Suicide and Suicide Prevention 101

In the U.S., suicidal behavior constitutes a major public and mental health problem. It is a tragic response to multiple problems involving depression, substance abuse, and other factors like exposure to trauma and violence, and loss of key social, family and community foundations. It is a single response to a multitude of problems.

Suicide is the 11th leading cause of death overall, and the 8th leading cause of death for males whom often use lethal means and consequently are four times more likely to die from suicide than are females (CDC, 2004). Nearly 60% of all suicides are committed with a firearm (CDC, 2004). Suicide is the 19th leading cause of death for women; however they report higher rates of depression and suicide attempts about three times as often as men during their lifetime (Krug et al. 2002). Research on suicide suggests that for every completed suicide there are 100-200 attempts.

Older Americans are disproportionately likely to die by suicide. Comprising only 13 percent of the U.S. population, individuals age 65 and older accounted for nearly 18 percent of all suicide deaths in 2002. Among the highest rates (when categorized by gender and race) are for White men age 85 and older. The suicide rate for these men is more than five times the national U.S. rate of 51.1 per 100,000.

For young people, ages 15-24 years, suicide ranks as the 3rd leading cause of death and comprises 64 percent of all suicides. Depression in adolescents presents an enormous risk factor for suicide in youth, particularly if coupled with inhibited emotional, cognitive and/or academic development, family problems, and/or the presence of chronic illness. Co-occurring conditions such as substance abuse and mental illness can be tragic contributors to mortality.

Disparities in rates of suicide for racial and ethnic minorities are notable. For American Indian and Alaska Native (AIAN) populations, the age adjusted suicide rate for the HIS service area population was 20 per 100,000, 91 percent higher than for all races in the U.S. (11 per 100,000) (IHS, 2004). For AIANs aged 15-24, suicide is the 2nd leading cause of death with a prevalence rate of suicide is 2.4 times the national rate, or about 60 deaths per 100,000 individuals. Overall, violent deaths, unintentional injuries, homicide and suicide account for 75 percent of all mortality within 15-24 year old age range for AIAN (IHS, 2004).

Suicide among Latinos is the third leading cause of death for youth aged 10-34 years, occurring predominately among males (CDC, 2004). However, the National Household Survey on Drug Abuse (SAMHSA, 2003) cites a disturbing trend among U.S. born Latina youth, aged 12-17 years. The survey found that Latinas are also at high risk of suicide—and describe these youth who thought about or tried to kill themselves. These rates span across geographic regions and ethnic subgroups (Mexican, Puerto Rican, Central or South American and Cuban).

Although the rate of suicide among African Americans as a whole is 5.0 per 100,000, youth suicide is the 3rd leading cause of death with a rate of 7 per 100,000, after homicides and accidents. And the rate of suicide for males is almost 7 times higher than that of females (11.3 vs. 1.7 per 100,000).

Nationally, Asian American Pacific Islander (AAPI) women between the ages of 15-24 have the highest rates of suicide among women in that age group, and AAPI women over 65 have the highest rates of suicide among all races in that age. Meanwhile, even as AAPI suicide rates increase, AAPIs are the least likely of all races to seek help for their distress and when they seek professional help; their symptoms are likely to be more severe. Overall suicide rates for Filipino (3.5), Chinese (8.3), and Japanese (9.1) Americans are substantially lower. However, Native Hawaiian adolescents have a higher risk of suicide than do other adolescents in Hawaii.

This trend in suicidality for minorities will require a renewed and vitalized approach; one that involves the courage to switch gears. Reforms should promote culturally and linguistically competent prevention, early interventions, and involve families and whole communities.

What are the risk factors for suicidal behavior? Risk factors for suicide include, but are not limited to:

• Previous suicide attempt(s)
• History of mental disorders, particularly depression
• History of alcohol and substance abuse
• Family history of suicide
• Family history of child maltreatment
• Feelings of hopelessness
• Impulsive or aggressive tendencies
• Barriers to accessing mental health treatment
• Loss (relational, social, work, or financial)
• Physical illness
• Easy access to lethal methods
• Unwillingness to seek help because of the stigma attached to mental health and substance abuse disorders or suicidal thoughts
• Cultural and religious beliefs-for instance, the belief that suicide is a noble resolution of a personal dilemma
• Local epidemics of suicide
• Isolation, a feeling of being cut off from other people

Early signs:

• Depression
• Statements or expressions of guilt feelings
• Tension or anxiety
• Nervousness
• 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

Can suicidal behavior be treated?

YES! Hospitalization is often needed, both to treat the recent actions and to prevent future attempts. Psychiatric intervention is one of the most important aspects of treatment.

Statistics

• In 2002, 132,353 individuals were hospitalized following suicide attempts; 116,639 were treated in emergency departments and released.

• Among males, ages 15-24, American Indians and Alaska Natives have the highest suicide death rate of 27.9 per 100,000 population

• In 2002, the suicide rate among African American females was the lowest of all racial/gender groups-1.6 per 100,000 population.

• Suicidal ideation, suicide attempts, and injurious suicide attempts among male and female students in grades 9-12 decreased from 19.0 percent in 2001 to 16.9 percent in 2003.

• In 2003, among female Hispanic high school students (grades 9-12), 23.4 percent had seriously considered suicide, compared to just 14.7 percent of their African American counterparts.

• Almost 11 percent of African American male students in grades 9-12 seriously considered suicide in 2003.

If you are in crisis...call 1-800-273-TALK (1-800-273-8255)

For additional information on suicide and suicide prevention:

The National Institute of Mental Health
http://www.nimh.nih.gov/suicideprevention/index.cfm

SAMHSA, Center for Mental Health Services
http://www.mentalhealth.samhsa.gov/

American Psychological Association
http://www.apa.org/

American Psychiatric Association
http://www.psych.org/

American Association of Suicidology
http://www.suicidology.org

National Alliance for Mental Illness
ttp://www.nami.org/

National Mental Health Association
http://www.nmha.org/