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suicide
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{{short description|Intentional act of causing one's own death}}{{about|the cause of death|other uses|Suicide (disambiguation)}}{{pp-semi-protected|small=yes}}







factoids
| diagnosis =| differential =Mass media>media reporting of suicide, improving economic conditions| treatment =| medication =| prognosis =| frequency =| deaths = 828,000 / 1.5% (2015)}}Suicide is the act of intentionally causing one's own death.BOOK, Stedman's Medical Dictionary, 2006, Lippincott Williams & Wilkins, Philadelphia, 978-0-7817-3390-8, 28th, Mental disorders, including depression, bipolar disorder, schizophrenia, personality disorders, anxiety disorders, and substance abuse—including alcoholism and the use of benzodiazepines—are risk factors.JOURNAL, Hawton K, van Heeringen K, Suicide, Lancet, 373, 9672, 1372–81, April 2009, 19376453, 10.1016/S0140-6736(09)60372-X, 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, Some suicides are impulsive acts due to stress, such as from financial difficulties, troubles with relationships, or 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, 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 misuse; proper media reporting of suicide; and improving economic conditions.WEB, Suicide Fact sheet N°398,weblink WHO, 3 March 2016, April 2016, no,weblink" title="web.archive.org/web/20160304192347weblink">weblink 4 March 2016, BOOK,weblink Preventing Suicide A Resource for Media Professionals, 978-92-4-159707-4, Even though crisis hotlines are common, there is little evidence for their effectiveness.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., The most commonly used method of suicide varies between countries, 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, 2393–99, 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 global deaths in 2015, an increase from 712,000 deaths in 1990.JOURNAL, 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, JOURNAL, 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, 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, Approximately 0.5% of people die by suicide. In a given year this is roughly 12 per 100,000 people. Three quarters of suicides globally occur in the low and middle income countries. Rates of completed suicides are generally higher among men than among women, ranging from 1.5 times as much in the developing world to 3.5 times 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,weblink 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, 181–85, 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 among females.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 23–24, September 2011, 22164363, Views on suicide have been influenced by broad existential themes such as religion, honor, and the meaning of life.BOOK, Tomer, Adrian, vanc, Existential and Spiritual Issues in Death Attitudes, 2013, Psychology Press, 978-1-136-67690-1, 282,weblink BOOK, Ritzer, edited by George, Stepnisky, Jeffrey, vanc, The Wiley-Blackwell companion to major social theorists, 2011, Wiley-Blackwell, Malden, MA, 978-1-4443-9660-7, 65,weblink The Abrahamic religions traditionally consider suicide as an offense towards God, due to the belief in the sanctity of life.BOOK, God, Religion, Science, Nature, Culture, and Morality, 2014, Archway Publishing, 978-1-4808-1124-9, 254,weblink During the samurai era in Japan, a form of suicide known as seppuku (harakiri) was respected as a means of making up for failure or as a form of protest.BOOK, Colt, George Howe, The enigma of suicide, 1992, Simon & Schuster, New York, 978-0-671-76071-7, 139, 1st Touchstone,weblink Sati, a practice outlawed by the British Raj, expected the Indian widow to kill herself on her husband's funeral fire, either willingly or under pressure from her family and society.WEB,weblink Indian woman commits sati suicide, Bbc.co.uk, 2002-08-07, 2010-08-26, no,weblink" title="web.archive.org/web/20110202101233weblink">weblink 2011-02-02, Suicide and attempted suicide, while previously illegal, are no longer so in most Western countries.BOOK, White, Tony, vanc, Working with suicidal individuals : a guide to providing understanding, assessment and support, 2010, Jessica Kingsley Publishers, London, 978-1-84905-115-6, 12,weblink It remains a criminal offense in many countries.JOURNAL, Lester D, 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, and kamikaze and suicide bombings have been used as a military or terrorist tactic.JOURNAL, Aggarwal N, Rethinking suicide bombing, Crisis, 30, 2, 94–97, 2009, 19525169, 10.1027/0227-5910.30.2.94, {{TOC limit|3}}

Definitions

Suicide, from Latin suicidium, 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,weblink Attempted suicide or non-fatal suicidal behavior is self-injury with the desire to end one's life that does not result in death.BOOK, Krug, Etienne, vanc, World Report on Violence and Health (Vol. 1), 2002, World Health Organization, Genève, 978-92-4-154561-7, 185, Assisted suicide is when one individual helps another bring about their own death indirectly via providing either advice or the means to the end.BOOK, Gullota, Thomas P, vanc, Encyclopedia of Primary Prevention and Health Promotion, 2002, Kluwer Academic/Plenum, New York, 978-0-306-47296-1, 1112,weblink Bloom, Martin, 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. In a murder-suicide (or homicide-suicide), the individual aims at taking the life 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, Wasserman, editors, Danuta Wasserman, Camilla, Oxford textbook of suicidology, 134–36, 2009, Oxford University Press, Oxford, 978-0-19-857005-9, Extended suicide, 10.1093/med/9780198570059.003.0022, The normal verb in scholarly research and journalism for the act of suicide is commit.JOURNAL, Olson, Robert, vanc, Suicide and Language, Centre for Suicide Prevention, 2011, InfoExchange, 3, 4,weblink 15 May 2013, no,weblink" title="web.archive.org/web/20120506202903weblink">weblink 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,weblink no,weblink" title="web.archive.org/web/20140815173633weblink">weblink 2014-08-15, Some advocacy groups recommend saying completed suicide, took his/her own life, died by suicide, or killed him/herself instead of committed suicide.BOOK, Beck AT, Resnik HL, Lettieri DJ, vanc, The prediction of suicide, Bowie, MD, Charles Press, 1974, 41, Development of suicidal intent scales, 978-0-913486-13-9, y, WEB, Recommendations for Reporting on Suicide,weblink National Institute of Mental Health, 15 May 2013, 2001, yes,weblink" title="web.archive.org/web/20130427114237weblink">weblink 27 April 2013, WEB, Reporting Suicide and Self Harm,weblink Time To Change, 2 Jan 2016, 2008, no,weblink" title="web.archive.org/web/20160114191733weblink">weblink 2016-01-14, WEB, Media Guidelines for Reporting Suicide,weblink 2 Jan 2016, 2013, no,weblink" title="web.archive.org/web/20160118141920weblink">weblink 2016-01-18, Opponents of commit argue that it implies that suicide is criminal, sinful, or morally wrong.WEB, Ball, P. Bonny, vanc, The Power of words,weblink Canadian Association of Suicide Prevention, 16 May 2013, 2005, yes,weblink" title="web.archive.org/web/20130513011216weblink">weblink 13 May 2013,

Risk factors

(File:Suicide cases from 16 American states (2008).png|thumb|upright=1.35|The precipitating circumstances for suicide from 16 American states in 2008JOURNAL, Karch DL, Logan J, Patel N, Surveillance for violent deaths--National Violent Death Reporting System, 16 states, 2008, Morbidity and Mortality Weekly Report. Surveillance Summaries, 60, 10, 1–49, August 2011, 21866088, )Factors that affect the risk of suicide include mental disorders, drug misuse, psychological states, cultural, family and social situations, and genetics. 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, 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, Socio-economic problems such as unemployment, poverty, homelessness, and discrimination may trigger suicidal thoughts.JOURNAL, Qin P, Agerbo E, Mortensen PB, 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, JOURNAL, Suicide among adults aged 35-64 years--United States, 1999-2010, MMWR. Morbidity and Mortality Weekly Report, 62, 17, 321–15, May 2013, 23636024, 4604925, Centers for Disease Control Prevention (CDC), About 15–40% of people leave a suicide note.BOOK, Burl, Gilliland, Richard, James, vanc, Crisis intervention strategies, Brooks/Cole, Belmont, CA, 978-1-111-18677-7, 215,weblink 7th, 2012-05-08, no,weblink 2015-10-03, 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, Suicide among war veterans, International Journal of Environmental Research and Public Health, 9, 7, 2504–19, July 2012, 22851956, 3407917, 10.3390/ijerph9072504, 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,

Mental illness

File:'Suicidal melancholy' Wellcome L0022593 (cropped).jpg|thumb|left|A picture of a woman with depression who was suicidalsuicidalMental illness is often present at the time of suicide with estimates ranging from 27% to more than 90%.WEB, University of Manchester Centre for Mental Health and Risk, The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness,weblinkweblink" title="web.archive.org/web/20120714134607weblink">weblink yes, 14 July 2012, 25 July 2012, JOURNAL, Stone DM, Simon TR, Fowler KA, Kegler SR, Yuan K, Holland KM, Ivey-Stephenson AZ, Crosby AE, Vital Signs: Trends in State Suicide Rates - United States, 1999-2016 and Circumstances Contributing to Suicide - 27 States, 2015, en-us, MMWR. Morbidity and Mortality Weekly Report, 67, 22, 617–24, June 2018, 29879094, 5991813, 10.15585/mmwr.mm6722a1,weblink In Asia, rates of mental disorders appear to be lower than in Western countries. Of those who have been admitted to a psychiatric unit, their lifetime risk of completed suicide is about 8.6%. 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, Stan, Kutcher, Sonia, Chehil, vanc, Suicide Risk Management A Manual for Health Professionals., John Wiley & Sons, Chicester, 978-1-119-95311-1, 30–33, 2012,weblink 2nd, Other conditions implicated include schizophrenia (14%), personality disorders (8%),JOURNAL, Pompili M, Girardi P, Ruberto A, Tatarelli R, 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, 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 posttraumatic stress disorder.Others estimate that about half of people who complete 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, 453–61, 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., About 5% of people with schizophrenia die of suicide.JOURNAL, van Os J, Kapur S, Jim van Os, Schizophrenia, Lancet, 374, 9690, 635–45, August 2009, 19700006, 10.1016/S0140-6736(09)60995-8,weblink Eating disorders are another high risk condition.Among approximately 80% of completed 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 completed 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, Antidepressants of the SSRI type appear to increase the frequency of suicide among children but do not change the risk among adults.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,

Previous attempts and self-harm

A previous history of suicide attempts is the most accurate predictor of completed suicide. Approximately 20% of suicides have had a previous attempt, and of those who have attempted suicide, 1% complete suicide within a year and more than 5% die by suicide within 10 years. 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, 144–51, September 2009, 19826208, 10.2302/kjm.58.144, Some who self-harm, however, do still end their life by suicide, and risk for self-harm and suicide may overlap.

Substance misuse

(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, Jerome David, Levin, Joseph, Culkin, Richard S, Perrotto, vanc, Introduction to chemical dependency counseling, 2001, Jason Aronson, Northvale, NJ, 978-0-7657-0289-0, 150–52,weblink Both chronic substance misuse as well as acute intoxication are associated.BOOK, Behavioral science in medicine, Fadem, Barbara, vanc, Lippincott Williams & Wilkins, 2004, 978-0-7817-3669-5, Philadelphia, 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 suicideJOURNAL, 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 asscociated with an increased rate of attempted and completed suicide. The prosuicidal effects of benzodiazepines are suspected to be due to a psychiatric disturbance caused by side effects 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, 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, 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,weblink In adolescents who misuse alcohol, neurological and psychological dysfunctions may contribute to the increased risk of suicide.JOURNAL, Sher L, 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, 11–18, 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, 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,weblink Lexicon of psychiatry, neurology, and the neurosciences, Frank J., Ayd, vanc, 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.

Childhood trauma

Childhood trauma is a risk factor for suicidality. Some may take their own lives to escape bullying or prejudice.JOURNAL, Cox WT, Abramson LY, Devine PG, Hollon SD, Stereotypes, Prejudice, and Depression: The Integrated Perspective, Perspectives on Psychological Science, 7, 5, 427–49, September 2012, 26168502, 10.1177/1745691612455204,weblinkweblink" title="web.archive.org/web/20121020230619weblink">weblink no, 2012-10-20, A history of childhood sexual abuseJOURNAL, Wegman HL, Stetler C, 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, Sexual abuse is believed to contribute to approximately 20% of the overall risk.

Problem gambling

Problem gambling is associated with increased suicidal ideation and attempts compared to the general population.BOOK, Stefano, Pallanti, Nicolò Baldini, Rossi, Eric, Hollander, 11. Pathological Gambling, Eric, Hollander, Dan J., Stein, vanc, Clinical manual of impulse-control disorders,weblink 2006, American Psychiatric Pub, 978-1-58562-136-1, 253, Between 12 and 24% 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, 542–49, June 2008, 18461253, 10.1590/S0034-89102008005000026, Other factors that increase the risk in problem gamblers include mental illness, alcohol and drug misuse.JOURNAL, Hansen M, Rossow I, [Gambling and suicidal behaviour], Tidsskrift for den Norske Laegeforening, 128, 2, 174–76, January 2008, 18202728,

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, 1230–38, December 2010, 20104515, 10.1002/gps.2473, 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, 229–32, August 2007, 17708726,weblinkweblink" title="web.archive.org/web/20110910033458weblink">weblink no, 2011-09-10, cancer,JOURNAL, Anguiano L, Mayer DK, Piven ML, Rosenstein D, A literature review of suicide in cancer patients, Cancer Nursing, 35, 4, E14–26, Jul–Aug 2012, 21946906, 10.1097/NCC.0b013e31822fc76c, 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, Yip, Paul S.F., vanc, Suicide in Asia : causes and prevention, 2008, Hong Kong University Press, Hong Kong, 978-962-209-943-2, 11,weblink 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, 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).

Psychosocial states

A number of psychological states increase the risk of suicide including: hopelessness, loss of pleasure in life, depression and anxiousness. 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, 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, Suicide in which the reason is that the person feels that they are not part of society is known as egoistic suicide.BOOK, Stein, George, Wilkinson, Greg, vanc, Seminars in general adult psychiatry, 2007, Gaskell, London, 978-1-904671-44-2, 2nd, 144,weblink Rates of suicide appear to decrease around Christmas.JOURNAL, Carley S, Hamilton M, Best evidence topic report. Suicide at christmas, Emergency Medicine Journal, 21, 6, 716–17, November 2004, 15496706, 1726490, 10.1136/emj.2004.019703, One study however found the risk may be greater for males on their birthday.JOURNAL, Williams A, While D, Windfuhr K, Bickley H, Hunt IM, Shaw J, Appleby L, Kapur N, Birthday blues: examining the association between birthday and suicide in a national sample, Crisis, 32, 3, 134–42, 2011, 21616762, 10.1027/0227-5910/a000067, In those who are admitted to hospital, agitation appears to be a risk.JOURNAL, Bostwick, JM, Rackley, SJ, Completed suicide in medical/surgical patients: who is at risk?, Current Psychiatry Reports, June 2007, 9, 3, 242–46, 17521522, Recent life stresses such as a loss of a family member or friend, loss of a job, or social isolation (such as living alone) increase the risk. Those who have never married are also at greater risk. Being religious may reduce one's risk of suicide.JOURNAL, Koenig HG, Research on religion, spirituality, and mental health: a review, Canadian Journal of Psychiatry, 54, 5, 283–91, May 2009, 19497160, 10.1177/070674370905400502,weblinkweblink" title="web.archive.org/web/20150406183754weblink">weblink no, 2015-04-06, 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 rates. 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, 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, Evolutionary psychology. Controversies, questions, prospects, and limitations, The American Psychologist, 65, 2, 110–26, 1 January 2010, 20141266, 10.1037/a0018413, 10.1.1.601.8691, Poverty is associated with the risk of suicide.JOURNAL, Stark CR, Riordan V, O'Connor R, A conceptual model of suicide in rural areas, Rural and Remote Health, 11, 2, 1622, 2011, 21702640, Increasing relative poverty compared to those around a person increases suicide risk.JOURNAL, Daly, Mary, vanc, Relative Status and Well-Being: Evidence from U.S. Suicide Deaths, Federal Reserve Bank of San Francisco Working Paper Series, Sep 2012,weblink no,weblink" title="web.archive.org/web/20121019134902weblink">weblink 2012-10-19, Over 200,000 farmers in India have died by suicide since 1997, partly due to issues of debt.NEWS, Lerner, George, vanc, Activist: Farmer suicides in India linked to debt, globalization,weblink 13 February 2013, CNN World, Jan 5, 2010, yes,weblink" title="web.archive.org/web/20130116020225weblink">weblink 16 January 2013, 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, Suicide in China: unique demographic patterns and relationship to depressive disorder, Current Psychiatry Reports, 10, 1, 80–86, February 2008, 18269899, 10.1007/s11920-008-0014-5,

Media

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, Media guidelines for the responsible reporting of suicide: a review of effectiveness, Crisis, 33, 4, 190–98, 2012, 22713977, 10.1027/0227-5910/a000137, When detailed descriptions of how to kill oneself by a specific means are portrayed, this method of suicide may increase in the population as a whole.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, Suicide in the media: a quantitative review of studies based on non-fictional stories, Suicide & 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, Amresh, Shrivastava, Megan, Kimbrell, David, Lester, vanc, 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, Suicide-related Internet use: A review, The Australian and New Zealand Journal of Psychiatry, 49, 8, 697–705, August 2015, 25698810, 10.1177/0004867415569797, 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, When media follows recommended reporting guidelines the risk of suicides can be decreased. Getting buy-in from industry, however, can be difficult, especially in the long term.

Rational

Rational suicide is the reasoned taking of one's own life,BOOK, Loue, Sana, vanc, Encyclopedia of aging and public health : with 19 tables, 2008, Springer, New York, 978-0-387-33753-1, 696, although some consider suicide as never 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, 2018, 13, 691–99, 10.2147/CIA.S130670, 29719381, 5916258, JOURNAL, Calabrò, RS, Naro, A, De Luca, R, Russo, M, Caccamo, L, Manuli, A, Bramanti, A, Bramanti, P, The Right to Die in Chronic Disorders of Consciousness: Can We Avoid the Slippery Slope Argument?, Innovations in Clinical Neuroscience, 2016, 13, 11–12, 12–24, 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, Harry R., vanc, Aging: concepts and controversies, 2010, Pine Forge Press, Los Angeles, 978-1-4129-6966-6, 158,weblink 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, Tarek, Sobh, vanc, Innovations and advances in computer sciences and engineering, 2010, Springer Verlag, Dordrecht, 978-90-481-3658-2, 503,weblink 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, Robert E, Hales, Robert I, Simon, vanc, The American Psychiatric Publishing textbook of suicide assessment and management, American Psychiatric Pub., Washington, DC, 978-1-58562-414-0, 714,weblink 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, 371–76, 2009, 19767502, Mass suicides are often performed under social pressure where members give up autonomy to a leader.BOOK, William, Kornblum, Carolyn D, Smith, vanc, Sociology in a changing world, Wadsworth Cengage Learning, Belmont, CA, 978-1-111-30157-6, 27,weblink 9th, 2011-01-31, Mass suicides can take place with as few as two people, often referred to as a suicide pact.BOOK, Campbell, Robert Jean, Campbell's psychiatric dictionary, 2004, Oxford University Press, Oxford, 978-0-19-515221-0, 636,weblink 8th, In extenuating situations where continuing to live would be intolerable, some people use suicide as a means of escape.BOOK, Veatch, Robert M., vanc, Medical ethics, 1997, Jones and Bartlett, Sudbury, MA, 978-0-86720-974-7, 292,weblink 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 by deliberately touching the electrified fences.BOOK, Gutman, Yisrael, Berenbaum, Michael, vanc, 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,

Methods

(File:SuicideCFR.png|thumb|upright=1.35|Case fatality rate by suicide method in the United States)(File:2010 suicide rates - gun versus non-gun - high-income countries.png|thumb|upright=1.35|Deaths by gun-related suicide versus non-gun-related suicide rates per 100,000 in high-income countries in 2010.JOURNAL, Grinshteyn, Erin, Hemenway, David, Violent Death Rates: The US Compared with Other High-income OECD Countries, 2010, The American Journal of Medicine, March 2016, 129, 3, 266–73, 10.1016/j.amjmed.2015.10.025, 26551975,weblink )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 the male suicides and 39% of the female suicides.BOOK, Rory C., O'Connor, Stephen, Platt, Jacki, Gordon, vanc, International Handbook of Suicide Prevention: Research, Policy and Practice,weblink 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, It is also common in Latin America due to easy access within the farming populations. In many countries, drug overdoses account for approximately 60% of suicides among women and 30% among men.BOOK, John, Geddes, Jonathan, Price, Rebecca, McKnight, Michael, Gelder, Richard, Mayou, vanc, Psychiatry, Oxford University Press, Oxford, 978-0-19-923396-0, 62,weblink 4th, 2012-01-05, 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%, car exhaust 40–60%, 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, Etienne, vanc, World Report on Violence and Health, Volume 1, 2002, World Health Organization, Genève, 978-92-4-154561-7, 196, In Japan, self-disembowelment known as seppuku (or hara-kiri) 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, 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, however this method has decreased relatively since guns have become less common.JOURNAL, Reisch T, Steffen T, Habenstein A, Tschacher W, 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, Sussie, vanc, Culture and mental health sociocultural influences, theory, and practice, 2009, Wiley-Blackwell, Chichester, 978-1-4443-0581-4, 301,weblink Gurung, Regan A.R., no,weblink 2015-10-03, In the United States, 57% of suicides involve the use of firearms, with this method being somewhat more common in men than women. The next most common cause was hanging in males and self-poisoning in females. Together, hanging and poisoning constituted about 40% of U.S. suicides ({{as of|2005|lc=y}}).WEB,weblink U.S. Suicide Statistics (2005), 2008-03-24, no,weblink" title="web.archive.org/web/20080406015555weblink">weblink 2008-04-06,

Pathophysiology

There is no known unifying underlying pathophysiology for either suicide or depression. It is however believed to result from an interplay of behavioral, socio-environmental and psychiatric 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, posttraumatic stress disorder, schizophrenia and obsessive–compulsive disorder.JOURNAL, Sher L, The role of brain-derived neurotrophic factor in the pathophysiology of adolescent suicidal behavior, International Journal of Adolescent Medicine and Health, 23, 3, 181–85, 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, 455–58, May 2011, 21051476, 10.1093/qjmed/hcq207, Serotonin, a brain neurotransmitter, is believed to be low in those who die by suicide. This is partly based on evidence of increased levels of 5-HT2A receptors found after death.BOOK, Dwivedi, Yogesh, vanc, The neurobiological basis of suicide, 2012, Taylor & Francis/CRC Press, Boca Raton, FL, 978-1-4398-3881-5, 166,weblink Other evidence includes reduced levels of a breakdown product of serotonin, 5-Hydroxyindoleacetic acid, in the cerebral spinal fluid.BOOK, George, Stein, Greg, Wilkinson, vanc, Seminars in general adult psychiatry, 2007, Gaskell, London, 978-1-904671-44-2, 145,weblink 2nd, Direct evidence is however hard to gather. 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, 812–13, November 2009, 19833253, 2770810, 10.1016/j.biopsych.2009.08.033,

Prevention

File:suicidemessageggb01252006.JPG|thumb|As a suicide prevention initiative, this sign promotes a special telephone available on the Golden Gate Bridge that connects to a crisis hotlinecrisis hotline(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 preventative measures. Reducing access to certain methods, such as firearms or toxins such as opioids can reduce risk.JOURNAL, Zalsman, G, Hawton, K, Wasserman, D, van Heeringen, K, Arensman, E, Sarchiapone, M, Carli, V, Höschl, C, Barzilay, R, July 2016, Suicide prevention strategies revisited: 10-year systematic review.,weblink The Lancet. Psychiatry, 3, 7, 646–59, 10.1016/S2215-0366(16)30030-X, 27289303, Studies of telephone and internet services usually have relatively low levels of evidence. (page 652), Balazs, J, Purebl, G, Kahn, JP, Sáiz, PA, Lipsicas, CB, Bobes, J, Cozman, D, Hegerl, U, Zohar, J, 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, 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, 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 preventative strategy (such as reducing the number of bars).JOURNAL, Vijayakumar L, Kumar MS, Vijayakumar V, Substance use and suicide, Current Opinion in Psychiatry, 24, 3, 197–202, May 2011, 21430536, 10.1097/YCO.0b013e3283459242, Although crisis hotlines are common there is little evidence to support or refute their effectiveness. In young adults who have recently thought about suicide, cognitive behavioral therapy appears to improve outcomes.JOURNAL, Robinson J, Hetrick SE, Martin C, 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, 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, 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, The World Suicide Prevention Day is observed annually on September 10 with the support of the International Association for Suicide Prevention and the World Health Organization.WEB,weblink World Suicide Prevention Day -10 September, 2013, IASP, 29 October 2013, no,weblink" title="web.archive.org/web/20131104145146weblink">weblink 4 November 2013, Preventing childhood trauma provides an opportunity for suicide prevention.JOURNAL, 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, 400–03, September 2017, 28483301, 5603224, 10.1016/j.amepre.2017.03.015,

Screening

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, 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, 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, Marshall B, Clinard, Robert F, Meier, vanc, Sociology of deviant behavior, 2008, Wadsworth Cengage Learning, Belmont, CA, 978-0-495-81167-1, 169,weblink 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, 620–27, October 2009, 19617829, 2879582, 10.1097/MOP.0b013e3283307a89, Assessing those at high risk however 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. Evidence however 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, Is hospitalization useful for suicidal patients with borderline personality disorder?, Journal of Personality Disorders, 18, 3, 240–47, June 2004, 15237044, 10.1521/pedi.18.3.240.35443, JOURNAL, Goodman M, Roiff T, Oakes AH, Paris J, 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, 10.1002/14651858.CD005652.pub2, Lieb, Klaus, 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,weblinkweblink" title="web.archive.org/web/20130515165611weblink">weblink no, 2013-05-15, Evidence however has not found a decrease in completed suicides.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, 23152227, 10.1002/14651858.CD004851.pub3, Hetrick, Sarah E, In older persons, however, they might decrease the risk. Lithium appears effective at lowering the risk in those with bipolar disorder and unipolar depression to nearly the same levels as 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, 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 281–83, 2003, 12665398, 10.2165/00023210-200317040-00004, In the United States, health professionals are legally required to take reasonable steps to try to prevent suicide.NEWS, Caldwell, Benjamin E., Whose Conscience Matters?,weblink 22 January 2018, Family Therapy Magazine (page 22), American Association for Marriage and Family Therapy (AAMFT), September–October 2013, WEB, FindLaw's California Court of Appeal case and opinions.,weblink Findlaw, 22 January 2018, 6 June 1978,

Epidemiology

(File:Self-harm world map-Deaths per million persons-WHO2012.svg|thumb|upright=1.4|Deaths per million persons from self-inflicted injuries in 2012.{{legend|#ffff20|3–23}}{{legend|#ffe820|24–32}}{{legend|#ffd820|33–49}}{{legend|#ffc020|50–61}}{{legend|#ffa020|62–76}}{{legend|#ff9a20|77–95}}{{legend|#f08015|96–121}}{{legend|#e06815|122–146}}{{legend|#d85010|147–193}}{{legend|#d02010|194–395}})(File:Suicide-vs-violent-deaths.png|thumb|upright=1.4|Suicide vs violent deaths 2016)Approximately 0.5% to 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,WEB, Suicide prevention, World Health Organization, Aug 31, 2012, WHO Sites: Mental Health,weblink 2013-01-13, 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,weblink World Health Organization, 10 February 2013, no,weblink" title="web.archive.org/web/20091111101009weblink">weblink 11 November 2009, WEB, Suicide rates Data by country,weblink who.int, 23 November 2014, no,weblink" title="web.archive.org/web/20151015120314weblink">weblink 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, June 7, 2018, Suicide rates rising across the U.S.,weblink CDC Newsroom, October 11, 2018, Rates have increased in the United States in the last few years, with the highest value being in 2017 (the most recent data).WEB, Products - Data Briefs - Number 330 - September 2018,weblink www.cdc.gov, 26 March 2019, en-us, 14 February 2019, About 650,000 people are seen in emergency departments yearly due to attempting suicide. The country's 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,weblink Centers for Disease Control and Prevention, 15 July 2013, May 2, 2013, no,weblink" title="web.archive.org/web/20130621045612weblink">weblink 21 June 2013, Lithuania, Japan and Hungary have the highest rates. Around 75% of suicides occur in the developing world. The countries with the greatest absolute numbers of suicides are China and India, accounting for over half the total. In China, suicide is the 5th leading cause of death.

Sex and gender

{{Double image|right|Suicide world map - 2009 Male.svg|250|Suicide world map - 2009 Female,2.svg|250|Suicide rate per 100,000 males (top/left) and female (bottom/right) (data from 1978–2008).{{smalldiv|{{Col-begin}}{{Col-break}}{{legend|#b3b3b3|no data}}{{legend|#ffff65|< 1}}{{legend|#fff200|1–5}}{{legend|#ffdc00|5–5.8}}{{Col-break}}{{legend|#ffc600|5.8–8.5}}{{legend|#ffb000|8.5–12}}{{legend|#ff9a00|12–19}}{{legend|#ff8400|19–22.5}}{{Col-break}}{{legend|#ff6e00|22.5–26}}{{legend|#ff5800|26–29.5}}{{legend|#ff4200|29.5–33}}{{legend|#ff2c00|33–36.5}}{{Col-break}}{{legend|#cb0000|>36.5}}{{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,weblink 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, Theodore A., Fava, Maurizio, Wilens, Timothy E., Rosenbaum, Jerrold F., vanc, Massachusetts General Hospital Comprehensive Clinical Psychiatry, 2015, Elsevier Health Sciences, 978-0-323-32899-9, 589, 2,weblink en, no,weblink 2016-09-14, BOOK, Krug, Etienne G., World Report on Violence and Health, 2002, World Health Organization, 978-92-4-154561-7, 191,weblink en, no,weblink 2016-09-14, Researchers have attributed the difference between attempted and completed suicides among the sexes to males using more lethal means to end their lives.BOOK, David Sue, Derald Wing Sue, Stanley Sue, Diane Sue, Understanding abnormal behavior, Wadsworth/Cengage Learning, Belmont, CA, 978-1-111-83459-3, 255,weblink Tenth ed., [student ed.], 2012-01-01, no,weblink 2015-10-30, BOOK, Updesh Kumar, Manas K Mandal, Suicidal Behaviour: Assessment of People-At-Risk, 978-81-321-0499-5, Sage Publications India, 2010, 139, March 4, 2017,weblink no,weblink March 5, 2017, BOOK, Lee Ellis, Scott Hershberger, Evelyn Field, Scott Wersinger, Sergio Pellis, David Geary, Craig Palmer, Katherine Hoyenga, Amir Hetsroni, Kazmer Karadi, Sex Differences: Summarizing More than a Century of Scientific Research, 978-1-136-87493-2, Psychology Press, 2013, 387, March 4, 2017,weblink no,weblink March 5, 2017, However, separating intentional suicide attempts from non-suicidal self-harm is not currently done in the United States when gathering statistics at the national level.WEB, Suicide Statistics,weblink American Foundation for Suicide Prevention (AFSP), 3 September 2016, no,weblink 2 September 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, 888–89, 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 transgender, lesbian, gay, and bisexual 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, 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,weblink 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, JOURNAL, Virupaksha HG, Muralidhar D, Ramakrishna J, Suicide and Suicidal Behavior among Transgender Persons, Indian Journal of Psychological Medicine, 38, 6, 505–09, 2016, 28031583, 5178031, 10.4103/0253-7176.194908, This is believed to in part be due to social stigmatisation.WEB,weblink Reports, 25 July 2016, 2011, yes,weblink" title="web.archive.org/web/20140908030754weblink">weblink 2014-09-08,

Age

In many countries the rate of suicide is highest in the middle-agedJOURNAL, Pitman A, Krysinska K, Osborn D, King M, 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,weblink 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.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, 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: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 RomeIn ancient Athens, a person who committed 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,weblink Fatal freedom : the ethics and politics of suicide, Szasz, Thomas, Praeger, 1999, 978-0-275-96646-1, Westport, CT, 11, vanc, 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, Michael R. Leming, George E., Understanding dying, death, and bereavement, Wadsworth Cengage Learning, Belmont, CA, 978-0-495-81018-6, 290,weblink 7th, 2010-09-02, 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.Suicide 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, W.S.F. Pickering, Geoffrey Walford, Durkheim's Suicide : a century of research and debate, 2000, Routledge, London, 978-0-415-20582-5, 69,weblink 1. publ., no,weblink 2016-04-02, BOOK, Maris, Ronald, vanc, Comprehensive textbook of suicidology, 2000, Guilford Press, New York, 978-1-57230-541-0, 540,weblink 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.WEB,weblink Suicide, Stanford Encyclopedia of Philosophy, 2017, The secularization of society that began during The Enlightenment questioned traditional religious attitudes 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?" 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,weblink A Companion to the Eighteenth-Century English Novel and Culture, Paula R., Backscheider, Catherine, Ingrassia, vanc, 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 that 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, Irina, vanc, Suicide as a cultural institution in Dostoevsky's Russia, 1997, Cornell university press, Ithaca, 978-0-8014-8425-4, 60,weblink no,weblink 2015-09-28, In 1882, the deceased were permitted daylight burial in EnglandBOOK,weblink Life, Death and the Law: Law and Christian Morals in England and the United States, Norman St. John-Stevas, 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, Georges, 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|SamuraiSamuraiIn most Western countries, suicide is no longer a crime. It was, however, in most Western European countries from the Middle Ages until at least the 1800s. It remains a criminal offense in most Muslim-majority nations.In Australia suicide is not a crime.BOOK, David, Lanham, Bronwyn F, Bartal, Robert C, Evans, David, Wood, vanc, Criminal laws in Australia, 2006, The Federation Press, Annandale, N.S.W., 978-1-86287-558-6, 229,weblink It however 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, Duffy, Michael Costa, Mark, Labor, prosperity and the nineties : beyond the bonsai economy, 1991, Federation Press, Sydney, 978-1-86287-060-4, 315,weblink 2nd, The Northern Territory of Australia briefly had legal physician-assisted suicide from 1996 to 1997.BOOK,weblink Hospice or hemlock? : searching for heroic compassion, Putnam, Constance E, Praeger, 2002, 978-0-89789-921-5, Westport, CT, 143, vanc, No country in Europe currently considers suicide or attempted suicide to be a crime. 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, however many organisations have stopped it because of the negative connotation.Holt, Gerry."When suicide was illegal" {{webarchive|url=https://web.archive.org/web/20140207074649weblink |date=2014-02-07 }}. BBC News. 3 August 2011. Accessed 11 August 2011.NEWSPAPER, Guardian & Observer style guide,weblink Guardian website, The Guardian, 29 November 2011, no,weblink" title="web.archive.org/web/20131019070418weblink">weblink 19 October 2013, 2015-12-31, In India, suicide used to be illegal and surviving family could face legal difficulties.BOOK, Nitish, Dogra, Sangeet, Srivastava, vanc, Climate change and disease dynamics in India, The Energy and Resources Institute, New Delhi, 978-81-7993-412-8, 256,weblink 2012-01-01, no,weblink 2015-09-28, The Indian government repealed this law in 2014.NEWS,weblink Govt decides to repeal Section 309 from IPC; attempt to suicide no longer a crime, Zee News, December 10, 2014, December 10, 2014, no,weblink" title="web.archive.org/web/20150515222001weblink">weblink May 15, 2015, 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, Dutch 'mercy killing law' passed,weblink 27 February 2019, 11 April 2001, If such protocol is not followed, it is an offence punishable by law (see Euthanasia in the Netherlands). In Germany, active euthanasia is illegal and anyone present during suicide may be prosecuted for failure to render aid in an emergency.WEB, German politician Roger Kusch helped elderly woman to die,weblink Times Online, July 2, 2008, no,weblink" title="web.archive.org/web/20100601051855weblink">weblink June 1, 2010, 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, A suicide right for the mentally ill? A Swiss case opens a new debate, The Hastings Center Report, 37, 3, 21–23, May 2007, 17649899, 10.1353/hcr.2007.0035, In the United States, suicide is not illegal but may be associated with penalties for those who attempt it.BOOK, McLaughlin, Columba, vanc, Suicide-related behaviour understanding, caring and therapeutic responses, 2007, John Wiley & Sons, Chichester, 978-0-470-51241-8, 24,weblink Physician-assisted suicide is legal in the state of Washington for people with terminal diseases.NEWS, Chapter 70.245 RCW, The Washington death with dignity act,weblink Washington State Legislature, no,weblink" title="web.archive.org/web/20100708000006weblink">weblink 2010-07-08, In Oregon, people with terminal diseases may request medications to help end their life.WEB,weblink Oregon Revised Statute - 127.800 s.1.01. Definitions, Oregon State Legislature, no,weblink" title="web.archive.org/web/20151007062220weblink">weblink 2015-10-07, Canadians who have attempted suicide may be barred from entering the US. US laws allow border guards to deny access to people who have a mental illness, including those with previous suicide attempts.WEB,weblink CBCNews.ca Mobile, Cbc.ca, 1999-02-01, 2014-08-06, no,weblink" title="web.archive.org/web/20140807054409weblink">weblink 2014-08-07, WEB, Claude Adams, US border suicide profiling must stop: Report,weblink globalnews.ca, 7 August 2014, April 15, 2014, no,weblink" title="web.archive.org/web/20140808055456weblink">weblink 8 August 2014,

Religious views

File:A Hindoo Widow Burning Herself with the Corpse of her Husband.jpg|thumb|A HinduHinduIn most forms of Christianity, suicide is considered a sin, 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, Ronald Roth, D.Acu.,weblink Suicide & Euthanasia – a Biblical Perspective, Acu-cell.com, 2009-05-06, yes,weblink" title="web.archive.org/web/20090418073913weblink">weblink 2009-04-18, WEB,weblink Norman N. Holland, Literary Suicides: A Question of Style, Clas.ufl.edu, 2009-05-06, no,weblink" title="web.archive.org/web/20090528090133weblink">weblink 2009-05-28, In Catholic doctrine, the argument is based on the commandment "Thou shalt not kill" (made applicable under the New Covenant by Jesus in the Gospel of Matthew"he said, “.. If you wish to enter into life, keep the commandments” " (NRSV) {{Bibleverse|Matthew|19:17|KJV}}), as well as the idea 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,weblink Catechism of the Catholic Church – Part 3 Section 2 Chapter 2 Article 5, Scborromeo.org, 1941-06-01, 2009-05-06, no,weblink" title="web.archive.org/web/20090425163428weblink">weblink 2009-04-25, However, it is believed that mental illness or grave fear of suffering diminishes the responsibility of the one completing suicide.WEB,weblink Catechism of the Catholic Church – Part 3 Section 2 Chapter 2 Article 5, Scborromeo.org, 1941-06-01, 2009-05-06, no,weblink" title="web.archive.org/web/20090425163428weblink">weblink 2009-04-25, 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, Jews have committed individual suicide or mass suicide (see 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,weblink Euthanasia and Judaism: Jewish Views of Euthanasia and Suicide, 2008-09-16, ReligionFacts.com, no,weblink" title="web.archive.org/web/20060506200930weblink">weblink 2006-05-06, Islamic religious views are against suicide. The Quran forbids it by stating "do not kill or destroy yourself".JOURNAL, Gearing RE, Lizardi D, 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.In Hinduism, suicide is generally frowned upon 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/20080507034203weblink |date=2008-05-07 }} However, Hinduism accepts a man's right to end one's life through the non-violent practice of fasting to death, termed Prayopavesa.WEB,weblink Hinduism – Euthanasia and Suicide, 2009-08-25, BBC, no,weblink" title="web.archive.org/web/20090225155507weblink">weblink 2009-02-25, 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, was prevalent in Hindu society during the Middle Ages.BBC News, "India wife dies on husband's pyre" {{webarchive|url=https://web.archive.org/web/20100415045908weblink |date=2010-04-15 }}, Aug. 22, 2006.

Philosophy

A number of questions are raised within the philosophy of suicide, included what constitutes suicide, whether or not suicide can be a rational choice, and the moral permissibility of suicide.BOOK,weblink Suicide (Stanford Encyclopedia of Philosophy), Plato.stanford.edu, 2009-05-06, 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 Christian 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, 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.Raymond Whiting: A natural right to die: twenty-three centuries of debate, pp. 13–17; Praeger (2001) {{ISBN|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 and American bioethicist Jacob Appel.Wesley J. Smith, Death on Demand: The assisted-suicide movement sheds its fig leaf, The Weekly Standard, June 5, 2007

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, (see Suicide in Japan).Internet searches for information on suicide return webpages that 10-30% of the time encourage or facilitate suicide attempts. 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,

Locations

{{See also|List of suicide sites}}Some landmarks have become known for high levels of suicide attempts. These include San Francisco's Golden Gate Bridge, Japan's Aokigahara Forest,BOOK, Peter, Robinson, Sine, Heitmann, Peter U C, Dieke, vanc, Research themes for tourism, 2010, CABI, Oxfordshire [etc.], 978-1-84593-684-6, 172,weblink England's Beachy HeadBOOK, David, Picard, Mike, Robinson, vanc, Emotion in motion : tourism, affect and transformation, Ashgate, Farnham, Surrey, 978-1-4094-2133-7, 176,weblink 2012-11-28, and Toronto's Bloor Street Viaduct.BOOK, Dennis, Richard, vanc, Cities in modernity : representations and productions of metropolitan space, 1840–1930, 2008, Cambridge Univ. Press, Cambridge [u.a.], 978-0-521-46841-1, 20,weblink Repr., {{As of|2010}}, the Golden Gate Bridge has had more than 1,300 die by suicide by jumping since its construction in 1937.BOOK, McDougall, Tim, Armstrong, Marie, Trainor, Gemma, vanc, 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,weblink Many locations where suicide is common have constructed barriers to prevent it;BOOK,weblink Building hope : leadership in the nonprofit world, Bateson, John, Praeger, 2008, 978-0-313-34851-8, Westport, CT, 180, vanc, 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 appear to be generally effective.BOOK, Miller, David, vanc, Child and Adolescent Suicidal Behavior: School-Based Prevention, Assessment, and Intervention, 2011, 978-1-60623-997-1, 46,weblink

Notable cases

File:Tojo suicide.jpg|thumb|Japanese general Hideki TojoHideki TojoAn example of mass suicide is the 1978 Jonestown killings/suicide in which 909 members of the Peoples Temple, an American religious group led by Jim Jones, ended their lives by drinking grape Flavor Aid laced with cyanide and various prescription drugs.Hall 1987, p.282Alternative Considerations of Jonestown and Peoples Temple. San Diego State University.WEB,weblink Archived copy, 2011-11-10, yes,weblink January 24, 2011, "1978:Mass Suicide Leaves 900 Dead {{webarchive|url=https://web.archive.org/web/20121104074001weblink |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, Sucide and Self-Starvation, Philosophy, 59, 229, 349–363, O'Keeffe, Terence M., 1984, 10.1017/S0031819100069941, During World War II, Erwin Rommel was found to have foreknowledge of the July 20 plot on Hitler's life; he was threatened with public trial, execution and reprisals on his family unless he took his own life.BOOK, Watson, Bruce, vanc, 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, Ronald, vanc, Comprehensive textbook of suicidology, 2000, Guilford Press, New York [u.a.], 978-1-57230-541-0, 97–103,weblink Suicidal behavior has been observed in salmonella seeking to overcome competing bacteria by triggering an immune system response against them.NEWSPAPER,weblink In Salmonella Attack, Taking One for the Team, The New York Times, Chang, Kenneth, August 25, 2008, no,weblink" title="web.archive.org/web/20170805103824weblink">weblink August 5, 2017, Suicidal defenses by workers are also noted 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,weblink PDF,weblink" title="web.archive.org/web/20091127130838weblink">weblink no, 2009-11-27, Pea aphids, when threatened by a ladybug, can explode themselves, scattering and protecting their brethren and sometimes even killing the ladybug.JOURNAL,weblink Animal Suicide Sheds Light on Human Behavior, Larry O'Hanlon, Mar 10, 2010, Discovery News, no,weblink" title="web.archive.org/web/20100725200146weblink">weblink 2010-07-25, Some species of termites have soldiers that explode, covering their enemies with sticky goo.WEB,weblink Life In The Undergrowth, BBC, JOURNAL, Bordereau C, Robert A, Van Tuyen V, Peppuy A, Suicidal defensive behaviour by frontal gland dehiscence in Globitermes sulphureus Haviland soldiers (Isoptera), 44, 3, Insectes Sociaux, August 1997, 289–97, 10.1007/s000400050049, There have been anecdotal reports of dogs, horses and dolphins killing themselves.JOURNAL, Do Animals Commit Suicide? A Scientific Debate, Time, Mar 19, 2010, Nobel, Justin, vanc,weblink There, however, has been 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, 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, Melissa, Hogenboom, vanc, 6 July 2016, 2017-07-20, Many animals seem to kill themselves, but it is not suicide, BBC,weblink no,weblink" title="web.archive.org/web/20170226233605weblink">weblink 26 February 2017,

References

{{Reflist}}

Further reading

{{Library resources box}}
  • BOOK, Gambotto, Antonella, 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, Christian, Goeschel, vanc, Oxford University Press, 2009, 978-0-19-953256-8,weblink harv,

External links

{{Medical condition classification and resources| ICD10 = {{ICD10|X60-X84}}E950}}| DiseasesDB=12641| MedlinePlus = 001554| eMedicineSubj = article| eMedicineTopic = 288598| MeshName = Suicide| MeshNumber = F01.145.126.980.875}}{{Sister project links|display=Suicide}} {{Suicide navbox}}{{Authority control}}{{Good article}}

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