Reflex Sympathetic Dystrophy Syndrome
Complex Regional Pain Syndrome
Frequently Asked Questions about Suicide
What should you do if someone tells you they are thinking about suicide?
If someone tells you they are thinking about suicide, you should take their distress
seriously, listen non judgmentally, and help them get to a professional for evaluation and
treatment. People consider suicide when they are hopeless and unable to see alternative
solutions to problems. Suicidal behavior is most often related to a mental disorder
(depression) or to alcohol or other substance abuse. Suicidal behavior is also more likely to
occur when people experience stressful events (major losses, incarceration). If someone is
in imminent danger of harming himself or herself, do not leave the person alone. You may
need to take emergency steps to get help, such as calling 911. When someone is in a
suicidal crisis, it is important to limit access to firearms or other lethal means of committing
What are the most common methods of suicide?
Firearms are the most commonly used method of suicide for men and women, accounting
for 60 percent of all suicides. Nearly 80 percent of all firearm suicides are committed by
white males. The second most common method for men is hanging; for women, the
second most common method is self-poisoning including drug overdose. The presence of a
firearm in the home has been found to be an independent, additional risk factor for suicide.
Thus, when a family member or health care provider is faced with an individual at risk for
suicide, they should make sure that firearms are removed from the home.
Why do men commit suicide more often than women do?
More than four times as many men as women die by suicide; but women attempt suicide
more often during their lives than do men, and women report higher rates of depression.
Men and women use different suicide methods. Women in all countries are more likely to
ingest poisons than men. In countries where the poisons are highly lethal and/or where
treatment resources scarce, rescue is rare and hence female suicides outnumber males.
Who is at highest risk for suicide in the U.S.?
There is a common perception that suicide rates are highest among the young. However, it
is the elderly, particularly older white males that have the highest rates. And among white
males 65 and older, risk goes up with age. White men 85 and older have a suicide rate that
is six times that of the overall national rate. Some older persons are less likely to survive
attempts because they are less likely to recuperate. Over 70 percent of older suicide victims
have been to their primary care physician within the month of their death, many did not tell
their doctors they were depressed nor did the doctor detect it. This has led to research
efforts to determine how to best improve physicians? Abilities to detect and treat depression
in older adults.
Are gay and lesbian youth at high risk for suicide?
With regard to completed suicide, there are no national statistics for suicide rates among
gay, lesbian or bisexual (GLB) persons. Sexual orientation is not a question on the death
certificate, and to determine whether rates are higher for GLB persons, we would need to
know the proportion of the U.S. population that considers themselves gay, lesbian or
bisexual. Sexual orientation is a personal characteristic that people can, and often do choose
to hide, so that in psychological autopsy studies of suicide victims where risk factors are
examined, it is difficult to know for certain the victim?s sexual orientation. This is
particularly a problem when considering GLB youth who may be less certain of their sexual
orientation and less open. In the few studies examining risk factors for suicide where sexual
orientation was assessed, the risk for gay or lesbian persons did not appear any greater than
among heterosexuals, once mental and substance abuse disorders were taken into account.
With regard to suicide attempts, several state and national studies have reported that high
school students who report to be homosexually and bisexually active have higher rates of
suicide thoughts and attempts in the past year compared to youth with heterosexual
experience. Experts have not been in complete agreement about the best way to measure
reports of adolescent suicide attempts, or sexual orientation, so the data are subject to
question. But they do agree that efforts should focus on how to help GLB youth grow up to
be healthy and successful despite the obstacles that they face. Because school based suicide
awareness programs have not proven effective for youth in general, and in some cases have
caused increased distress in vulnerable youth, they are not likely to be helpful for GLB
youth either. Because young people should not be exposed to programs that do not work,
and certainly not to programs that increase risk, more research is needed to develop safe
and effective programs.
Are African American youth at great risk for suicide?
Historically, African Americans have had much lower rates of suicides compared to white
Americans. However, beginning in the 1980s, the rates for African American male youth
began to rise at a much faster rate than their white counterparts. The most recent trends
suggest a decrease in suicide across all gender and racial groups, but health policy experts
remain concerned about the increase in suicide by firearms for all young males. Whether
African American male youth are more likely to engage in victim-precipitated homicide? By
deliberately getting in the line of fire of either gang or law enforcement activity, remains an
important research question, as such deaths are not typically classified as suicides.
Is suicide related to impulsiveness?
Impulsiveness is the tendency to act without thinking through a plan or its consequences. It
is a symptom of a number of mental disorders, and therefore, it has been linked to suicidal
behavior usually through its association with mental disorders and/or substance abuse. The
mental disorders with impulsiveness most linked to suicide include borderline personality
disorder among young females, conduct disorder among young males and antisocial
behavior in adult males, and alcohol and substance abuse among young and middle-aged
males. Impulsiveness appears to have a lesser role in older adult suicides. Attention deficit
hyperactivity disorder that has impulsiveness as a characteristic is not a strong risk factor
for suicide by itself. Impulsiveness has been linked with aggressive and violent behaviors
including homicide and suicide. However, impulsiveness without aggression or violence
present has also been found to contribute to risk for suicide.
Is there such a thing as "rational" suicide?
Some right-to-die advocacy groups promote the idea that suicide, including assisted suicide,
can be a rational decision. Others have argued that suicide is never a rational decision and
that it is the result of depression, anxiety, and fear of being dependent or a burden. Surveys
of terminally ill persons indicate that very few consider taking their own life, and when they
do, it is in the context of depression. Attitude surveys suggest that assisted suicide is more
acceptable by the public and health providers for the old who are ill or disabled, compared
to the young who are ill or disabled. At this time, there is limited research on the frequency
with which persons with terminal illness have depression and suicidal ideation, whether they
would consider assisted suicide, the characteristics of such persons, and the context of
their depression and suicidal thoughts, such as family stress, or availability of palliative care.
Neither is it yet clear what effect other factors such as the availability of social support,
access to care, and pain relief may have on end-of-life preferences.
This public debate will be better informed after such research is conducted.
What biological factors increase risk for suicide?
Researchers believe that both depression and suicidal behavior can be linked to decreased
serotonin in the brain. Low levels of a serotonin metabolite, 5-HIAA, have been detected in
cerebral spinal fluid in persons who have attempted suicide, as well as by postmortem
studies examining certain brain regions of suicide victims. One of the goals of
understanding the biology of suicidal behavior is to improve treatments. Scientists have
learned that serotonin receptors in the brain increase their activity in persons with major
depression and suicidality, which explains why medications that desensitize or
down-regulate these receptors (such as the serotonin reuptake inhibitors, or SSRIs) have
been found effective in treating depression. Currently, studies are underway to examine to
what extent medications like SSRIs can reduce suicidal behavior.
Can the risk for suicide be inherited?
There is growing evidence that familial and genetic factors contribute to the risk for suicidal
behavior. Major psychiatric illnesses, including bipolar disorder, major depression,
schizophrenia, alcoholism and substance abuse, and certain personality disorders, which
run in families, increase the risk for suicidal behavior. This does not mean that suicidal
behavior is inevitable for individuals with this family history; it simply means that such
persons may be more vulnerable and should take steps to reduce their risk, such as getting
evaluation and treatment at the first sign of mental illness.
Does depression increase the risk for suicide?
Although the majority of people who have depression do not die by suicide, having major
depression does increase suicide risk compared to people without depression. The risk of
death by suicide may, in part, be related to the severity of the depression. New data on
depression that has followed people over long periods of time suggests that about 2 percent
of those people ever treated for depression in an outpatient setting will die by suicide.
Among those ever treated for depression in an inpatient hospital setting, the rate of death by
suicide is twice as high (4 percent). Those treated for depression as inpatients following
suicide ideation or suicide attempts are about three times as likely to die by suicide (6
percent) as those who were only treated as outpatients. There are also dramatic gender
differences in lifetime risk of suicide in depression. Whereas about 7 percent of men with a
lifetime history of depression will die by suicide, only 1 percent of women with a lifetime
history of depression will die by suicide.
Another way about thinking of suicide risk and depression is to examine the lives of people
who have died by suicide and see what proportion of them were depressed. From that
perspective, it is estimated that about 60 percent of people who commit suicide have had a
mood disorder (e.g., major depression, bipolar disorder, dysthymia). Younger persons who
kill themselves often have a substance abuse disorder in addition to being depressed.
Does alcohol and other drug abuse increase the risk for suicide?
A number of recent national surveys have helped shed light on the relationship between
alcohol and other drug use and suicidal behavior. A review of minimum-age drinking laws
and suicides among youths age 18 to 20 found that lower minimum-age drinking laws was
associated with higher youth suicide rates. In a large study following adults who drink
alcohol, suicide ideation was reported among persons with depression. In another survey,
persons who reported that they had made a suicide attempt during their lifetime were more
likely to have had a depressive disorder, and many also had an alcohol and/or substance
abuse disorder. In a study of all nontraffic injury deaths associated with alcohol
intoxication, over 20 percent were suicides.
In studies that examine risk factors among people who have completed suicide, substance
use and abuse occurs more frequently among youth and adults, compared to older persons.
For particular groups at risk, such as American Indians and Alaskan Natives, depression
and alcohol use and abuse are the most common risk factors for completed suicide. Alcohol
and substance abuse problems contribute to suicidal behavior in several ways. Persons who
are dependent on substances often have a number of other risk factors for suicide. In
addition to being depressed, they are also likely to have social and financial problems.
Substance use and abuse can be common among persons prone to be impulsive, and among
persons who engage in many types of high risk behaviors that result in self-harm.
Fortunately, there are a number of effective prevention efforts that reduce risk for
substance abuse in youth, and there are effective treatments for alcohol and substance use
problems. Researchers are currently testing treatments specifically for persons with
substance abuse problems who are also suicidal, or have attempted suicide in the past.
What does "suicide contagion" mean, and what can be done to prevent it?
Suicide contagion is the exposure to suicide or suicidal behaviors within one's family, one's
peer group, or through media reports of suicide and can result in an increase in suicide and
suicidal behaviors. Direct and indirect exposure to suicidal behavior has been shown to
precede an increase in suicidal behavior in persons at risk for suicide, especially in
adolescents and young adults.
The risk for suicide contagion as a result of media reporting can be minimized by factual
and concise media reports of suicide. Reports of suicide should not be repetitive, as
prolonged exposure can increase the likelihood of suicide contagion. Suicide is the result of
many complex factors; therefore media coverage should not report oversimplified
explanations such as recent negative life events or acute stressors. Reports should not
divulge detailed descriptions of the method used to avoid possible duplication. Reports
should not glorify the victim and should not imply that suicide was effective in achieving a
personal goal such as gaining media attention. In addition, information such as hotlines or
emergency contacts should be provided for those at risk for suicide.
Following exposure to suicide or suicidal behaviors within one's family or peer group,
suicide risk can be minimized by having family members, friends, peers, and colleagues of
the victim evaluated by a mental health professional. Persons deemed at risk for suicide
should then be referred for additional mental health services.
Is it possible to predict suicide?
At the current time there is no definitive measure to predict suicide or suicidal behavior.
Researchers have identified factors that place individuals at higher risk for suicide, but very
few persons with these risk factors will actually commit suicide. Risk factors include
mental illness, substance abuse, previous suicide attempts, family history of suicide, history
of being sexually abused, and impulsive or aggressive tendencies. Suicide is a relatively rare
event and it is therefore difficult to predict which persons with these risk factors will
ultimately commit suicide.
My thanks to the NIMH for allowing us the use of this information for the ongoing attempt
to educate others.
When you feel like giving up...
...Remember why you held on in the first place.