Methods: How People Harm Themselves

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Methods: How People Harm Themselves

Making guns harder to obtain would prevent many suicide deaths.

When they can be obtained, firearms are an important method of suicide in both men and women. Whether handguns or long weapons, they are highly likely to cause extensive and severe trauma.

In addition, the trauma occurs so rapidly that help cannot be accessed in time. Firearms are a violent method more favored by males and this choice may come from the angry, aggressive and disfiguring meaning that is conveyed by shooting or may simply be an indication of men being more familiar using the device.

When firearms are restricted or unavailable, as has happened in several natural experiments, the overall rate of suicide drops because the number of firearm suicides decrease. It is accepted that substitution by other methods does occur over time, but lives continue until this happens and positive changes might occur in the interim.

Brent and Bridge, Firearms availability and suicide, American Behavioral Scientist, 2003

Suicidal behavior using drugs or poisons is more common in women.

The availability of and familiarity with drugs and poisons is more likely in women. Suicidal behavior may thus be an act of opportunity, taken when available.

Suicidal behavior includes non-fatal or life outcomes and most ingestions of drugs and poisons have this result. There are several explanations. Toxicity or lethality of drugs and poisons is decreasing, especially drugs used to treat mental health conditions.

Most ingestions are not rapidly lethal. There is more time for help to become available and more time makes room for one to change their mind. In addition, emergency medical care for poisoning has improved markedly over the past several decades in many countries.

Canetto and Sakinofsky, The gender paradox in suicide, Suicide and Life-Threatening Behavior, 1998

Preferred methods for suicide change with time.

There will always be means available to end ones life intentionally. The individual's choice may have symbolic meaning or be intended to convey a message to those left behind.

The arrival of new methods may replace older ones. This occurred in Northern Europe when carbon monoxide in coal gas (highly lethal and readily available in every kitchen oven) was replaced by natural gas (low lethality) for cooking.

Availability of a certain method can change. This occurs now in efforts to restrict access to obtaining firearms either by legislation or through buyback programs. More ominously, manuals for ending life promoted by the euthanasia movement are known to have increased the use of certain methods.

Marzuk and others, Increase in fatal suicidal poisonings and suffocations in the year Final Exit was published: A national study, American Journal of Psychiatry, 1994

Different cultures have "preferred" methods for suicide.

Availability is a significant factor in a community?s choice of accepted methods for suicide. In Southeast Asia, the availability of the insecticide Paraquat has led to it being a preferred choice for suicide. Methods also have a cultural meaning of being honorable (or shameful).

For example, in Japan deaths using swords, deaths involving a ritual aspect of sacrifice or penance are looked upon more favorably. Some methods are almost "prescribed" as appropriate (or as unacceptable).

Water has been particularly noted as defining acceptable death by sacrifice (cleansing) in some regions of the world.

Qin and Mortensen, Specific characteristics of suicide in China, Acta Psychiatrica Scandinavica, 2001

Certain suicide methods are more common in some regions than others.

The choice of a means for suicide or self-harm changes over time, in different places and in varying cultures. Choice may have a personal meaning, but choice is also impacted by socially prescribed meanings, by availability and by "fashion."

There are also ?in vogue? methods such as "trainwalking" in Europe. Methods that imitate those chosen by famous persons such as overdoses after Marilyn Monroe suicide and an increase in paracetamol (acetaminophen) poisoning after an actress on a popular British soap opera used this method are other studied examples.

Suicides occur by all kinds of methods.

Ingenuity and variety are common in devising ways to end one?s life, but there are certain methods of suicide that are widely and generally used.

The International Classification of Diseases (ICD) lists these as "E-codes" (950-959) in ICD 9 and the new ICD 10 lists them as "X-codes" (60-84).

The most common causes are poisoning, hanging/strangulation/suffocation, drowning/submersion, firearm, cut/pierce with a sharp or blunt object, fall/jumping, fire/burn, and motor vehicle.

International Classification of Diseases 10th Revision

Some methods of suicide are more deadly than others.

The likelihood that any particular means of harm may result in death is expressed as the lethality of that method. Lethality includes the actual nature, extent and severity of the damage caused to various organ systems in the body, the rapidity of such action and the potential for reversibility of the damage with appropriate and timely treatment. Various scales to compare the lethality of different methods have been created.

The method people choose may not indicate how serious they are about dying...

Euthanasia manuals and internet ?suicide help? sites often elaborate these methods in some detail. We do not list these as our interest is in preserving, protecting and promoting life.

Studies support the fact that there is a lack of knowledge in the general community about the anatomy, physiology and pharmacology of methods for self-harm. Industrial chemists, medically trained personnel and pharmacists are all at increased risk not only because of access to lethal methods, but also because of their knowledge about which drugs and chemicals are most dangerous, and in what amounts.

Every year, a number of people who take overdoses of acetaminophen/paracetamol with little intention to die tragically lose their lives from the complications of liver damage and destruction that occur when the overdose is not treated promptly.

Clinical experience with sites for cutting and for firearm wounding in persons who seriously intended to die indicates (thankfully) their lack of knowledge of anatomy in applying the method ineffectively.

Cantor and Baume, Changing methods of suicide by young Australians 1974-1994, Archives of Suicide Research, 1998

...but most people are not aware of which methods are more dangerous.

Many caregivers assume that the lethality of a method chosen for self-harm is a measure of how much a person intended to die.

A review of all studies (over 15 have been done) indicated that the link between more intent to die and greater lethality of method is only shown in one-half of them. The absence of a significant link is explained in part by availability and knowledge.

Personal, regional and cultural preferences for certain methods regardless of lethality is another explanation.

http://www.livingworks.net/

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