|Suicide is a difficult subject. The word “suicide” congers up images of death, defeat, weakness, failure, shame, and too many other bitter images. Most people are uncomfortable speaking about suicide, most people feeling suicidal do not admit it publicly, and most people who have survived the suicide death of a loved one grieve in silence. A profound public stigma surrounds the topic of suicide. Because of the negative connotations and silence surrounding suicide, what we know about suicide too often gets obscured by popular myths and misconceptions. In order to dispel some of the misunderstandings about suicide and to encourage conversations about the facts of suicide, this article will review some of the research and findings about suicide and suicidal behavior, with a focus on the role guns play in suicides in America.
In 2010, 38,364 Americans intentionally took their own lives; for the country as a whole, there were 12.1 suicides per 100,000 persons. Compared to the suicide rate in other countries, the USA ranks about 30th in the world (suicide rate is the number of suicides per unit population – this allows the comparison of suicides across groups of different sizes): the countries with the highest suicide rates are Greenland, South Korea, and Lithuania (with suicide rates of 108 suicides / 100,000 population, 31.7 / 100,000, and 31.0 / 100,000, respectively) Of the 38,000 suicides that occurred in the USA in 2010, 78.9% were completed by men, and 21.1% were completed by women (a “completed suicide” is a suicidal act that results in death), Typically, the suicide rate for men in America is 4 times higher than the suicide rate for women; in 2010 the suicide rate for all men was 19.9 / 100,000, and the suicide rate for all women was 5.2 / 100,000 (data from the Centers for Disease Control (CDC).
In America, the suicide rate varies by age group, with older adults completing more suicides than younger people. In 2010, the suicide rate for persons age 45-64 was 18.6 suicides per 100,000 population, for persons 85 years and older the suicide rate is 17.6 / 100,000. The suicide rate for persons below the age of 45 was just about 15 / 100,000, while the suicide rate for persons younger than 24 years is 10.5 / 100,000. Suicide rates also vary by race and ethnicity: in 2010, the highest suicide rate was among whites (approx. 14 suicides per 100,000 population), the next highest rate was among American Indians (approx. 11 / 100,000), and suicide rates for Blacks, Hispanics, and Asian/Pacific Islanders were all below 6.0 / 100,000 (data from the CDC).
So in America, the people who kill themselves are most commonly older white men.
In 2010, some 478,000 people sought care at hospitals for intentionally self-inflicted injuries. This number gives us some idea of the number of attempted suicidal acts, but it cannot be taken as an accurate count of attempted suicides (a suicide attempt is an act intended to be lethal that does not kill), because not everyone who intentionally hurts themselves intends for those injuries to be lethal, and some people who make a suicide attempt but do not die do not then seek treatment at a hospital and keep their actions and injuries a secret. A study of eight US states in 2000 reported an estimated rate of attempted suicides to be 119 attempts / 100,000 population (Spicer RS, 2000). The CDC estimates that there are 25 attempted suicides for every one completed suicide in America. In a study of American adults (aged ≥ 18 yrs.), 8.3 million adults (3.7% of the US adult population) admitted to thinking about killing themselves in the previous year; 2.2 million adults (1.0% of the US adult population) admitted to making suicidal plans in the previous year; and 1.0 million adults (0.5% of the US adult population) attempted suicide in the previous year. In a study of a nationally-representative sample of high-school students, 12.8% of students admitted making a suicide plan in the previous year; and 7.8% of students admitted attempting suicide at least once in the previous year (Crosby AD Suicidal thoughts and behaviors among adults aged > 18 years – United States, 2008-2009. MMWR Surveillance Summary, 2001; 60(13)).
According to a 2011 CDC study, 1.4 million women and 1.04 million men made suicide plans during the study period (2008-2009), and approximately 600,000 women and 400,000 men made suicide attempts during the study period (Crosby AD Suicidal thoughts and behaviors among adults aged > 18 years – United States, 2008-2009. MMWR Surveillance Summary, 2001; 60(13)). So while more men than women kill themselves in the USA, women make more suicide attempts than do men.
The causes of suicide are varied and complex. Psychiatric illness and drug and alcohol problems play a major role in suicidal behavior. In an autopsy study of people who had completed suicide, fully 33% had elevated levels of alcohol in their blood, 23% tested positive for antidepressant medications, and 20% tested positive for opiates (data from the World Health Organization (WHO): Preventing Suiicde: A Resource for Primary Healthcare Workers). Many people who attempt suicide report experiencing stressful life events, such as loss of a loved one, recent unemployment, or a financial reversal. Medical science has identified risk factors for a suicide attempt (a risk factor is an event or setting the has been shown to increase the risk or probability of a disorder) – these include psychiatric illness, old age, alcoholism or substance dependency, a prior history of a suicide attempt, violence in the household, access to firearms, and in children, physical or sexual abuse.(Cheng AT, 2000; Conwell Y, 2002; Beautrais AL, 2002)
Treatment for suicidal ideation (suicidal ideation is repeatedly thinking about killing oneself) and suicidal behavior may consist of psychotropic medications and/or psychotherapy. For people who pose a high risk for suicide, hospitalization helps to secure the individual in a safe environment - free of common dangers and where they can be closely watched. Treatment for suicidal ideation and suicidal behavior has been shown in controlled clinical trials to reduce suicidal attempts (Brown GK, 2005; Hawton K, 1998). Educating physicians and care-givers to recognize and treat depression and other psychiatric conditions is an important strategy to prevent and reduce the incidence of death from suicide (Mann JJ, 2005)
Treatment for suicide works. Nine out of ten people who survive a suicide attempt will NOT go on to die by suicide at a later date. In a meta-analysis of over 90 studies, only 7% of people who made a suicide attempt that resulted in medical care eventually died by suicide, 23% tried again to kill themselves but did not succeed, and over 70% did not try suicide again (Owens D, Horrocks J, and House A. Fatal and non-fatal repetition of self-harm: systematic review. British Journal of Psychiatry. 2002;181:193-199).
|Is suicide on your mind? Would you like to talk to someone about suicide? The National Suicide Prevention Lifeline (1-800-273-TALK)(1-800-273-8255) is open 7 days a week, around the clock. If you are thinking about suicide, or wondering how you can help a friend, or grieving a suicide death of a loved one, the Lifeline is available to you, free of charge.
|With this information as background, we can address some of the more common and pervasive confusions and /or myths about guns and suicide with some facts.
Most gun deaths in America are suicide deaths.
The risk of dying from a suicide attempt is greatest when a gun is used
Table 1: Frequency and relative lethality of different suicide methodsFrom the table we can see that the vast majority of suicide attempts (in America) are not fatal, and that the most common methods for attempting suicide are Poisonings/Overdoses and Cutting/Stabbing. However, the most lethal suicide method is firearms, which results in death 85% of the time.
In suicide, the method one chooses has a lot to do with whether one lives or dies. In a study of suicide attempts occurring in Illinois from 1990 to 1997, persons who used a gun to attempt suicide were 2.6 times more likely to die than persons attempting suicide by suffocation or hangings (the second-most lethal suicide method) (Shenassa ED, 2003).
Suicide is more likely to occur when a gun is available
Two western, industrialized, multicultural countries – similar to the USA – placed severe limitations on the availability of guns among the general population, providing researchers an opportunity to see how the implementation of such laws might change the incidence of gun suicides. In 1996, Australia passed new gun control laws to outlaw shotguns and semi-automatic rifles, along with new licensing, registration, and storage requirements. In a study that examined rates of gun deaths before and after the passing of the gun control measures, there were statistically significant reductions in mass shootings, total firearm deaths, firearm suicides, and firearm homicides. (Chapman S, 2006). Another study reported a reduction in firearm suicides only (Baker J, 2007)
In 1977, Canada passed Bill C-51, increasing the regulations on acquiring guns and introduced controls on ammunition sales. An analysis of the suicide data showed decreases in the rate of gun suicides and the percentages of suicides using a gun after passage of the law (Lester D, 1993; Leenaars AA, 2003). A second piece of legislation – Bill C-17, passed in 1991 to restrict sales of some guns and adding new licensing requirements – has also been shown to have reduced both firearm suicides and homicides (Bridges FS, 2004).
Here in the USA, we know that restricting access to firearms reduces both suicide attempts and deaths from suicides by virtue of the routine admission of severely suicidal people to psychiatric facilities where guns are not available to the patients who are thinking of killing themselves.
|Some popular myths about suicide.
Myth 1: Suicidal people are absolutely intent on dying.
It is part of our biologically-inborn human nature to live and to go on living. Researchers had long ago identified ambivalence as a core feature of a suicidal crisis (a “suicidal crisis” is the name given for that period of time when a person is actively making plans to kill themselves) (Shneidman, E.S. A conspectus of the suicidal scenario. In R.W. Maris, A.L. Berman, J.T. Maltsberger, & R. I. Yufit (Eds.), Assessment and prediction of suicide (pp. 50-64). Guilford Press, New York.1992) (Cardell, R., & Horton-Deutsch, S. A model for assessment of inpatient suicide potential. Archives of Psychiatric Nursing. 1994; 8:366-372) (WHO). Most people who are thinking about killing themselves are highly ambivalent about this course of action, and spend as much time thinking about living as they do thinking about killing themselves. In this highly liable emotional state, the suicidal person is easily influenced. Insignificant events are given out-sized import (“if the phone doesn't ring in the next five minutes, that means I should kill myself.”). However, this ambivalence gives clinicians and care-givers opportunities to intervene and present alternatives to the suicidal act. This is one reason why the New York State Bridge Authority installed phones linking to the National Suicide Prevention Lifeline on bridges around New York City and across the Hudson River.
Myth 2: Suicide happens without warning.
Myth 3: Once a person is suicidal, they will then always be suicidal
Nine out of ten people who survive a suicide attempt will NOT go on to die by suicide at a later date. In a meta-analysis of over 90 studies, only 7% of people who made suicide attempts that resulted in medical care eventually died by suicide, 23% tried again to kill themselves but did not succeed, and over 70% never made repeat suicide attempts (Owens D, Horrocks J, and House A. Fatal and non-fatal repetition of self-harm: systematic review. British Journal of Psychiatry. 2002;181:193-199).
Myth 4: People have a right to choose to die
There are people who find themselves with a painful and terminal illness without hope of useful medical intervention, for whom suicide or voluntary euthanasia may be a rational choice. For such people, perhaps a good measure of that person's ability to think soundly and rationally about their desire to kill themselves is their willingness to talk openly about their thinking with a doctor and with their family members and loved one, and to include the concerns of their loved ones in their own plans.
Myth 5: You can't stop someone who wants to die; they will find a way to kill themselves
Myth 6: Suicide is painless.
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