Suicide: Understanding Risks & Prevention

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Suicide: Understanding Risks & Prevention

by Mayo Clinic

Maybe you're severely depressed. Or you're experiencing an overwhelming amount of physical or emotional pain. Perhaps you're in financial trouble that seems insurmountable. Maybe things seem so hopeless that you've decided suicide is an option.

Some 30,000 Americans take their own lives each year, making suicide the 11th leading cause of death in the United States ? outpacing homicide. But learning more about the causes, prevention efforts and risk factors can help you gain a better understanding of suicide and even stop a death ? your own or a loved one's.

People who attempt suicide do so for myriad reasons. In general, they feel it's the only way to fix problems that seem overwhelming, unbearable and unchangeable. They may see no other options or feel they're a burden to others. They may be consumed by self-hatred and a sense of hopelessness about the future.

A specific crisis ? a job loss or relationship breakup, for instance ? may drive someone to a desperate, impulsive suicide attempt. Or suicide may be the culmination of long-lasting depression or anguish.

The continuum of suicide

Suicide is not an illness or condition, but rather a complex set of behaviors that actually exists on a continuum, from ideas to actions. For instance, you may wish you were dead but never intend to act on those thoughts. You may think about suicide or taking action to end your life but not have a specific plan. On the other hand, you may have very specific plans, with dates, locations and methods. And you may have a plan as well as the intent and the means to do it. These thoughts or plans about suicide are known collectively as suicidal ideation.

Some people also engage in suicidal behavior. It includes acts that are intended to bring death or risky behavior that's unlikely to result in death but may be an indication that you're self-destructive or thinking about suicide. These acts may include overdosing, dangerous driving or excessive drinking, for example.

Attempted suicide generally refers to an act that intends to cause your own death but fails to. Each year, more than half a million Americans require emergency medical attention after suicide attempts.

Not all seemingly self-destructive behavior is suicidal behavior. Acts that may resemble suicidal behavior but that aren't intended to lead to death are known as parasuicide. Some people engage in self-injurious behavior such as self-mutilation as a way of soothing themselves, for example. However, people who engage in self-harm are at higher risk of suicide.

Completed suicide is taking your own life. However, it's impossible to guess precisely why someone took their own life, or if they even intended to. In some cases, people may engage in suicidal behavior or parasuicide but kill themselves accidentally ? they didn't wish for the act to progress to a lethal outcome. For instance, they make take an overdose and expect to be discovered in time to be rescued. In any case, the only way to understand the true intent behind any self-destructive act is to talk to the person about it.

Risk factors

Regardless of what specifically motivates a person to attempt or commit suicide, a number of medical, biological, psychological and social risk actors are often involved. Those factors can vary based on age, gender and ethnic group, and they can change over time.

Some factors consistently increase a person's risk of suicide and attempted suicide. Among the factors that put people at higher risk:

* A prior suicide attempt

* Having a psychiatric disorder, such as depression, bipolar disorder, schizophrenia or personality disorders

* Alcohol or substance abuse

* A family history of mental disorders or substance abuse

* A family history of suicide

* Family violence, including physical or sexual abuse

* Firearms in the home

* A significant medical illness, such as cancer or chronic pain

Many of these risk factors occur in combination. Someone who is suicidal may be depressed, abuse alcohol and have experienced sexual abuse, for instance. On the other hand, many people who have a variety of these risk factors are not suicidal. Many people are under the influence of drugs or alcohol at the time of their suicidal act. Even people who don't generally abuse substances may do so in an effort to gain courage to carry out a suicide.

Women are more likely than men to engage in parasuicide. Men are more likely to complete a suicide because they typically use more lethal means, such as a gun. However, this tide is changing as guns become more available and acceptable for use by both men and women.

Older adults are disproportionately more likely to take their own lives. While people over age 65 account for only 13 percent of the population, they account for 18 percent of deaths by suicide. White men over age 85 have the highest suicide rate. Most older men who commit suicide have a cluster of risk factors because of their circumstances. For instance, they may be unable to remain independent in activities of daily living and bodily functioning, and with many of their loved ones no longer alive, they may feel isolated, alone and helpless.

Prevention programs

People who have protective factors ? the opposite of risk factors ? are less likely to attempt suicide. Those factors include effective and appropriate medical care, easy access to treatment, family or community support, skills in problem solving and conflict resolution, and cultural and religious beliefs against suicide.

Still, it's impossible to accurately predict which particular individuals will attempt to take their own life. But increasing public awareness and education, improving attention to psychiatric and substance abuse disorders by doctors, enhancing services, and gaining scientific knowledge can all help improve suicide prevention efforts.

In the months or days leading up to suicide, many people, especially older adults and women, visit their doctor. But most never reveal their suicidal feelings at these appointments in a way that doctors can recognize. Some suicide prevention programs are aimed at better screening methods during visits to primary care doctors, which could improve the recognition of mental disorders. Recognizing depression, substance abuse and other disorders associated with suicide could provide an opportunity to frankly ask those at risk if they're considering suicide, with referrals to appropriate treatment.

Expanded services could also offer an opportunity to prevent suicide attempts. Broadening access to treatment through public and private insurance programs could improve the likelihood that the most vulnerable people would get appropriate treatment. Beefing up referral programs in communities and workplaces and addressing the social isolation of the elderly could help steer people to treatment programs and other supportive services. And public education about mental disorders could decrease the stigma that often prevents people from seeking medical help.

Better understanding of the biology of suicide could also help improve treatment. Research shows that suicidal behavior may be linked, at least in part, to a decrease in the brain of the neurotransmitter serotonin, for instance. Medications that increase levels of serotonin may help reduce suicidal behavior.

In addition, evidence suggests that genetic factors may increase the risk of suicidal behavior. Major psychiatric illnesses, such as bipolar disorder and schizophrenia, are thought to have a familial link. On the other hand, suicidal behavior could be influenced more by a tendency toward impulsive behavior than by a specific psychiatric illness. Identifying people at increased risk could lead to earlier recognition and better treatment of those illnesses and, as a result, less suicidal behavior.

Hope for the future

Becoming more aware of the factors that may put you or a family member or friend ? at risk can help keep you off of a path to permanent self-destruction. When problems seem so overwhelming that you see no options other than to end your own life, your distress has distorted your thinking. But awareness of your own vulnerability can help guide you to treatment and hope.

April 15, 2004

� 1998-2004 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved.
A single copy of these materials may be reprinted for noncommercial personal use only.

http://www.cnn.com/HEALTH/library/MH/00053.html

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