Epidemiology of suicide

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Psychology and suicide
Psychological research and suicide
Suicide
Epidemiology of suicide
Causes of suicide
Suicide methods
Parasuicide
Suicide and adolesence
Suicide and the elderly
Suicide and depression
Suicide and anxiety
Suicide and personality disorder
Suicide and psychosis
Suicide and substance abuse
Psychological care and suicide
Assessment of suicide risk
Predicting suicide
Managing suicide risk
Suicide prevention
Crisis hotline
Crisis hotlines by country
Medical care and suicide
Medical views of suicide
Suicide risk and antidepressants
Suicide watch

It is probable that the incidence of suicide is widely under-reported due to both religious and social pressures, and possibly completely unreported in some areas. Nevertheless, from the known suicides, certain trends are apparent. However, since the data is skewed, attempts to compare suicide rates between nations is statistically unwise. The trends themselves are not the cause, but may be indicative of a root cause.

Epidemiology

Rate of suicide in the United States.

A recent report by the World Health Organisation (WHO) states that nearly a million people take their own lives every year, more than those murdered or killed in war. WHO figures show a suicide takes place somewhere in the world every 40 seconds. The numbers are highest in Europe's Baltic states, where around 40 people per 100,000 die by suicide each year, second in line is in the Sub-Saharan Africa where 32 people per 100,000 die by suicide each year. The lowest numbers are seen in Malta, a devout Catholic island state in the Mediterranean Sea, where some years the rate is zero.

Gender and suicide

U.S. Suicide Rates by Age, Gender, and Racial Group.

In the United States, males are four times more likely to die by suicide than females. Male suicide rates are higher than females in all age groups (the ratio varies from 3:1 to 10:1). In other western countries, males are also much more likely to die by suicide than females (usually by a factor of 3–4:1). It was the 8th leading cause of death for males, and 19th leading cause of death for females.

Excess male mortality from suicide is also evident from data from non-Western countries. In 1979-81, out of 74 countries with a non-zero suicide rate, two reported equal rates for the sexes (Seychelles and Kenya), three reported female rates exceeding male rates (Papua-New Guinea, Macao, and French Guiana), while the remaining 69 countries had male suicide rates greater than female suicide rates.

While there are more completed male suicides than female, females are more likely to attempt suicide. One possible explanation of this statistical phenomenon, supported by a study by Rich, Ricketts, Fowler, and Young, is that males tend to use more "violent, immediately lethal methods of suicide" than females. Another explanation is that females are more likely to use self-harm as a cry for help or an extreme grab for attention, while suicidal males would be more likely to genuinely want to end their lives^{[How to reference and link to summary or text]}.

Main article: Suicide and gender

Race and suicide

Suicide rates for females 15 years or older.

By race, in the United States, non-Hispanic whites are nearly 2.5 times more likely to kill themselves than are blacks or Hispanics. There is a marked divergence by age as seen in the chart below. Suicide rates for younger blacks and whites are approximately equal, but older whites, elderly white men especially, commit suicide far more often than older blacks. However Native Americans, people of mixed race, and Filipino Americans are the three high risk groups of suicide in the United States than any ethnic group.

Template:Main Suicide and Race

Age and suicide

Children of either sex are 10–20 times less likely to die by suicide, and teenagers 1.5–2 times less likely than adults of the same sex.

Main article: suicide and adolesence

The incidence of suicide among males over 75 years old is roughly twice that of other adult males.

Main article: Suicide and the elderly

Social factors and suicide

Higher levels of social and national cohesion reduce suicide rates. Suicide levels are highest among the retired, unemployed, impoverished, divorced, the childless, urbanites, empty nesters, and other people who live alone. Suicide rates also rise during times of economic uncertainty (although poverty is not a direct cause, it can contribute to the risk of suicide). Epidemiological studies generally show a relationship between suicide or suicidal behaviors and socio-economic disadvantage, including limited educational achievement, homelessness, unemployment, economic dependence and contact with the police or justice system War is always associated with a steep fall in suicides; for example, during World War I and World War II the rate fell markedly, even in neutral countries^{[How to reference and link to summary or text]}.

Suicide trends

Certain time trends can be related to the type of death. In the United Kingdom, for example, the steady rise in suicides from 1945 to 1965 was curtailed following the removal of carbon monoxide from domestic gas supplies which occurred with the change from coal gas to natural gas. Methods vary across cultures, and the easy availability of lethal agents and materials plays a role.

It is estimated that global annual suicide fatalities could rise to 1.5 million by 2020. Worldwide, suicide ranks among the three leading causes of death among those aged 15-44 years. Suicide attempts are up to 20 times more frequent than completed suicides.

In 1998, the World Health Organization ranked suicide as the twelfth leading cause of death worldwide and eighth for the United States. The highest rates of suicide in the world are found in Eastern European countries. The lowest rates are found mainly in Latin America and a few countries in Asia.

Worldwide, the incidence of suicides is higher than the incidence of intentional homicides, except in Latin America and among certain minority groups such as African-Americans.

According to the National Institute of Mental Health, suicide contagion is a serious problem, especially for young people. Suicide can be facilitated in vulnerable teens by exposure to real or fictional accounts of suicide, including media coverage of suicide, such as intensive reporting of the suicide of a celebrity or idol.

High-risk groups

Several groups have a greater than average incidence of suicide. These high-risk groups usually are indicative of a larger problem leading to their decision.

These groups include:

• Males 65 and older. See: Suicide and the elderly
• People who have lost a spouse, especially empty-nesters. See Suicide and bereavement
• People in poor health, especially those with chronic pain and/or with a terminal illness.See Suicide and physical illness
• Males who have recently divorced. See Suicide and divorce
• Ethnic minorities
• Criminals on the run.
• Victims of spousal abuse.
• People who live in metropolitan areas.
• POWs, refugees, and internally displaced persons.
• People who live in poverty; people who are homeless.
• Closeted homosexuals and bisexuals.
• Transsexuals, especially male-to-females.
• Youth aged 15-24 are, as a whole, not a high-risk group. See Suicide and adolesence However, some of them are:
  • Gay and lesbian youth.
  • Native American youth.
  • Alaska Native youth.
  • Incarcerated youth.
  • Youth with access to firearms.
  • Youth engaging in high-risk sexual or drug related behavior.
  • Low income youth.
• People who suffer from mental illness,
  • bipolar disorder, major depression, See Suicide and depression
  • borderline personality disorder, See Suicide and personality disorder
  • schizophrenia. See Suicide and psychosis
• People who are disabled, such as blind, deaf, and/or paralyzed; those who were born with such disabilites are at high-risk.
• People who have previously attempted suicide.
• Victims of childhood sexual abuse or rape.
• People with no one to depend on emotionally (no friends or parents to talk to).

Possible warning signs

The warning signs listed are not necessarily risk factors for suicide and may include common behaviors among distressed persons. Many people experience occasional mood swings and behavior changes that may not be due to depressive or suicidal thoughts.

• Giving away prized possessions
• Abrupt and extreme changes in eating and sleeping habits
• Loss of interests in activities normally enjoyed
• Negative comments about oneself
• Talking about attempting suicide
• Self harm
• Extreme lack of concern for personal safety
• Extreme interest in suicide.
• Preoccupation with death or tragedy.

See also

• Epidemiology of adolescent suicide
• List of countries by suicide rate
• Official suicide statistics: Constraints and limitations
• Seasonal effects on suicide rates

Key texts

Papers

• Eddleston M. Patterns and problems of deliberate self-poisoning in the developing world. QJM 2000;93:715–731.
• Eddleston M, Sheriff MH, Hawton K. Deliberate self harm and attempted suicide in Sri Lanka: an overlooked tragedy in the developing world. BMJ 1998;317:133–135.
• Kerkhof AJFM. Attempted suicide: trends and patterns. In: Hawton K, van Heeringen K, eds. International handbook of suicide and attempted suicide. Chichester: Wiley, 2000:49–64.
• Kochanek KD, Murphy SL, Anderson, RN, Scott, C. Deaths: final data for 2002. National Vital Statistics Reports; 53(5). Hyattsville, MD: National Center for Health Statistics, 2004.
• Moscicki EK. Epidemiology of suicide. In: Jacobs D, ed. The Harvard Medical School Guide to Suicide Assessment and Intervention. San Francisco, CA: Jossey Bass, 1999; 40 71.
• Moscicki EK. Epidemiology of completed and attempted suicide: toward a framework for prevention. Clinical Neuroscience Research, 2001; 1: 310 23.
• Schmidtke A, Bille-Brahe U, DeLeo D, et al. Attempted suicide Europe: rates, trends and sociodemographic characteristics of suicide attempters during the period 1989–1992. Results of the WHO/EURO Multicentre Study on Parasuicide. Acta Psychiatr Scand 1996;93:327–338.
• The University of York. NHS Centre for Reviews and Dissemination. 1998. Deliberate self harm and attempted suicide. Effective Health Care 4:1–12.
• Weissman MM, Bland RC, Canino GJ, et al. Prevalence of suicide ideation and suicide attempts in nine countries. Psychol Med 1999;29:9–17.

Additional material

Papers

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