for suicidal feelings, what to do if
you or someone you know is suicidal, and possible suicide therapies.
National Institute of Mental Health (NIMH)
Call NIMH Public Inquiries at 1-800-421-4211 for information on
depression and other mental illnesses. Or visit www.nimh.nih.gov/
National Mental Health Association (NMHA)
Call NMHA at 1-800-228-1114 or 1-800-969-NMHA (6642) for information on
depression and its treatment and for referrals to local screening sites.
Their web address is www.nmha.org/ For TTY, call 1-800-433-5959.
The National Mental Illness Screening Project Suicide Division
Their hotline can help you locate a free, confidential screening near
you. Call 1-800-573-4433 or www.nmisp.org/ You can also send
them a free fax at 1-888-803-7447.
Suicide Awareness-Voices of Education (SA\VE)
SA/VE's web site, www.save.org/ provides suicide education,
facts, and statistics on suicide and depression. It links to information
on warning signs of suicide and the role a friend or family member can
play in helping a suicidal person. SA/VE's phone number is 612-946-7998.
Suicide Information & Education Centre (SIEC)
SIEC is a special library and resource center providing information on
suicide and suicidal behavior. Call 403-245-3900 or visit
www.suicideinfo.ca/
Suicide Prevention Advocacy Network (SPAN)
SPAN is a nonprofit organization dedicated to creating an effective
national suicide prevention strategy. SPAN links the energy of those
bereaved by suicide with the expertise of leaders in science, business,
government, and public service to achieve the goal of significantly
reducing the national suicide rate by the year 2010. Call 1-888-649-1366
or visit spanusa.org/
PREVENTING YOUTH SUICIDE
RESOURCE LINKS LOCATED AT END OF ARTICLE
Teen Suicide-Suicide is the 9th leading cause of death in the United
States, claiming about 29,000 lives each year. And suicide is the 3rd
leading cause of death in younger people age 15-24, with about 12 people
in this age group dying each day from suicide. In addition, there are
an estimated 8-25 attempted suicides to one completion; the ratio is
higher in women and youth and lower in men and the elderly.
Children who are going to commit suicide can be hard to identify, but
specific risk factors do exist and according the American Academy of
Pediatrics, they can include having a:
• history of depression • previous suicide attempt • family history of
psychiatric disorders, especially depression or suicidal behavior •
disruption in the family • chronic physical or psychiatric illness •
alcohol use and alcoholism • history of physical or sexual abuse
If someone tells you they are thinking about suicide, you should take
their distress seriously, listen non-judgmentally, 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. 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.
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.
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.
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.
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.
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.
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.
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. 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.
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.
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.
To help prevent suicide, follow these tips suggested by the Centers for
Disease Control and Prevention and the National Depressive and
Manic-Depressive Association.
For Individuals:
• Know that help is available. Call 1-800-SUICIDE or a local crisis
center to talk to a counselor if you feel suicidal. Express your
feelings to trusted friends or relatives.
• Avoid drugs and alcohol. Most deaths by suicide result from sudden,
uncontrolled impulses; drugs and alcohol contribute to such impulses.
Drugs and alcohol also interfere with the effectiveness of medications
prescribed for depressive disorders.
• Recognize the earliest warning signs of a suicidal episode. There are
often subtle warning signs your body will give you when an episode is
developing. As you learn to manage your illness, you will learn how to
be sensitive to these signs. This is a signal to treat yourself with the
utmost care, as opposed to becoming angry or disgusted with yourself.
• Write down your thoughts. Each day, write about your hopes for the
future and the people you value in your life. Read what you've written
when you need to remind yourself why your own life is important.
For Families and Friends:
• Be a good listener. If people express suicidal thoughts or feel
depressed, hopeless, or worthless, be supportive. You may encounter
negative reactions from the individual who believes that his or her
condition is hopeless and will never get better. Let them know you are
there for them and are willing to help them seek professional help.
Never issue challenges or dares.
• Many people find it awkward to put into words how another person's
life is important for their own well-being, but it is important to
stress that the person's life is important to you and to others.
Emphasize in specific terms the ways in which the person's suicide would
be devastating to you and to others.
• Express empathy and concern for people who express thoughts about
committing suicide. Suicidal ideation is frequently accompanied by a
self-absorbed, uncommunicative, and withdrawn state of mind. When you
try to help, the individual may be reluctant to discuss what he or she
is thinking. At such times, it is important to acknowledge the reality
of the individual's pain and hopelessness. If the person is not
comfortable talking with you, encourage him or her to talk with someone
else.
• Describe specific behaviors and events that trouble you. Noting
particular ways in which a person's behavior has changed may help to get
communication started.
• Familiarize yourself with suicide intervention resources such as
mental health centers, counseling centers, and hotlines.
• Restrict inappropriate access to firearms.
For Communities:
• Build support for families, communities, and neighborhoods.
• Ensure accessible and effective clinical care for mental, physical,
and substance abuse disorders.
• Expand suicide prevention efforts for youths, emphasizing nonviolent
handling of disputes, conflict resolution, and skill-building in problem
solving.
• Promote awareness of suicide intervention resources such as mental
health centers, counseling centers, and hotlines.
Suicide is the eighth leading cause of death for all Americans. Suicide
rates are the highest among people age 65 and older, and suicide is the
third leading cause of death for people ages 15 to 24. Among youths 10
to 14 years old, suicide rates increased 100 percent from 1980 to 1996.
Suicide affects many populations. From 1979 to 1992, suicide rates for
Native Americans (including American Indians and Native Alaskans) were
1.5 times the national rates. Young males ages 15 to 24 accounted for 64
percent of all suicides among Native Americans. Suicide rates are higher
than the national average for some groups of Asian Americans/Pacific
Islanders. In Hawaii, the suicide rate for this group is 4 percent
higher than the rate for the rest of the population. Asian American
women have the highest suicide rate among women age 65 and older. While
the suicide rate among young people is greatest among white males, from
1980 to 1996 the suicide rate increased most rapidly (and more than
doubled) among black males ages 15 to 19. Hispanic students were more
likely than white students to have reported a suicide attempt.
Nationwide in 1997, 21 percent of high school students had seriously
considered attempting suicide within the past year, and 8 percent had
attempted suicide within the past year. Although females are more likely
than males to attempt suicide, males are more likely to die in their
first attempt than females.
Nearly 60 percent of all suicides in the United States are committed
with a firearm. Because firearms are particularly lethal, these people
usually do not have another chance.
The people most at risk for committing suicide are those who have
several of the following characteristics:
• have attempted suicide in the past
• have a family history of suicide
• have a firearm in the home
• consume alcohol and/or abuse other substances
• are depressed (changes in sleeping patterns and appetite, feeling
worthless)
• have experienced violence (physical, sexual, domestic, or child abuse)
• are experiencing unusual stress due to adverse life events, such as
separation or divorce
• have spent time in jail or prison
• have a medical condition
• move frequently from one location to another
• experienced poor parent/child communication
• feel socially isolated
Resources:
www.fnyar.ca/
www.turtleisland.org/discussion/viewtopic.php?t=481/
www.mentalhealth.org/suicideprevention/fivews.asp/
www.keepkidshealthy.com/welcome/conditions/youth_suicide.html/
In an emergency, call 1-800-SUICIDE (1-800-784-2433), the national
suicide hotline.
American Association of Suicidology
Their web site, www.suicidology.org/, provides information on
current research, prevention, ways to help a suicidal person, and
surviving suicide. A list of crisis centers is also included. Their
phone number is 202-237-2280.
American Foundation for Suicide Prevention
Their web site, www.afsp.org/,provides research, education, and
current statistics regarding suicide; links to other suicide and mental
health sites are offered. Information and help is also available by
calling 1-888-333-AFSP (2377).
American Psychiatric Association
Call 1-800-852-8330 for information and referrals to psychiatrists in
your area. Or visit their web site at www.afsp.org/
American Psychological Association (APA)
APA's web site, www.apa.org/, provides information about who is
at risk, suicide warning signs, and steps toward suicide prevention.
Call APA at 1-800-964-2000 if you have questions about their web site or
any other mental health issues.
Boys Town
Boys Town is an organization that cares for troubled children—both boys
and girls—and for families in crisis. Their hotline staff is trained to
handle calls and questions about violence and suicide. Call
1-800-448-3000 (crisis hotline) or 1-800-545-5771. Or visit them on the
web at www.girlsandboystown.org/home.asp
Centers for Disease Control and Prevention
National Center for Injury Prevention and Control
Division of Violence Prevention
Visit their web site, www.cdc.gov/ncipc/ for links to suicide
statistics, the SafeUSA web site, and safety information. Or call
770-488-4362.
The Center for Mental Health Services
Visit their web site, www.mentalhealth.org/highlights/suicide to
learn more about Suicide Awareness Week, May 7-13, 2000.
National Alliance for the Mentally Ill (NAMI)
NAMI's toll-free number, 1-800-950-NAMI (6264), provides information
about family support and self-help groups. Their web site,
www.nami.org/, includes links to information about teen suicide,
child suicide, brain biology and suicide, as well as general suicide
information links.
National Depressive and Manic-Depressive Association (NDMDA)
Call NDMDA at 1-800-82-NDMDA (63632) for information on local patient
and support groups. Their web site, www.nami.org/ provides
information about biological causes for suicidal feelings, what to do if
you or someone you know is suicidal, and possible suicide therapies.
National Institute of Mental Health (NIMH)
Call NIMH Public Inquiries at 1-800-421-4211 for information on
depression and other mental illnesses. Or visit www.nimh.nih.gov/
National Mental Health Association (NMHA)
Call NMHA at 1-800-228-1114 or 1-800-969-NMHA (6642) for information on
depression and its treatment and for referrals to local screening sites.
Their web address is www.nmha.org/ For TTY, call 1-800-433-5959.
The National Mental Illness Screening Project Suicide Division
Their hotline can help you locate a free, confidential screening near
you. Call 1-800-573-4433 or www.nmisp.org/ You can also send
them a free fax at 1-888-803-7447.
Suicide Awareness-Voices of Education (SA\VE)
SA/VE's web site, www.save.org/ provides suicide education,
facts, and statistics on suicide and depression. It links to information
on warning signs of suicide and the role a friend or family member can
play in helping a suicidal person. SA/VE's phone number is 612-946-7998.
Suicide Information & Education Centre (SIEC)
SIEC is a special library and resource center providing information on
suicide and suicidal behavior. Call 403-245-3900 or visit
www.suicideinfo.ca/
Suicide Prevention Advocacy Network (SPAN)
SPAN is a nonprofit organization dedicated to creating an effective
national suicide prevention strategy. SPAN links the energy of those
bereaved by suicide with the expertise of leaders in science, business,
government, and public service to achieve the goal of significantly
reducing the national suicide rate by the year 2010. Call 1-888-649-1366
or visit spanusa.org/