Suicide
Suicide
is the act of intentionally causing one's own death. Risk factors include mental disorders such as depression, bipolar disorder,
schizophrenia, personality disorders, alcoholism, or substance misuse. Those who have previously attempted suicide are at higher risk
for future attempts. Although crisis hotlines are common, there is little evidence for their effectiveness.
The most commonly used method of suicide varies between countries, and is partly related to the availability of effective means.
Common methods include hanging, pesticide poisoning, and firearms. Suicide resulted in 828,000 deaths globally in 2015 . This
makes it the 10th leading cause of death worldwide.
Approximately 0.5% to 1.4% of people die by suicide, about 12 per 100,000 persons per year. There are an estimated 10 to 20
million nonfatal attempted suicides every year. Nonfatal suicide attempts may lead to injury and long term disabilities.
Views on suicide have been influenced by broad existential themes such as religion, honor, and the meaning of life. The Abrahamic
religions traditionally consider suicide an offense towards God due to the belief in the sanctity of life. 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. 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 the family and society. Suicide and attempted suicide, while previously illegal, are no longer so in most Western countries. It
remains a criminal offense in many countries. 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. The word is from the Latin suicidium,
which means "the killing of oneself".
Definitions
Suicide, also known as completed suicide, is the "act of taking one's own life". Assisted suicide is when one individual helps another
bring about their own death indirectly via providing either advice or the means to the end. This is in contrast to euthanasia, where
another person takes a more active role in bringing about a person's death. There is growing consensus that it is more appropriate to
use "completed suicide", "died by suicide" or simply "killed him/herself" to describe the act of suicide, and this is reflected in mental
health organisations' media guidance. Despite these efforts, "committed suicide" and similar descriptions remain common in both
scholarly research and journalism.
Risk factors
Factors that affect the risk of suicide include mental disorders, drug misuse, psychological states, cultural, family and social situations,
and genetics. For example, suicide rates have been found to be greater in households with firearms than those without them.
Socioeconomic problems such as unemployment, poverty, homelessness, and discrimination may trigger suicidal thoughts. About 15–
40% of people leave a suicide note. 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. Genetics appears to account for between 38% and 55% of
suicidal behaviors.
Mental disorders
Mental disorders are often present at the time of suicide with estimates ranging from 27% to more than 90%. Other conditions
implicated include schizophrenia, personality disorders, bipolar disorder, and posttraumatic stress disorder. About 5% of people with
schizophrenia die of suicide. Eating disorders are another high risk condition. Approximately 25–40% of those who completed suicide
had contact with mental health services in the prior year. Antidepressants of the SSRI type appear to increase the risk of suicide in
children but do not change the risk in adults.
Previous attempts and self harm
A previous history of suicide attempts is the most accurate predictor of completed suicide. Some who self harm, however, do still end
their life by suicide, and risk for self harm and suicide may overlap. Both chronic substance misuse as well as acute intoxication are
associated. Substance misuse is also associated with mental health disorders. with alcoholism present in between 15% and 61% of
cases. Alcoholics who attempt suicide are usually male, older, and have tried to take their own lives in the past. In adolescents who
misuse alcohol, neurological and psychological dysfunctions may contribute to the increased risk of suicide.
The misuse of cocaine and methamphetamine has a high correlation with suicide. In those who use cocaine the risk is greatest during
the withdrawal phase. Those who used inhalants are also at significant risk with around 20% attempting suicide at some point and
more than 65% considering it. 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. Between 12 and 24% pathological
gamblers attempt suicide. Other factors that increase the risk in problem gamblers include mental illness, alcohol and drug misuse.
Medical conditions
There is an association between suicidality and physical health problems such as traumatic brain injury, cancer, kidney failure, HIV,
and systemic lupus erythematosus.
Sleep disturbances such as insomnia and sleep apnea are risk factors for depression and suicide. In some instances the sleep
disturbances may be a risk factor independent of depression. 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 . In older adults the perception of being a burden to others is important. Suicide in which the reason is
that the person feels that they are not part of society is known as egoistic suicide. Rates of suicide appear to decrease around
Christmas. One study however found the risk may be greater for males on their birthday.
Recent life stresses such as a loss of a family member or friend, loss of a job, or social isolation increase the risk. This has been
attributed to the negative stance many religions take against suicide and to the greater connectedness religion may give.
Some may take their own lives to escape bullying or prejudice. A history of childhood sexual abuse and time spent in foster care are
also risk factors. Sexual abuse is believed to contribute to about 20% of the overall risk.
Poverty is associated with the risk of suicide. Increasing relative poverty compared to those around a person increases suicide risk.
Over 200,000 farmers in India have died by suicide since 1997, partly due to issues of debt. In China suicide is three times rural regions as urban ones, partly, it is believed, due to financial difficulties in this area of the country.
Media
The media, which includes the Internet, plays an important role. 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. It appears that while news media has a significant
effect; that of the entertainment media is equivocal. 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, who had planned to kill himself until his friends helped him out. When media follows recommended reporting
guidelines the risk of suicides can be decreased. although others consider suicide as never rational. 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. Some suicide bombers are motivated
by a desire to obtain martyrdoms. Murder–suicide is an act of homicide followed within a week by suicide of the person who carried
out the act.
Mass suicides are often performed under social pressure where members give up autonomy to a leader. Mass suicides can take place
with as few as two people, often referred to as a suicide pact.
In extenuating situations where continuing to live would be intolerable, some people use suicide as a means of escape. Some inmates
in Nazi concentration camps are known to have killed themselves by deliberately touching the electrified fences.
Methods
The leading method of suicide varies among countries. The leading methods in different regions include hanging, pesticide poisoning,
and firearms. accounting for 53% of the male suicides and 39% of the female suicides.
Worldwide, 30% of suicides are estimated to occur from pesticide poisoning, most of which occur in the developing world. It is also
common in Latin America due to easy access within the farming populations. Many are unplanned and occur during an acute period of
ambivalence. In Japan, selfdisembowelment known as seppuku still occurs; Jumping to one's death is common in both Hong Kong
and Singapore at 50% and 80% respectively. In the United States, 57% of suicides involve the use of firearms, with this method being
somewhat more common in men than women.
Pathophysiology
There is no known unifying underlying pathophysiology for either suicide or depression. and indirectly associated through its role in
major depression, posttraumatic stress disorder, schizophrenia and obsessive–compulsive disorder. Postmortem studies have found
reduced levels of BDNF in the hippocampus and prefrontal cortex, in those with and without psychiatric conditions. 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 5HT2A
receptors found after death. Other evidence includes reduced levels of a breakdown product of serotonin, 5Hydroxyindoleacetic acid,
in the cerebral spinal fluid. Direct evidence is however hard to gather.
Prevention
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 can reduce risk. Treatment of drug and alcohol addiction, depression, and those
who have attempted suicide in the past may also be effective. 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. Economic development through its ability to reduce poverty may be able to decrease suicide rates. 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.
Screening
There is little data on the effects of screening the general population on the ultimate rate of suicide. 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. 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. Assessing those at high risk however is recommended. Some clinicians
get patients to sign suicide prevention contracts where they agree to not harm themselves if released.
There is tentative evidence that psychotherapy, specifically, dialectical behaviour therapy reduces suicidality in adolescents as well as
in those with borderline personality disorder. It may also be useful in decreasing suicide attempts in adults at high risk. Evidence
however has not found a decrease in completed suicides. In older persons, however, they might decrease the risk. Clozapine may
decrease the thoughts of suicide in some people with schizophrenia.
Epidemiology
Approximately 0.5% to 1.4% of people die by suicide, a mortality rate of 11.6 per 100,000 persons per year. with these increases seen
primarily in the developing world. It was ranked as the 10th leading cause of death in the United States in 2009 at about 36,000 cases
a year, with about 650,000 people seen in emergency departments yearly due to attempting suicide. Lithuania, Japan and Hungary
have the highest rates. In the western world, males die three to four times more often by means of suicide than do females.
Researchers have attributed the difference between attempted and completed suicides among the sexes to males using more lethal
means to end their lives. However, separating intentional suicide attempts from nonsuicidal self harm is not currently done in the
United States when gathering statistics at the national level.
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 . In the
Eastern Mediterranean, suicide rates are nearly equivalent between males and females.
A number of reviews have found an increased risk of suicide among transgender, lesbian, gay, and bisexual people. Among
transgender persons rates of attempted suicide are between 30 and 50%.
Age
In many countries the rate of suicide is highest in the middle aged or elderly. and in young males is second only to accidental death. However, it was deemed to be an acceptable method to deal with military defeat. Aristotle condemned all forms of suicide while Plato
was ambivalent.
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.
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?"
By the 19th century, the act of suicide had shifted from being viewed as caused by sin to being caused by insanity in Europe. In 1882,
the deceased were permitted daylight burial in England 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 selfdeath which were often
characterized as a form of self murder in the West.
Social and culture
Legislation
In most Western countries, suicide is no longer a crime. 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. The Northern Territory of Australia briefly had legal physician assisted suicide from 1996 to 1997.
No country in Europe currently considers suicide or attempted suicide to be a crime.
In India, suicide used to be illegal and surviving family could face legal difficulties. The Indian government repealed this law in 2014.
In Germany, active euthanasia is illegal and anyone present during suicide may be prosecuted for failure to render aid in an
emergency. Switzerland has recently 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.
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. In Oregon, people with terminal diseases may request medications
to help end their life.
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.
Religious views
In 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. In Catholic doctrine, the argument is based on the commandment "Thou shalt not kill", 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.
However, it is believed that mental illness or grave fear of suffering diminishes the responsibility of the one completing suicide.
Counter Arguments include the following: that the sixth commandment is more accurately translated as "thou shalt not murder", that
God has given free will to humans, that taking one's own life no more violates God's Law than does curing a disease and that a
number of suicides by followers of God are recorded in the Bible with no dire condemnation.
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 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" . 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.
Islamic religious views are against suicide. The hadiths also state individual suicide to be unlawful and a sin. However, Hinduism
accepts a man's right to end one's life through the nonviolent practice of fasting to death, termed Prayopavesa. But Prayopavesa is
strictly restricted to people who have no desire or ambition left, and no responsibilities remaining in this life.
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. 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, 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. 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. 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
Advocacy
Advocacy of suicide has occurred in many cultures and subcultures. The Japanese military during World War II encouraged andglorified 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" .
Internet searches for information on suicide return webpages that 1030% of the time encourage or facilitate suicide attempts.
Locations
Some landmarks have become known for high levels of suicide attempts. England's Beachy Head and Toronto's Bloor Street Viaduct.
, the Golden Gate Bridge has had more than 1,300 die by suicide by jumping since its construction in 1937. Many locations where
suicide is common have constructed barriers to prevent it; this includes the Luminous Veil in Toronto, They appear to be generally
effective. 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".
The 1981 hunger strikes, led by Bobby Sands, resulted in 10 deaths. The cause of death was recorded by the coroner as "starvation,
selfimposed" rather than suicide; this was modified to simply "starvation" on the death certificates after protest from the dead strikers'
families. 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.
Other species
As suicide requires a willful attempt to die, some feel it therefore cannot be said to occur in nonhuman animals. Suicidal behavior has
been observed in salmonella seeking to overcome competing bacteria by triggering an immune system response against them. 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.
Pea aphids, when threatened by a ladybug, can explode themselves, scattering and protecting their brethren and sometimes even killing
the ladybug. Some species of termites have soldiers that explode, covering their enemies with sticky goo.
There have been anecdotal reports of dogs, horses and dolphins killing themselves, though with little conclusive evidence. There has
been little scientific study of animal suicide
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