SUICIDE

Causes, Incidence and Risk Factors

Suicidal behaviors indicate that a person wishes to, intends to, or actually attempts to commit suicide. Suicidal behaviors can accompany many emotional disturbances, including depression, schizophrenia, and other psychotic illnesses. In fact, more than 90% of all suicides are related to an emotional or psychiatric illness. Suicidal behaviors occur as a response to a situation that the person views as overwhelming, such as social isolation, death of a loved one, emotional trauma, serious physical illness, growing old, unemployment or financial problems, guilt feelings, drug abuse, and alcohol abuse.

Suicide accounts for about 1% of all deaths each year. The highest rate is among the elderly, but there has been a steady increase in the rate among young people (particularly adolescents). Suicide is now the third leading cause of death for those 15 to 19 years old (after accidents and homicide). The incidence of reported suicides varies widely from country to country in the world; however, this may be in part related to reporting (especially in cultures where suicide is considered sinful or shameful). Suicide attempts (where the person tries to harm him- or herself but the attempt does not result in death) far outnumber actual suicides.

The method of suicide attempt varies from relatively nonviolent methods (such as poisoning, overdose, or inhaling car exhaust) to violent methods (such as shooting or cutting oneself). Males are more likely to choose violent methods, which probably accounts for the fact that suicide attempts by males are more likely to be successful. Many unsuccessful suicide attempts are carried out in a manner or setting that makes rescue possible; they must be viewed as a cry for help.

Symptoms

Early signs:

• depression
• statements or expressions of guilt feelings
• tension or anxiety
• nervousness
• insomnia
• loss of appetite
• loss of weight
• impulsiveness

Critical signs:

• sudden change in behavior (especially calmness after a period of anxiety)
• giving away belongings, attempts to "get one's affairs in order"
• direct or indirect threats to commit suicide
• direct attempts to commit suicide

Treatment

Emergency measures may be necessary if the person has attempted suicide; first aid for bleeding, CPR or mouth-to-mouth resuscitation, or other measures may be required. Hospitalization is often needed, both to treat the current attempt and to prevent future attempts. Psychiatric counseling is one of the most important aspects of treatment.

Expectations (Prognosis)

All suicide threats and attempts should be taken seriously. About one-third of people who attempt suicide will repeat the attempt within one year, and about 10% of those who threaten or attempt suicide eventually do kill themselves.

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