Most suicides are men (76% 1999) aged between 25-34 or over 75. Particularly worrying however are the deaths of young men aged 15-24 amongst whom suicide rates rose 75% between 1982-1991 (DoH 1996). Attempted suicides have risen 172% since 1985 (Samaritans). For young men suicide is now the second leading cause of death.

Death by suicide among women is steadily falling, a trend recently reinforced by the government's limit on the number of paracetamol tablets that can be sold at one time - removing a convenient means of overdosing.

It is very difficult to predict who will take their own life. Nine out of ten suicides are the tragic outcome of mental illness (DoH 1996) - 10% of known schizophrenics and 15% of known depressed, alcohol dependent and personality disordered patients commit suicide - but very often families, friends and health professionals only realise a person had a mental health problem after the tragedy.

In many cases the shame of being labelled 'mentally ill' prevents the suicide victim seeking help. One analysis of suicide notes revealed 'evidence of hopelessness and unbearable psychological pain in 90 per cent' of them and argued for better ways of identifying the sufferers before they die.

Doctors need to be more aware of the danger signals. The UKs first psychological study of suicides among the under-35s found that the majority had been to see their GP in the three months before their death[2]. Other surveys found two-thirds visit their doctors in the month before their suicide - 40% in the previous week - but they had not talked directly about their troubles.

What to look out for

Suicidal thoughts are much more common than people think. Learning how to predict who will take their own life and when they will do it is a great challenge facing the psychiatric profession and indeed all of us.

Factors leading to a suicide attempt may include [3]:

    * relationship problems with family, friends, peers - a common event prior to a suicide attempt is a serious argument with a significant person

    * feeling isolated with no-one to talk to

    * alcohol and drug misuse (one third of suicides are intoxicated at the time of death)

    * worries about sexual orientation

    * unemployment

    * physical and sexual abuse

    * being held in custody

    * bullying

    * exam pressure

    * media reports of a suicide of a young person or a famous personality

    * death of a parent, relative or friend

    * a broken relationship

    * family breakdown

Also watch for

    * a diagnosed depressed person apparently feeling much better (or worse)

    * a diagnosed depressed person abusing alcohol and drugs

    * delusions, like guilt or shame for an imaginary transgression

    * comments about death or suicide

    * preparations for death, like giving away sentimental possessions or writing letters to friends

According to the Rural Stress Information Network suicide risk is extremely high if:

    * there is a readily available lethal method, and the person has indicated their intention to use it (e.g. farmers with shotguns)

    * the individual has set a deadline, such as an anniversary or birthday and has indicated that something significant will happen on that day or is uncharacteristically tidying up 'loose ends'

Suicidal thoughts are a sign that you need to take stock of what is happening to you and do something about it. It is likely that you are becoming depressed and need some help to get over it. (Department of Health 1996)

HOW TO HELP

The Samaritans say that 26% of us personally knows someone who has died by suicide. Perhaps the starting point for identifying suicide risk is to consider our response to the emotional distress we see in the people around us. How do we, and our friends, respond to mental health issues? Are we afraid of getting involved? Are we afraid of making a bad situation worse? What should we do?:

    * Take seriously anyone who talks about suicide, or attempts it - however ineffectually. People who talk about suicide are crying out for help. 85% of teenagers who have attempted suicide talked to someone first.

    * Listen but don't judge. Stay calm. Be Quiet. Let the person talk. Maintain eye contact. If appropriate move closer to the person, perhaps hold their hand.

    * Seek help - you can't handle this alone. Involve family, the person's GP, school, college or workplace counsellors, mental health professionals, community organisations or even dial 999 for police help in an emergency - even if the person says they want to be left alone

    * Express concern. Give the person concrete examples of what leads you to believe they are close to suicide

    * Ask direct questions. Ask how the person is planning their suicide. Most suicides plan their suicide acts for weeks or months.

    * Don't promise not to tell - you will probably need to tell people who can help and the more people who show concern for the person the better

    * Offer reassurance. Remind the person that things will get better but suicide is permanent. Most suicidal people are undecided about living or dying

    * Families of known depressives should guard prescription drugs carefully as 15% of deaths from overdoses are by prescribed anti-depressants. (SANE)

Talking about suicide with someone who says they feel suicidal will not make them more likely to harm themselves.

[1]O'Connor and Sheehy The Psychologist January 2001

[2] British Journal of Psychiatry. August 1999

[3] The Samaritans Youth Pack, and Suicide Watch at www.intelihealth.com

[4] Sources: The Samaritans, Childline, Suicide Watch at www.intelihealth.com

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