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).
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