In Harms Way: Suicide in America
Suicide is a tragic and potentially preventable public health
problem. In 2000, suicide was the 11th leading cause of death in
the U.S. Specifically, 10.6 out of every 100,000 persons died by
suicide. The total number of suicides was 29,350, or 1.2 percent
of all deaths. Suicide deaths outnumber homicide deaths by five
to three. It has been estimated that there may be from 8 to 25
attempted suicides per every suicide death. The alarming numbers
of suicide deaths and attempts emphasize the need for carefully
designed prevention efforts. Suicidal behavior is complex. Some
risk factors vary with age, gender, and ethnic group and may
even change over time. The risk factors for suicide frequently
occur in combination. Research has shown that more than 90
percent of people who kill themselves have depression or another
diagnosable mental or substance abuse disorder, often in
combination with other mental disorders. Also, research
indicates that alterations in neurotransmitters such as
serotonin are associated with the risk for suicide. Diminished
levels of this brain chemical have been found in patients with
depression, impulsive disorders, a history of violent suicide
attempts, and also in postmortem brains of suicide victims.
Adverse life events in combination with other risk factors such
as depression may lead to suicide. However, suicide and suicidal
behavior are not normal responses to stress. Many people have
one or more risk factors and are not suicidal. Other risk
factors include: prior suicide attempt; family history of mental
disorder or substance abuse; family history of suicide; family
violence, including physical or sexual abuse; firearms in the
home; incarceration; and exposure to the suicidal behavior of
others, including family members, peers, or even in the media.
Gender Differences Suicide was the eighth leading cause of death
for males and the 19th leading cause of death for females in
2000. More than four times as many men as women die by suicide,
although women report attempting suicide during their lifetime
about three times as often as men. Suicide by firearm is the
most common method for both men and women, accounting for 57
percent of all suicides in 2000. White men accounted for 73
percent of all suicides and 80 percent of all firearm suicides.
Children, Adolescents, and Young Adults In 2000, suicide was the
third leading cause of death among 15- to 24-year-olds--10.4 of
every 100,000 persons in this age group--following unintentional
injuries and homicide. Suicide was also the 3rd leading cause of
death among children ages 10 to 14, with a rate of 1.5 per
100,000 children in this age group. The suicide rate for
adolescents ages 15 to 19 was 8.2 deaths per 100,000 teenagers,
including five times as many males as females. Among people 20
to 24 years of age, the suicide rate was 12.8 per 100,000 young
adults, with seven times as many deaths among men as among
women.1 Older Adults Older adults are disproportionately likely
to die by suicide. Comprising only 13 percent of the U.S.
population, individuals age 65 and older accounted for 18
percent of all suicide deaths in 2000. Among the highest rates
(when categorized by gender and race) were white men age 85 and
older: 59 deaths per 100,000 persons, more than five times the
national U.S. rate of 10.6 per 100,000.1 Attempted Suicides
Overall, there may be between 8 and 25 attempted suicides for
every suicide death; the ratio is higher in women and youth and
lower in men and the elderly.2 Risk factors for attempted
suicide in adults include depression, alcohol abuse, cocaine
use, and separation or divorce. Risk factors for attempted
suicide in youth include depression, alcohol or other drug use
disorder, physical or sexual abuse, and disruptive behavior. As
with people who die by suicide, many people who make serious
suicide attempts have co-occurring mental or substance abuse
disorders. The majority of suicide attempts are expressions of
extreme distress and not just harmless bids for attention. A
suicidal person should not be left alone and needs immediate
mental health treatment.
Prevention Preventive efforts to reduce suicide should be based
on research that shows which risk and protective factors can be
modified, as well as which groups of people are appropriate for
the intervention. In addition, prevention programs must be
carefully tested to determine if they are safe, truly effective,
and worth the considerable cost and effort needed to implement
and sustain them. Many interventions designed to reduce
suicidality also include the treatment of mental and substance
abuse disorders. Because older adults, as well as women who die
by suicide, are likely to have seen a primary care provider in
the year prior to their suicide, improving the recognition and
treatment of mental disorders and other suicide risk factors in
primary care settings may be one avenue to prevent suicides
among these groups. Recently, the manufacturer of the medication
clozapine received the first ever Food and Drug Administration
indication for effectiveness in preventing suicide attempts
among persons with schizophrenia. Additional promising
pharmacologic and psychosocial treatments for suicidal
individuals are currently being tested. If someone is suicidal,
he or she must not be left alone. Try to get the person to seek
help immediately from his or her doctor or the nearest hospital
emergency room, or call 911. It is also important to limit the
person's access to firearms, medications, or other lethal
methods for suicide.