This is a very complicated issue. There is international evidence that communities with lower social standing or with diminished expectations of success (less hopeful) are associated with higher suicide rates.

Farm laborers have been found to have higher rates than professional workers; blue-collar workers higher than white-collar workers, lower income groups more than higher income groups.

Areas with less money in a household appear on average to have more suicide.

But there are many explanations for living in lower income areas and a large number of these are also linked to suicide in their own right. It is likely for example that persons with chronic, persistent and severe mental disorders will find themselves living in lower income communities.

Is the link to suicide their income level or the disorder that has limited their earning potential?

No one knows which is the greater contributor. In another recent study, depression was four times more likely in communities with poverty. If suicide were to occur in these communities, would it be caused by depression or by poverty or by some contribution of each?

This is an example of a much larger scientific issue in which summary or outcome measures associated with a behavior like suicide are used as if they are a cause of it.

The real explanations may lie in factors that lead to the outcome measure or even in some factor that is common to both the underlying factor(s) and the summary measure.

Very sophisticated statistical techniques are needed to sort out the relative contribution of different factors. Very few studies have the ability or power to provide sure conclusions about the contribution of individual factors such as economic status.

Much more work is needed to sort out the effects of one's social economic status from the many other factors associated with it.

In our risk review of the factors that alert us to the possibility of suicide, resources are an important item.

Financial resources must certainly be considered, but there are many supports against suicide that are available to persons at risk whether or not they have financial security. It may be true that success is more important than wealth because positive outcomes tend to lead to optimistic or hopeful outlooks.

But optimism may also be a trait of some persons even when they are consistently challenged by apparent failures. It seems inaccurate to draw conclusions based solely on success without knowing the story behind the success.

Sometimes the first failure after a lifetime of unbroken success leads to suicide because the person has no skills to cope with the discomfort or distress that comes with it. In sum, we believe that it is a culturally driven and unproven proposition that a person's financial wealth or social influence afford protection against suicide.

There are (too many) wealthy and influential families with suicide survivors, just as there are in every community and at every level of society.

-Hawton and others, The influence of the economic and social environment on deliberate self-harm and suicide, Psychological Medicine, 2001

Individuals with legal concerns can be more at risk than others.

Suicide is the leading cause of death in prisons and correctional institutions. The most common location is the jail, remand centre or lockup: the point of first contact with the justice and legal system for offenders.

Suicide may be linked to individual feelings of shame and disappointment associated with breaking the law as much as to any feature of the institution itself. Jail suicide is a very large problem in almost all communities.

The importance of this stressor is emphasized in an Alberta study where 14% of suicides in a given year were in active contact with the legal and justice system at or around the time of their deaths. The number of deaths by persons who were witnesses to or victims of criminal activity was even more distressing.

-Bonner, Correctional suicide in the year 2000 and beyond, Suicide and Life-Threatening Behavior, 2000

Increases in suicide have been connected to both good and bad economic times.

Offering explanations based on simple associations to available: hard or numerical data is a great temptation, but such explanations may offer only limited help in understanding why suicide happens.

For example, historical information shows that male suicide rates increased substantially in many nations, some as high as 108%, during the Great Depression in the 1930s.

This led to a belief that adversity killed off the weaker members of society, a sort of "survival of the fittest" explanation (or is that "survival of the fittest" rationalization).

But even with the increases, most people confronted by material disadvantages in this decade did not kill themselves. Any explanation must invoke some other factor(s) in addition to bad economics.

It is notable that the 1930s increase is relative to earlier and later decades in which there were world wars, which are known to decrease the suicide rate. Perhaps the 1930s were not an increase, but the actual measure of the amount of suicide in the population.

Good economic times indicated by measures of financial health of an entire economy may have little relation to some towns and communities in economic difficulties in the midst of these prosperous overall times.

Often, the new economic strength is at the cost of leaving behind older communities whose success was based on old or obsolete industries.

This was particularly evident during the 1990's as industrial wealth of nations boomed while agricultural communities were more and more bankrupt and abandoned.

When good economic events can be isolated, it has not been uncommon for new and wealthy satellite suburbs to have major problems with suicide among youths and stay at home partners.

Another largely unknown fact is the increased frequency of suicide known among winners of large pools or lotteries prizes.

-Yang and others, Suicide and unemployment: Predicting the smoothed trend and yearly fluctuations, The Journal of Socio-Economics, 1992

Suicide rates are higher among unemployed persons.

Although findings have been mixed in some studies, upward trends in unemployment in a country are statistically associated with increases in suicide.

Forced unemployment often signals loss of or change in resources, both financial and social. Suicide related to unemployment occurs at two times: immediately related to stress with shame and adjustment and much later when resources are exhausted and hope is diminished.

The positive relationship between unemployment and suicide is often stronger for men than for women. Unemployment represents a stress that may have personal meanings such as a loss of esteem and personal consequences such as depression and hopelessness.

-Kposowa, Unemployment and suicide, Psychological Medicine, 2001

Work as a helper or caregiver does not protect against suicide.

Some occupations have more risk of suicide than others, but for different reasons. Physicians, pharmacists, and dentists, with access to and information about lethal drugs and chemicals, have been linked to high suicide risk.

Police personnel and psychiatrists also appear to have a higher rate of suicide, as do women physicians. Many explanations have been offered, mostly around the personal isolation that can go with jobs like these.

Others have stated that jobs requiring service to other humans are more likely to have risk attached to them because the lack of control over the behavior of others combines with a responsibility for such behaviors and leads to intolerable stress. Whatever the actual reason, being a caregiver offers no special protection or immunity from suicide.

-Boxer and others, Suicide and occupation: A review of the literature. Journal of Occupational and Environmental Medicine, 1995

Individuals from any religious background can be at risk of suicide.

From the beginning of the modern study of suicide, the protective effect of belonging to a religious group has been noted. Not only is there the feeling of belonging, but also the faith itself offers hope and a sense of future: all of these are antidotes to suicide.

There is no evidence that a particular faith, belief or religious group offers more individual protection than any other, although some recent country-based evidence indicates that membership in a religion offers some protection for men.

Older information noted decreased suicide in countries with a large proportion of Roman Catholics, but the data was distorted by social and political beliefs.

These much diminished the likelihood that suicide deaths would be properly labeled or identified. At present, the fact of underreporting of suicide in Catholic nations is widely accepted.

Other information suggested that those of Jewish faith were less likely to suicide. This is now recognized as an effect of the cultural and social closeness of the Jewish community more than any specific religious beliefs or practices. All of these religious effects on reducing suicide risk are small.

-Kelleher and others, Religious sanctions and rates of suicide worldwide, Crisis, 1998

-Groups

There are many things that can increase suicide risk and the possibility of self-harm.

Most of the recognized and labeled factors have been associated with suicidal behaviors in research studies.

The association does not mean that a person who has lived or experienced that hazard is bound to become a person at risk. It does mean they are part of a group of people who are more ?vulnerable? or at risk than a person that has never had that experience.

There is no hazard associated with suicide for which everyone with the hazard becomes a person at risk. If the association were that strong, the factor would actually predict suicidal behavior perfectly.

One reason there are nothing close to perfect predictors is that coping, personal choice and the willingness to seek help are all important in estimating how important an event or experience is in making a person vulnerable to suicide.

In all countries, suicide is now one of the leading causes of death among young adults.

In all countries reporting suicide information to the World Health Organization, suicide is now one of the three leading causes of death among young adults (persons 15 - 35 years of age). What was once predominantly a problem in elder age groups now predominates in younger people in a third of all countries.

-WHO, Facts and Figures about Suicide, 1999

-Gay and lesbian persons may be more at risk.

This has been a controversial issue for some time. There are many methodology limitations associated with gathering data because there is an almost complete absence of sexual orientation questions in population surveys and there is a lack of researchable sexual orientation information on death records.

Results consistently indicated that gay, lesbian and bisexual persons, particularly gay men, had substantially higher self-reported rates of suicidal ideation and suicide attempts, and may have higher suicide rates than heterosexual persons.

Both critics and proponents of the research findings often misreported the speculations about suicide rates as facts, which increased misgivings about all findings.

Recent research using more representative sampling methods and more rigorous data analysis are confirming earlier findings that this group is considerably more at risk than their heterosexual counterparts.

Death-record information about sexual orientation is still too limited for any direct comparisons about suicide rates, so this conclusion remains speculative, not factual.

-Russell, Sexual minority youth and suicide risk, American Behavioral Scientist, 2003

Children as young as 4 years old have died by suicide.

This shocking fact is derived from data on accidental poisons, some case reports of intentional motor vehicle and childhood pedestrian injuries, and very rare coroner verdicts of suicide in young children.

Although actual deaths in children are rare, suicidal behaviors are not and indications suggest the prevalence is increasing.

There are others who dispute the possibility of child suicide based on theory. They do not believe that children can be held responsible for their actions beneath a certain legal age (around 10 - 14 usually) because they cannot understand the outcomes of their actions.

This is particularly true of suicide because child development experts state that a child must be 8 - 10 years old in their intellectual development before having an understanding of the finality of death.

-Pfeffer, Suicidal behavior in prepubertal children: From the 1980s to the new millennium, In Review of Suicidology, 2000

Adult males are the largest group of persons who die by suicide.

From early teens through to extreme old age, males are more at risk of death by suicide. This finding appears across all cultures and countries except in rural China and for younger women in parts of India.

In most measures, men are 3 to 8 times as likely to die by suicide as women, and so make up 75-90% of all suicides. More recently, it appears that men are also self-harming more often, though this is still a behavior more identified with females. No satisfactory explanation for this single group being at such definite risk has been put forward.

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

Childhood abuse may increase suicide risk later.

Experiencing physical abuse and domestic violence during childhood often leads to difficulties in adult life.

Experiences of sexual abuse, especially in mother-child relationships, are known to increase risk in both genders. Women who have experienced childhood abuse are at a greater risk of having attempted suicide.

-Dieserud and others, Negative life events in childhood, psychological problems and suicide attempts in adulthood, Archives of Suicide Research, 2002

Mental health concerns increase suicide risk.

Some professionals regard mental health diagnoses and disorders as a necessary condition for suicidal behavior. These health conditions are certainly found more often in the life history of persons at risk than in persons not at risk.

The power of an active episode of certain major mental disorders should not be underestimated. Episodes of major depression, psychoses in either acute and in residual phases and crises of living associated with personality disorders all increase the likelihood of suicidal behavior.

The more types of mental disorder that one experiences (called comorbidity), the stronger the state of vulnerability.

...but those without such concerns can also be at risk.

But almost 17% of the populations have one of these disorders at any time and one-half of us will be diagnosed with one of these disorders during our lifetimes.

Mental disorders are so common that the vulnerability associated with them is of limited value as a specific indicator for suicidal behavior.

Some have argued that the real issue of vulnerability for mental disorders is not the actual problems of thought and feeling that define them, but the ways that society and others fail to support persons with such problems.

Stigma exists for mental disorders equally as strongly as it does for suicide. Finally, persons with mental disorders do learn to cope over time. Thus, people with mental disorders are more likely to be at risk than to actually act on their thoughts of suicide.

-Tanney, Psychiatric diagnoses and suicidal acts, Comprehensive Textbook on Suicidology, 2000

People in institutions are at higher risk of suicide.

Jails, prisons and mental hospitals are unusual places. People living in them are stressed physically, socially or mentally and may already be at risk for these reasons.

The social organization of a large institution can also contribute to risk by creating dependency, sapping creativity or personal strength, and overall, weakening the coping and adaptive abilities of residents.

In sum, they are stressful places to be in no matter how humanely they are organized and often persons who enter them are already stressed, vulnerable and at risk.

Left-handed people are at slightly greater risk.

This is an example of an association which has been demonstrated statistically, but which has no acceptable explanation. It is a good example of a problem with the methods used to study suicide and suicidal persons which use group data and mathematical or actuarial sciences.

Of course some persons at risk will be left-handed, but many more will not be. The same is also true for right-handed or ambidextrous persons.

-Chyatte and Smith, Brain asymmetry predicts suicide among Navy alcohol abusers, 1981

Men are more likely than women to die by suicide.

In most countries, this is a fact of suicide. Men die by suicide about three or four times as often as women. It is useful to note that, overall, more women engage in suicidal behavior resulting in injury or a non-fatal outcome.

Men as a sex are more vulnerable to death from conception onwards. Some argue that men are socially reared to be more alone and independent, and to have more difficulty seeking help when in distress (men are very unwilling to ask for help when lost, for example).

Others still suggest that the coping conditions and styles of men are more aligned to fighting, violence, anger and modification by acute substance abuse.

There are many explanations, but some unknown protective factor in women and not just vulnerability in men must also be considered as a possibility.

Gender is perhaps the most important, but most ignored, demographic factor that needs consideration in designing both prevention and intervention programs.

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

Young women are the largest single group of persons who deliberately harm themselves.

Non-fatal injury is the most common outcome of a suicidal behavior. The highest rates of non-fatal injury are found among young women (14 - 29 years of age). It appears that in most cases their intent is not to die but to change some aspect of their present life circumstances.

Ramsay has called these behaviors, "life attempts." This is of course a very dangerous way to accomplish life change. "Accidental" suicides are possible if rescue is miscalculated or the danger of the chosen method is higher than the person expects.

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

Suicide rates tend to be higher in aboriginal communities.

Death by suicide is recognized in almost all native/aboriginal cultures. Rates are higher in young native or aboriginal persons of both genders than for other racial/cultural groups.

This has been noted in most locations where data is available (North America, Australia, New Zealand and northern Europe) and thus appears a cultural and not a racial issue.

Most explanations refer to a loss of cultural roots and origins (as a minority culture overwhelmed by globalization), cultural dislocation and even disintegration as a critical stressor.

-Chandler and others, A study of Native and Non-Native North American adolescents, Monographs of the Society for Research in Child Development, 2003

...but rates vary among aboriginal communities.

Some native communities appear relatively protected from the problem of suicide. Even tribes a short distance apart geographically may have markedly different experiences with suicide.

There may be community beliefs about death and suicide that protect or promote suicide. At this time, there is some but not yet strong evidence that communities with sustained cultural continuity roots are more protected.

-Graham, Using reasons for living to connect to American Indian healing traditions, Journal of Sociology and Social Welfare, 2002

Having children offers some protection from suicide.

Children offer meaning to the lives of parents. Children are frequently mentioned as a reason for living. The desire to ensure the survival and health of our offspring may be ?wired? into our biological makeup in some way.

The ?empty nest? syndrome of parents whose children are grown and leaving home was previously said to account for a increase in suicide that occurred in women in their late forties and fifties, although the increase for women those ages is not obvious in many locations currently.

-Qin and others, Gender differences in risk factors for suicide in Denmark, British Journal of Psychiatry, 2000

People without a life partner can be more at risk.

Being partnered may just mean not being alone and being alone is a risk alert for suicidal behavior. Data from many places about relationship status confirms that being single, divorced or widowed is associated with a higher suicide rate for men and women.

Women do seem to manage loss of relationship better than men however. Separating the effect of loss of relationship (stressor) from the resulting being without relationship (alone) is a complex problem.

-Heikkinen and others, Social factors in suicide, British Journal of Psychiatry, 1995

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