Suicide exists in all countries of the world and there are records of suicides dating back to the earliest historical records of humankind. In 2000 the World Health Organization estimated that approximately 1 million people commit suicide annually. Suicide is among the top ten causes of death and one of the three leading causes in the fifteen-to-thirty-five-years age group worldwide. In the United States, where suicide is the ninth leading cause of death (and where the number of victims is 50% higher than the number of homicides), the Surgeon General in 1999 issued a Call to Action to Prevent Suicide, labeling suicide "a significant public health problem."
Suicide is a tragic phenomenon that has preoccupied professionals from a variety of disciplines. Deaths by suicide have broad psychological and social impacts on families and societies throughout the world. On average, each suicide intimately affects at least six other people, and if the suicide occurs in the school or workplace it can significantly impact hundreds. Suicide's toll on the living has been estimated by the World Health Organization in terms of disability-adjusted life years, which indicates the number of healthy years of life lost to an illness or event. According to their calculations, the burden of suicide is equal to the burden of all wars and homicides throughout the world. Despite progress in controlling many other causes of death, suicide has been on the rise— becoming one of the leading causes of death.
The taking of one's own life is the result of a complex interaction of psychological, sociological, environmental, genetic, and biological risk factors. Suicide is neither a disease nor the result of a disease or illness, but rather a desperate act by people who feel that ending their life is the only way to stop their interminable and intolerable suffering.
Despite the magnitude of social damage caused by suicide, it is a fairly rare event. Suicide rates of between 15 to 25 deaths per 100,000 population each year may be considered high. Most people who are seriously suicidal, even those who attempt suicide, rarely have a fatal outcome (although, in the United States, 500,000 people annually require emergency room treatment because of their attempts). For each completed suicide (a suicide that results in death) there are at least six or seven suicide attempts that result in hospitalizations and, according to community surveys, for each completed suicide at least 100 people report that they attempted suicide without being hospitalized as a suicide attempter. Furthermore, if one asks in a community survey if people seriously considered suicide, about one person in twenty-five says that they have done so.
Research shows that the vast majority, at least 80 percent, of persons who died by suicide had been or could be diagnosed as suffering from a mental disorder, usually mood disorders and depression. People who suffer from the mental disorders of depression and manic depression, alcoholism, or schizophrenia have between a 4 percent and 15 percent lifetime risk of suicide. These mental disorders do not "cause" suicide, but people with mental disorders are at much greater risk of committing suicide. For this reason, the diagnosis and treatment of mood disorders, alcoholism, and schizophrenia may prevent suicides.
Besides mental disorders, there are numerous other risk factors that help identify who is at greater risk of suicide. The most important risk factor is gender, with men in Europe and the Americas committing suicide about five times more than women even though women are more likely to attempt suicide. People with some physical illnesses have greater suicide risks. In most countries, men over the age of seventy-five have the greatest risk of suicide of all age groups. Those who live alone or are separated are more vulnerable to suicide, including divorced, widowed, and single people. Also at higher risk are individuals who have lost a job.
Various situational factors also increase the risk of suicide. Individuals who are exposed to suicide in real life or through the media have a higher like-lihood of suicidal behavior. Research on firearms and the availability of other means of suicide has shown that if a method is readily available a death by suicide is more likely to occur. For this reason control of firearms and reducing access to other preferred means of suicide, such as putting up barriers on bridges and getting rid of medications in the home of a suicidal adolescent, may help prevent suicides.
The crisis situation in which a person attempts or commits suicide is often precipitated by a stressful life event. Suicides are more likely to occur after an argument with family members or lovers following rejection or separation, financial loss and bereavement, job loss, retirement, or failure at school. Usually these events are "the last straw" for a suicidal person. They are generally not what caused the suicide but what resulted in an increased likelihood that the suicide would occur then.
People who consider suicide generally feel ambivalent about ending their own life. It is this ambivalence that leads desperately suicidal people to talk about their plans as they "cry for help." Telephone help lines, therapists, and friends strengthen the will to live of ambivalent people by helping them explore other options for changing their situation.
The psychoanalyst Edwin Shneidman described the mental state of suicidal individuals experiencing unendurable psychological pain and feelings of frustration. According to Shneidman, suicide is seen as the only solution to their problems, one that results in stopping intolerable feelings. Besides feeling ambivalent, suicide-prone individuals tend to have what he calls "constriction"—rigid and persistent preoccupations with suicide as the solution to their problems. These individuals believe that the drastic option of ending their own life by suicide is the only way out unless others help break this pattern of constricted thought.
Many countries, including the United States, have created national suicide prevention programs that utilize a variety of strategies. These programs involve a variety of actions. Some prevention methods begin very early, teaching young children ages five to seven how to better cope with everyday problems. Other programs focus on teaching high school students how to better recognize signs of suicide in friends and how to obtain help. Actions also focus upon educating "gatekeepers," such as physicians, counselors, and teachers, who may come into contact with suicidal persons. The World Health Organization publishes resources on preventing suicide in its web site ( www.who.org ), and Befrienders International has extensive information on suicide and its prevention available in several languages at www.befrienders.org .
Hawton, Keith, and Kees van Heeringen, eds. The International Handbook of Suicide and Attempted Suicide. New York: John Wiley and Sons, 2000.
Phillips, David P. "The Werther Effect: Suicide and Other Forms of Violence are Contagious." Sciences 25 (1985):32–39.
Shneidman, Edwin. Suicide As Psychache: A Clinical Approach to Self-Destructive Behavior. Northvale, NJ: Jason Aronson, 1993.
World Health Organization. World Health Statistics Annual, 1995. Geneva: Author, 1996.
BRIAN L. MISHARA