[quote-tag-mismatch]Don't give some short little pigeon hole answer you got to give the WHOLE definition. This is NOT something that can just fit in a tiny little box but this will help to give you some insight.
Suicide (Latin suicidium, from sui caedere, "to kill oneself") is the act of intentionally causing one's own death. Suicide is often committed out of despair, the cause of which is frequently attributed to a mental disorder such as depression, bipolar disorder, schizophrenia, borderline personality disorder,[1] alcoholism, or drug abuse.[2] Stress factors such as financial difficulties or troubles with interpersonal relationships often play a role. Efforts to prevent suicide include limiting access to firearms, treating mental illness and drug misuse, and improving economic development. Although crisis hotlines are common, there is little evidence for their effectiveness.[3]
The most commonly used method of suicide varies by country and is partly related to availability. Common methods include: hanging, pesticide poisoning, and firearms. Around 800,000 to a million people die by suicide every year, making it the 10th leading cause of death worldwide.[2][4] Rates are higher in men than in women, with males three to four times more likely to kill themselves than females.[5] There are an estimated 10 to 20 million non-fatal attempted suicides every year.[6] Attempts are more common in young people and females.
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, seppuku was respected as a means of atonement for failure or as a form of protest. Sati, a now outlawed East Indian practice, expected the widow to immolate herself on her husband's funeral pyre, either willingly or under pressure from the family and society.[7]
Suicide and attempted suicide, while previously criminally punishable, is no longer in most Western countries. It remains a criminal offense in many countries. In the 20th and 21st centuries, suicide in the form of self-immolation has been used as a medium of protest, and kamikaze and suicide bombings have been used as a military or terrorist tactic.[8]
Definitions
Main article: Suicide terminology
Suicide, also known as completed suicide, is the "act of taking one's own life".[9] Attempted suicide or non-fatal suicidal behavior is self-injury with the desire to end one's life that does not result in death.[10] Assisted suicide is when one individual helps another bring about their own death indirectly via providing either advice or the means to the end.[11] This is in contrast to euthanasia, where another person takes a more active role in bringing about a person's death.[11] Suicidal ideations is thoughts of ending one's life but not taking any active efforts to do so.[10]
Risk factors
The precipitating circumstances for suicide from 16 American states in 2008.[12]
Factors that affect the risk of suicide include psychiatric disorders, drug misuse, psychological states, cultural, family and social situations, and genetics.[13] Mental illness and substance misuse frequently co-exist.[14] Other risk factors include having previously attempted suicide,[15] the ready availability of a means to commit the act, a family history of suicide, or the presence of traumatic brain injury.[16] For example, suicide rates have been found to be greater in households with firearms than those without them.[17] Socio-economic problems such as unemployment, poverty, homelessness, and discrimination may trigger suicidal thoughts.[18][19] About 15�40% of people leave a suicide note.[20] Genetics appears to account for between 38% and 55% of suicidal behaviors.[21] War veterans have a higher risk of suicide due in part to higher rates of mental illness and physical health problems related to war.[22]
Mental disorders
Mental disorders are often present at the time of suicide with estimates ranging from 27%[23] to more than 90%.[15] Of those who have been admitted to a psychiatric unit, their lifetime risk of completed suicide is about 8.6%.[15] 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.[24] Other conditions implicated include schizophrenia (14%), personality disorders (14%),[25] bipolar disorder,[24] and posttraumatic stress disorder.[15] About 5% of people with schizophrenia die of suicide.[26] Eating disorders are another high risk condition.[27]
A history of previous suicide attempts is the greatest predictor of eventual completion of suicide.[15] Approximately 20% of suicides have had a previous attempt and of those who have attempted suicide 1% complete suicide within a year[15] and more than 5% commit suicide after 10 years.[27] Acts of self-harm are not usually suicide attempts and most who self-harm are not at high risk of suicide.[28] Some who self-harm, however, do still end their life by suicide, and risk for self-harm and suicide may overlap.[28]
In approximately 80% of completed suicides the individual has seen a physician within the year before their death,[29] including 45% within the prior month.[30] Approximately 25�40% of those who completed suicide had contact with mental health services in the prior year.[23][29]
Substance use
"The Drunkard's Progress", 1846 demonstrating how alcoholism can lead to poverty, crime, and eventually suicide
Substance abuse is the second most common risk factor for suicide after major depression and bipolar disorder.[31] Both chronic substance misuse as well as acute intoxication are associated.[14][32] When combined with personal grief, such as bereavement, the risk is further increased.[32] Additionally substance misuse is associated with mental health disorders.[14]
Most people are under the influence of sedative-hypnotic drugs (such as alcohol or benzodiazepines) when they commit suicide[33] with alcoholism present in between 15% and 61% of cases.[14] Countries that have higher rates of alcohol use and a greater density of bars generally also have higher rates of suicide[34] with this link being primarily related to distilled spirit use rather than total alcohol use.[14] About 2.2�3.4% of those who have been treated for alcoholism at some point in their life die by suicide.[34] Alcoholics who attempt suicide are usually male, older, and have tried to commit suicide in the past.[14] Between 3 and 35% of deaths among those who use heroin are due to suicide (approximately 14 fold greater than those who do not use).[35]
The misuse of cocaine and methamphetamines has a high correlation with suicide.[14][36] In those who use cocaine the risk is greatest during the withdrawal phase.[37] Those who used inhalants are also at significant risk with around 20% attempting suicide at some point and more than 65% considering it.[14] Smoking cigarettes is associated with the risk of suicide.[38] 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.[38] Cannabis however does not appear to independently increase the risk.[14]
Problem gambling
Problem gambling is associated with increased suicidal ideation and attempts compared to the general population.[39] Between 12 and 24% pathological gamblers attempt suicide.[40] The rate of suicide among their spouses is three times greater than that of the general population.[40] Other factors that increase the risk in problem gamblers include mental illness, alcohol and drug misuse.[41]
Medical conditions
There is an association between suicidality and physical health problems such as[27] chronic pain,[42] traumatic brain injury,[43] cancer,[44] kidney failure (requiring hemodialysis, HIV, and systemic lupus erythematosus.[27] The diagnosis of cancer approximately doubles the subsequent risk of suicide.[44] The prevalence of increased suicidality persisted after adjusting for depressive illness and alcohol abuse. In people with more than one medical condition the risk was particularly high. In Japan, health problems are listed as the primary justification for suicide.[45]
Sleep disturbances such as insomnia[46] and sleep apnea are risk factors for depression and suicide. In some instances the sleep disturbances may be a risk factor independent of depression.[47] 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).[15]
Psychosocial states
A number of psychological states increase the risk of suicide including: hopelessness, loss of pleasure in life, depression and anxiousness.[24] A poor ability to solve problems, the loss of abilities one used to have, and poor impulse control also play a role.[24][48] In older adults the perception of being a burden to others is important.[49] Suicide in which the reason is that the person feels that they are not part of society is known as egoistic suicide.[50]
Recent life stresses such as a loss of a family member or friend, loss of a job, or social isolation (such as living alone) increases the risk.[24] Those who have never married are also at greater risk.[15] Being religious may reduce one's risk of suicide.[51] This has been attributed to the negative stance many religions take against suicide and to the greater connectedness religion may give.[51] Muslims, among religious people, appear to have a lower rate.[52]
Some may commit suicide to escape bullying or prejudice.[53] A history of childhood sexual abuse[54] and time spent in foster care are also risk factors.[55] Sexual abuse is believed to contribute to about 20% of the overall risk.[21]
An evolutionary explanation for suicide is that it may improve inclusive fitness. This may occur if the person committing 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.[48][56]
Poverty is associated with the risk of suicide.[57] Increasing relative poverty compared to those around a person increases suicide risk.[58] Over 200,000 farmers in India have committed suicide since 1997 partly due to issues of debt.[59] 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.[60]
Media
New York Daily Mirror front page heralding Marilyn Monroe's death
The media, which includes the Internet, plays an important role.[13] How it presents depiction of suicide may have a negative effect, with high volume, prominent, repetitive coverage glorifying or romanticizing suicide having the most impact.[61] 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.[62]
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.[63] This risk is greater in adolescents who may romanticize death.[64] It appears that while news media has a significant effect, that of the entertainment media is equivocal.[65] 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 (fearing the loss of a loved one) had planned to kill himself until his friends helped him out.[63] When media follows recommended reporting guidelines the risk of suicides can be decreased.[61] Getting buy-in from industry, however, can be difficult, especially in the long term.[61]
Rational
Rational suicide is the reasoned taking of one's own life,[66] although some feel that suicide is never logical.[66] The act of taking one's life for the benefit of others is known as altruistic suicide.[67] 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.[67] Suicide in some Eskimo cultures has been seen as an act of respect, courage, or wisdom.[68]
A suicide attack is a political action where an attacker carries out violence against others which they understand will result in their own death.[69] Some suicide bombers are motivated by a desire to obtain martyrdoms.[22] Kamikaze missions were carried out as a duty to a higher cause or moral obligation.[68] Murder�suicide is an act of homicide followed within a week by suicide of the person who carried out the act.[70]
Mass suicides are often performed under social pressure where members give up autonomy to a leader.[71] Mass suicides can take place with as few as two people, often referred to as a suicide pact.[72]
In extenuating situations where continuing to live would be intolerable, some people use suicide as a means of escape.[73] Some inmates in Nazi concentration camps are known to have killed themselves by deliberately touching the electrified fences.[74]
Methods
Case fatality rate by suicide method in the United States.[17]
Main article: Suicide methods
The leading method of suicide varies among countries. The leading methods in different regions include hanging, pesticide poisoning, and firearms.[75] These differences are believed to be in part due to availability of the different methods.[62] A review of 56 countries found that hanging was the most common method in most of the countries,[76] accounting for 53% of the male suicides and 39% of the female suicides.[77]
Worldwide, 30% of suicides are from pesticides. The use of this method, however, varies markedly from 4% in Europe to more than 50% in the Pacific region.[78] It is also common in Latin America due to easy access within the farming populations.[62] In many countries, drug overdoses account for approximately 60% of suicides among women and 30% among men.[79] Many are unplanned and occur during an acute period of ambivalence.[62] 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 6-75%, and medication overdose 1.5-4%.[62] The most common attempted methods of suicide differ from the most common successful methods; Up to 85% of attempts are via drug overdose in the developed world.[27]
In China, the consumption of pesticides is the most common method.[80] In Japan, self disembowelment known as seppuku or hara-kiri still occurs;[80] however, hanging is the most common.[81] Jumping to one's death is common in both Hong Kong and Singapore at 50% and 80% respectively.[62] In Switzerland, where nearly everyone owns a firearm, the most suicides are by hanging.[82] In the United States, 57% of suicides involve the use of firearms with this method being somewhat more common in men than women.[15] The next most common cause was hanging in males and self poisoning in females.[15] Together these methods comprised about 40% of U.S. suicides.[83]
Pathophysiology
There is no known unifying underlying pathophysiology for either suicide or depression.[15] It is however believed to result from an interplay of behavioral, socio-environmental and psychiatric factors.[62]
Low levels of brain-derived neurotrophic factor (BDNF) are both directly associated with suicide[84] and indirectly associated through its role in major depression, posttraumatic stress disorder, schizophrenia and obsessive�compulsive disorder.[85] Post-mortem studies have found reduced levels of BDNF in the hippocampus and prefrontal cortex, in those with and without psychiatric conditions.[86] Serotonin, a brain neurotransmitter, is believed to be low in those who commit suicide. This is partly based on evidence of increased levels of 5-HT2A receptors found after death.[87] Other evidence includes reduced levels of a breakdown product of serotonin, 5-Hydroxyindoleacetic acid, in the cerebral spinal fluid.[88] Direct evidence is however hard to gather.[87] 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.[89]
Prevention
Main article: Suicide prevention
As a suicide prevention initiative, this sign promotes a special telephone available on the Golden Gate Bridge that connects to a crisis hotline.
Suicide prevention is a term used for the collective efforts to reduce the incidence of suicide through preventive measures. Reducing access to certain methods, such as firearms or toxins reduces the risk.[62][90] Other measures include reducing access to charcoal and barriers on bridges and subway platforms.[62][91] Treatment of drug and alcohol addiction, depression, and those who have attempted suicide in the past may also be effective.[90] Some have proposed reducing access to alcohol as a preventative strategy (such as reducing the number of bars).[14] Although crisis hotlines are common there is little evidence to support or refute their effectiveness.[3][92] In young adults who have recently thought about suicide, cognitive behavioral therapy appears to improve outcomes.[93] Economic development through its ability to reduce poverty may be able to decrease suicide rates.[57] Efforts to increase social connection especially in elderly males may be effective.[94] 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.[95]
Screening
There is little data on the effects of screening the general population on the ultimate rate of suicide.[96][97] 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.[98] Assessing those at high risk however is recommended.[15] Asking about suicidality does not appear to increase the risk.[15]
Mental illness
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.[15] Possessions that may be used to harm oneself are typically removed.[27] Some clinicians get patients to sign suicide prevention contracts where they agree to not harm themselves if released.[15] Evidence however does not support a significant effect from this practice.[15] If a person is at low risk, out-patient mental health treatment may be arranged.[27] 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.[99][100]
There is tentative evidence that psychotherapy, specifically, dialectical behaviour therapy reduces suicidality in adolescents[101] as well as in those with borderline personality disorder.[102] It may also be useful in decreasing suicide attempts in adults at high risk.[103] Evidence however has not found a decrease in completed suicides.[101]
There is controversy around the benefit versus harm of antidepressants.
