It is among the leading causes of death worldwide.
Approximately 1 million people die by suicide each year.
In the United States, over 42,000 suicides occur annually.
Some individuals engage in parasuicides, which are unsuccessful suicide attempts.
Suicide is not officially classified as a mental disorder in DSM-5.
Suicidal behavior disorder has been proposed for the next DSM revision.
Suicide has been recorded throughout history, involving figures like King Shaul, Ernest Hemingway, and Robin Williams.
What Is Suicide?
Suicide: A self-inflicted death in which one makes an intentional, direct, and conscious effort to end one’s life.
Intentional Death (Shneidman): Categorizes individuals based on their intent.
Death Seeker: Clearly intends to end their life.
Death Initiator: Intends to end their life because they believe the process of death is already underway.
Death Ignorer: Does not believe that their self-inflicted death will mean the end of their existence; believes they are trading their present lives for a happier existence.
Death Darer: Has ambivalent feelings about death and shows this in the act itself (e.g., Russian roulette).
Subintentional Death: Indirect, covert, partial, or unconscious self-destructive behavior.
Self-injury or self-mutilation, such as cutting, burning, or banging one’s head.
17% of teens engage in self-injurious behavior, particularly skin cutting, which is often connected to chronic feelings of emptiness.
How Suicide Is Studied:
Retrospective analysis (psychological autopsy): Examination of suicide through suicide notes or statements from people who knew the deceased.
Studying people who survive their suicide attempts: There are 12 nonfatal suicide attempts for every fatal suicide.
Internet and Suicide
Pro-Suicide Websites: These sites have tripled over the past seven years.
Some provide advice or information about how to die by suicide to 7.5% of teenagers.
Live-Streaming Suicides: Social networking efforts are being used to identify people at risk and provide aid and information.
Patterns and Statistics
Suicide rates vary by:
Country
Gender and marital status
Race and ethnicity
Social environment
Religious devoutness (not exclusively affiliation)
Underreporting of suicide may exist.
Triggers of Suicide
Common triggers and possibilities:
Stressful events: Loss of a loved one, divorce or rejection, loss of a job, financial loss, natural disasters.
Long-term stress: Social isolation, serious illness.
Mood and thought changes: Feelings of pessimism.
Dichotomous thinking: Viewing problems and solutions in rigid, black-and-white terms.
Alcohol and other drug use.
Mental disorders.
Modeling.
Stressful Events and Situations:
Immediate Stressors: Loss of loved one, job loss, financial loss, natural disasters.
Long-Term Stressors: Social isolation, serious illness, abusive environments, occupational stress.
Mood and Thought Changes:
Changes in mood and shifts in thinking patterns often precede suicide attempts.
Competition for jobs, college positions, academic and athletic honors.
Weakening family ties.
Availability of alcohol/drugs.
Mass media.
U.S. teen suicide rates vary by ethnicity.
Young white Americans are more suicide-prone than African Americans or Hispanic Americans at this age.
Highest suicide rates are displayed by American Indians.
Incidence rates are closing among all groups.
The Elderly:
U.S. elderly are most likely to commit suicide and are most successful.
Contributory factors:
Illness.
Loss of close friends and relatives.
Loss of control over one's life.
Loss of social status.
Ethnicity.
Treatment and Suicide
Treatments After Suicide Attempts:
Medical care.
Appropriate follow-up with psychotherapy or drug therapy.
Therapies: Psychodynamic therapy, drug therapy, group and family therapies, cognitive-behavioral therapy (Beck), mindfulness-based, dialectical behavior therapy.
Therapy Goals:
Keep the patient alive.
Reduce psychological pain.
Achievement of a nonsuicidal state of mind and a sense of hope.
Development of better ways of stress management.
Suicide Prevention:
Prevention programs and crisis hotlines.
Staffed by professionals or paraprofessionals.
Offered through various modalities.
Suicide Prevention Goals for Initial Contact:
Establishing a positive relationship.
Understanding and clarifying the problem.
Assessing suicide potential.
Assessing and mobilizing the caller's resources.
Formulating a plan.
Longer-term prevention: Referral, therapy, reduction of access to common suicide means.
Do Suicide Prevention Programs Work?:
Assessment of program effectiveness is difficult.
Variety of program types, variables, and confounds.
Mixed results.
Accurate suicide risk assessment is elusive.
Newer assessment approaches: Nonverbal behaviors, psychophysiological measures, brain scans, Self-Injury Implicit Association Test (Nock).
Psychological and Biological Insights Lag Behind:
Suicide has received much more examination from the sociocultural model than from any other.
Sociocultural factors shed light on the general background and triggers of suicide but typically leave us unable to predict that a given person will attempt suicide.
Clinicians do not yet fully understand why some people kill themselves while others in similar circumstances manage to find better ways of addressing their problems.