Title: Suicide Content: Suicide is when a person chooses to kill themselves.The word suicide comes from the Latin words sui caedere, which means "to kill oneself". When someone kills themselves, people say that they have "committed suicide," "completed suicide," or "died by suicide". When a person seriously considers killing themselves, they are described as suicidal. Suicide is one of the top three causes of death for young people aged 14–35. It is the second most common cause of death for college students. Every 3 seconds, a person somewhere in the world tries to kill themselves. Every 40 seconds, someone dies by suicide. For every suicide, at least six other people are seriously affected.(WHO 2000) When people start having thoughts about killing themselves, it may be a medical emergency. They should get a suicide risk assessment as soon as possible. They should not be left alone. There are many reasons why a person might think about suicide. Most people who are suicidal have some type of mental disorder. They may have a chronic condition, which has been going on for a long time. But it may be an acute condition, which means the first symptoms of mental illness happened rather quickly. Depression is a mental illness that may affect a person to have suicidal thoughts. Depression may also be a symptom of other mental or medical disorders. Another mental condition which may lead to self-harm or suicide is schizophrenia. The stress of life, and its events, like losing a job or getting sick, are less likely to cause suicide. Other causes of suicidal thoughts are extreme cases of bullying and inceldom. Although depression is the main factor in suicide, it is also treatable, and suicide is often preventable. ==Risk factors== thumb|right|275px|Examples of suicide risk and protective factors. Source: 2012 National Strategy for Suicide Prevention There are many risk factors for suicide. However, it is important to remember that risk factors are not the same as causes. Risk factors do not cause suicide or suicidal thoughts. They only make it more likely that some people with those risk factors may become suicidal. If a person has a risk factor, that does not mean they will become suicidal. ===Mental disorders=== Mental illness is present at the time of suicide 27% to more than 90% of the time. Of those who have been hospitalized for suicidal behavior, the lifetime risk of completed suicide is 8.6%. Comparatively, non-suicidal people hospitalized for affective disorders have a 4% lifetime risk of suicide. Half of all people who die by suicide may have major depressive disorder; having this or one of the other mood disorders such as bipolar disorder increases the risk of suicide 20-fold. Other conditions implicated include schizophrenia (14%), personality disorders (8%), obsessive compulsive disorder, and posttraumatic stress disorder. Those with autism spectrum disorders also attempt and consider suicide more frequently. Among people with a mental disorder, 25% also have alcohol abuse issues. People who abuse alcohol have a 50% greater risk of suicide than those who do not.Benjamin James Sadock, M.D., Virginia Alcott Sadock: Kapalan and Sadock's Concise Textbook of Clinical Psychiatry. Lippincott Williams & Wilkins; Third edition (2008) While acts of self-harm are not considered suicide attempts, a person who self-harms may be more likely to die by suicide. ====Emotions==== * Hopelessness: Feeling like there is no chance that things will get better. Hopelessness is very common in people who die by suicide.American Psychiatric Association: American Psychiatric Association Practice Guidelines for the Treatment of Psychiatric Disorders: Compendium 2006. American Psychiatric Publishing; 1 edition (2006) pp.1410-1411 * Perceived burdensomeness: When a person feels like they are a burden to others (like they just cause problems for other people). Suicidal people often feel hopeless at the same time. * Loneliness: Feeling alone. Sometimes people actually are alone; sometimes they just feel lonely. People are more likely to feel suicidal if: ** They do not have people to support them, such as family and friends ** They feel like they do not belong or fit in with other people ** They live alone ====Substance abuse==== Substance abuse is the second most common reason for suicide and feeling suicidal. Only two serious mental illnesses - depression and bipolar disorder - cause more harm. A person is at greater risk for suicide whether they have been using drugs for a long time or just a short time. When a drug abuser is also suffering from great sadness or grief, suicide is even more common. ====Problem gambling==== Problem gamblers have more suicidal ideation and make more suicide attempts compared to the general population. (Problem gambling is gambling that causes major problems in a person's life.) If a person becomes a problem gambler earlier in life, they have a higher risk of suicide for the rest of their life. Gambling-related suicide attempts are usually made by older people with gambling problems. Substance useLadd, G. T., Petry N. M. (2003) A comparison of pathological gamblers with and without substance abuse treatment histories. Experimental and Clinical Psychopharmacology, 11, 202-9. and mental disorders increase the risk of suicide even more in people with problem gambling. ===Medical conditions=== There is a link between suicidality and medical conditions, including chronic pain, mild brain injury, (MBI) or traumatic brain injury (TBI). People with these conditions had a higher rate of suicide that was not caused by depression or alcohol abuse. People with more than one medical condition had an even higher risk of suicide. Problems with sleeping, such as insomnia and sleep apnea, may be risk factors for depression and suicide. In some people, the sleep problem itself, not depression, may be what increases their risk for depression. People being treated for mood disorders should be checked by a doctor. This should include a physical examination and blood tests. This can ensure the person's mood disorder is not caused by a medical problem. Many medical conditions can cause problems with mood and thinking.Janis Cutler, Eric Marcus. Psychiatry Oxford University Press, USA; 2 edition (2010) p.82 Seeing a doctor will also help make sure that it is safe to prescribe medications for the person's mood disorder. ====Biology==== thumb|left|Brain immaturity The human brain does not mature until the ages of 20-25. This clip shows the changes in grey matter between the ages of 5-20. Brain immaturity may have an influence on youth suicide.B.J. Casey, Rebecca M. Jones,a and Todd A. Hareb. The Adolescent Brain. Ann N Y Acad Sci. 2008 March; 1124: 111–126. doi: 10.1196/annals.1440.010 PMCID: PMC2475802 NIHMSID: NIHMS56148 [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2475802/] Some mental disorders that are risk factors for suicide may be partly caused by problems in the brain and body.Phillips J, Murray P, Kirk P., The biology of disease; pp.5-9 * Serotonin is an important brain neurotransmitter (a chemical messenger). Some studies have found that people who tried to kill themselves had low brain serotonin levels. People who died by suicide had the lowest levels.David M. Stoff, Elizabeth J. Susman: Developmental psychobiology of aggression; Cambridge University Press (2005) S. Hossein Fatemi, Paula J. Clayton:The medical basis of psychiatry. p.562 Springer(1994);, Low serotonin levels are a risk factor for suicide, even if a person has never had depression.J. John Mann, M.D., Neurobiological Aspects of SuicideRoberto Tatarelli, Maurizio Pompili, Paolo Girardi: Suicide in psychiatric disorders. p.266; Nova Science Pub Inc;(2007) Alan F. Schatzberg: The American Psychiatric Publishing textbook of mood disorders. p.489; American Psychiatric Publishing; (2005) * Brain-derived neurotrophic factor (BDNF):BDNF brain-derived neurotrophic factor [ Homo sapiens ]Gene ID: 627, updated on 9-Sep-2012: This is a protein that helps nerves grow. Problems with how BDNF works may help cause several mood disorders linked with suicidal behavior, including major depressive disorder.Castrén E, Rantamäki T. Dev The role of BDNF and its receptors in depression and antidepressant drug action: Reactivation of developmental plasticity. Neurobiol. 2010 Apr;70(5):289-97. PMID 20186711Molendijk ML, Bus BA, Spinhoven P, | display-authors = etal Serum levels of brain-derived neurotrophic factor in major depressive disorder: state-trait issues, clinical features and pharmacological treatment. Mol Psychiatry. 2011 Nov;16(11):1088-95. doi: 10.1038/mp.2010.98. Epub 2010 Sep 21. PMID 20856249 Studies of suicide victims have shown very low levels of BDNF in the hippocampus and prefrontal cortex, even in people who had no mental illness.Sher L. Brain-derived neurotrophic factor and suicidal behavior. QJM. 2011 May;104(5):455-8. PMID 21051476Alan F. Schatzberg, Charles B: The American Psychiatric Publishing Textbook of Psychopharmacology. pp-918-919. American Psychiatric Publishers Inc; 4 edition (2009) Even if they have the same risk factors, some people are at a higher risk for suicide than others. This is partly because of genetic inheritance. Genetics causes about 30–50% of the difference in suicide risk among different people. For example, a person whose parent died by suicide is much more likely to try to kill themselves. Epigenetics may also affect suicide risk.Trygve Tollefsbol: Handbook of Epigenetics: The New Molecular and Medical Genetics. p.562: Elsevier Science;(2010);Arturas Petronis: Brain, Behavior and Epigenetics, p.61 Springer (2011); ===Media coverage=== How the media shows news stories of suicide may have a negative effect and trigger the possibility of copycat suicides (this is called the Werther effect). This risk is greater in teenagers and young adults.Thomas H. Ollendick, Carolyn S. Schroeder: Encyclopedia of clinical child and pediatric psychology, p.61; Springer;(2003) Marion Crook: Out of the darkness: teens and suicide p.56 Arsenal Pulp Press (2004) The opposite of the Werther effect is the Papageno effect. This means that the media can help make suicide less likely if they cover good ways of dealing with stress and difficult things in life. ===Others=== A person is also more likely to die by suicide if: * They have an item they can use to kill themselves * Someone in their family has died by suicide * They have had a head injury * They do not have a job * They are poor or homeless * They have to deal with discrimination * They were physically or sexually abused as a child * They spent time in foster care * They are under stress from something, for example a school assignment or work. * They are afflicted with Gender dysphoria *They are being actively harassed, bullied or emotionally abused. ==Protective factors== Protective factors make it less likely that a person will die by suicide. They help protect a person from the risk of suicide. They can also help protect a suicidal person from the effects of suicidal thinking. Protective factors can be internal, such as a person's personal strengths and beliefs. For example:Robert I. Simon: Preventing Patient Suicide: Clinical Assessment and Management American Psychiatric Publishing, Inc.; 1 edition (2010) pp.51-57 * Having skills like good ways of dealing with stress and solving problems * Having religious or cultural beliefs that say life is important * Having reasons for livingMalone KM1, Oquendo MA, Haas GL, Ellis SP, | display-authors = etal Protective factors against suicidal acts in major depression: reasons for living. Am J Psychiatry. 2000 Jul;157(7):1084-8. PMID 10873915 Protective factors can also be external, such as a person's relationships and life situation. These factors can include: * Having strong connections with family and friends who are supportive * Not being able to get items that are very deadly if used for a suicide attempt (like a gun) * Having someone who helps the person get the treatment and help they need * Being able to easily get good care and treatment for mental, physical, and substance abuse disorders Protective factors are as important to identify as risk factors. Just as risk factors can be reduced, protective factors can be increased. ==Prevention== Suicide prevention tries to decrease the number of suicides by using protective measures. Some prevention strategies make it harder for people to get the most common things used to commit suicide. This includes taking away guns, poisons, and drugs. Studies have shown that good treatment of depression, alcohol abuse, and drug abuse can decrease the number of suicides. So does follow-up contact with those who have made a suicide attempt. In many countries, people at high risk of hurting themselves can check themselves into a hospital emergency department. In some countries or states, a doctor, judge, or police officer can force a person to go to the hospital if they seem suicidal, even if the person does not want to go. The person will be watched closely at the hospital to make sure they do not hurt themselves. A doctor or mental health professional will decide whether the person needs to go to a psychiatric hospital. "SOS Signs of Suicide" is a suicide prevention program used in secondary schools for students between 13 and 17 years old. The program educates students about suicide and tests them for suicide risk. Students who have done this program make fewer suicide attempts than students who have not done the program.SAMSHA"S National Registry of Evidence-based Programs and Practices. SOS Signs of Suicide Suicide hotlines, and crisis intervention centers help students at high risk. They help people who have suicidal thoughts.Nolen-Hoeksema, Susan.Abnormal Psychology, 6e. McGraw-Hill, 2014. pg. 210. A suicide risk assessment looks at how likely a person is to attempt suicide. A good assessment can help prevent suicide. It is also the first step in coming up with a treatment plan. Even though suicide risk assessments are very important, they are usually not done. Many mental health care workers have little or no training in how to do a suicide risk assessment. ==Epidemiology== thumb|left|United States suicide rates in 2009.thumb|World suicide rates in 2009. Grey areas are those where there is little or no data. Worldwide, suicide rates have increased by 60% in the past 45 years, mainly in the developing countries. As of 2006: * Suicide was the tenth leading cause of death in the world * About a million people die of suicide every year (this means that 16 out of every 100,000 people in the world died from suicide every year) * A person completed suicide every 40 seconds According to 2007 information, suicides happen twice as often as homicides in the United States. Suicide is the 11th leading cause of death in the country, ahead of liver disease and Parkinson's disease. Suicide rates vary a great deal across the world. Lithuania has the highest suicide rate. 30% of deaths by suicide are by people who are intoxicated.(Source: SAMSHA) In the United States, suicide has been increasing for African American teens. Native Americans and whites have the highest rate of suicide in the United States.More blacks than whites have committed suicide during the COVID-19 pandemic.Pandemic Tied to Higher Suicide Rate in Blacks, Lowered Rate in Whites: Study White men are most likely to commit suicide. White males account for nearly 70% of suicide deaths. Middle-aged white men have the highest suicide rate. ==Methods== thumb|120px|Death rates of suicide methods in the United States The most common ways of death by suicide are not the same in every country. In different areas, they include hanging, pesticide poisoning, and firearms. A 2008 report compared 56 countries using information from the World Health Organization. It found that: * Hanging was the most common method in most of the countries.Ajdacic-Gross, Vladeta, et al. . Bulletin of the World Health Organization 86 (9): 726–732. September 2008. Retrieved 2 August 2011. Archived 2 August 2011. See html version. * The data can be seen here . 53% of men who committed suicide, and 39% of women, used hanging. * Worldwide, 30% of people who die by suicide use pesticides. This method was most common in the Pacific area, where over half of people who died by suicide used pesticides. It was least common in Europe, where only 4% used this method. * In the United States 52% of suicides involve the use of firearms. * In the United States, asphyxiation and poisoning are also common. About 40% of suicides in the United States used one of these methods. Other people in the world die by suicide by: * Blunt force trauma (for example, from jumping off a building) * Cutting themselves and bleeding to death * Drowning themselves * Setting themselves on fire * Electrocuting themselves * Starving themselves Sometimes, suicidal people do something that will make another person kill them. For example, a suicidal person might point a gun at a police officer so the police officer will shoot the person in self-defense. This is commonly called "suicide by cop." ==Views of suicide== Modern medicine treats suicide as a mental health issue. It is considered a medical emergency when a person starts having many thoughts about killing themselves. The Abrahamic religions (like Christianity, Judaism, and Islam) think that life is sacred. They believe that when a person kills themselves, they are murdering what God has made. For this reason, many followers of Abrahamic religions think that when a person dies by suicide, they will go to Hell. The Dharmic and Taoist religions (like Buddhism, Hinduism, Jainism, Taoism, Confucianism, and Shinto) believe that someone who does by suicide will be reincarnated in the next life with a less enlightened soul. However, many people of these religions are more likely to commit suicide because they believe there will be the next life. They think that by dying by suicide, they may have a better chance in the next life. ==Suicide as a weapon== There are several famous examples of suicide attacks in history. The Kamikazes were one example. They were Japanese fighter pilots during World War II, who would try to kill American soldiers by crashing their planes into American ships. By crashing their planes, they would kill themselves as well. The September 11, 2001 terrorist attacks on the United States were also done by suicide attackers. They flew planes into the World Trade Center buildings and the Pentagon. ==Help for suicidal people== Learn more about suicide and how to get help for yourself or others * Learn from the National Suicide Prevention Lifeline * Learn from the Canadian Association for Suicide Prevention * Help for military veterans ===Hotlines=== ====United States==== * The National Suicide Prevention Lifeline 3 digit code: 988 * The National Suicide Prevention Lifeline: (800) 273-TALK (available 24 hours a day, 7 days a week) or through online chat * List of hotlines for LGBT adults and young people (from the It Gets Better Project) * http://lostallhope.com Online help for suicidal people. ====Canada==== * Find a hotline near you (list from the Canadian Association for Suicide Prevention) * Kids Help Phone : (800) 668-6868 (for kids and teenagers) ====Other countries==== * To find a hotline in your country, use one of these lists from the International Association for Suicide Prevention or Befrienders Worldwide * Crisis Text Line: Text 741741 ==Related pages== * Euthanasia * Mass suicide * Overdose * Suicidal ideation * Suicide pact * Copycat suicide * Right to die * Seppuku