We, the Depressed, in our darkest hours have
No energy to move
No reason to live
No will to survive
No hope in a cure
No reason to try.
We roam the earth as the living dead
Wanting only to extinguish
That persistent heart that beats,
That ceaseless breath that enters,
That pain that never relents.
Every cell of our being wants to die,
Yet Do We Live.
Throughout the world, about 2000 people kill themselves each day. That's about 80 per hour, three quarters of a million a year. In the U.S.
Another estimated 300,000 (or more) Americans a year survive a suicide attempt. A majority have injuries minor enough to need no more than emergency room treatment. However, about 116,000 are hospitalized, of whom 110,000 are eventually discharged alive. Their average hospital stay is 10 days; the average cost is $15,000.
"...without knowledge of proper dosages and methods, suicide attempts are often bungled, leaving the victim worse off than before. Many intended suicides by gunshot leave the person alive but brain-damaged; drug overdoses that are not fatal may have the same effect. One eighty-three-year-old woman obtained an insufficient number of pills and lost consciousness but did not die; her daughter ended up smothering her with a plastic bag."
Seventeen percent, some 19,000, of these people are permanently disabled, restricted in their ability to work, each year, at a cost of $127,000 per person. Such injury is tragic, either if someone were trying to kill herself and failed, or, perhaps even sadder, if the suicide attempt was intended as a "cry for help".
About 1.4% of Americans end their lives by suicide. This is the eighth leading cause of death in the U.S.
There are more suicides than the official numbers show, but there is no general agreement as to how many more. Estimates of under-reporting range from around 1% to 300%...
Reasons for under-reporting include:
(1) Families or family physicians may hide evidence due to the stigma of suicide. For example, "Physicians and surviving relatives have told me in confidence of many deaths which were suicides, but which had been certified as natural or accidental deaths by a physician, either through error, misinformation, or deliberate falsehood....My own estimate is that there were an additional 10,000 deaths yearly [in the U.S.] which would have been certified as suicides if there had been complete and impartial investigations."
(2) The determination of cause-of-death is judged by local standards, which vary widely. In one egregious instance, a coroner would cite suicide only in deaths where a suicide note was found, and suicide notes are only found in around one quarter of known suicides.
(3) There are lots of ambiguous situations, some of which are suicides, but which almost always end up classified as "accidental" or "undetermined" the single-car "accident" with no skid marks; the "fall" off the night ferry; the "stumble" in front of the train; the "inadvertent" overdose; the gun-cleaning "mishap".
(4) Compared to the "accidental" or "undetermined" motive categories, there is a much larger number of deaths officially classified as "ill-defined and unknown causes of mortality," where even the actual cause of death is uncertain, and some of which are undoubtedly suicides.
(5) The frequency of physician-assisted suicide for the terminally ill is unknown, but, based on anecdotal evidence, is probably both substantial and increasing.
On the other side of the ledger, some doubtful cases may be classified as suicides as well. These usually occur in institutions, such as prisons, hospitals, religious orders, and the military, which control their population more-or-less completely.
For such institutions a verdict of suicide is likely to be the least embarrassing (after "natural") cause of death: homicides must be investigated and a murderer sought; accidents may be the basis of negligence lawsuits.
The number of suicide attempts is also subject to dispute. Based on a range of studies, there are probably between 10-20 attempts for every suicide, or roughly 300,000-600,000 attempts per year in the U.S.
Race
Suicide rates among American Indian and Alaskan natives between 15 and 34 years are almost twice the national average for this age range. Hispanic females make significantly more suicide attempts than their male or non-Hispanic counterparts.
The risk of suicide is increased by concurrent alcohol and drug abuse, access to lethal means, hopelessness, pessimism, and impulsivity, and is reduced by help-seeking behavior, access to psychiatric treatment, and availability of family and other social supports.
Sex
More women than men seek treatment for depression, but this is not necessarily reflective of the true incidence of the disease.
- Although depression is more often diagnosed in women, more men than women die from suicide by a factor of 4.5:1. White men complete more than 78% of all suicides, and 56% of suicide deaths in males involve firearms. Poisoning is the predominant method among females.
- An estimated 8-25 attempted suicides occur for every completion. Many of these are never discovered or never reported. It is important to understand that the majority of suicide attempts are expressions of extreme distress, not merely bids for attention.
Age
The highest suicide rates are found in men older than 75 years. However, suicide is also a selective killer of youth. It is the third leading cause of death among people aged 15-24 years, after unintentional injuries and homicide, and the second leading cause of death in college students. The mean age for successful completed suicides is 40 years.
For adolescents, the attempt-to-fatality ratio may be 50:1; but this average masks the fact that the death rate for boys is a hundred times higher than for girls: around 10 percent and 0.1 percent, respectively. About 11% of high school students have made at least one suicide attempt. Ninety percent of adolescents' suicide attempts occur at home, and parents are home 70% of the time.
Risk Factors
Risk factors for thoughts of suicide can vary with age, gender, and ethnic group. And risk factors often occur in combinations.
Over 90% of people who die by suicide have clinical depression or another diagnosable mental disorder. Many times, people who die by suicide have a substance abuse problem. Often they have that problem in combination with other mental disorders.
Adverse or traumatic life events in combination with other risk factors, such as clinical depression, may lead to suicide. But suicide and suicidal behavior are never normal responses to stress.
Other risk factors for suicide include:
- One or more prior suicide attempts.
- Family history of mental disorder or substance abuse.
- Family history of suicide.
- Family violence.
- Physical or sexual abuse.
- Keeping firearms in the home.
- Incarceration.
- Exposure to the suicidal behavior of others.
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