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{{Short description|Intentional act of causing one’s own death}}{{pp|small=yes}}{{cs1 config|name-list-style=vanc}}{{For-multi|information on prevention|Suicide prevention|other uses|Suicide (disambiguation)}}{{Good article}}{{Use dmy dates|date=October 2022}}

factoids

| diagnosis = | differential = Mass media>media reporting about suicide, improving social and economic conditions| treatment = | medication = | prognosis = | frequency = 12 per 100,000 per year DATE=27 SEPTEMBER 2019 ARCHIVE-URL=HTTP://WEBARCHIVE.LOC.GOV/ALL/20040701084208/HTTP://WWW.WHO.INT/MENTAL_HEALTH/PREVENTION/SUICIDE/SUICIDEPREVENT/EN/ ARCHIVE-DATE=1 JULY 2004, 16 October 2019, | alt = }}{{Suicide sidebar}}File:988 Suicide & Crisis Lifeline logo - navy - square.svg|thumb|988 Suicide & Crisis Lifeline, a crisis linecrisis lineSuicide is the act of intentionally causing one’s own death.BOOK, Stedman’s Medical Dictionary,archive.org/details/stedmansmedicald00sted_3, registration, 2006, Lippincott Williams & Wilkins, Philadelphia, 978-0-7817-3390-8, 28th, Mental disorders (including depression, bipolar disorder, schizophrenia, personality disorders, anxiety disorders, attention deficit hyperactivity disorder, cognitive disengagement syndrome), physical disorders (such as chronic fatigue syndrome), and substance abuse (including alcoholism and the use of and withdrawal from benzodiazepines) are risk factors.JOURNAL, Hawton K, van Heeringen K, 208790312, Suicide, Lancet, 373, 9672, 1372–81, April 2009, 19376453, 10.1016/S0140-6736(09)60372-X, JOURNAL, Richa S, Fahed M, Khoury E, Mishara B, 25741716, Suicide in autism spectrum disorders, Archives of Suicide Research, 18, 4, 327–39, 2014, 24713024, 10.1080/13811118.2013.824834, JOURNAL, Dodds TJ, Prescribed Benzodiazepines and Suicide Risk: A Review of the Literature, The Primary Care Companion for CNS Disorders, 19, 2, March 2017, 28257172, 10.4088/PCC.16r02037, free, Some suicides are impulsive acts due to stress (such as from financial or academic difficulties), relationship problems (such as breakups or divorces), or harassment and bullying.JOURNAL, Bottino SM, Bottino CM, Regina CG, Correia AV, Ribeiro WS, Cyberbullying and adolescent mental health: systematic review, Cadernos de Saude Publica, 31, 3, 463–75, March 2015, 25859714, 10.1590/0102-311x00036114, free, WEB, Suicide rates rising across the U.S.,www.cdc.gov/media/releases/2018/p0607-suicide-prevention.html, CDC Online Newsroom, 19 September 2019, en-us, 11 April 2019, Relationship problems or loss, substance misuse; physical health problems; and job, money, legal or housing stress often contributed to risk for suicide., Those who have previously attempted suicide are at a higher risk for future attempts. Effective suicide prevention efforts include limiting access to methods of suicide such as firearms, drugs, and poisons; treating mental disorders and substance abuse; careful media reporting about suicide; improving economic conditions;WEB, Suicide Fact sheet N°398,www.who.int/mediacentre/factsheets/fs398/en/, WHO, 3 March 2016, April 2016, live,www.who.int/mediacentre/factsheets/fs398/en/," title="web.archive.org/web/20160304192347www.who.int/mediacentre/factsheets/fs398/en/,">web.archive.org/web/20160304192347www.who.int/mediacentre/factsheets/fs398/en/, 4 March 2016, BOOK,www.who.int/mental_health/prevention/suicide/resource_media.pdf, Preventing Suicide A Resource for Media Professionals, 2008, World Health Organization. Department of Mental Health and Substance Abuse, 978-92-4-159707-4, and dialectical behaviour therapy (DBT).JOURNAL, DeCou CR, Comtois KA, Landes SJ, Dialectical Behavior Therapy Is Effective for the Treatment of Suicidal Behavior: A Meta-Analysis, Behav Ther, 50, 1, 60–72, January 2019, 30661567, 10.1016/j.beth.2018.03.009, 58666001, Although crisis hotlines are common resources, their effectiveness has not been well studied.JOURNAL, Sakinofsky I, The current evidence base for the clinical care of suicidal patients: strengths and weaknesses, Canadian Journal of Psychiatry, 52, 6 Suppl 1, 7S–20S, June 2007, 17824349, Other suicide prevention strategies that have been considered are crisis centres and hotlines, method control, and media education... There is minimal research on these strategies. Even though crisis centres and hotlines are used by suicidal youth, information about their impact on suicidal behaviour is lacking., JOURNAL, Zalsman G, Hawton K, Wasserman D, van Heeringen K, Arensman E, Sarchiapone M, Carli V, Höschl C, Barzilay R, Balazs J, Purebl G, Kahn JP, Sáiz PA, Lipsicas CB, Bobes J, Cozman D, Hegerl U, Zohar J, 6, Suicide prevention strategies revisited: 10-year systematic review, The Lancet. Psychiatry, 3, 7, 646–59, July 2016, 27289303, 10.1016/S2215-0366(16)30030-X, Other approaches that need further investigation include gatekeeper training, education of physicians, and internet and helpline support., 1854/LU-8509936, free, The most commonly adopted method of suicide varies from country to country and is partly related to the availability of effective means.JOURNAL, Yip PS, Caine E, Yousuf S, Chang SS, Wu KC, Chen YY, Means restriction for suicide prevention, Lancet, 379, 9834, 2393–9, June 2012, 22726520, 6191653, 10.1016/S0140-6736(12)60521-2, Common methods of suicide include hanging, pesticide poisoning, and firearms.JOURNAL, Ajdacic-Gross V, Weiss MG, Ring M, Hepp U, Bopp M, Gutzwiller F, Rössler W, Methods of suicide: international suicide patterns derived from the WHO mortality database, Bulletin of the World Health Organization, 86, 9, 726–32, September 2008, 18797649, 2649482, 10.2471/BLT.07.043489, Suicides resulted in 828,000 deaths globally in 2015, an increase from 712,000 deaths in 1990.JOURNAL, Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, etal, GBD 2015 Mortality and Causes of Death Collaborators, Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015, Lancet, 388, 10053, 1459–1544, October 2016, 27733281, 5388903, 10.1016/S0140-6736(16)31012-1, . For the number 828,000, see Table 5, line “Self-harm”, second column (year 2015)JOURNAL, Naghavi M, Wang H, Lozano R, Davis A, Liang X, Zhou M, etal, GBD 2013 Mortality and Causes of Death Collaborators, Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013, Lancet, 385, 9963, 117–71, January 2015, 25530442, 4340604, 10.1016/S0140-6736(14)61682-2, . For the number 712,000, see Table 2, line “Self-harm”, first column (year 1990){{inconsistent|reason=misleading formulation, rate went down by a sixth, which contradicts Epidemiology: “Rates of suicide have increased by 60% from the 1960s to 2012“}} This makes suicide the 10th leading cause of death worldwide.JOURNAL, Värnik P, Suicide in the world, International Journal of Environmental Research and Public Health, 9, 3, 760–71, March 2012, 22690161, 3367275, 10.3390/ijerph9030760, free, Approximately 1.5% of all deaths worldwide are by suicide.JOURNAL, Fazel S, Runeson B, 210332277, Suicide, New England Journal of Medicine, January 2020, 382, 3, 266–74, 10.1056/NEJMra1902944, 31940700, 7116087, In a given year, this is roughly 12 per 100,000 people. Rates of suicide are generally higher among men than women, ranging from 1.5 times higher in the developing world to 3.5 times higher in the developed world. Suicide is generally most common among those over the age of 70; however, in certain countries, those aged between 15 and 30 are at the highest risk.BOOK, Preventing suicide: a global imperative, 2014, WHO, 978-92-4-156477-9, 7, 20, 40, Europe had the highest rates of suicide by region in 2015.WEB,www.who.int/gho/mental_health/suicide_rates_crude/en/, Suicide rates per (100 000 population), World Health Organization, There are an estimated 10 to 20 million non-fatal attempted suicides every year.JOURNAL, Bertolote JM, Fleischmann A, Suicide and psychiatric diagnosis: a worldwide perspective, World Psychiatry, 1, 3, 181–5, October 2002, 16946849, 1489848, Non-fatal suicide attempts may lead to injury and long-term disabilities. In the Western world, attempts are more common among young people and women.JOURNAL, Chang B, Gitlin D, Patel R, The depressed patient and suicidal patient in the emergency department: evidence-based management and treatment strategies, Emergency Medicine Practice, 13, 9, 1–23; quiz 23–4, September 2011, 22164363, Views on suicide have been influenced by broad existential themes such as religion, honor, and the meaning of life.BOOK, Tomer A, Existential and Spiritual Issues in Death Attitudes, 2013, Psychology Press, 978-1-136-67690-1, 282,books.google.com/books?id=hJTruwsicuoC&pg=PA282, BOOK, Ritzer G, Stepnisky J, The Wiley-Blackwell companion to major social theorists, 2011, Wiley-Blackwell, Malden, MA, 978-1-4443-9660-7, 65,books.google.com/books?id=MDwdmVUMIh8C&pg=PA65, The Abrahamic religions traditionally consider suicide as an offense towards God due to belief in the sanctity of life.BOOK, God, Religion, Science, Nature, Culture, and Morality, 2014, Archway Publishing, 978-1-4808-1124-9, 254,books.google.com/books?id=xGGVBQAAQBAJ&pg=PA254, During the samurai era in Japan, a form of suicide known as seppuku (, ) was respected as a means of making up for failure or as a form of protest.BOOK, Colt GH, The enigma of suicide, 1992, Simon & Schuster, New York, 978-0-671-76071-7, 139, 1st Touchstone,books.google.com/books?id=DOz3hStePfYC&pg=PA139, Similarly, a ritual fast unto death, known as Vatakkiruttal ({{indic|lang=ta|indic=வடக்கிருத்தல்|trans=Vaá¹­akkiruttal}}, ‘fasting facing north’), was a Tamil ritual suicide in ancient India during the Sangam age.WEB,www.cse.iitk.ac.in/users/amit/books/hart-2002-four-hundred-songs.html, Book excerptise: The Four Hundred Songs of War and Wisdom: An Anthology of Poems from Classical Tamil, the Purananuru by George L. (tr.) Hart and Hank Heifetz (tr.), Department of Computer Science and Engineering, IIT Kanpur, 26 February 2014, Kapilar for King Pari #107 — When Vel Pari is killed in battle, kapilar is supposed to have committed suicide by vadakirrutal - facing North and starving., Suicide and attempted suicide, while previously illegal, are no longer so in most Western countries.BOOK, White T, Working with suicidal individuals : a guide to providing understanding, assessment and support, 2010, Jessica Kingsley Publishers, London, 978-1-84905-115-6, 12,books.google.com/books?id=p_ZvK-DBYfIC&pg=PT12, It remains a criminal offense in some countries.JOURNAL, Lester D, 35754641, Suicide and islam, Archives of Suicide Research, 10, 1, 77–97, 2006, 16287698, 10.1080/13811110500318489, In the 20th and 21st centuries, suicide has been used on rare occasions as a form of protest; it may also be committed while or after murdering others, such as suicide attacks which have been used as both a military and terrorist tactic.JOURNAL, Aggarwal N, 35560934, Rethinking suicide bombing, Crisis, 30, 2, 94–7, 2009, 19525169, 10.1027/0227-5910.30.2.94, Suicide is often seen as a major catastrophe causing significant grief to the deceased’s relatives, friends and community members, and it is viewed negatively almost everywhere around the world.JOURNAL, Russell N, The Taboo of Suicide, Psychiatry, 31, 2, 173–183, May 1968, 27780435, 10.1080/00332747.1968.11023545, NEWS, Vaughan M, The ‘discovery’ of suicide in Africa,www.bbc.co.uk/programmes/articles/5PPwm7sf3xy78q7lz4tdpWC/the-discovery-of-suicide-in-africa, BBC, 16 June 2020, en-GB, WEB, Suicide,www.who.int/news-room/fact-sheets/detail/suicide, World Health Organization, 16 June 2020, en, {{TOC limit}}

Definitions

Suicide, derived from Latin , is “the act of taking one’s own life”.BOOK, Issues in Law & Medicine, Volume 3, 1987, National Legal Center for the Medically Dependent & Disabled, Incorporated, and the Horatio R. Storer Foundation, Incorporated, 39,books.google.com/books?id=g1cqAAAAMAAJ&q=Latin+suicidium%27+%22to+kill+oneself%22., Attempted suicide or non-fatal suicidal behavior amounts to self-injury with at least some desire to end one’s life that does not result in death.BOOK, Krug E, World Report on Violence and Health, 1, 2002, World Health Organization, Genève, 978-92-4-154561-7, 185,archive.org/details/worldreportonvio2002unse/page/185, JOURNAL, Turecki G, Brent DA, March 2016, Suicide and suicidal behaviour, Lancet, 387, 10024, 1227–39, 10.1016/S0140-6736(15)00234-2, 5319859, 26385066, Assisted suicide occurs when one individual helps another bring about their own death indirectly via providing either advice or the means to the end.BOOK, Gullota TP, Bloom M, Encyclopedia of Primary Prevention and Health Promotion, 2002, Kluwer Academic/Plenum, New York, 978-0-306-47296-1, 1112,books.google.com/books?id=Elx37xzO0bsC&pg=PA1112, This is in contrast to euthanasia, where another person takes a more active role in bringing about a person’s death.Suicidal ideation is thoughts of ending one’s life but not taking any active efforts to do so. It may or may not involve exact planning or intent. Suicidality is defined as “the risk of suicide, usually indicated by suicidal ideation or intent, especially as evident in the presence of a well-elaborated suicidal plan.“APA DICTIONARY, suicidality, suicidality, 2023-08-03, In a murder–suicide (or homicide–suicide), the individual aims at taking the lives of others at the same time. A special case of this is extended suicide, where the murder is motivated by seeing the murdered persons as an extension of their self.BOOK, Lester D, Wasserman D, Wasserman C, Oxford textbook of suicidology, 134–36, 2009, Oxford University Press, Oxford, 978-0-19-857005-9, Extended suicide, 10.1093/med/9780198570059.003.0022, Suicide in which the reason is that the person feels that they are not part of society is known as egoistic suicide.BOOK,books.google.com/books?id=6PGzHFuS1xkC&pg=PA144, Seminars in general adult psychiatry, Stein G, Wilkinson G, 2007, Gaskell, 978-1-904671-44-2, 2nd, London, 144, In 2011, in an article calling for changing the language used around suicide entitled “Suicide and language: Why we shouldn’t use the ‘C’ word,” the Centre for Suicide Prevention in Canada found that the normal verb in scholarly research and journalism for the act of suicide was commit, and argued for destigmatizing terminology related to suicide.JOURNAL, Olson R, Suicide and Language, Centre for Suicide Prevention, 2011, InfoExchange, 3, 4,suicideinfo.ca/LinkClick.aspx?fileticket=sNKET0k90VY%3d&tabid=554, 15 May 2013, live,suicideinfo.ca/LinkClick.aspx?fileticket=sNKET0k90VY%3D&tabid=554," title="web.archive.org/web/20120506202903suicideinfo.ca/LinkClick.aspx?fileticket=sNKET0k90VY%3D&tabid=554,">web.archive.org/web/20120506202903suicideinfo.ca/LinkClick.aspx?fileticket=sNKET0k90VY%3D&tabid=554, 6 May 2012, JOURNAL, Beaton S, Forster P, Maple M, Suicide and Language: Why we Shouldn’t Use the ‘C’ Word, In Psych, February 2013, 35, 1, 30–31,www.psychology.org.au/Content.aspx?ID=5048, live,www.psychology.org.au/Content.aspx?ID=5048," title="web.archive.org/web/20140815173633www.psychology.org.au/Content.aspx?ID=5048,">web.archive.org/web/20140815173633www.psychology.org.au/Content.aspx?ID=5048, 15 August 2014, The American Psychological Association lists “committed suicide” as a term to avoid because it “frame[s] suicide as a crime”.BOOK,www.apa.org/about/apa/equity-diversity-inclusion/language-guidelines.pdf, 13 February 2022, Inclusive Language Guidelines, American Psychological Association, Washington, D.C., 19, Some advocacy groups recommend using the terms took his/her own life, died by suicide, or killed him/herself instead of committed suicide.BOOK, Beck AT, Resnik HL, Lettieri DJ, The prediction of suicide, Bowie, MD, Charles Press, 1974, 41, Development of suicidal intent scales, 978-0-913486-13-9, WEB, Recommendations for Reporting on Suicide,www.nimh.nih.gov/health/topics/suicide-prevention/save_310_guide_v6.pdf, National Institute of Mental Health, 15 May 2013, 2001, dead,www.nimh.nih.gov/health/topics/suicide-prevention/save_310_guide_v6.pdf," title="web.archive.org/web/20130427114237www.nimh.nih.gov/health/topics/suicide-prevention/save_310_guide_v6.pdf,">web.archive.org/web/20130427114237www.nimh.nih.gov/health/topics/suicide-prevention/save_310_guide_v6.pdf, 27 April 2013, WEB, Reporting Suicide and Self Harm,www.time-to-change.org.uk/node/75408, Time To Change, 2 January 2016, 2008, live,www.time-to-change.org.uk/node/75408," title="web.archive.org/web/20160114191733www.time-to-change.org.uk/node/75408,">web.archive.org/web/20160114191733www.time-to-change.org.uk/node/75408, 14 January 2016, The Associated Press Stylebook recommends avoiding “committed suicide” except in direct quotes from authorities.TWEET, apstylebook, 865283308476928002, 18 May 2017, Avoid “committed suicide” except in direct quotes from authorities. Alternatives: “killed himself,” “took her own life,” “died by suicide.”, The Guardian and Observer style guides deprecate the use of “committed”,NEWS, Guardian and Observer style guide: S,www.theguardian.com/guardian-observer-style-guide-s, The Guardian, 4 May 2021, en, as does CNN.NEWS, Ravitz J, The words to say -- and not to say -- about suicide,edition.cnn.com/2018/06/09/health/suicide-language-words-matter/index.html, CNN, 11 June 2018, Opponents of commit argue that it implies that suicide is criminal, sinful, or morally wrong.WEB, Ball PB, The Power of words,www.suicideprevention.ca/about-suicide/the-power-of-words/, Canadian Association of Suicide Prevention, 16 May 2013, 2005, dead,www.suicideprevention.ca/about-suicide/the-power-of-words/," title="web.archive.org/web/20130513011216www.suicideprevention.ca/about-suicide/the-power-of-words/,">web.archive.org/web/20130513011216www.suicideprevention.ca/about-suicide/the-power-of-words/, 13 May 2013,

Pathophysiology

There is no known unifying underlying pathophysiology for suicide; it is believed to result from an interplay of behavioral, socio-economic and psychological factors.Low levels of brain-derived neurotrophic factor (BDNF) are both directly associated with suicideJOURNAL, Pjevac M, Pregelj P, Neurobiology of suicidal behaviour, Psychiatria Danubina, 24, Suppl 3, S336-41, October 2012, 23114813, and indirectly associated through its role in major depression, post-traumatic stress disorder, schizophrenia and obsessive–compulsive disorder.JOURNAL, Sher L, 25684743, The role of brain-derived neurotrophic factor in the pathophysiology of adolescent suicidal behavior, International Journal of Adolescent Medicine and Health, 23, 3, 181–5, 2011, 22191181, 10.1515/ijamh.2011.041, Post-mortem studies have found reduced levels of BDNF in the hippocampus and prefrontal cortex, in those with and without psychiatric conditions.JOURNAL, Sher L, Brain-derived neurotrophic factor and suicidal behavior, QJM, 104, 5, 455–8, May 2011, 21051476, 10.1093/qjmed/hcq207, free, Serotonin, a brain neurotransmitter, is believed to be low in those who die by suicide.BOOK, Yanowitch R, Coccaro EF, Aggression, The neurochemistry of human aggression, Advances in Genetics, 75, 151–69, 2011, 22078480, 10.1016/b978-0-12-380858-5.00005-8, Elsevier, 9780123808585, This is partly based on evidence of increased levels of 5-HT2A receptors found after death.BOOK, Dwivedi Y, The neurobiological basis of suicide, 2012, Taylor & Francis/CRC Press, Boca Raton, FL, 978-1-4398-3881-5, 166,books.google.com/books?id=5hcOf_SM-U0C&pg=PA166, Other evidence includes reduced levels of a breakdown product of serotonin, 5-hydroxyindoleacetic acid, in the cerebral spinal fluid.BOOK, Stein G, Wilkinson G, Seminars in general adult psychiatry, 2007, Gaskell, London, 978-1-904671-44-2, 145,books.google.com/books?id=6PGzHFuS1xkC&pg=PA145, 2nd, However, direct evidence is hard to obtain. Epigenetics, the study of changes in genetic expression in response to environmental factors which do not alter the underlying DNA, is also believed to play a role in determining suicide risk.JOURNAL, Autry AE, Monteggia LM, Epigenetics in suicide and depression, Biological Psychiatry, 66, 9, 812–3, November 2009, 19833253, 2770810, 10.1016/j.biopsych.2009.08.033,

Risk factors

{{Bar box|title=Precipitating circumstances in the US, 2017JOURNAL, Petrosky E, Ertl A, Sheats KJ, Wilson R, Betz CJ, Blair JM, Surveillance for Violent Deaths - National Violent Death Reporting System, 34 States, Four California Counties, the District of Columbia, and Puerto Rico, 2017, MMWR. Surveillance Summaries, 69, 8, 1–37, December 2020, 33270620, 7713989, 10.15585/mmwr.ss6908a1, |titlebar=#DDD|left1=Categories|right2=Percentage|width=500px|bars={{bar percent|Diagnosed mental problem|green|50}}{{bar percent|Recent or upcoming crisis|yellow|31}}{{bar percent|Intimate partner problem|teal|27}}{{bar percent|Physical health problem|lightblue|21}}{{bar percent|Alcohol problem|red|18}}{{bar percent|Substance abuse (excluding alcohol)|purple|18}}{{bar percent|Argument|orange|16}}{{bar percent|Family problem|blue|10}}{{bar percent|Job problem|gold|10}}{{bar percent|Financial problem|gray|9}}{{bar percent|Legal problem|fuchsia|8}}{{bar percent|Death of loved one|black|7}}barwidth=180px|float=right}}Factors that affect the risk of suicide include mental disorders, drug misuse, psychological states, cultural, family and social situations, genetics, experiences of trauma or loss, and nihilism.WEB, Suicide Risk and Protective Factors{{!, Suicide{{!}}Violence Prevention{{!}}Injury Center{{!}}CDC |url=https://www.cdc.gov/violenceprevention/suicide/riskprotectivefactors.html |website=www.cdc.gov |access-date=29 July 2019 |language=en-us |date=25 April 2019}} Mental disorders and substance misuse frequently co-exist. Other risk factors include having previously attempted suicide, the ready availability of a means to take one’s life, a family history of suicide, or the presence of traumatic brain injury.JOURNAL, Simpson G, Tate R, 24562104, Suicidality in people surviving a traumatic brain injury: prevalence, risk factors and implications for clinical management, Brain Injury, 21, 13–14, 1335–51, December 2007, 18066936, 10.1080/02699050701785542, For example, suicide rates have been found to be greater in households with firearms than those without them.JOURNAL, Miller M, Azrael D, Barber C, Suicide mortality in the United States: the importance of attending to method in understanding population-level disparities in the burden of suicide, Annual Review of Public Health, 33, 393–408, April 2012, 22224886, 10.1146/annurev-publhealth-031811-124636, free, Socio-economic problems such as unemployment, poverty, homelessness, and discrimination may trigger suicidal thoughts.JOURNAL, Qin P, Agerbo E, Mortensen PB, 25133734, Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial factors: a national register-based study of all suicides in Denmark, 1981–1997, The American Journal of Psychiatry, 160, 4, 765–72, April 2003, 12668367, 10.1176/appi.ajp.160.4.765, 10818/17040,ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.160.4.765, free, JOURNAL, Suicide among adults aged 35-64 years--United States, 1999-2010, MMWR. Morbidity and Mortality Weekly Report, 62, 17, 321–5, May 2013, 23636024, 4604925, Centers for Disease Control Prevention (CDC), Suicide might be rarer in societies with high social cohesion and moral objections against suicide. Genetics appears to account for between 38% and 55% of suicidal behaviors.JOURNAL, Brent DA, Melhem N, Familial transmission of suicidal behavior, The Psychiatric Clinics of North America, 31, 2, 157–77, June 2008, 18439442, 2440417, 10.1016/j.psc.2008.02.001, Suicides may also occur as a local cluster of cases.WEB,www.cdc.gov/violenceprevention/suicide/riskprotectivefactors.html, Suicide Risk and Protective Factors{{!, Suicide{{!}}Violence Prevention{{!}}Injury Center{{!}}CDC|date=25 April 2019|website=www.cdc.gov|access-date=17 June 2019}}Most research does not distinguish between risk factors that lead to thinking about suicide and risk factors that lead to suicide attempts.JOURNAL, May AM, Klonsky ED, 2016, What Distinguishes Suicide Attempters From Suicide Ideators? A Meta-Analysis of Potential Factors, Clinical Psychology: Science and Practice, 23, 1, 5–20, 10.1111/cpsp.12136, 35079333, JOURNAL, Klonsky ED, May AM, Differentiating suicide attempters from suicide ideators: a critical frontier for suicidology research, Suicide & Life-Threatening Behavior, 44, 1, 1–5, February 2014, 24313594, 10.1111/sltb.12068, Risks for suicide attempt, rather than just thoughts of suicide, include a high pain tolerance and a reduced fear of death.JOURNAL, Klonsky ED, Qiu T, Saffer BY, 21053071, Recent advances in differentiating suicide attempters from suicide ideators, Current Opinion in Psychiatry, 30, 1, 15–20, January 2017, 27798483, 10.1097/YCO.0000000000000294,

Previous attempts

A previous history of suicide attempts is the most accurate predictor of death by suicide. Approximately 20% of suicides have had a previous attempt, and of those who have attempted suicide, 1% die by suicide within a year and more than 5% die by suicide within 10 years.

Mental illness

{{seealso|Brain health and pollution}}Mental illness is present at the time of suicide 27% to more than 90% of the time.WEB, University of Manchester Centre for Mental Health and Risk, The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness,www.medicine.manchester.ac.uk/cmhr/centreforsuicideprevention/nci/reports/annual_report_2012.pdf,www.medicine.manchester.ac.uk/cmhr/centreforsuicideprevention/nci/reports/annual_report_2012.pdf," title="web.archive.org/web/20120714134607www.medicine.manchester.ac.uk/cmhr/centreforsuicideprevention/nci/reports/annual_report_2012.pdf,">web.archive.org/web/20120714134607www.medicine.manchester.ac.uk/cmhr/centreforsuicideprevention/nci/reports/annual_report_2012.pdf, dead, 14 July 2012, 25 July 2012, JOURNAL, Stone DM, Simon TR, Fowler KA, Kegler SR, Yuan K, Holland KM, Ivey-Stephenson AZ, Crosby AE, 6, Vital Signs: Trends in State Suicide Rates – United States, 1999–2016 and Circumstances Contributing to Suicide – 27 States, 2015, MMWR. Morbidity and Mortality Weekly Report, 67, 22, 617–624, June 2018, 29879094, 5991813, 10.15585/mmwr.mm6722a1, JOURNAL, Arsenault-Lapierre G, Kim C, Turecki G, Psychiatric diagnoses in 3275 suicides: a meta-analysis, BMC Psychiatry, 4, 1, 37, November 2004, 15527502, 534107, 10.1186/1471-244X-4-37, free, Of those who have been hospitalized for suicidal behavior, the lifetime risk of suicide is 8.6%.JOURNAL, Bostwick JM, Pankratz VS, Affective disorders and suicide risk: a reexamination, The American Journal of Psychiatry, 157, 12, 1925–32, December 2000, 11097952, 10.1176/appi.ajp.157.12.1925, Comparatively, non-suicidal people hospitalized for affective disorders have a 4% lifetime risk of suicide. Half of all people who die by suicide may have major depressive disorder; having this or one of the other mood disorders such as bipolar disorder increases the risk of suicide 20-fold.BOOK, Kutcher S, Chehil S, Suicide Risk Management A Manual for Health Professionals., John Wiley & Sons, Chicester, 978-1-119-95311-1, 30–33, 2012,books.google.com/books?id=fV8_1u0c7l0C&pg=PA31, 2nd, Other conditions implicated include schizophrenia (14%), personality disorders (8%),JOURNAL, Pompili M, Girardi P, Ruberto A, Tatarelli R, 27142497, Suicide in borderline personality disorder: a meta-analysis, Nordic Journal of Psychiatry, 59, 5, 319–24, 2005, 16757458, 10.1080/08039480500320025, JOURNAL, Bertolote JM, Fleischmann A, De Leo D, Wasserman D, 13331602, Psychiatric diagnoses and suicide: revisiting the evidence, Crisis, 25, 4, 147–55, 2004, 15580849, 10.1027/0227-5910.25.4.147, obsessive–compulsive disorder,JOURNAL, Angelakis I, Gooding P, Tarrier N, Panagioti M, Suicidality in obsessive compulsive disorder (OCD): a systematic review and meta-analysis, Clinical Psychology Review, 39, 1–15, July 2015, 25875222, 10.1016/j.cpr.2015.03.002, and post-traumatic stress disorder. Those with autism also attempt and consider suicide more frequently.JOURNAL, Zahid S, Upthegrove R, 10644601, Suicidality in Autistic Spectrum Disorders, Crisis, 38, 4, 237–246, July 2017, 28468556, 10.1027/0227-5910/a000458,pure-oai.bham.ac.uk/ws/files/36723961/Zahid_Upthegrove_Suicidality_Autistic_Spectrum_Disorders_Crisis.pdf, Others estimate that about half of people who die by suicide could be diagnosed with a personality disorder, with borderline personality disorder being the most common.JOURNAL, Lieb K, Zanarini MC, Schmahl C, Linehan MM, Bohus M, Borderline personality disorder, Lancet, 364, 9432, 453–461, 2004, 15288745, 10.1016/S0140-6736(04)16770-6, Between 40% and 65% of individuals who commit suicide meet criteria for a personality disorder, with borderline personality disorder being the most commonly associated., 54280127, About 5% of people with schizophrenia die of suicide.JOURNAL, van Os J, Kapur S, Schizophrenia, Lancet, 374, 9690, 635–645, August 2009, 19700006, 10.1016/S0140-6736(09)60995-8,xa.yimg.com/kq/groups/19525360/611943554/name/Schizophrenia+-+The+Lancet.pdf, 22 January 2013, dead, 208792724,xa.yimg.com/kq/groups/19525360/611943554/name/Schizophrenia+-+The+Lancet.pdf," title="web.archive.org/web/20130623065810xa.yimg.com/kq/groups/19525360/611943554/name/Schizophrenia+-+The+Lancet.pdf,">web.archive.org/web/20130623065810xa.yimg.com/kq/groups/19525360/611943554/name/Schizophrenia+-+The+Lancet.pdf, 23 June 2013, Jim van Os, Eating disorders are another high risk condition. Around 22% to 50% of people suffering with gender dysphoria have attempted suicide, however this greatly varies by region.WEB, Cheung A, Zwickl S, 23 March 2021, Why have nearly half of transgender Australians attempted suicide?,pursuit.unimelb.edu.au/articles/why-have-nearly-half-of-transgender-australians-attempted-suicide, 26 August 2022, Pursuit, en, Melbourne, Australia, University of Melbourne, NEWS, Transgender people and suicide,www.suicideinfo.ca/resource/transgender-people-suicide/, 26 August 2022, Centre for Suicide Prevention, en-CA, JOURNAL, Biggs M, Suicide by Clinic-Referred Transgender Adolescents in the United Kingdom, Archives of Sexual Behavior, 51, 2, 685–690, February 2022, 35043256, 8888486, 10.1007/s10508-022-02287-7, WEB, 13 July 2021, Suicide risk in transgender and gender diverse people,www.nationalelfservice.net/mental-health/suicide/suicide-risk-transgender-people/, 26 August 2022, National Elf Service, en-GB, WEB, Study Shows Shocking Rates of Attempted Suicide Among Trans Teens,www.hrc.org/news/new-study-reveals-shocking-rates-of-attempted-suicide-among-trans-adolescen, 26 August 2022, Human Rights Campaign, 12 September 2018, en-US, Among approximately 80% of suicides, the individual has seen a physician within the year before their death, including 45% within the prior month.JOURNAL, Luoma JB, Martin CE, Pearson JL, Contact with mental health and primary care providers before suicide: a review of the evidence, The American Journal of Psychiatry, 159, 6, 909–16, June 2002, 12042175, 5072576, 10.1176/appi.ajp.159.6.909, Approximately 25–40% of those who died by suicide had contact with mental health services in the prior year.JOURNAL, Pirkis J, Burgess P, Suicide and recency of health care contacts. A systematic review, The British Journal of Psychiatry, 173, 6, 462–74, December 1998, 9926074, 10.1192/bjp.173.6.462, 43144463, Antidepressants of the SSRI class appear to increase the frequency of suicide among children and young persons.JOURNAL, Sharma T, Guski LS, Freund N, Gøtzsche PC, Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports, BMJ, 352, i65, January 2016, 26819231, 4729837, 10.1136/bmj.i65, An unwillingness to get help for mental health problems also increases the risk.

Substance misuse

{{seealso|Substance-induced psychosis}}(File:The Drunkard’s Progress 1846.jpg|thumb|upright=1.35|“The Drunkard’s Progress”, 1846 demonstrating how alcoholism can lead to poverty, crime, and eventually suicide)Substance misuse is the second most common risk factor for suicide after major depression and bipolar disorder.BOOK, Levin JD, Culkin J, Perrotto RS, Introduction to chemical dependency counseling, 2001, Jason Aronson, Northvale, NJ, 978-0-7657-0289-0, 150–52,books.google.com/books?id=felzn3Ntd-cC&pg=RA1-PA151, Both chronic substance misuse as well as acute intoxication are associated.BOOK, Behavioral science in medicine, Fadem B, Lippincott Williams & Wilkins, 2004, 978-0-7817-3669-5, Philadelphia, 217,archive.org/details/behavioralscienc00fade_0/page/217, When combined with personal grief, such as bereavement, the risk is further increased. Substance misuse is also associated with mental health disorders.Most people are under the influence of sedative-hypnotic drugs (such as alcohol or benzodiazepines) when they die by suicide,JOURNAL, Youssef NA, Rich CL, Does acute treatment with sedatives/hypnotics for anxiety in depressed patients affect suicide risk? A literature review, Annals of Clinical Psychiatry, 20, 3, 157–69, 2008, 18633742, 10.1080/10401230802177698, with alcoholism present in between 15% and 61% of cases. Use of prescribed benzodiazepines is associated with an increased rate of suicide and attempted suicide. The pro-suicidal effects of benzodiazepines are suspected to be due to a psychiatric disturbance caused by side effects, such as disinhibition, or withdrawal symptoms. Countries that have higher rates of alcohol use and a greater density of bars generally also have higher rates of suicide.JOURNAL, Sher L, Alcohol consumption and suicide, QJM, 99, 1, 57–61, January 2006, 16287907, 10.1093/qjmed/hci146, free, About 2.2–3.4% of those who have been treated for alcoholism at some point in their life die by suicide. Alcoholics who attempt suicide are usually male, older, and have tried to take their own lives in the past. Between 3 and 35% of deaths among those who use heroin are due to suicide (approximately fourteenfold greater than those who do not use).JOURNAL, Darke S, Ross J, 11619947, Suicide among heroin users: rates, risk factors and methods, Addiction, 97, 11, 1383–94, November 2002, 12410779, 10.1046/j.1360-0443.2002.00214.x, free, In adolescents who misuse alcohol, neurological and psychological dysfunctions may contribute to the increased risk of suicide.JOURNAL, Sher L, 42672912, Functional magnetic resonance imaging in studies of the neurobiology of suicidal behavior in adolescents with alcohol use disorders, International Journal of Adolescent Medicine and Health, 19, 1, 11–8, 2007, 17458319, 10.1515/ijamh.2007.19.1.11, The misuse of cocaine and methamphetamine has a high correlation with suicide.JOURNAL, Darke S, Kaye S, McKetin R, Duflou J, 39592475, Major physical and psychological harms of methamphetamine use, Drug and Alcohol Review, 27, 3, 253–62, May 2008, 18368606, 10.1080/09595230801923702, In those who use cocaine, the risk is greatest during the withdrawal phase.BOOK,books.google.com/books?id=ea_QVG2BFy8C&q=256, Lexicon of psychiatry, neurology, and the neurosciences, Ayd FJ, Lippincott Williams & Wilkins, 2000, 978-0-7817-2468-5, 2nd, Philadelphia [u.a.], 256, Those who used inhalants are also at significant risk with around 20% attempting suicide at some point and more than 65% considering it. Smoking cigarettes is associated with risk of suicide.JOURNAL, Hughes JR, Smoking and suicide: a brief overview, Drug and Alcohol Dependence, 98, 3, 169–78, December 2008, 18676099, 2585177, 10.1016/j.drugalcdep.2008.06.003, There is little evidence as to why this association exists; however, it has been hypothesized that those who are predisposed to smoking are also predisposed to suicide, that smoking causes health problems which subsequently make people want to end their life, and that smoking affects brain chemistry causing a propensity for suicide. Cannabis, however, does not appear to independently increase the risk.

Self-harm

Non-suicidal self-harm is common with 18% of people engaging in self-harm over the course of their life.JOURNAL, Plener PL, Schumacher TS, Munz LM, Groschwitz RC, The longitudinal course of non-suicidal self-injury and deliberate self-harm: a systematic review of the literature, Borderline Personality Disorder and Emotion Dysregulation, 2, 1, 2, 2015, 26401305, 4579518, 10.1186/s40479-014-0024-3, free, {{Rp|page=1}} Acts of self-harm are not usually suicide attempts and most who self-harm are not at high risk of suicide.JOURNAL, Greydanus DE, Shek D, Deliberate self-harm and suicide in adolescents, The Keio Journal of Medicine, 58, 3, 144–151, September 2009, 19826208, 10.2302/kjm.58.144, free, 10397/4495, free, Some who self-harm, however, do still end their life by suicide, and risk for self-harm and suicide may overlap. Individuals who have been identified as self-harming after being admitted to hospital are {{Estimate|68|38|105|unit=%|mini=yes}} more likely to die by suicide.JOURNAL, Chan MK, Bhatti H, Meader N, Stockton S, Evans J, O’Connor RC, Kapur N, Kendall T, 6, Predicting suicide following self-harm: systematic review of risk factors and risk scales, The British Journal of Psychiatry, 209, 4, 277–283, October 2016, 27340111, 10.1192/bjp.bp.115.170050, 3428927, free, {{Rp|page=279}}

Psychosocial factors

A number of psychological factors increase the risk of suicide including: hopelessness, loss of pleasure in life, depression, anxiousness, agitation, rigid thinking, rumination, thought suppression, and poor coping skills.JOURNAL, O’Connor RC, Nock MK, The psychology of suicidal behaviour, The Lancet. Psychiatry, 1, 1, 73–85, June 2014, 26360404, 10.1016/S2215-0366(14)70222-6, JOURNAL, Bostwick JM, Rackley SJ, 7093281, Completed suicide in medical/surgical patients: who is at risk?, Current Psychiatry Reports, 9, 3, 242–6, June 2007, 17521522, 10.1007/s11920-007-0026-6, A poor ability to solve problems, the loss of abilities one used to have, and poor impulse control also play a role.JOURNAL, Joiner TE, Brown JS, Wingate LR, 42500507, The psychology and neurobiology of suicidal behavior, Annual Review of Psychology, 56, 287–314, 2005, 15709937, 10.1146/annurev.psych.56.091103.070320, In older adults, the perception of being a burden to others is important.JOURNAL, Van Orden K, Conwell Y, Suicides in late life, Current Psychiatry Reports, 13, 3, 234–41, June 2011, 21369952, 3085020, 10.1007/s11920-011-0193-3, Those who have never married are also at greater risk. Recent life stresses, such as a loss of a family member or friend or the loss of a job, might be a contributing factor.Certain personality factors, especially high levels of neuroticism and introvertedness, have been associated with suicide. This might lead to people who are isolated and sensitive to distress to be more likely to attempt suicide. On the other hand, optimism has been shown to have a protective effect. Other psychological risk factors include having few reasons for living and feeling trapped in a stressful situation. Changes to the stress response system in the brain might be altered during suicidal states. Specifically, changes in the polyamine systemJOURNAL, Turecki G, Polyamines and suicide risk, Molecular Psychiatry, 18, 12, 1242–3, December 2013, 24166408, 5293538, 10.1038/mp.2013.153, and hypothalamic–pituitary–adrenal axis.JOURNAL, Nemeroff CB, Owens MJ, Bissette G, Andorn AC, Stanley M, 23574459, Reduced corticotropin releasing factor binding sites in the frontal cortex of suicide victims, Archives of General Psychiatry, 45, 6, 577–9, June 1988, 2837159, 10.1001/archpsyc.1988.01800300075009, Social isolation and the lack of social support has been associated with an increased risk of suicide. Poverty is also a factor,JOURNAL, Stark CR, Riordan V, O’Connor R, 2011, A conceptual model of suicide in rural areas,www.rrh.org.au/articles/subviewnew.asp?ArticleID=1622, Rural and Remote Health, 11, 2, 1622, 21702640, with heightened relative poverty compared to those around a person increasing suicide risk.JOURNAL, Daly M, Sep 2012, Relative Status and Well-Being: Evidence from U.S. Suicide Deaths,www.frbsf.org/publications/economics/papers/2012/wp12-16bk.pdf, live, Federal Reserve Bank of San Francisco, Working Paper Series, 01–52, 10.24148/wp2012-16,www.frbsf.org/publications/economics/papers/2012/wp12-16bk.pdf," title="web.archive.org/web/20121019134902www.frbsf.org/publications/economics/papers/2012/wp12-16bk.pdf,">web.archive.org/web/20121019134902www.frbsf.org/publications/economics/papers/2012/wp12-16bk.pdf, 19 October 2012, Over 200,000 farmers in India have died by suicide since 1997, partly due to issues of debt.NEWS,articles.cnn.com/2010-01-05/world/india.farmer.suicides_1_farmer-suicides-andhra-pradesh-vandana-shiva, Activist: Farmer suicides in India linked to debt, globalization, Lerner G, 5 January 2010, CNN World, 13 February 2013,articles.cnn.com/2010-01-05/world/india.farmer.suicides_1_farmer-suicides-andhra-pradesh-vandana-shiva?_s=PM%3AWORLD," title="web.archive.org/web/20130116020225articles.cnn.com/2010-01-05/world/india.farmer.suicides_1_farmer-suicides-andhra-pradesh-vandana-shiva?_s=PM%3AWORLD,">web.archive.org/web/20130116020225articles.cnn.com/2010-01-05/world/india.farmer.suicides_1_farmer-suicides-andhra-pradesh-vandana-shiva?_s=PM%3AWORLD, 16 January 2013, dead, In China, suicide is three times as likely in rural regions as urban ones, partly, it is believed, due to financial difficulties in this area of the country.JOURNAL, Law S, Liu P, 24474367, Suicide in China: unique demographic patterns and relationship to depressive disorder, Current Psychiatry Reports, 10, 1, 80–6, February 2008, 18269899, 10.1007/s11920-008-0014-5, Being religious may reduce one’s risk of suicide while beliefs that suicide is noble may increase it.JOURNAL, Koenig HG, 14523984, Research on religion, spirituality, and mental health: a review, Canadian Journal of Psychiatry, 54, 5, 283–91, May 2009, 19497160, 10.1177/070674370905400502,www.psychology.hku.hk/ftbcstudies/refbase/docs/hill/2003/29_Hill+Pargament2003.pdf, live,www.psychology.hku.hk/ftbcstudies/refbase/docs/hill/2003/29_Hill+Pargament2003.pdf," title="web.archive.org/web/20150406183754www.psychology.hku.hk/ftbcstudies/refbase/docs/hill/2003/29_Hill+Pargament2003.pdf,">web.archive.org/web/20150406183754www.psychology.hku.hk/ftbcstudies/refbase/docs/hill/2003/29_Hill+Pargament2003.pdf, 6 April 2015, free, BOOK, Zuckerman P, Martin M, The Cambridge Companion to Atheism, 2007, Cambridge Univ. Press, 978-0521603676, 58–59, Concerning suicide rates, religious nations fare better than secular nations. According to the 2003 World Health Organization’s report on international male suicides rates, of the top ten nations with the highest male suicide rates, all but one (Sri Lanka) are strongly irreligious nations with high levels of atheism. Of the top remaining nine nations leading the world in male suicide rates, all are former Soviet/Communist nations, such as Belarus, Ukraine, and Latvia. Of the bottom ten nations with the lowest male suicide rates, all are highly religious nations with statistically insignificant levels of organic atheism., This has been attributed to the negative stance many religions take against suicide and to the greater connectedness religion may give. Muslims, among religious people, appear to have a lower rate of suicide; however, the data supporting this is not strong. There does not appear to be a difference in rates of attempted suicide. Young women in the Middle East may have higher rates.JOURNAL, Rezaeian M, Suicide among young Middle Eastern Muslim females, Crisis, 31, 1, 36–42, 2010, 20197256, 10.1027/0227-5910/a000005,

Medical conditions

There is an association between suicidality and physical health problems such as chronic pain,JOURNAL, Manthorpe J, Iliffe S, Suicide in later life: public health and practitioner perspectives, International Journal of Geriatric Psychiatry, 25, 12, 1230–1238, December 2010, 20104515, 10.1002/gps.2473, 23697880, traumatic brain injury,JOURNAL, Simpson GK, Tate RL, Preventing suicide after traumatic brain injury: implications for general practice, The Medical Journal of Australia, 187, 4, 229–232, August 2007, 17708726, 10.5694/j.1326-5377.2007.tb01206.x,www.mja.com.au/public/issues/187_04_200807/sim11240_fm.html, live, 44454339,www.mja.com.au/public/issues/187_04_200807/sim11240_fm.html," title="web.archive.org/web/20110910033458www.mja.com.au/public/issues/187_04_200807/sim11240_fm.html,">web.archive.org/web/20110910033458www.mja.com.au/public/issues/187_04_200807/sim11240_fm.html, 10 September 2011, cancer,JOURNAL, Anguiano L, Mayer DK, Piven ML, Rosenstein D, A literature review of suicide in cancer patients, Cancer Nursing, 35, 4, E14–E26, Jul–Aug 2012, 21946906, 10.1097/NCC.0b013e31822fc76c, 45874503, free, chronic fatigue syndrome,JOURNAL, Chu L, Elliott M, Stein E, Jason LA, Identifying and Managing Suicidality in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, Healthcare, 9, 6, May 2021, 629, 34070367, 8227525, 10.3390/healthcare9060629, free, kidney failure (requiring hemodialysis), HIV, and systemic lupus erythematosus. The diagnosis of cancer approximately doubles the subsequent frequency of suicide. The prevalence of increased suicidality persisted after adjusting for depressive illness and alcohol abuse. Among people with more than one medical condition the frequency was particularly high. In Japan, health problems are listed as the primary justification for suicide.BOOK,books.google.com/books?id=HuHQbtlyM40C&pg=PA11, Suicide in Asia : causes and prevention, Yip PS, Hong Kong University Press, 2008, 978-962-209-943-2, Hong Kong, 11, Sleep disturbances, such as insomniaJOURNAL, Ribeiro JD, Pease JL, Gutierrez PM, Silva C, Bernert RA, Rudd MD, Joiner TE, Sleep problems outperform depression and hopelessness as cross-sectional and longitudinal predictors of suicidal ideation and behavior in young adults in the military, Journal of Affective Disorders, 136, 3, 743–50, February 2012, 22032872, 10.1016/j.jad.2011.09.049, and sleep apnea, are risk factors for depression and suicide. In some instances, the sleep disturbances may be a risk factor independent of depression.JOURNAL, Bernert RA, Joiner TE, Cukrowicz KC, Schmidt NB, Krakow B, Suicidality and sleep disturbances, Sleep, 28, 9, 1135–41, September 2005, 16268383, 10.1093/sleep/28.9.1135, free, A number of other medical conditions may present with symptoms similar to mood disorders, including hypothyroidism, Alzheimer’s, brain tumors, systemic lupus erythematosus, and adverse effects from a number of medications (such as beta blockers and steroids).

Occupational factors

{{See also|Suicide in the military}}Certain occupations carry an elevated risk of self-harm and suicide, such as military careers. Research in several countries has found that the rate of suicide among former armed forces personnel in particular,WEB, Australian Institute of Health and Welfare, 29 September 2021, Serving and ex-serving Australian Defence Force members who have served since 1985: suicide monitoring 2001 to 2019,www.aihw.gov.au/getmedia/c0338ed6-a0da-4f5a-b503-41abde024230/aihw-phe-290.pdf.aspx, live, 26 August 2022, aihw.gov.au, 26 August 2022,web.archive.org/web/20220826112322/https://www.aihw.gov.au/getmedia/c0338ed6-a0da-4f5a-b503-41abde024230/aihw-phe-290.pdf.aspx, WEB, Department of National Defence, 11 May 2022, 2021 Report on Suicide Mortality in the Canadian Armed Forces (1995 to 2020),www.canada.ca/en/department-national-defence/corporate/reports-publications/health/2021-report-on-suicide-mortality-in-the-caf-1995-to-2020.html, live, 30 August 2022, www.canada.ca, 30 August 2022,web.archive.org/web/20220830091042/https://www.canada.ca/en/department-national-defence/corporate/reports-publications/health/2021-report-on-suicide-mortality-in-the-caf-1995-to-2020.html, WEB, Simkus K, Hall A, Heber A, VanTil L, 18 June 2020, Veteran Suicide Mortality Study: Follow-up period from 1976 to 2014,www.veterans.gc.ca/eng/about-vac/research/research-directorate/publications/reports/veteran-suicide-mortality-study-2019, live, 30 August 2022, Ottawa, ON, Veterans Affairs Canada, 30 August 2022,web.archive.org/web/20220830104419/https://www.veterans.gc.ca/eng/about-vac/research/research-directorate/publications/reports/veteran-suicide-mortality-study-2019, WEB, US Department of Veterans Affairs (Office of Mental Health and Suicide Prevention), September 2021, 2001-2019 National Suicide Data Appendix,www.mentalhealth.va.gov/docs/data-sheets/2019/2001-2019-National-Data-Appendix_508.xlsx, 30 August 2022, va.gov, and young veterans especially,JOURNAL, Kapur N, While D, Blatchley N, Bray I, Harrison K, Suicide after leaving the UK armed forces--a cohort study, PLOS Medicine, 6, 3, e26, March 2009, 19260757, 2650723, 10.1371/journal.pmed.1000026, Hotopf M, free, JOURNAL, Jones M, Jones N, Burdett H, Bergman BP, Fear NT, Wessely S, Rona RJ, Do Junior Entrants to the UK Armed Forces have worse outcomes than Standard Entrants?, BMJ Military Health, April 2021, 169, 3, 218–224, 33879526, 10.1136/bmjmilitary-2021-001787, 233313427,eprints.gla.ac.uk/239172/1/239172.pdf, 8 September 2022, 8 October 2022,eprints.gla.ac.uk/239172/1/239172.pdf," title="web.archive.org/web/20221008164347eprints.gla.ac.uk/239172/1/239172.pdf,">web.archive.org/web/20221008164347eprints.gla.ac.uk/239172/1/239172.pdf, dead, is markedly higher than that found in the general population. War veterans have a higher risk of suicide due in part to higher rates of mental illness, such as post-traumatic stress disorder, and physical health problems related to war.JOURNAL, Rozanov V, Carli V, July 2012, Suicide among war veterans, International Journal of Environmental Research and Public Health, 9, 7, 2504–19, 10.3390/ijerph9072504, 3407917, 22851956, free,

Media

{{See also|Copycat suicide|Social media and suicide}}File:Lotte_an_Werthers_Grabmal.jpg|thumb|upright=1.4|In Goethe’s The Sorrows of Young Werther, the title character kills himself due to a love triangle involving Charlotte (pictured at his grave). Some admirers of the story were triggered into copycat suicidecopycat suicideThe media, including the Internet, plays an important role. Certain depictions of suicide may increase its occurrence, with high-volume, prominent, repetitive coverage glorifying or romanticizing suicide having the most impact.JOURNAL, Bohanna I, Wang X, 1262883, Media guidelines for the responsible reporting of suicide: a review of effectiveness, Crisis, 33, 4, 190–8, 2012, 22713977, 10.1027/0227-5910/a000137, For example, about 15–40% of people leave a suicide note,BOOK,books.google.com/books?id=E2sKf-sexZwC&pg=PA215, Crisis intervention strategies, Gilliland B, James R, 8 May 2012, Brooks/Cole, 978-1-111-18677-7, 7th, Belmont, CA, 215,web.archive.org/web/20151003151518/https://books.google.com/books?id=E2sKf-sexZwC&pg=PA215, 3 October 2015, live, and media are discouraged from reporting the contents of that message. When detailed descriptions of how to kill oneself by a specific means are portrayed, this method of suicide can be imitated in vulnerable people. This phenomenon has been observed in several cases after press coverage.JOURNAL, Exeter DJ, Boyle PJ, Does young adult suicide cluster geographically in Scotland?, Journal of Epidemiology and Community Health, 61, 8, 731–6, August 2007, 17630375, 2653005, 10.1136/jech.2006.052365, JOURNAL, Gould MS, Wallenstein S, Davidson L, Suicide clusters: a critical review, Suicide & Life-Threatening Behavior, 19, 1, 17–29, 1989, 2652386, 10.1111/j.1943-278X.1989.tb00363.x, In a bid to reduce the adverse effect of media portrayals concerning suicide report, one of the effective methods is to educate journalists on how to report suicide news in a manner that might reduce that possibility of imitation and encourage those at risk to seek for help. When journalists follow certain reporting guidelines the risk of suicides can be decreased. Getting buy-in from the media industry, however, can be difficult, especially in the long term.This trigger of suicide contagion or copycat suicide is known as the “Werther effect”, named after the protagonist in Goethe’s The Sorrows of Young Werther who killed himself and then was emulated by many admirers of the book. This risk is greater in adolescents who may romanticize death.JOURNAL, Stack S, 21353878, Suicide in the media: a quantitative review of studies based on non-fictional stories, Suicide and Life-Threatening Behavior, 35, 2, 121–33, April 2005, 15843330, 10.1521/suli.35.2.121.62877, It appears that while news media has a significant effect, that of the entertainment media is equivocal.JOURNAL, Pirkis J, Suicide and the media, Psychiatry, 8, 7, 269–71, July 2009, 10.1016/j.mppsy.2009.04.009, BOOK, Shrivastava A, Kimbrell M, Lester D, Suicide from a global perspective : psychosocial approaches, 2012, Nova Science Publishers, New York, 978-1-61470-965-7, 115–18, It is unclear if searching for information about suicide on the Internet relates to the risk of suicide.JOURNAL, Mok K, Jorm AF, Pirkis J, 26744237, Suicide-related Internet use: A review, The Australian and New Zealand Journal of Psychiatry, 49, 8, 697–705, August 2015, 25698810, 10.1177/0004867415569797, 11343/58519, free, The opposite of the Werther effect is the proposed “Papageno effect”, in which coverage of effective coping mechanisms may have a protective effect. The term is based upon a character in Mozart’s opera The Magic Flute—fearing the loss of a loved one, he had planned to kill himself until his friends helped him out.JOURNAL, Sisask M, Värnik A, Media roles in suicide prevention: a systematic review, International Journal of Environmental Research and Public Health, 9, 1, 123–38, January 2012, 22470283, 3315075, 10.3390/ijerph9010123, free, As a consequence, fictional portrayals of suicide, showing alternative consequences or negative consequences, might have a preventive effect,JOURNAL, Scalvini M, Rigamonti F, 22599053, Why we must defend suicide in fiction, BMJ, 359, j4743, October 2017, 29046321, 10.1136/bmj.j4743, for instance fiction might normalize mental health problems and encourage help-seeking.JOURNAL, Scalvini M, 18 June 2020, 13 Reasons Why : can a TV show about suicide be ‘dangerous’? What are the moral obligations of a producer?, Media, Culture & Society, 42, 7–8, 1564–1574, 10.1177/0163443720932502, 0163-4437, free,

Environmental exposures

Some environmental exposures, including air pollution, intense sunlight, sunlight duration, hot weather, and high altitude, are associated with suicide.JOURNAL, Cornelius, Sarah L., Berry, Tara, Goodrich, Amanda J., Shiner, Brian, Riblet, Natalie B., 2021-07-23, The Effect of Meteorological, Pollution, and Geographic Exposures on Death by Suicide: A Scoping Review, International Journal of Environmental Research and Public Health, 18, 15, 7809, 10.3390/ijerph18157809, free, 1660-4601, 8345465, 34360101, There is a possible association between short-term PM10 exposure and suicide.JOURNAL, Go, Tae-Hwa, Kim, Min-Hyuk, Choi, Yoon-Young, Han, Jaehyun, Kim, Changsoo, Kang, Dae Ryong, The short-term effect of ambient particulate matter on suicide death, Environmental Health, Springer Science and Business Media LLC, 23, 1, 3 Jan 2024, 1476-069X, 10.1186/s12940-023-01042-2, free, meta-analysis, JOURNAL, Braithwaite I, Zhang S, Kirkbride JB, Osborn DP, Hayes JF, December 2019, Air Pollution (Particulate Matter) Exposure and Associations with Depression, Anxiety, Bipolar, Psychosis and Suicide Risk: A Systematic Review and Meta-Analysis, Environmental Health Perspectives, 127, 12, 126002, 10.1289/EHP4595, 6957283, 31850801, These factors might affect certain high-risk individuals more than others.The time of year may also affect suicide rates. There appears to be a decrease around Christmas,JOURNAL, Carley S, Hamilton M, November 2004, Best evidence topic report. Suicide at christmas, Emergency Medicine Journal, 21, 6, 716–7, 10.1136/emj.2004.019703, 1726490, 15496706, but an increase in rates during spring and summer, which might be related to exposure to sunshine. Another study found that the risk may be greater for males on their birthday.JOURNAL, 6, Williams A, While D, Windfuhr K, Bickley H, Hunt IM, Shaw J, Appleby L, Kapur N, 2011, Birthday blues: examining the association between birthday and suicide in a national sample, Crisis, 32, 3, 134–42, 10.1027/0227-5910/a000067, 21616762, Genetics might influence rates of suicide. A family history of suicide, especially in the mother, affects children more than adolescents or adults. Adoption studies have shown that this is the case for biological relatives, but not adopted relatives. This makes familial risk factors unlikely to be due to imitation. Once mental disorders are accounted for, the estimated heritability rate is 36% for suicidal ideation and 17% for suicide attempts. An evolutionary explanation for suicide is that it may improve inclusive fitness. This may occur if the person dying by suicide cannot have more children and takes resources away from relatives by staying alive. An objection is that deaths by healthy adolescents likely does not increase inclusive fitness. Adaptation to a very different ancestral environment may be maladaptive in the current one.JOURNAL, Confer JC, Easton JA, Fleischman DS, Goetz CD, Lewis DM, Perilloux C, Buss DM, 1 January 2010, Evolutionary psychology. Controversies, questions, prospects, and limitations, The American Psychologist, 65, 2, 110–26, 10.1.1.601.8691, 10.1037/a0018413, 20141266,

Other factors

Trauma is a risk factor for suicidality in both childrenJOURNAL, Ports KA, Merrick MT, Stone DM, Wilkins NJ, Reed J, Ebin J, Ford DC, Adverse Childhood Experiences and Suicide Risk: Toward Comprehensive Prevention, American Journal of Preventive Medicine, 53, 3, 400–403, September 2017, 28483301, 5603224, 10.1016/j.amepre.2017.03.015, and adults. Some may take their own lives to escape bullying or prejudice.JOURNAL, Cox WT, Abramson LY, Devine PG, Hollon SD, 1512121, Stereotypes, Prejudice, and Depression: The Integrated Perspective, Perspectives on Psychological Science, 7, 5, 427–49, September 2012, 26168502, 10.1177/1745691612455204, A history of childhood sexual abuseJOURNAL, Wegman HL, Stetler C, 25054003, A meta-analytic review of the effects of childhood abuse on medical outcomes in adulthood, Psychosomatic Medicine, 71, 8, 805–12, October 2009, 19779142, 10.1097/PSY.0b013e3181bb2b46, and time spent in foster care are also risk factors.JOURNAL, Oswald SH, Heil K, Goldbeck L, History of maltreatment and mental health problems in foster children: a review of the literature, Journal of Pediatric Psychology, 35, 5, 462–72, June 2010, 20007747, 10.1093/jpepsy/jsp114, free, Sexual abuse is believed to contribute to approximately 20% of the overall risk. Significant adversity early in life has a negative effect on problem-solving skills and memory, both of which are implicated in suicidality. According to a 2022 study, adverse childhood experiences maybe “associated with a two-fold higher odds” of anxiety disorders, depression and suicidality.“JOURNAL, Sahle BW, Reavley NJ, Li W, Morgan AJ, Yap MB, Reupert A, Jorm AF, The association between adverse childhood experiences and common mental disorders and suicidality: an umbrella review of systematic reviews and meta-analyses, Eur Child Adolesc Psychiatry, 31, 10, 1489–1499, October 2022, 33638709, 10.1007/s00787-021-01745-2, 232065964,www.childhoodadversity.org.au/media/m4ndp0sa/umbrella-review.pdf, Problem gambling is associated with increased suicidal ideation and attempts compared to the general population.BOOK, Pallanti S, Rossi NB, Hollander E, 11. Pathological Gambling, Hollander E, Stein DJ, Clinical manual of impulse-control disorders,books.google.com/books?id=u2wVP8KJJtcC&pg=PA253, 2006, American Psychiatric Pub, 978-1-58562-136-1, 253, Between 12 and 24% of pathological gamblers attempt suicide. The rate of suicide among their spouses is three times greater than that of the general population.JOURNAL, Oliveira MP, Silveira DX, Silva MT, [Pathological gambling and its consequences for public health], Revista de Saude Publica, 42, 3, 542–9, June 2008, 18461253, 10.1590/S0034-89102008005000026, free, Other factors that increase the risk in problem gamblers include concomitant mental illness, alcohol, and drug misuse.JOURNAL, Hansen M, Rossow I, [Gambling and suicidal behaviour], Tidsskrift for den Norske Laegeforening, 128, 2, 174–6, January 2008, 18202728, Infection by the parasite Toxoplasma gondii, more commonly known as toxoplasmosis, has been linked with suicide risk. One explanation states that this is caused by altered neurotransmitter activity due to the immunological response.

Rational

File:72nd Shinbu 1945 Kamikaze.jpg|thumb|180px|Teenage recruits for Japanese KamikazeKamikazeRational suicide is the reasoned taking of one’s own life.BOOK, Loue S, Encyclopedia of aging and public health : with 19 tables, 2008, Springer, New York, 978-0-387-33753-1, 696, However, some consider suicide as never being rational.Euthanasia and assisted suicide are accepted practices in a number of countries among those who have a poor quality of life without the possibility of getting better.JOURNAL, Conejero I, Olié E, Courtet P, Calati R, Suicide in older adults: current perspectives, Clinical Interventions in Aging, 13, 691–699, 2018, 29719381, 5916258, 10.2147/CIA.S130670, free, JOURNAL, Calabrò RS, Naro A, De Luca R, Russo M, Caccamo L, Manuli A, Bramanti A, Bramanti P, 6, The Right to Die in Chronic Disorders of Consciousness: Can We Avoid the Slippery Slope Argument?, Innovations in Clinical Neuroscience, 13, 11–12, 12–24, 2016, 28210521, 5300707, They are supported by the legal arguments for a right to die.The act of taking one’s life for the benefit of others is known as altruistic suicide.BOOK, Moody HR, Aging: concepts and controversies, 2010, Pine Forge Press, Los Angeles, 978-1-4129-6966-6, 158,books.google.com/books?id=qj8GS77QAgwC&pg=PA158, 6th, An example of this is an elder ending his or her life to leave greater amounts of food for the younger people in the community. Suicide in some Inuit cultures has been seen as an act of respect, courage, or wisdom.A suicide attack is a political or religious action where an attacker carries out violence against others which they understand will result in their own death.BOOK, Sobh T, Innovations and advances in computer sciences and engineering, 2010, Springer Verlag, Dordrecht, 978-90-481-3658-2, 503,books.google.com/books?id=B-Zf1sQZapMC&pg=PA503, Online-Ausg., Some suicide bombers are motivated by a desire to obtain martyrdoms or are religiously motivated. Kamikaze missions were carried out as a duty to a higher cause or moral obligation.BOOK, Hales RE, Simon RI, The American Psychiatric Publishing textbook of suicide assessment and management, American Psychiatric Pub., Washington, DC, 978-1-58562-414-0, 714,books.google.com/books?id=H8tigTjBCRkC&pg=PA714, 2nd, 2012, Murder–suicide is an act of homicide followed within a week by suicide of the person who carried out the act.JOURNAL, Eliason S, Murder-suicide: a review of the recent literature, The Journal of the American Academy of Psychiatry and the Law, 37, 3, 371–6, 2009, 19767502, Mass suicides are often performed under social pressure where members give up autonomy to a leader (see Notable cases below).BOOK, Kornblum W, Smith CD, Sociology in a changing world, Wadsworth Cengage Learning, Belmont, CA, 978-1-111-30157-6, 27,books.google.com/books?id=DtKcG6qoY5AC&pg=PT51, 9th, 31 January 2011, Mass suicides can take place with as few as two people, often referred to as a suicide pact.BOOK, Campbell RJ, Campbell’s psychiatric dictionary, 2004, Oxford University Press, Oxford, 978-0-19-515221-0, 636,books.google.com/books?id=Vrlsos_O13UC&pg=PA636, 8th, In extenuating situations where continuing to live would be intolerable, some people use suicide as a means of escape.BOOK, Veatch RM, Medical ethics, 1997, Jones and Bartlett, Sudbury, MA, 978-0-86720-974-7, 292,books.google.com/books?id=UCOT4sj-DwUC&pg=PA292, 2nd, BOOK, Warburton N, 2004, 21, The Basics - Philosophy, 4th, Routledge, New York, 978-0-415-32773-2, Some inmates in Nazi concentration camps are known to have killed themselves during the Holocaust by deliberately touching the electrified fences.BOOK, Gutman Y, Berenbaum M, Anatomy of the Auschwitz death camp, 1998, Publ. in association with the United States Holocaust Memorial Museum, Washington, D.C. by Indiana University Press, Bloomington, 978-0-253-20884-2, 400, 1st,

Prevention

{{multiple image }}(File:Tromsøbrua suicide prevention fence 2008-06-28 (cropped).jpg|thumb|A suicide prevention fence on a bridge)Suicide prevention is a term used for the collective efforts to reduce the incidence of suicide through preventive measures. Protective factors for suicide include support, and access to therapy. About 60% of people with suicidal thoughts do not seek help.JOURNAL, Bruffaerts R, Demyttenaere K, Hwang I, Chiu WT, Sampson N, Kessler RC, Alonso J, Borges G, de Girolamo G, de Graaf R, Florescu S, Gureje O, Hu C, Karam EG, Kawakami N, Kostyuchenko S, Kovess-Masfety V, Lee S, Levinson D, Matschinger H, Posada-Villa J, Sagar R, Scott KM, Stein DJ, Tomov T, Viana MC, Nock MK, 6, Treatment of suicidal people around the world, The British Journal of Psychiatry, 199, 1, 64–70, July 2011, 21263012, 3167419, 10.1192/bjp.bp.110.084129, Reasons for not doing so include low perceived need, and wanting to deal with the problem alone. Despite these high rates, there are few established treatments available for suicidal behavior.Reducing access to certain methods, such as firearms or toxins such as opioids and pesticides, can reduce risk of suicide by that method.WEB, Suicide prevention, World Health Organization, 31 August 2012, WHO Sites: Mental Health,www.who.int/mental_health/prevention/suicide/suicideprevent/en/,webarchive.loc.gov/all/20040701084208/http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/, dead, 1 July 2004, 13 January 2013, Reducing access to easily-accessible methods of suicide may make impulsive attempts less likely to succeed.JOURNAL, Miller M, Hemenway D, 35738851, Guns and suicide in the United States, The New England Journal of Medicine, 359, 10, 989–91, September 2008, 18768940, 10.1056/NEJMp0805923, free, Other measures include reducing access to charcoal (for burning) and adding barriers on bridges and subway platforms.JOURNAL, Cox GR, Owens C, Robinson J, Nicholas A, Lockley A, Williamson M, Cheung YT, Pirkis J, 6, Interventions to reduce suicides at suicide hotspots: a systematic review, BMC Public Health, 13, 214, March 2013, 23496989, 3606606, 10.1186/1471-2458-13-214, free, Treatment of drug and alcohol addiction, depression, and those who have attempted suicide in the past, may also be effective. Some have proposed reducing access to alcohol as a preventive strategy (such as reducing the number of bars).JOURNAL, Vijayakumar L, Kumar MS, Vijayakumar V, 206143129, Substance use and suicide, Current Opinion in Psychiatry, 24, 3, 197–202, May 2011, 21430536, 10.1097/YCO.0b013e3283459242, In young adults who have recently thought about suicide, cognitive behavioral therapy appears to improve outcomes.JOURNAL, Robinson J, Hetrick SE, Martin C, 24708914, Preventing suicide in young people: systematic review, The Australian and New Zealand Journal of Psychiatry, 45, 1, 3–26, January 2011, 21174502, 10.3109/00048674.2010.511147, School-based programs that increase mental health literacy and train staff have shown mixed results on suicide rates. Economic development through its ability to reduce poverty may be able to decrease suicide rates. Efforts to increase social connection, especially in elderly males, may be effective.JOURNAL, Fässberg MM, van Orden KA, Duberstein P, Erlangsen A, Lapierre S, Bodner E, Canetto SS, De Leo D, Szanto K, Waern M, 6, A systematic review of social factors and suicidal behavior in older adulthood, International Journal of Environmental Research and Public Health, 9, 3, 722–45, March 2012, 22690159, 3367273, 10.3390/ijerph9030722, free, In people who have attempted suicide, following up on them might prevent repeat attempts.JOURNAL, Luxton DD, June JD, Comtois KA, 25181980, Can postdischarge follow-up contacts prevent suicide and suicidal behavior? A review of the evidence, Crisis, 34, 1, 32–41, January 2013, 22846445, 10.1027/0227-5910/a000158, Although crisis hotlines are common, there is little evidence to support or refute their effectiveness. Preventing childhood trauma provides an opportunity for suicide prevention. The World Suicide Prevention Day is observed annually on 10 September with the support of the International Association for Suicide Prevention and the World Health Organization.WEB,www.iasp.info/wspd/, World Suicide Prevention Day −10 September, 2013, IASP, 29 October 2013, live,www.iasp.info/wspd/," title="web.archive.org/web/20131104145146www.iasp.info/wspd/,">web.archive.org/web/20131104145146www.iasp.info/wspd/, 4 November 2013,

Screening

{{BlockquoteSuicidal ideation>ideation, substance abuse, Meaning (existential), anger, feeling trapped, Beck Hopelessness Scale>hopelessness, Solitude, anxiety, Recklessness (psychology)>recklessness, and mood).BOOK There is little data on the effects of screening the general population on the ultimate rate of suicide.JOURNAL, Williams SB, O’Connor EA, Eder M, Whitlock EP, 8881023, Screening for child and adolescent depression in primary care settings: a systematic evidence review for the US Preventive Services Task Force, Pediatrics, 123, 4, e716-35, April 2009, 19336361, 10.1542/peds.2008-2415, JOURNAL, LeFevre ML, Screening for suicide risk in adolescents, adults, and older adults in primary care: U.S. Preventive Services Task Force recommendation statement, Annals of Internal Medicine, 160, 10, 719–26, May 2014, 24842417, 10.7326/M14-0589, free, Screening those who come to the emergency departments with injuries from self-harm have been shown to help identify suicide ideation and suicide intention. Psychometric tests such as the Beck Depression Inventory or the Geriatric Depression Scale for older people are being used.BOOK, Clinard MB, Meier RF, Marshall B. Clinard, Sociology of deviant behavior, 2008, Wadsworth Cengage Learning, Belmont, CA, 978-0-495-81167-1, 169,books.google.com/books?id=VB3OezIoI44C&pg=PA169, 14th, As there is a high rate of people who test positive via these tools that are not at risk of suicide, there are concerns that screening may significantly increase mental health care resource utilization.JOURNAL, Horowitz LM, Ballard ED, Pao M, Suicide screening in schools, primary care and emergency departments, Current Opinion in Pediatrics, 21, 5, 620–7, October 2009, 19617829, 2879582, 10.1097/MOP.0b013e3283307a89, Assessing those at high risk, though, is recommended. Asking about suicidality does not appear to increase the risk.

Mental illness

{{See also|Antidepressants and suicide risk}}In those with mental health problems, a number of treatments may reduce the risk of suicide. Those who are actively suicidal may be admitted to psychiatric care either voluntarily or involuntarily. Possessions that may be used to harm oneself are typically removed.BOOK, Tintinalli, Judith E., Emergency Medicine: A Comprehensive Study Guide (Emergency Medicine (Tintinalli)), McGraw-Hill Companies, New York, 2010, 1940–46, 978-0-07-148480-0, Some clinicians get patients to sign suicide prevention contracts where they agree to not harm themselves if released. However, evidence does not support a significant effect from this practice. If a person is at low risk, outpatient mental health treatment may be arranged. Short-term hospitalization has not been found to be more effective than community care for improving outcomes in those with borderline personality disorder who are chronically suicidal.JOURNAL, Paris J, 28921269, Is hospitalization useful for suicidal patients with borderline personality disorder?, Journal of Personality Disorders, 18, 3, 240–7, June 2004, 15237044, 10.1521/pedi.18.3.240.35443, JOURNAL, Goodman M, Roiff T, Oakes AH, Paris J, 7261201, Suicidal risk and management in borderline personality disorder, Current Psychiatry Reports, 14, 1, 79–85, February 2012, 22113831, 10.1007/s11920-011-0249-4, There is tentative evidence that psychotherapy, specifically dialectical behaviour therapy, reduces suicidality in adolescentsJOURNAL, Dialectical behaviour therapy in adolescents for suicide prevention: systematic review of clinical-effectiveness, CADTH Technology Overviews, 1, 1, e0104, 2010, 22977392, 3411135, Canadian Agency for Drugs Technologies in Health (CADTH), as well as in those with borderline personality disorder.JOURNAL, Stoffers JM, Völlm BA, Rücker G, Timmer A, Huband N, Lieb K, Psychological therapies for people with borderline personality disorder, The Cochrane Database of Systematic Reviews, 8, 8, CD005652, August 2012, 22895952, 6481907, 10.1002/14651858.CD005652.pub2, Lieb K, It may also be useful in decreasing suicide attempts in adults at high risk.JOURNAL, O’Connor E, Gaynes BN, Burda BU, Soh C, Whitlock EP, Screening for and treatment of suicide risk relevant to primary care: a systematic review for the U.S. Preventive Services Task Force, Annals of Internal Medicine, 158, 10, 741–54, May 2013, 23609101, 10.7326/0003-4819-158-10-201305210-00642, free, There is controversy around the benefit-versus-harm of antidepressants. In young persons, some antidepressants, such as SSRIs, appear to increase the risk of suicidality from 25 per 1000 to 40 per 1000.JOURNAL, Hetrick SE, McKenzie JE, Cox GR, Simmons MB, Merry SN, Newer generation antidepressants for depressive disorders in children and adolescents, The Cochrane Database of Systematic Reviews, 11, CD004851, November 2012, 9, 23152227, 10.1002/14651858.CD004851.pub3, 8786271, Hetrick SE, 11343/59246, free, In older persons, however, they may decrease the risk. Lithium appears effective at lowering the risk in those with bipolar disorder and major depression to nearly the same levels as that of the general population.JOURNAL, Baldessarini RJ, Tondo L, Hennen J, Lithium treatment and suicide risk in major affective disorders: update and new findings, The Journal of Clinical Psychiatry, 64, Suppl 5, 44–52, 2003, 12720484, JOURNAL, Cipriani A, Hawton K, Stockton S, Geddes JR, Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis, BMJ, 346, jun27 4, f3646, June 2013, 23814104, 10.1136/bmj.f3646, free, Clozapine may decrease the thoughts of suicide in some people with schizophrenia.JOURNAL, Wagstaff A, Perry C, Clozapine: in prevention of suicide in patients with schizophrenia or schizoaffective disorder, CNS Drugs, 17, 4, 273–80; discussion 281–3, 2003, 12665398, 10.2165/00023210-200317040-00004, Ketamine, which is a dissociative anaesthetic, seems to lower the rate of suicidal ideation.JOURNAL, Rajkumar R, Fam J, Yeo EY, Dawe GS, Ketamine and suicidal ideation in depression: Jumping the gun?, Pharmacological Research, 99, 23–35, September 2015, 25982932, 10.1016/j.phrs.2015.05.003, In the United States, health professionals are legally required to take reasonable steps to try to prevent suicide.NEWS, Caldwell BE, Whose Conscience Matters?,www.aamft.org/imis15/Documents/SO13FTMSinglePage.pdf, 22 January 2018, Family Therapy Magazine (page 22), American Association for Marriage and Family Therapy (AAMFT), September–October 2013, 22 January 2018,web.archive.org/web/20180122235109/https://www.aamft.org/imis15/Documents/SO13FTMSinglePage.pdf, dead, CASE, Bellah v. Greenson,caselaw.findlaw.com/ca-court-of-appeal/1836783.html, California First District Court of Appeals, Findlaw, 22 January 2018, 6 June 1978,

Methods

(File:200012 Suicide methods in order of lethality - variable-width bar chart.svg|thumb|upright=1.25 |Though substance overdose is the most common method of attempted suicide in the U.S., guns are the most lethal (most likely to result in death).JOURNAL, Spicer, Rebecca S., Miller, Ted R., Suicide Acts in 8 States: Incidence and Case Fatality Rates by Demographics and Method, American Journal of Public Health, December 2000, 90, 12, 1885–1891, 10.2105/ajph.90.12.1885, 11111261, 1446422, Table 1, )(File:2010 suicide rates - gun versus non-gun - high-income countries.png|thumb|upright=1.25|Deaths by gun-related suicide versus non-gun-related suicide rates per 100,000 in high-income countries in 2010JOURNAL, Grinshteyn E, Hemenway D, Violent Death Rates: The US Compared with Other High-income OECD Countries, 2010, The American Journal of Medicine, 129, 3, 266–73, March 2016, 26551975, 10.1016/j.amjmed.2015.10.025,www.amjmed.com/article/S0002-9343(15)01030-X/pdf, free, )The leading method of suicide varies among countries. The leading methods in different regions include hanging, pesticide poisoning, and firearms. These differences are believed to be in part due to availability of the different methods. A review of 56 countries found that hanging was the most common method in most of the countries, accounting for 53% of male suicides and 39% of female suicides.BOOK, O’Connor RC, Platt S, Gordon J, International Handbook of Suicide Prevention: Research, Policy and Practice,books.google.com/books?id=3fDGLWQtwFkC&pg=PA34, 1 June 2011, John Wiley and Sons, 978-1-119-99856-3, 34, Worldwide, 30% of suicides are estimated to occur from pesticide poisoning, most of which occur in the developing world. The use of this method varies markedly from 4% in Europe to more than 50% in the Pacific region.JOURNAL, Gunnell D, Eddleston M, Phillips MR, Konradsen F, The global distribution of fatal pesticide self-poisoning: systematic review, BMC Public Health, 7, 357, December 2007, 18154668, 2262093, 10.1186/1471-2458-7-357, free, It is also common in Latin America due to the ease of access within the farming populations. In many countries, drug overdoses account for approximately 60% of suicides among women and 30% among men.BOOK, Geddes J, Price J, McKnight R, Gelder M, Mayou R, Psychiatry, Oxford University Press, Oxford, 978-0-19-923396-0, 62,books.google.com/books?id=F4THKWvbAPEC&pg=PA62, 4th, 5 January 2012, Many are unplanned and occur during an acute period of ambivalence. The death rate varies by method: firearms 80–90%, drowning 65–80%, hanging 60–85%, jumping 35–60%, charcoal burning 40–50%, pesticides 60–75%, and medication overdose 1.5–4.0%. The most common attempted methods of suicide differ from the most common methods of completion; up to 85% of attempts are via drug overdose in the developed world.In China, the consumption of pesticides is the most common method.BOOK, Krug E, World Report on Violence and Health, 1, 2002, World Health Organization, Genève, 978-92-4-154561-7, 196,archive.org/details/worldreportonvio2002unse/page/196, In Japan, self-disembowelment known as seppuku (harakiri) still occurs; however, hanging and jumping are the most common.JOURNAL, Yoshioka E, Hanley SJ, Kawanishi Y, Saijo Y, Time trends in method-specific suicide rates in Japan, 1990–2011, Epidemiology and Psychiatric Sciences, 25, 1, 58–68, February 2016, 25373686, 10.1017/S2045796014000675, 6998669, Jumping to one’s death is common in both Hong Kong and Singapore at 50% and 80% respectively. In Switzerland, firearms are the most frequent suicide method in young males, although this method has decreased since guns have become less common.JOURNAL, Reisch T, Steffen T, Habenstein A, Tschacher W, Wolfgang Tschacher, 8405876, Change in suicide rates in Switzerland before and after firearm restriction resulting from the 2003 “Army XXI” reform, The American Journal of Psychiatry, 170, 9, 977–84, September 2013, 23897090, 10.1176/appi.ajp.2013.12091256, BOOK, Eshun S, Gurung RA, Culture and mental health sociocultural influences, theory, and practice, 2009, Wiley-Blackwell, Chichester, 978-1-4443-0581-4, 301,books.google.com/books?id=Y6uUDBBGqF4C&pg=PA301, live,web.archive.org/web/20151003161655/https://books.google.com/books?id=Y6uUDBBGqF4C&pg=PA301, 3 October 2015, In the United States, 50% of suicides involve the use of firearms, with this method being somewhat more common in men (56%) than women (31%).WEB,www.nimh.nih.gov/health/statistics/suicide.shtml, Suicide – Mental Health Statistics, April 2019, National Institute of Mental Health, 15 October 2019, The next most common cause was hanging in males (28%) and self-poisoning in females (31%). Together, hanging and poisoning constituted about 42% of U.S. suicides ({{as of|2017|lc=y|}}).

Epidemiology

(File:2019 Gun suicides per capita - by country.svg |thumb|The US has had the largest number of gun-related suicides in the world every year from 1990 through at least 2019. With 4% of the world’s population, the US had 44% of global gun suicides in 2019, and the highest rate per capita.NEWS, Fox, Kara, Shveda, Krystina, Croker, Natalie, Chacon, Marco, How US gun culture stacks up with the world,www.cnn.com/2021/11/26/world/us-gun-culture-world-comparison-intl-cmd/index.html, CNN, 26 November 2021,web.archive.org/web/20231221215124/https://www.cnn.com/2021/11/26/world/us-gun-culture-world-comparison-intl-cmd/index.html/, 21 December 2023, live, Article updated October 26, 2023. CNN cites data source: Institute for Health Metrics and Evaluation (Global Burden of Disease 2019), UN Population Division.)Approximately 1.4% of people die by suicide, a mortality rate of 11.6 per 100,000 persons per year. Suicide resulted in 842,000 deaths in 2013 up from 712,000 deaths in 1990. Rates of suicide have increased by 60% from the 1960s to 2012, with these increases seen primarily in the developing world. Globally, {{As of|2008|lc=y}}/2009, suicide is the tenth leading cause of death. For every suicide that results in death there are between 10 and 40 attempted suicides.Suicide rates differ significantly between countries and over time. As a percentage of deaths in 2008 it was: Africa 0.5%, South-East Asia 1.9%, Americas 1.2% and Europe 1.4%. Rates per 100,000 were: Australia 8.6, Canada 11.1, China 12.7, India 23.2, United Kingdom 7.6, United States 11.4 and South Korea 28.9.WEB, Deaths estimates for 2008 by cause for WHO Member States,www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html, World Health Organization, 10 February 2013, live,www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html," title="web.archive.org/web/20091111101009www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html,">web.archive.org/web/20091111101009www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html, 11 November 2009, WEB, Suicide rates Data by country,apps.who.int/gho/data/node.main.MHSUICIDE?lang=en., who.int, 23 November 2014, live,apps.who.int/gho/data/node.main.MHSUICIDE?lang=en.," title="web.archive.org/web/20151015120314apps.who.int/gho/data/node.main.MHSUICIDE?lang=en.,">web.archive.org/web/20151015120314apps.who.int/gho/data/node.main.MHSUICIDE?lang=en., 15 October 2015, It was ranked as the 10th leading cause of death in the United States in 2016 with about 45,000 cases that year.NEWS, 7 June 2018, Suicide rates rising across the U.S.,www.cdc.gov/media/releases/2018/p0607-suicide-prevention.html, CDC Newsroom, 11 October 2018, Rates have increased in the United States in the last few years, with about 49,500 people dying by suicide in 2022, the highest number ever recorded.NEWS, August 10, 2023, Suicides in the U.S. reached all-time high in 2022, CDC data shows,www.nbcnews.com/health/mental-health/cdc-data-finds-suicides-reached-time-high-2022-rcna99327, NBC News, August 11, 2023, In the United States, about 650,000 people are seen in emergency departments yearly due to attempting suicide. The United States rate among men in their 50s rose by nearly half in the decade 1999–2010.WEB, CDC finds suicide rates among middle-aged adults increased from 1999 to 2010,www.cdc.gov/media/releases/2013/p0502-suicide-rates.html, Centers for Disease Control and Prevention, 15 July 2013, 2 May 2013, live,www.cdc.gov/media/releases/2013/p0502-suicide-rates.html," title="web.archive.org/web/20130621045612www.cdc.gov/media/releases/2013/p0502-suicide-rates.html,">web.archive.org/web/20130621045612www.cdc.gov/media/releases/2013/p0502-suicide-rates.html, 21 June 2013, Greenland, Lithuania, Japan, and Hungary have the highest rates of suicide. Around 75% of suicides occur in the developing world. The countries with the greatest absolute numbers of suicides are China and India, partly due to their large population size, accounting for over half the total. In China, suicide is the 5th leading cause of death.File:Death rate from suicides (IHME (1990 to 2016)), OWID.svg|Death rate from suicide per 100,000 as of 2017WEB, Death rate from suicides,ourworldindata.org/grapher/suicide-death-rates, Our World in Data, 4 March 2020, File:Share of deaths from suicide, OWID.svg|Share of deaths from suicide, 2017WEB, Share of deaths from suicide,ourworldindata.org/grapher/share-deaths-suicide, Our World in Data, 4 March 2020, An unofficial report estimated 5,000 suicides in Iran in 2022.WEB,www.etemadonline.com/%D8%A8%D8%AE%D8%B4-%D8%A7%D8%AC%D8%AA%D9%85%D8%A7%D8%B9%DB%8C-23/628479-%D8%AE%D9%88%D8%AF%DA%A9%D8%B4%DB%8C-%D8%A7%DB%8C%D8%B1%D8%A7%D9%86-%D9%85%D8%AF%D8%AF%DA%A9%D8%A7%D8%B1%DB%8C-%D9%85%D8%B1%DA%AF, میزان خودکشی در ایران Ø·ÛŒ یک دهه گذشته، بیش از ۴۰درصد رشد کرده, etemadonline.com, Persian, 28 December 2023,

Sex and gender

{{multiple image| align = right| image1 = Male suicide rates 2015 (crude).svg| width1 = 250| alt1 = | caption1 = | image2 = Female suicide rates 2015 (crude).svg| width2 = 250| alt2 = | caption2 = | footer = Suicide rates per 100,000 males (left) and females (right).{{Col-begin}}{{Col-break}}{{legend|#fef23d|0 – 5}}{{legend|#f0c809|5 – 10}}{{Col-break}}{{legend|#ff980d|10 – 15}}{{legend|#f05c0d|15 – 25}}{{Col-break}}{{legend|#cd281b|25 – 35}}{{legend|#b00507|Above 35}}{{Col-break}}{{legend|#d1d1d1|No data}}{{col-end}}}}Globally {{As of|2012|lc=y}}, death by suicide occurs about 1.8 times more often in males than females.WEB, Estimates for 2000–2012,www.who.int/entity/healthinfo/global_burden_disease/GHE_DthGlobal_2000_2012.xls?ua=1, WHO, 24 August 2016, In the Western world, males die three to four times more often by means of suicide than do females. This difference is even more pronounced in those over the age of 65, with tenfold more males than females dying by suicide. Suicide attempts and self-harm are between two and four times more frequent among females.BOOK, Stern TA, Fava M, Wilens TE, Rosenbaum JF, Massachusetts General Hospital Comprehensive Clinical Psychiatry, 2015, Elsevier Health Sciences, 978-0-323-32899-9, 589, 2,books.google.com/books?id=y5nTBgAAQBAJ&pg=PA589, live,web.archive.org/web/20160914014509/https://books.google.com/books?id=y5nTBgAAQBAJ&pg=PA589, 14 September 2016, BOOK, Krug EG, World Report on Violence and Health, 2002, World Health Organization, 978-92-4-154561-7, 191,books.google.com/books?id=db9OHpk-TksC&pg=PA191, live,web.archive.org/web/20160914020823/https://books.google.com/books?id=db9OHpk-TksC&pg=PA191, 14 September 2016, Researchers have attributed the difference between suicide and attempted suicide among the sexes to males using more lethal means to end their lives.BOOK, Sue D, Sue DW, Sue S, Sue D, Understanding abnormal behavior, Wadsworth/Cengage Learning, Belmont, CA, 978-1-111-83459-3, 255,books.google.com/books?id=mTs--Kt-9a0C&pg=PA255, Tenth [student], 1 January 2012, live,web.archive.org/web/20151030225833/https://books.google.com/books?id=mTs--Kt-9a0C&pg=PA255, 30 October 2015, Derald Wing Sue, BOOK, Osváth P, Voros V, Fekete SA, Gender Issues in Suicide Risk Assessment, Kumar U, Mandal MK, Suicidal Behaviour: Assessment of People-At-Risk, 978-81-321-0499-5, SAGE Publications India, 2010, 139, 4 March 2017,books.google.com/books?id=W5WHAwAAQBAJ&pg=PA139, BOOK, Ellis L, Hershberger S, Pellis S, Field E, Wersinger S, Pellis S, Geary D, Palmer C, Hoyenga K, Hetsroni A, Karadi K, Sex Differences: Summarizing More than a Century of Scientific Research, 978-1-136-87493-2, Psychology Press, 2013, 387, 4 March 2017,books.google.com/books?id=Skw2mezpvO4C&pg=PA387, live,web.archive.org/web/20170305152038/https://books.google.com/books?id=Skw2mezpvO4C&pg=PA387, 5 March 2017, However, separating intentional suicide attempts from non-suicidal self-harm is not currently done in places like the United States when gathering statistics at the national level.WEB, Suicide Statistics,afsp.org/about-suicide/suicide-statistics/, American Foundation for Suicide Prevention (AFSP), 3 September 2016, live,web.archive.org/web/20160902201450/https://afsp.org/about-suicide/suicide-statistics/, 2 September 2016, 16 February 2016, China has one of the highest female suicide rates in the world and is the only country where it is higher than that of men (ratio of 0.9).JOURNAL, Weiyuan C, Women and suicide in rural China, Bulletin of the World Health Organization, 87, 12, 888–9, December 2009, 20454475, 2789367, 10.2471/BLT.09.011209, In the Eastern Mediterranean, suicide rates are nearly equivalent between males and females. The highest rate of female suicide is found in South Korea at 22 per 100,000, with high rates in South-East Asia and the Western Pacific generally.A number of reviews have found an increased risk of suicide among lesbian, gay, bisexual, and transgender people.JOURNAL, Haas AP, Eliason M, Mays VM, Mathy RM, Cochran SD, D’Augelli AR, Silverman MM, Fisher PW, Hughes T, Rosario M, Russell ST, Malley E, Reed J, Litts DA, Haller E, Sell RL, Remafedi G, Bradford J, Beautrais AL, Brown GK, Diamond GM, Friedman MS, Garofalo R, Turner MS, Hollibaugh A, Clayton PJ, 6, Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: review and recommendations, Journal of Homosexuality, 58, 1, 10–51, 2011, 21213174, 3662085, 10.1080/00918369.2011.534038, WEB, Suicide Attempts among Transgender and Gender Non-Conforming Adults,williamsinstitute.law.ucla.edu/wp-content/uploads/AFSP-Williams-Suicide-Report-Final.pdf, 28 April 2018, Jan 2014, Among transgender persons, rates of attempted suicide are about 40% compared to a general population rate of 5%.JOURNAL, Williams A, Risk factors for suicide in the transgender community, European Psychiatry, April 2017, 41, S894, 10.1016/j.eurpsy.2017.01.1820, 149086762, JOURNAL, Virupaksha HG, Muralidhar D, Ramakrishna J, Suicide and Suicidal Behavior among Transgender Persons, Indian Journal of Psychological Medicine, 38, 6, 505–509, 2016, 28031583, 5178031, 10.4103/0253-7176.194908, free, This is believed to in part be due to social stigmatisation.WEB,www.thetaskforce.org/downloads/reports/reports/ntds_full.pdf, Reports, 25 July 2016, 2011, dead,www.thetaskforce.org/downloads/reports/reports/ntds_full.pdf," title="web.archive.org/web/20140908030754www.thetaskforce.org/downloads/reports/reports/ntds_full.pdf,">web.archive.org/web/20140908030754www.thetaskforce.org/downloads/reports/reports/ntds_full.pdf, 8 September 2014,

Age

(File:Suicide rates by age, OWID.svg|thumb|upright=1.6|Suicide rates by ageWEB, Suicide rates by age,ourworldindata.org/grapher/suicide-rates-by-age-detailed, Our World in Data, 4 March 2020, )In many countries, the rate of suicide is highest in the middle-agedJOURNAL, Pitman A, Krysinska K, Osborn D, King M, 193711, Suicide in young men, Lancet, 379, 9834, 2383–92, June 2012, 22726519, 10.1016/S0140-6736(12)60731-4, or elderly. The absolute number of suicides, however, is greatest in those between 15 and 29 years old, due to the number of people in this age group. Worldwide, the average age of suicide is between age 30 and 49 for both men and women.WEB, Summary tables of mortality estimates by cause, age and sex, globally and by region, 2000–2016,www.who.int/healthinfo/global_burden_disease/GHE2016_Deaths_Global_2000_2016.xls, World Health Organization, 21 December 2018, 2018, This means that half of people who died by suicide were approximately age 40 or younger, and half were older. Suicidality is rare in children, but increases during the transition to adolescence.JOURNAL, Glenn CR, Kleiman EM, Kellerman J, Pollak O, Cha CB, Esposito EC, Porter AC, Wyman PA, Boatman AE, 6, Annual Research Review: A meta-analytic review of worldwide suicide rates in adolescents, Journal of Child Psychology and Psychiatry, and Allied Disciplines, 61, 3, 294–308, March 2020, 31373003, 10.1111/jcpp.13106, 199380438, In the United States, the suicide death rate is greatest in Caucasian men older than 80 years, even though younger people more frequently attempt suicide. It is the second most common cause of death in adolescentsJOURNAL, Hawton K, Saunders KE, O’Connor RC, 151486181, Self-harm and suicide in adolescents, Lancet, 379, 9834, 2373–82, June 2012, 22726518, 10.1016/S0140-6736(12)60322-5, and in young males is second only to accidental death. In young males in the developed world, it is the cause of nearly 30% of mortality. In the developing world rates are similar, but it makes up a smaller proportion of overall deaths due to higher rates of death from other types of trauma. In South-East Asia, in contrast to other areas of the world, deaths from suicide occur at a greater rate in young females than elderly females.

History

File:10 2023 - Palazzo Altemps, Roma, Lazio, 00186, Italia - Galata suicida (Ludovisi Gaul) - Arte Ellenistica Greca - Copia Romana - Photo Paolo Villa FO232046 ombre gimp bis.jpg|thumb|upright|The Ludovisi Gaul killing himself and his wife, Roman copy after the Hellenistic original, Palazzo Massimo alle TermePalazzo Massimo alle TermeIn ancient Athens, a person who died by suicide without the approval of the state was denied the honors of a normal burial. The person would be buried alone, on the outskirts of the city, without a headstone or marker.BOOK,archive.org/details/fatalfreedomethi00szas, registration, Fatal freedom : the ethics and politics of suicide, Szasz T, Praeger, 1999, 978-0-275-96646-1, Westport, CT, 11, It was also common for the hand to be cut off the body and buried separatelyBOOK, Battin, M. Pabst, The ethics of suicide: historical sources, 2015, Oxford University Press, 978-0-19-938580-5, Oxford ; New York, 2, - the hand (and the instrument used) being considered the perpetrator.JOURNAL, Naiden, F. S., May 2015, The Sword Did It: A Greek Explanation for Suicide,www.cambridge.org/core/journals/classical-quarterly/article/abs/sword-did-it-a-greek-explanation-for-suicide/D39F17D5B29D7FF301160467678808AD, The Classical Quarterly, en, 65, 1, 85–95, 10.1017/S0009838814000858, 0009-8388, However, it was deemed to be an acceptable method to deal with military defeat. In Ancient Rome, while suicide was initially permitted, it was later deemed a crime against the state due to its economic costs.BOOK, Dickinson MR, Leming GE, Understanding dying, death, and bereavement, Wadsworth Cengage Learning, Belmont, CA, 978-0-495-81018-6, 290,books.google.com/books?id=L8ETDRsB8ZYC&pg=PA290, 7th, 2 September 2010, Aristotle condemned all forms of suicide while Plato was ambivalent. In Rome, some reasons for suicide included volunteering death in a gladiator combat, guilt over murdering someone, to save the life of another, as a result of mourning, from shame from being raped, and as an escape from intolerable situations like physical suffering, military defeat, or criminal pursuit.File:La mort de seneque.jpg|thumb|The Death of Seneca (1684), painting by Luca Giordano, depicting the suicide of Seneca the Younger in Ancient RomeAncient RomeSuicide came to be regarded as a sin in Christian Europe and was condemned at the Council of Arles (452) as the work of the Devil. In the Middle Ages, the Church had drawn-out discussions as to when the desire for martyrdom was suicidal, as in the case of martyrs of Córdoba. Despite these disputes and occasional official rulings, Catholic doctrine was not entirely settled on the subject of suicide until the later 17th century. A criminal ordinance issued by Louis XIV of France in 1670 was extremely severe, even for the times: the dead person’s body was drawn through the streets, face down, and then hung or thrown on a garbage heap. Additionally, all of the person’s property was confiscated.BOOK, Pickering WS, Walford G, Durkheim’s Suicide : a century of research and debate, 2000, Routledge, London, 978-0-415-20582-5, 69,books.google.com/books?id=9KQO6dGY1cwC&pg=PA69, 1. publ., live,web.archive.org/web/20160402063717/https://books.google.com/books?id=9KQO6dGY1cwC&pg=PA69, 2 April 2016, BOOK, Maris R, Comprehensive textbook of suicidology, 2000, Guilford Press, New York, 978-1-57230-541-0, 540,books.google.com/books?id=Zi-xoFAPnPMC&pg=PA540, Attitudes towards suicide slowly began to shift during the Renaissance. John Donne’s work Biathanatos contained one of the first modern defences of suicide, bringing proof from the conduct of Biblical figures, such as Jesus, Samson and Saul, and presenting arguments on grounds of reason and nature to sanction suicide in certain circumstances.BOOK,plato.stanford.edu/entries/suicide/, Suicide, Stanford Encyclopedia of Philosophy, 2017, The secularization of society that began during the Enlightenment questioned traditional religious attitudes (such as Christian views on suicide) toward suicide and brought a more modern perspective to the issue. David Hume denied that suicide was a crime as it affected no one and was potentially to the advantage of the individual. In his 1777 Essays on Suicide and the Immortality of the Soul he rhetorically asked, “Why should I prolong a miserable existence, because of some frivolous advantage which the public may perhaps receive from me?” Hume’s analysis was criticized by philosopher Philip Reed as being “uncharacteristically (for him) bad”, since Hume took an unusually narrow conception of duty and his conclusion depended upon the suicide producing no harm to others – including causing no grief, feelings of guilt, or emotional pain to any surviving friends and family – which is almost never the case.BOOK, Reed P,books.google.com/books?id=BOcJEAAAQBAJ, Exploring the Philosophy of Death and Dying: Classical and Contemporary Perspectives, 30 December 2020, Routledge, 978-1-000-21674-5, Timmerman T, Cholbi M, en, Suicide and its Discontents, A shift in public opinion at large can also be discerned; The Times in 1786 initiated a spirited debate on the motion “Is suicide an act of courage?”.BOOK,books.google.com/books?id=bWTcejAzQ8kC, A Companion to the Eighteenth-Century English Novel and Culture, Backscheider PR, Ingrassia C, 2008, John Wiley & Sons, 530, 978-1-4051-5450-5, By the 19th century, the act of suicide had shifted from being viewed as caused by sin to being caused by insanity in Europe. Although suicide remained illegal during this period, it increasingly became the target of satirical comments, such as the Gilbert and Sullivan comic opera The Mikado, which satirized the idea of executing someone who had already killed himself.By 1879, English law began to distinguish between suicide and homicide, although suicide still resulted in forfeiture of estate.BOOK, Paperno I, Suicide as a cultural institution in Dostoevsky’s Russia, 1997, Cornell university press, Ithaca, 978-0-8014-8425-4, 60,books.google.com/books?id=m3pqf8f-6bMC&pg=PA60, live,web.archive.org/web/20150928063739/https://books.google.com/books?id=m3pqf8f-6bMC&pg=PA60, 28 September 2015, In 1882, the deceased were permitted daylight burial in EnglandBOOK,books.google.com/books?id=S60656aS4PAC, Life, Death and the Law: Law and Christian Morals in England and the United States, St John-Stevas N, 2002, Beard Books, 233, 978-1-58798-113-5, and by the middle of the 20th century, suicide had become legal in much of the Western world. The term suicide first emerged shortly before 1700 to replace expressions on self-death which were often characterized as a form of self-murder in the West.BOOK, Minois G, History of Suicide: Voluntary Death in Western Culture, 2001, Johns Hopkins University Press, Baltimore, 978-0-8018-6647-0, Johns Hopkins University,

Social and culture

Legislation

File:Wakisashi-sepukku-p1000699.jpg|thumb|A tantō knife prepared for seppuku (abdomenabdomenFile:Seppuku-2.jpg|thumb|SamuraiSamuraiNo country in Europe currently considers suicide or attempted suicide to be a crime.BOOK,books.google.com/books?id=I2FJRbekdC8C&pg=PA24, Suicide-related behaviour understanding, caring and therapeutic responses, McLaughlin C, John Wiley & Sons, 2007, 978-0-470-51241-8, Chichester, 24, It was, however, in most Western European countries from the Middle Ages until at least the 19th century. The Netherlands was the first country to legalize both physician-assisted suicide and euthanasia, which took effect in 2002, although only doctors are allowed to assist in either of them, and have to follow a protocol prescribed by Dutch law.NEWS,news.bbc.co.uk/2/hi/europe/1269682.stm, Dutch ‘mercy killing law’ passed, 11 April 2001, 27 February 2019, If such protocol is not followed, it is an offence punishable by law. In Germany, active euthanasia is illegal and anyone present during suicide may be prosecuted for failure to render aid in an emergency.NEWS,www.timesonline.co.uk/tol/news/world/europe/article4251894.ece, German politician Roger Kusch helped elderly woman to die, 2 July 2008, Times Online,www.timesonline.co.uk/tol/news/world/europe/article4251894.ece," title="web.archive.org/web/20100601051855www.timesonline.co.uk/tol/news/world/europe/article4251894.ece,">web.archive.org/web/20100601051855www.timesonline.co.uk/tol/news/world/europe/article4251894.ece, 1 June 2010, live, Switzerland has taken steps to legalize assisted suicide for the chronically mentally ill. The high court in Lausanne, Switzerland, in a 2006 ruling, granted an anonymous individual with longstanding psychiatric difficulties the right to end his own life.JOURNAL, Appel JM, 28038414, A suicide right for the mentally ill? A Swiss case opens a new debate, The Hastings Center Report, 37, 3, 21–3, May 2007, 17649899, 10.1353/hcr.2007.0035, England and Wales decriminalized suicide via the Suicide Act 1961 and the Republic of Ireland in 1993. The word “commit” was used in reference to its being illegal, but many organisations have stopped it because of the negative connotation.Holt, Gerry.“When suicide was illegal” {{webarchive|url=https://web.archive.org/web/20140207074649www.bbc.co.uk/news/magazine-14374296|date=7 February 2014}}. BBC News. 3 August 2011. Accessed 11 August 2011.NEWS, Guardian & Observer style guide,www.theguardian.com/styleguide/s, Guardian website, The Guardian, 29 November 2011, live,www.theguardian.com/styleguide/s," title="web.archive.org/web/20131019070418www.theguardian.com/styleguide/s,">web.archive.org/web/20131019070418www.theguardian.com/styleguide/s, 19 October 2013, 31 December 2015, In the United States, suicide is not illegal, but may be associated with penalties for those who attempt it. Physician-assisted suicide is legal in the state of Washington for people with terminal diseases.NEWS,apps.leg.wa.gov/RCW/default.aspx?cite=70.245, Chapter 70.245 RCW, The Washington death with dignity act, Washington State Legislature,apps.leg.wa.gov/RCW/default.aspx?cite=70.245," title="web.archive.org/web/20100708000006apps.leg.wa.gov/RCW/default.aspx?cite=70.245,">web.archive.org/web/20100708000006apps.leg.wa.gov/RCW/default.aspx?cite=70.245, 8 July 2010, live, In Oregon, people with terminal diseases may request medications to help end their life.WEB,public.health.oregon.gov/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Pages/ors.aspx, Oregon Revised Statute – 127.800 s.1.01. Definitions, Oregon State Legislature,public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/ors.aspx," title="web.archive.org/web/20151007062220public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/ors.aspx,">web.archive.org/web/20151007062220public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/ors.aspx, 7 October 2015, live, Canadians who have attempted suicide may be barred from entering the United States. U.S. laws allow border guards to deny access to people who have a mental illness, including those with previous suicide attempts.WEB,www.cbc.ca/m/news/#!/content/1.1034903, CBCNews.ca Mobile, 1 February 1999, Cbc.ca,www.cbc.ca/m/news/#!/content/1.1034903," title="web.archive.org/web/20140807054409www.cbc.ca/m/news/#!/content/1.1034903,">web.archive.org/web/20140807054409www.cbc.ca/m/news/#!/content/1.1034903, 7 August 2014, live, 6 August 2014, WEB,globalnews.ca/news/1271798/us-border-suicide-profiling-must-stop-report/, US border suicide profiling must stop: Report, Adams C, 15 April 2014, globalnews.ca,globalnews.ca/news/1271798/us-border-suicide-profiling-must-stop-report/," title="web.archive.org/web/20140808055456globalnews.ca/news/1271798/us-border-suicide-profiling-must-stop-report/,">web.archive.org/web/20140808055456globalnews.ca/news/1271798/us-border-suicide-profiling-must-stop-report/, 8 August 2014, live, 7 August 2014, In Australia, suicide is not a crime.BOOK, Lanham D, Bartal BF, Evans RC, Wood D, Criminal laws in Australia, 2006, The Federation Press, Annandale, N.S.W., 978-1-86287-558-6, 229,books.google.com/books?id=D97doQ1iZx4C&pg=PA229, However, it is a crime to counsel, incite, or aid and abet another in attempting to die by suicide, and the law explicitly allows any person to use “such force as may reasonably be necessary” to prevent another from taking their own life.BOOK, Costa M, Duffy M, Labor, prosperity and the nineties : beyond the bonsai economy, 1991, Federation Press, Sydney, 978-1-86287-060-4, 315,books.google.com/books?id=TqZqTHwvCH8C&pg=PA315, 2nd, The Northern Territory of Australia briefly had legal physician-assisted suicide from 1996 to 1997.BOOK,books.google.com/books?id=GmFwa3I7vqMC&pg=PA143, Hospice or hemlock? : searching for heroic compassion, Putnam CE, Praeger, 2002, 978-0-89789-921-5, Westport, CT, 143, In India, suicide was illegal until 2014, and surviving family members used to face legal difficulties.BOOK, Dogra M, Srivastava S, Climate change and disease dynamics in India, The Energy and Resources Institute, New Delhi, 978-81-7993-412-8, 256,books.google.com/books?id=UGrUgX-nKTIC&pg=PA256, 1 January 2012, live,web.archive.org/web/20150928054921/https://books.google.com/books?id=UGrUgX-nKTIC&pg=PA256, 28 September 2015, NEWS,zeenews.india.com/news/india/govt-decides-to-repeal-section-309-from-ipc-attempt-to-suicide-no-longer-a-crime_1512479.html, Govt decides to repeal Section 309 from IPC; attempt to suicide no longer a crime, Zee News, 10 December 2014, 10 December 2014, live,zeenews.india.com/news/india/govt-decides-to-repeal-section-309-from-ipc-attempt-to-suicide-no-longer-a-crime_1512479.html," title="web.archive.org/web/20150515222001zeenews.india.com/news/india/govt-decides-to-repeal-section-309-from-ipc-attempt-to-suicide-no-longer-a-crime_1512479.html,">web.archive.org/web/20150515222001zeenews.india.com/news/india/govt-decides-to-repeal-section-309-from-ipc-attempt-to-suicide-no-longer-a-crime_1512479.html, 15 May 2015, It remains a criminal offense in most Muslim-majority nations.In Malaysia, suicide per se is not a crime; however, attempted suicide is. Under Section 309 of the Penal Code, a person convicted of attempting suicide can be punished with imprisonment of up to one year, fined, or both. There are ongoing efforts to decriminalise attempted suicide, although rights groups and non-governmental organisations such as the local chapter of Befrienders say that progress has been slow.WEB,www.freemalaysiatoday.com/category/nation/2022/06/19/why-so-long-to-decriminalise-suicide-says-befrienders/, Why so long to decriminalise suicide, says Befrienders, 19 June 2022, Free Malaysia Today, WEB,www.channelnewsasia.com/asia/decriminalising-suicides-lies-malaysias-cabinet-2971011, Decision on decriminalising suicide attempts in Malaysia lie with cabinet: Khairy, 28 September 2022, Channel News Asia, Proponents of decriminalisation argue that suicide legislation may deter people from seeking help, and may even strengthen the resolve of would-be suicides to end their lives to avoid prosecution.WEB,www.academia.edu/45126006, Malaysia’s Pathway to the Decriminalisation of Suicides: Students’ Opinion and Discussions (pdf), 27 December 2020, academia.edu, The first reading of a bill to repeal Section 309 of the Penal Code was tabled in Parliament in April 2023, bringing Malaysia one step closer towards decriminalising attempted suicide.WEB,www.malaymail.com/news/malaysia/2023/04/07/as-decriminalisation-nears-a-brief-look-at-how-suicide-became-a-crime-in-malaysia/63525, As decriminalisation nears, a brief look at how suicide became a crime in Malaysia, 7 April 2023, Malay Mail, Suicide became a trending crisis in North Korea in 2023; a secret order criminalized suicide as treason against socialist state.WEB, Zitser, Joshua, Kim Jong Un orders North Koreans to stop killing themselves after number of suicides skyrocketed,www.businessinsider.com/kim-jong-un-bans-suicide-after-numbers-skyrocketed-report-2023-6, 2023-06-12, Business Insider, en-US,

Religious views

Christianity

Most forms of Christianity consider suicide sinful, based mainly on the writings of influential Christian thinkers of the Middle Ages, such as St. Augustine and St. Thomas Aquinas, but suicide was not considered a sin under the Byzantine Christian code of Justinian, for instance.WEB, Roth R,www.acu-cell.com/suicide.html, Suicide & Euthanasia – a Biblical Perspective, Acu-cell.com, 6 May 2009, dead,acu-cell.com/suicide.html," title="web.archive.org/web/20090418073913acu-cell.com/suicide.html,">web.archive.org/web/20090418073913acu-cell.com/suicide.html, 18 April 2009, WEB,www.clas.ufl.edu/users/nholland/suicide.htm, Norman N. Holland, Literary Suicides: A Question of Style, Clas.ufl.edu, 6 May 2009, live,www.clas.ufl.edu/users/nholland/suicide.htm," title="web.archive.org/web/20090528090133www.clas.ufl.edu/users/nholland/suicide.htm,">web.archive.org/web/20090528090133www.clas.ufl.edu/users/nholland/suicide.htm, 28 May 2009, In Catholic and Orthodox doctrine, suicide is considered to be murder, violating the commandment “Thou shalt not kill,” and historically neither church would even hold a burial service for a member that died by suicide, deeming it an act that condemned the person to hell, since they died in a state of mortal sin.WEB,uscatholic.org/articles/201410/is-suicide-a-sin/, 14 April 2022, Is suicide a sin?, 28 October 2014, The basic idea being that life is a gift given by God which should not be spurned, and that suicide is against the “natural order” and thus interferes with God’s master plan for the world.WEB,www.scborromeo.org/ccc/p3s2c2a5.htm#2280, Catechism of the Catholic Church – Part 3 Section 2 Chapter 2 Article 5, Scborromeo.org, 1 June 1941, 6 May 2009, live,www.scborromeo.org/ccc/p3s2c2a5.htm#2280," title="web.archive.org/web/20090425163428www.scborromeo.org/ccc/p3s2c2a5.htm#2280,">web.archive.org/web/20090425163428www.scborromeo.org/ccc/p3s2c2a5.htm#2280, 25 April 2009, However, it is believed that mental illness or grave fear of suffering diminishes the responsibility of the one completing suicide.WEB,www.scborromeo.org/ccc/p3s2c2a5.htm#2282, Catechism of the Catholic Church – Part 3 Section 2 Chapter 2 Article 5, Scborromeo.org, 1 June 1941, 6 May 2009, live,www.scborromeo.org/ccc/p3s2c2a5.htm#2282," title="web.archive.org/web/20090425163428www.scborromeo.org/ccc/p3s2c2a5.htm#2282,">web.archive.org/web/20090425163428www.scborromeo.org/ccc/p3s2c2a5.htm#2282, 25 April 2009,

Judaism

Judaism focuses on the importance of valuing this life, and as such, suicide is tantamount to denying God’s goodness in the world. Despite this, under extreme circumstances when there has seemed no choice but to either be killed or forced to betray their religion, there are several accounts of Jews having died by suicide, either individually or in groups (see Holocaust, Masada, First French persecution of the Jews and York Castle for examples), and as a grim reminder there is even a prayer in the Jewish liturgy for “when the knife is at the throat”, for those dying “to sanctify God’s Name” (see Martyrdom). These acts have received mixed responses by Jewish authorities, regarded by some as examples of heroic martyrdom, while others state that it was wrong for them to take their own lives in anticipation of martyrdom.WEB,www.religionfacts.com/euthanasia/judaism.htm, Euthanasia and Judaism: Jewish Views of Euthanasia and Suicide, 16 September 2008, ReligionFacts.com, live,www.religionfacts.com/euthanasia/judaism.htm," title="web.archive.org/web/20060506200930www.religionfacts.com/euthanasia/judaism.htm,">web.archive.org/web/20060506200930www.religionfacts.com/euthanasia/judaism.htm, 6 May 2006,

Islam

Islamic religious views are against suicide. The Quran forbids it by stating “do not kill or destroy yourself”.WEB, Surah An-Nisa - 29,quran.com/an-nisa/29, 2023-02-25, Quran.com, en, JOURNAL, Gearing RE, Lizardi D, 30494312, Religion and suicide, Journal of Religion and Health, 48, 3, 332–41, September 2009, 19639421, 10.1007/s10943-008-9181-2, The hadiths also state individual suicide to be unlawful and a sin. Stigma is often associated with suicide in Islamic countries.

Hinduism and Jainism

File:A Hindoo Widow Burning Herself with the Corpse of her Husband.jpg|thumb|A Hindu widow burning herself with her husband’s corpse, 1820s]]In Hinduism, suicide is generally disdained and is considered equally sinful as murdering another in contemporary Hindu society. Hindu Scriptures state that one who dies by suicide will become part of the spirit world, wandering earth until the time one would have otherwise died, had one not taken one’s own life.Hindu Website. Hinduism and suicide {{webarchive|url=https://web.archive.org/web/20080507034203www.hinduwebsite.com/Hinduism/h_suicide.asp |date=7 May 2008 }} However, Hinduism accepts a man’s right to end one’s life through the non-violent practice of fasting to death, termed Prayopavesa;WEB,www.bbc.co.uk/religion/religions/hinduism/hinduethics/euthanasia.shtml, Hinduism – Euthanasia and Suicide, 25 August 2009, BBC, live,www.bbc.co.uk/religion/religions/hinduism/hinduethics/euthanasia.shtml," title="web.archive.org/web/20090225155507www.bbc.co.uk/religion/religions/hinduism/hinduethics/euthanasia.shtml,">web.archive.org/web/20090225155507www.bbc.co.uk/religion/religions/hinduism/hinduethics/euthanasia.shtml, 25 February 2009, but Prayopavesa is strictly restricted to people who have no desire or ambition left, and no responsibilities remaining in this life.Jainism has a similar practice named Santhara. Sati, or self-immolation by widows, is a rare and illegal practice in Hindu society.NEWS, India wife dies on husband’s pyre,news.bbc.co.uk/2/hi/south_asia/5273336.stm, 30 June 2019, 22 August 2006,

Ainu

Within the Ainu religion, someone who dies by suicide is believed to become a ghost (tukap) who would haunt the living,Takako Yamada: The Worldview of the Ainu. Nature and Cosmos Reading from Language, p. 25–37, p. 123. to come to fulfillment from which they were excluded during life.Norbert Richard Adami: Religion und Schaminismus der Ainu auf Sachalin (Karafuto), Bonn 1989, p. 45. Also, someone who insults another so they kill themselves is regarded as co-responsible for their death.Adami: Religion und Schaminismus der Ainu auf Sachalin (Karafuto), p. 79, p. 119. According to Norbert Richard Adami, this ethic exists due to the case that solidarity within the community is much more important to Ainu culture than it is to the Western world.

Philosophy

A number of questions are raised within the philosophy of suicide, including what constitutes suicide, whether or not suicide can be a rational choice, and the moral permissibility of suicide.BOOK,plato.stanford.edu/entries/suicide/, Suicide (Stanford Encyclopedia of Philosophy), Plato.stanford.edu, 6 May 2009, Suicide, 2017, Arguments as to acceptability of suicide in moral or social terms range from the position that the act is inherently immoral and unacceptable under any circumstances, to a regard for suicide as a sacrosanct right of anyone who believes they have rationally and conscientiously come to the decision to end their own lives, even if they are young and healthy.Opponents to suicide include philosophers such as Augustine of Hippo, Thomas Aquinas, Immanuel KantKant, Immanuel. (1785) Kant: The Metaphysics of Morals, M. Gregor (trans.), Cambridge: Cambridge University Press, 1996. {{ISBN|978-0-521-56673-5}}. p. 177. and, arguably, John Stuart Mill – Mill’s focus on the importance of liberty and autonomy meant that he rejected choices which would prevent a person from making future autonomous decisions.JOURNAL, Safranek John P, 1998, Autonomy and Assisted Suicide: The Execution of Freedom, The Hastings Center Report, 28, 4, 32–36, 10.2307/3528611, 3528611, 9762538, Others view suicide as a legitimate matter of personal choice. Supporters of this position maintain that no one should be forced to suffer against their will, particularly from conditions such as incurable disease, mental illness, and old age, with no possibility of improvement. They reject the belief that suicide is always irrational, arguing instead that it can be a valid last resort for those enduring major pain or trauma.BOOK, Whiting R, A natural right to die: twenty-three centuries of debate, 13–17, Praeger, 2001, 0-313-31474-8, A stronger stance would argue that people should be allowed to autonomously choose to die regardless of whether they are suffering. Notable supporters of this school of thought include Scottish empiricist David Hume, who accepted suicide so long as it did not harm or violate a duty to God, other people, or the self, and American bioethicist Jacob Appel.JOURNAL, Wesley J. Smith, Smith WJ, Death on Demand: The assisted-suicide movement sheds its fig leaf, NRL News, August 2007, 34, 8, 18,www.nrlc.org/archive/news/2007/NRL08/Smith.html, 25 July 2020, 16 April 2021,web.archive.org/web/20210416021221/https://www.nrlc.org/archive/news/2007/NRL08/Smith.html, dead,

Advocacy

{{See also|Advocacy of suicide}}File:Alexandre-Gabriel Decamps - The Suicide - Walters 3742.jpg|thumb|In this painting by Alexandre-Gabriel Decamps, the palette, pistol, and note lying on the floor suggest that the event has just taken place; an artist has taken his own life.WEB, The Walters Art MuseumThe Walters Art MuseumAdvocacy of suicide has occurred in many cultures and subcultures. The Japanese military during World War II encouraged and glorified kamikaze attacks, which were suicide attacks by military aviators from the Empire of Japan against Allied naval vessels in the closing stages of the Pacific Theater of World War II. Japanese society as a whole has been described as “suicide-tolerant“JOURNAL, Ozawa-de Silva C, Too lonely to die alone: internet suicide pacts and existential suffering in Japan, Culture, Medicine and Psychiatry, 32, 4, 516–51, December 2008, 18800195, 10.1007/s11013-008-9108-0, 145475668, (see Suicide in Japan).Internet searches for information on suicide return webpages that, in a 2008 study, about 50% of the time provide information on suicide methods. A similar study found that 11% of sites encouraged suicide attempts.JOURNAL, Luxton, David D., June, Jennifer D., Fairall, Jonathan M., May 2012, Social Media and Suicide: A Public Health Perspective, American Journal of Public Health, 102, Suppl 2, S195–S200, 10.2105/AJPH.2011.300608, 0090-0036, 3477910, 22401525, There is some concern that such sites may push those predisposed over the edge. Some people form suicide pacts online, either with pre-existing friends or people they have recently encountered in chat rooms or message boards. The Internet, however, may also help prevent suicide by providing a social group for those who are isolated.JOURNAL, Durkee T, Hadlaczky G, Westerlund M, Carli V, Internet pathways in suicidality: a review of the evidence, International Journal of Environmental Research and Public Health, 8, 10, 3938–52, October 2011, 22073021, 3210590, 10.3390/ijerph8103938, free,

Locations

{{See also|List of suicide sites|Suicides at the Golden Gate Bridge}}Some landmarks have become known for high levels of suicide attempts. These include China’s Nanjing Yangtze River Bridge,WEB,www.thenational.ae/world/asia/a-voice-of-reason-on-yangtze-bridge-1.228563, A voice of reason on Yangtze bridge, The National, 8 July 2008, en, 16 October 2019, San Francisco’s Golden Gate Bridge, Japan’s Aokigahara Forest,BOOK, Robinson P, Heitmann S, Dieke PU, Research themes for tourism, 2010, CABI, Oxfordshire [etc.], 978-1-84593-684-6, 172,books.google.com/books?id=219aFMSRPqgC&pg=PA172, England’s Beachy Head,BOOK, Picard D, Robinson M, Emotion in motion : tourism, affect and transformation, Ashgate, Farnham, Surrey, 978-1-4094-2133-7, 176,books.google.com/books?id=PjuY_4Vy_UUC&pg=PT176, 28 November 2012, and Toronto’s Bloor Street Viaduct.BOOK, Dennis R, Cities in modernity : representations and productions of metropolitan space, 1840–1930, 2008, Cambridge Univ. Press, Cambridge [u.a.], 978-0-521-46841-1, 20,books.google.com/books?id=Gq9_uNNkmKUC&pg=PA20, Repr., {{As of|2010}}, the Golden Gate Bridge has had more than 1,300 suicides by jumping since its construction in 1937.BOOK, McDougall T, Armstrong M, Trainor G, Helping children and young people who self-harm: an introduction to self-harming and suicidal behaviours for health professionals, 2010, Routledge, Abingdon, Oxon, 978-0-415-49913-2, 23,books.google.com/books?id=2VfP1-o0BgcC&pg=PA23, Many locations where suicide is common have constructed barriers to prevent it;BOOK,archive.org/details/buildinghopelead0000bate, registration, Building hope : leadership in the nonprofit world, Bateson J, Praeger, 2008, 978-0-313-34851-8, Westport, CT, 180, this includes the Luminous Veil in Toronto, the Eiffel Tower in Paris, the West Gate Bridge in Melbourne, and Empire State Building in New York City. They generally appear to be effective.BOOK, Miller D, Child and Adolescent Suicidal Behavior: School-Based Prevention, Assessment, and Intervention, 2011, 978-1-60623-997-1, 46, Guilford Press,books.google.com/books?id=bAHcIUDoVEoC&pg=PA46,

Notable cases

File:Tojo suicide.jpg|thumb|Japanese general Hideki TojoHideki TojoAn example of mass suicide is the 1978 Jonestown mass murder/suicide in which 909 members of the Peoples Temple, an American new religious movement led by Jim Jones, ended their lives by drinking grape Flavor Aid laced with cyanide and various prescription drugs.Hall 1987, p.282WEB, Alternative Considerations of Jonestown and Peoples Temple,jonestown.sdsu.edu/AboutJonestown/Tapes/Tapes/DeathTape/death.html, San Diego State University, 10 November 2011, dead,jonestown.sdsu.edu/AboutJonestown/Tapes/Tapes/DeathTape/death.html," title="web.archive.org/web/20110220005202jonestown.sdsu.edu/AboutJonestown/Tapes/Tapes/DeathTape/death.html,">web.archive.org/web/20110220005202jonestown.sdsu.edu/AboutJonestown/Tapes/Tapes/DeathTape/death.html, 20 February 2011, “1978:Mass Suicide Leaves 900 Dead {{webarchive|url=https://web.archive.org/web/20121104074001news.bbc.co.uk/onthisday/hi/dates/stories/november/18/newsid_2540000/2540209.stm |date=2012-11-04 }}”. Retrieved 9 November 2011.Thousands of Japanese civilians took their own lives in the last days of the Battle of Saipan in 1944, some jumping from “Suicide Cliff” and “Banzai Cliff”.John Toland, (The Rising Sun: The Decline and Fall of the Japanese Empire 1936–1945), Random House, 1970, p. 519 The 1981 Irish hunger strikes, led by Bobby Sands, resulted in 10 deaths. The cause of death was recorded by the coroner as “starvation, self-imposed” rather than suicide; this was modified to simply “starvation” on the death certificates after protest from the dead strikers’ families.JOURNAL, 3750951, Suicide and Self-Starvation, Philosophy, 59, 229, 349–363, O’Keeffe TM, 1984, 10.1017/S0031819100069941, 154281192, During World War II, Erwin Rommel was found to have foreknowledge of the 20 July plot on Hitler’s life; he was threatened with public trial, execution, and reprisals on his family unless he killed himself.BOOK, Watson B, Exit Rommel: The Tunisian Campaign, 1942–43, Stackpole Books, 2007, 170, 978-0-8117-3381-6,

Other species

As suicide requires a willful attempt to die, some feel it therefore cannot be said to occur in non-human animals.BOOK, Maris R, Comprehensive textbook of suicidology, 2000, Guilford Press, New York [u.a.], 978-1-57230-541-0, 97–103,books.google.com/books?id=Zi-xoFAPnPMC&pg=PA97, Suicidal behavior has been observed in Salmonella seeking to overcome competing bacteria by triggering an immune system response against them.NEWS,www.nytimes.com/2008/08/26/science/26obsalm.html, In Salmonella Attack, Taking One for the Team, The New York Times, Chang K, 25 August 2008, live,www.nytimes.com/2008/08/26/science/26obsalm.html?ref=science," title="web.archive.org/web/20170805103824www.nytimes.com/2008/08/26/science/26obsalm.html?ref=science,">web.archive.org/web/20170805103824www.nytimes.com/2008/08/26/science/26obsalm.html?ref=science, 5 August 2017, Suicidal defenses by workers are also seen in the Brazilian ant Forelius pusillus, where a small group of ants leaves the security of the nest after sealing the entrance from the outside each evening.JOURNAL, Tofilski A, Couvillon MJ, Evison SE, Helanterä H, Robinson EJ, Ratnieks FL, Preemptive defensive self-sacrifice by ant workers, The American Naturalist, 172, 5, E239-43, November 2008, 18928332, 10.1086/591688, 7052340,www.cyf-kr.edu.pl/~rotofils/Tofilski_etal_2008.pdf, live,www.cyf-kr.edu.pl/~rotofils/Tofilski_etal_2008.pdf," title="web.archive.org/web/20091127130838www.cyf-kr.edu.pl/~rotofils/Tofilski_etal_2008.pdf,">web.archive.org/web/20091127130838www.cyf-kr.edu.pl/~rotofils/Tofilski_etal_2008.pdf, 27 November 2009, Pea aphids, when threatened by a ladybug, can explode themselves, scattering and protecting their brethren and sometimes even killing the ladybug; this form of suicidal altruism is known as autothysis.NEWS,news.discovery.com/animals/animal-suicide-behavior.html, Animal Suicide Sheds Light on Human Behavior, O’Hanlon L, 10 March 2010, Discovery News, live,news.discovery.com/animals/animal-suicide-behavior.html," title="web.archive.org/web/20100725200146news.discovery.com/animals/animal-suicide-behavior.html,">web.archive.org/web/20100725200146news.discovery.com/animals/animal-suicide-behavior.html, 25 July 2010, Some species of termites (for example Globitermes sulphureus)JOURNAL, Bordereau C, Robert A, Van Tuyen V, Peppuy A, 19770804, 1 August 1997, Suicidal defensive behaviour by frontal gland dehiscence in Globitermes sulphureus Haviland soldiers (Isoptera), Insectes Sociaux, 44, 3, 289–97, 10.1007/s000400050049, 1420-9098, have soldiers that explode, covering their enemies with sticky goo.WEB,www.bbc.co.uk/pressoffice/pressreleases/stories/2005/10_october/20/life_horrors.shtml, Life In The Undergrowth, BBC, There have been anecdotal reports of dogs, horses, and dolphins killing themselves,MAGAZINE, Do Animals Commit Suicide? A Scientific Debate, Time, 19 March 2010, Nobel J,www.time.com/time/health/article/0,8599,1973486,00.html,www.time.com/time/health/article/0,8599,1973486,00.html," title="web.archive.org/web/20100322192029www.time.com/time/health/article/0,8599,1973486,00.html,">web.archive.org/web/20100322192029www.time.com/time/health/article/0,8599,1973486,00.html, dead, 22 March 2010, but little scientific study of animal suicide.JOURNAL, Stoff DM, Mann JJ, Suicide research. Overview and introduction, Annals of the New York Academy of Sciences, 836, 1, 1–11, December 1997, 9616791, 10.1111/j.1749-6632.1997.tb52352.x, 1997NYASA.836....1S, 31876340,zenodo.org/record/1230754, Animal suicide is usually put down to romantic human interpretation and is not generally thought to be intentional. Some of the reasons animals are thought to unintentionally kill themselves include: psychological stress, infection by certain parasites or fungi, or disruption of a long-held social tie, such as the ending of a long association with an owner and thus not accepting food from another individual.WEB, Hogenboom M, 6 July 2016, 20 July 2017, Many animals seem to kill themselves, but it is not suicide, BBC,www.bbc.com/earth/story/20160705-many-animals-seem-to-kill-themselves-but-it-is-not-suicide, live,www.bbc.com/earth/story/20160705-many-animals-seem-to-kill-themselves-but-it-is-not-suicide," title="web.archive.org/web/20170226233605www.bbc.com/earth/story/20160705-many-animals-seem-to-kill-themselves-but-it-is-not-suicide,">web.archive.org/web/20170226233605www.bbc.com/earth/story/20160705-many-animals-seem-to-kill-themselves-but-it-is-not-suicide, 26 February 2017,

See also

• Caring letters
• List of suicide crisis lines
• List of countries by suicide rate
• Prisoner suicide
• Substance-induced psychosis
• Youth suicide

References

{{Reflist}}

Further reading

{{Library resources box}}

• BOOK, Gambotto A, The Eclipse: A Memoir of Suicide, Broken Ankle Books, Australia, 2004, 978-0-9751075-1-5, The Eclipse: A Memoir of Suicide,
• BOOK, Suicide in Nazi Germany, Goeschel C, Oxford University Press, 2009, 978-0-19-953256-8,books.google.com/books?id=EIjccRg7_UYC,

External links

• {{Curlie|Health/Mental_Health/Disorders/Suicide}}
• BOOK, Preventing suicide: a global imperative., 2014, WHO, 978-92-4-156477-9,apps.who.int/iris/bitstream/handle/10665/131056/9789241564779_eng.pdf?sequence=1,
• Freakonomics podcast: The Suicide Paradox

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