Suicide (cont.)

Medical Author:

Roxanne Dryden-Edwards, MD

Roxanne Dryden-Edwards, MD

Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

View Full Profile

Medical Editor:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

View Full Profile

In this Article

• What is suicide?
• What are the effects of suicide?
• What are some possible causes of suicide?
• What are the risk factors and protective factors for suicide?
• What are the signs and symptoms for suicide?
• How are suicidal thoughts and behaviors assessed?
• What is the treatment for suicidal thoughts and behaviors?
• How can people cope with suicidal thoughts?
• How can people cope with the suicide of a loved one?
• Where can people get help?
• Suicide At A Glance
• Patient Comments: Suicide - Symptoms and Signs
• Suicide Index

• Suicide is the process of purposely ending one's own life. How societies view suicide varies by culture, religion, ethnic norms, and the circumstances under which it occurs.
• Nearly 1 million people worldwide commit suicide each year -- about 30,000 each year in the United States.
• Self-mutilation is the act of deliberately hurting oneself without meaning to cause one's own death.
• Physician-assisted suicide is defined as a doctor ending the life of a person who is incurably ill in a way that is either painless or minimally painful for the purpose of ending the suffering of the individual.
• The effects of suicide on the loved ones of the deceased can be devastating, resulting in suicide survivors enduring a variety of conflicting, painful emotions.
• Life circumstances that may immediately precede a suicide include the time period of at least a week after discharge from a psychiatric hospital, a sudden change in how the person appears to feel, or a real or imagined loss.
• Firearms are the most common means by which people take their lives. Other common methods include overdose of medication, asphyxiation, and hanging.
• There are gender, age, ethnic, and geographical risk factors for suicide, as well as those based on family history, life stresses, and medical and mental-health status.
• In children and teens, bullying and being bullied seem to be associated with their committing suicide, and being bullied may put them at risk for committing murder-suicide.
• Warning signs that an individual is imminently planning to kill him- or herself may include the making of a will, getting his/her affairs in order, suddenly visiting or writing letters to loved ones, buying instruments of suicide, experiencing a sudden change in mood, or writing a suicide note.
• Many people who complete suicide do not tell any health professional of their intent in the months before they do so. If they communicate a plan to anyone, it is more likely to be a friend or family member.
• The assessment of suicide risk often involves an evaluation of the presence, severity, and duration of suicidal thoughts as part of a mental-health evaluation.
• Treatment of suicidal thinking or attempt involves adapting immediate treatment to the sufferer's individual needs. Those with a strong social support system, who have a history of being hopeful and have a desire to resolve conflicts may need only a brief crisis-oriented intervention. Those with more severe symptoms or less social support may need hospitalization and long-term outpatient mental-health services.
• Treatment of any underlying emotional problem using a combination of psychotherapy, safety planning, and medication remains the mainstay of suicide prevention.
• People who are contemplating suicide are encouraged to talk to a doctor or other health professional, spiritual advisor, or immediately go to the closest emergency room or mental-health crisis center for help. Those who have experienced suicidal thinking are commonly directed to keep a list of people to call in the event that those thoughts return. Other strategies include having someone hold all medications to prevent overdose, removing any weapons from the home, scheduling frequent stress-relieving activities, getting together with others, writing down feelings, and avoiding the use of alcohol or other drugs.
• Techniques for coping with the suicide of a loved one include nutritious eating, getting extra rest, writing about their emotions, talking to others about the experience, thinking of ways to handle painful memories, understanding their state of mind will vary, resisting pressure to grieve by any one else's time table, and survivors doing what is right for them.
• To help children and adolescents cope with the suicide of a loved one it is important to ensure they receive consistent caretaking, frequent interaction with supportive peers and adults, and understanding of their feelings as they relate to their age.

REFERENCES:

Adams, K. "Managing Grief Through Journal Writing." Center for Journal Therapy. 2006.

Alexander, R.E. "Stress-Related Suicide by Dentists and Other Health Care Workers: Fact or Folklore?" Journal of the American Dental Association 132.6 (2001): 786-794.

Aseltine, R.H. and DeMartino, R. "An Outcome Evaluation of the SOS Suicide Prevention Program." American Journal of Public Health 94.3 (2004): 446-451.

Bender, E. "Suicide Expert Calls for More Aggressive Screening." Psychiatric News 38.11 June 6, 2003: 28.

Brown, H. "Suicide by Cop: When It Happens to You, There's Almost Always Police Stress as a Result." Police Stressline, 2003.

Center for Suicide Prevention. "Grief After Suicide: Notes From the Literature on Qualitative Differences and Stigma." SIEC Alert 46, November 2001.

Conwell, Y., Duberstein, P.R., Connor, K., Eberly, S., Cox, C. and Caine, E.D. "Access to Firearms and Risk for Suicide in Middle-aged and Older Adults." American Journal of Geriatric Psychiatry 10 Aug. 2002: 407-416.

Cuellar, J. and Curry, T.R. "The Prevalence and Comorbidity Between Delinquency, Drug Abuse, Suicide Attempts, Physical and Sexual Abuse, and Self-Mutilation Among Delinquent Hispanic Females." Hispanic Journal of Behavioral Science 29.1 (2007): 68-82.

Eliason, S. Murder-suicide: A review of the recent literature. Journal of the American Academy of Psychiatry and the Law 37.3 (2009); 371-376.

Fawcett, J. "Treating Impulsivity and Anxiety in the Suicidal Patient." Annals of the New York Academy of Sciences 932 (2001): 94-105.

Frierson, R.L., Melikian, M. and Wadman, P.C. "Principles of Suicide Risk Assessment. How to Interview Depressed Patients and Tailor Treatment." Postgraduate Medicine 112.3 Sept. 2002.

Frileux, S., Lelievre, C., Munoz Sastre, M.T., Mullet, E. and Sorum, P.C. "When Is Physician Assisted Suicide or Euthanasia Acceptable?" Journal of Medical Ethics 29 (2003): 330-336.

Gibbons, R.D., K. Hur, D.K. Bhaumik, and J.J. Mann. "The Relationship Between Antidepressant Prescription Rates and Rate of Early Adolescent Suicide." American Journal of Psychiatry 163 Nov. 2006: 1898-1904.

Hem, E., A.M. Berg, and O. Ekeberg. "Suicide Among Police Officers." American Journal of Psychiatry 161 Apr. 2004: 767-768.

Horowitz, M.J., Siegel, B., Holen, A., Bonanno, G.A., Milgrath, C. and Stinson, C.H. "Diagnostic Criteria for Complicated Grief Disorder." Focus 1 (2003): 290-298.

JAMA Patient Page. Suicide. Journal of the American Medical Association 293.20 (2005).

Johansson, L, Lindqvist, P, Eriksson, A. Teenage suicide cluster formation and contagion: implications for primary care. Biomedical Central Family Practice 2006 May; 7: 32.

Kim, Young-Shin. "Bullying and Being Bullied Linked to Suicide in Children, Review of Studies Suggests." Science Daily. July 19, 2008.

Klonsky, E.D., Oltmanns, T.F. and Turkheimer, E. "Deliberate Self-Harm in a Nonclinical Population: Prevalence and Psychological Correlates." American Journal of Psychiatry 160 Aug. 2003: 1501-1508.

Mayo Foundation. "Suicide: Coping When a Loved One Takes Their Life." 2007.

Mayo Foundation. "Suicide: Don't Let Despair Obscure Other Options." 2007.

Melhem, N.M., Day, N., Shear, K., Day, R., Reynolds, C.F. and Brent, D. "Traumatic Grief Among Adolescents Exposed to a Peer's Suicide." American Journal of Psychiatry 161 Aug. 2004: 1411-1416.

National Institute of Mental Health. "Suicide in the United States: Statistics and Prevention." Oct. 3, 2007.

Neimeyer, R.A., Prigerson, H.G. and Davies, B. "Mourning and Meaning." American Behavioral Scientist 46.2 (2002): 235-251.

Osterweil, N. "APA: Simple Screen Improves Suicide Risk Assessment." Psychiatric Times May 25, 2007.

Palmer, L.I. "The Legal and Political Future of Physician-Assisted Suicide." Journal of the American Medical Association 289 (2003): 2283.

Pfeffer, C.R. "Death." Psychiatric Times 17.9 Sept. 2000.

Qin, P., Agerbo, E. and Mortensen, P.B. "Suicide Risk in Relation to Socioeconomic, Demographic, Psychiatric and Familial Factors: A National Register-Based Study of All Suicides in Denmark, 1981-1997." American Journal of Psychiatry 160 Apr. 2003: 765-772.

Rao, K.N., C.Y. Sudarshan, and S. Begum. "Self-injurious Behavior: A Clinical Appraisal." Indian Journal Psychiatry 50.4 Oct.-Dec. 2008: 288-297.

Rask, K., Kaunonen, M. and Paunonen-Ilmonen, M. "Adolescent Coping With Grief After the Death of a Loved One." International Journal of Nursing Practice 8(3) June 2002: 137-142.

Reinherz, H.Z., Tanner, J.L. and Berger, S.R. "Adolescent Suicidal Ideation as Predictive of Psychopathology, Suicidal Behavior and Compromised Functioning at Age 30." American Journal of Psychiatry 163 (2006): 1226-3122.

Reuter-Rice, K. "Male Adolescent Bullying and the School Shooter." Journal of School Nursing  24.6 (2008): 350-359.

Russell, S.T., and K. Joyner. "Adolescent Sexual Orientation and Suicide Risk: Evidence From a National Study." American Journal of Public Health 91.8 Aug. 2001: 1276-1281.

Shain, B.N. "Committee on Adolescence. Suicide and Suicide Attempts in Adolescents." Pediatrics 120.3 Sept. 2007: 669-676.

Sher, L. "Preventing Suicide." Quarterly Journal of Medicine 97.10 (2004): 677-680.

Silva, M.J. and Vitiello, B. "The Treatment for Adolescents With Depression Study (TADS): Methods and Message at 12 Weeks." Journal of the American Academy of Child and Adolescent Psychiatry 45 (2006): 1393-1403.

Soreff, S. "Suicide." eMedicine.com. Sept. 28, 2006.

United States. Centers for Disease Control and Prevention. "National Suicide Statistics at a Glance 2009." Sept. 30, 2009. <http://www.cdc.gov/violenceprevention/suicide/statistics/aag.html>.

van Houwelingen, C.A., and D.G. Beersma. "Seasonal Changes in 24-Hour Patterns of Suicide Rates: A Study on Train Suicides in the Netherlands." Journal of Affective Disorders 66.2-3 Oct. 2001: 215-223.

Washington State Legislature. Initiative Measure Number 1000. The Washington Death with Dignity Act 2008 January.