| Article Index |
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| Suicide Overview |
| General Information |
| Classification |
| Causes |
| Intervention |
| All Pages |
There are approximately 400 deaths from suicide per year in Ireland at present. Medical research confirms that the vast majority of such deaths occur in people who have depression, or who suffer from other illnesses such as schizophrenia, panic attacks, or alcohol or drug problems.
If these illnesses had been treated, such deaths might well have been prevented in a significant number of cases.
For every death from suicide, it is estimated there are 10-30 times as many attempted suicides or episodes of deliberate self-harm. People commit deliberate self-harm in an attempt to end their lives, but also in an attempt to simply seek oblivion or to be “out of it”.
It must be remembered that those who have attempted suicide are much more at risk than the rest of the population of eventually repeating the act, but dying on the next attempt.
This is particularly the case for males who have attempted suicide and remained alive. It is estimated that 5% of such males will eventually die from suicide, and 2% of women who have survived deliberate self-harm will eventually die from suicide.
General Information
Suicide (Latin suicidium, from sui caedere, "to kill oneself") is the act of a human being intentionally causing his or her own death. Suicide is often committed out of despair, or attributed to some underlying mental disorder which includes depression, bipolar disorder, schizophrenia, alcoholism and drug abuse. Financial difficulties, interpersonal relationships and other undesirable situations play a significant role.
Over one million people commit suicide every year. The World Health Organization estimates that it is the thirteenth-leading cause of death worldwide. It is a leading cause of death among teenagers and adults under 35. There are an estimated 10 to 20 million non-fatal attempted suicides every year worldwide.
Views on suicide have been influenced by broader cultural views on existential themes such as religion, honor, and the meaning of life. The Abrahamic religions consider suicide an offense towards God due to religious belief in the sanctity of life. In the West it was often regarded as a serious crime. Conversely, during the samurai era in Japan, seppuku was respected as a means of atonement for failure or as a form of protest. In the 20th century, suicide in the form of self-immolation has been used as a form of protest, and in the form of kamikaze and suicide bombing as a military or terrorist tactic. Sati is a Hindu funeral practice in which the widow would immolate herself on her husband's funeral pyre, either willingly, or under pressure from the family and in-laws.
Medically assisted suicide (euthanasia, or the right to die) is currently a controversial ethical issue involving people who are terminally ill, in extreme pain, or have (perceived or construed) minimal quality of life through injury or illness. Self-sacrifice for others is not always considered suicide, as the goal is not to kill oneself but to save another; however, Émile Durkheim's theory termed such acts "
Classification
Self-harm
Self-harm is not a suicide attempt; however, initially self-harm was erroneously classified as a suicide attempt. There is a non-causal correlation between self-harm and suicide; both are most commonly a joint effect of depression.
Euthanasia and assisted suicide
Euthanasia machine invented by Dr. Philip Nitschke, on display at Science Museum, London.Individuals who wish to end their own lives may enlist the assistance of another person to achieve death. The other person, usually a family member or physician, may help carry out the act if the individual lacks the physical capacity to do so even with the supplied means. Assisted suicide is a contentious moral and political issue in many countries, as seen in the scandal surrounding Dr. Jack Kevorkian, a medical practitioner who supported euthanasia, was found to have helped patients end their own lives, and was sentenced to prison time.
Murder–suicide
A murder–suicide is an act in which an individual kills one or more other persons immediately before or at the same time as him or herself.
The motivation for the murder in murder–suicide can be purely criminal in nature or be perceived by the perpetrator as an act of care for loved ones in the context of severe depression.
Suicide attack
A suicide attack is when an attacker perpetrates an act of violence against others, typically to achieve a military or political goal, that results in his or her own death as well. Suicide bombings are often regarded as an act of terrorism. Historical examples include the assassination of Czar Alexander II and the in-part successful kamikaze attacks by Japanese air pilots during the Second World War.
Mass suicide
Some suicides are done under peer pressure or as a group. Mass suicides can take place with as few as two people, in a "suicide pact", or with a larger number of people. An example is the mass suicide that took place by members of the Peoples Temple, an American cult led by Jim Jones in Guyana in 1978.
Suicide pact
A suicide pact describes the suicides of two or more individuals in an agreed-upon plan. The plan may be to die together, or separately and closely timed. Suicide pacts are generally distinct from mass suicide. The latter refers to incidents in which a larger number of people kill themselves together for the same ideological reason, often within a religious, political, military or paramilitary context. Suicide pacts, on the other hand, usually involve small groups of people (such as married or romantic partners, family members, or friends) whose motivations are intensely personal and individual.
Metaphorical suicide
The metaphorical sense of "willful destruction of one's self-interest", for example political suicide.
Causes
A number of factors are associated with the risk of suicide including: mental illness, drug addiction, and socio-economic factors. While external circumstances, such as a traumatic event, may trigger suicide it does not seem to be an independent cause. Thus suicides are more likely to occur during periods of socioeconomic, familial and individual crisis.
Mental illness
Mental disorders are frequently present at the time of suicide with estimates from 87%[11] to 98%. When broken down into type mood disorders are present in 30%, substance abuse in 18%, schizophrenia in 14%, and personality disorders in 13.0% of suicides. About 5% of people with schizophrenia die of suicide.
Depression, one of the most commonly diagnosed psychiatric disorders is being diagnosed in increasing numbers in various segments of the population worldwide, and is often a precipitating factor in suicide. Depression in the United States alone affects 17.6 million Americans each year or 1 in 6 people.
Within the next twenty years depression is expected to become the second leading cause of disability worldwide and the leading cause in high-income nations, including the United States.
In approximately 75% of completed suicides the individuals had seen a physician within the prior year before their death, 45%-66% within the prior month. Approximately 33% - 41% of those who completed suicide had contact with mental health services in the prior year, 20% within the prior month.
Conservative estimates are, that 10% of all psychological symptoms may be due to medical reasons, with the results of one study, suggesting that about 50% of individuals with a serious mental illness have general medical conditions that are largely undiagnosed and untreated and may cause or exacerbate psychiatric symptoms (Rothbard AB,et al. 2009)
Substance abuse
Substance abuse is the second most common cause of suicide after mood disorders. Both chronic substance misuse as well as acute substance abuse is associated with an increased risk of suicide.
This is attributed to the intoxicating and disinhibiting effects of many psychoactive substances; when combined with personal grief such as bereavement the risk of suicide is greatly increased. More than 50% of suicides are related to alcohol or drug use.
Up to 25% of drug addicts and alcoholics commit suicide. In adolescents the figure is higher with alcohol or drug misuse playing a role in up to 70% of suicides. It has been recommended that all drug addicts or alcoholics are investigated for suicidal thoughts due to the high risk of suicide.
Misuse of drugs such as cocaine have a high correlation with suicide. Suicide is most likely to occur during the "crash" or withdrawal phase of cocaine in chronic abusers.
Polysubstance misuse has been found to more often result in suicide in younger adults whereas suicide from alcoholism is more common in older adults. In San Diego it was found that 30% of suicides in people under the age of 30 had used cocaine. In New York City during a crack epidemic one in five people who committed suicide were found to have recently consumed cocaine.
The "come down" or withdrawal phase from cocaine can result in intense depressive symptoms coupled with other distressing mental effects which serve to increase the risk of suicide. It has been found that drinking 6 drinks or more per day results in a sixfold increased risk of suicide.
Alcohol misuse is associated with a number of mental health disorders, and alcoholics have a very high suicide rate. High rates of major depressive disorder occur in heavy drinkers and those who abuse alcohol.
Controversy has previously surrounded whether those who abused alcohol who developed major depressive disorder were self medicating (which may be true in some cases) but recent research has now concluded that chronic excessive alcohol intake itself directly causes the development of major depressive disorder in a significant number of alcohol abusers.
Chronic prescribed benzodiazepine use or chronic misuse is associated with depression as well as suicide. Care should be taken when prescribing especially to at risk patients. Depressed adolescents who were taking benzodiazepines were found to have a greatly increased risk of self harm or suicide, although the sample size was small. The effects of benzodiazepines in individuals under the age of 18 requires further research.
Additional caution is required in using benzodiazepines in depressed adolescents.[36] Benzodiazepine dependence often results in an increasingly deteriorating clinical picture which includes social deterioration leading to comorbid alcoholism and drug abuse. Suicide is a common outcome of chronic benzodiazepine dependence. Benzodiazepine misuse or misuse of other CNS depressants increases the risk of suicide in drug misusers. 11% of males and 23% of females with a sedative hypnotic misuse habit commit suicide.
Cigarette smoking
There have been various studies done showing a positive link between smoking, suicidal ideation and suicide attempts.
In a study conducted among nurses, those smoking between 1-24 cigarettes per day had twice the suicide risk; 25 cigarettes or more, 4 times the suicide risk, than those who had never smoked. In a study of 300,000 male U.S.
Army soldiers, a definitive link between suicide and smoking was observed with those smoking over a pack a day having twice the suicide rate of non-smokers.
Problem gambling
Problem gambling is often associated with increased suicidal ideation and attempts compared to the general population.
Early onset of problem gambling increases the lifetime risk of suicide. However, gambling-related suicide attempts are usually made by older people with problem gambling. Both comorbid substance use and comorbid mental disorders increase the risk of suicide in people with problem gambling.
A 2010 Australian hospital study found that 17% of suicidal patients admitted to the Alfred Hospital's emergency department were problem gamblers.
Biological
Genetics has an effect on suicide risk accounting for 30–50% of the variance. Much of this relationship acts through the heritability of mental illness.
Social (As a form of defiance or protest)
In Ireland protesting via hunger strike to the death has been used as a tactic in recent times for political causes.
During The Troubles in Northern Ireland a hunger strike was launched by the provisional IRA to demand that their prisoners be reclassified as prisoners of war rather than as terrorists, during the infamous 1981 hunger strikes, led by Bobby Sands; this protest resulted in 10 deaths.
The cause of death was recorded as "starvation, self-imposed" rather than suicide by the coroner, modified to simply "starvation" on the death certificates after protests from the striker's families.
Judicial suicide
A person who has committed a crime may commit suicide to avoid prosecution and disgrace, such as in murder–suicides.
Nazi leader Hermann Göring, a high-ranked Nazi and head of the Luftwaffe, committed suicide with cyanide capsules rather than be hanged after his conviction at the Nuremberg Trials.
Some school shootings, including the Virginia Tech massacre, concluded with the perpetrator committing suicide.
Military suicide
A kamikaze attack on the escort carrier USS White PlainsIn the final days of World War II, some Japanese pilots volunteered for kamikaze missions in an attempt to forestall defeat for the Empire of Japan, while Japanese ground forces initiated banzai charges.
Near the end of WWII the Japanese designed a small aircraft whose only purpose was kamikaze missions. Similarly, units of the Luftwaffe flew Selbstopfereinsatz (self-sacrifice missions) against Soviet bridges.
In Nazi Germany, many soldiers and government officials[who?] (including Adolf Hitler) killed themselves rather than surrender to Allied forces. The Japanese also built one-man "human torpedo" suicide submarines called Kaitens.
Dutiful suicide
Dutiful suicide is an act, or non-fatal attempt at the act, of fatal self-violence at one's own hands done in the belief that it will secure a greater good, rather than to escape harsh or impossible conditions.
It can be voluntary, to relieve some dishonor or punishment, or imposed by threats of death or reprisals on one's family or reputation (a kind of murder by remote control). It can be culturally traditional or generally abhorred; it can be heavily ritualized as in seppuku or purely functional.
Dutiful suicide can be distinguished from a kamikaze or suicide bomb attack, in which a fighter consumes his own life in delivering a weapon to the enemy.
Disgraced Roman aristocrats were sometimes allowed to commit suicide to spare themselves a trial and penalties against their families. An example of this was Emperor Nero who reportedly committed forced suicide facing a revolt and execution.
A more modern case is Erwin Rommel, who was found to have foreknowledge of the July 20 Plot on Hitler's life. Rommel was threatened with public trial, execution and reprisals on his family unless he killed himself, which he did.
Suicide as an escape
In situations where continuing to live is intolerable, some people use suicide as a means of escape. Some inmates in Nazi concentration camps are known to have killed themselves by delibertely touching the electrified fences.
According to a report by Tata Institute of Social Sciences in Mumbai, 150,000 debt-ridden farmers in India have committed suicide in the past decade.
Other factors
Socio-economic factors such as unemployment, poverty, homelessness, and discrimination may trigger suicidal thoughts. Poverty may not be a direct cause but it can increase the risk of suicide, as it is a major risk group for depression.
Advocacy of suicide has sometimes been cited as a contributing factor.[citation needed] Intelligence may also factor.
Initially proposed as a part of an evolutionary psychology explanation, which posited a minimum intelligence required for one to commit suicide, the positive correlation between IQ and suicide has been replicated in a number of studies.
Some scientists doubt however that intelligence can be a cause of suicide, and the intelligence is no longer a predictor of suicide when regressed with national religiousness and perceptions of personal health.
Intervention
The predominant view of modern medicine is that suicide is a mental health concern, associated with psychological factors such as the difficulty of coping with depression, inescapable suffering or fear, or other mental disorders and pressures.
A suicide attempt is sometimes interpreted as a "cry for help" and attention, or to express despair and the wish to escape, rather than a genuine intent to die. Most people who attempt suicide do not complete suicide on a first attempt; those who later gain a history of repetitions have a significantly higher probability of eventual completion of suicide.
In the United States, individuals who express the intent to harm themselves may be automatically determined to lack the present mental capacity to refuse treatment, and can be transported to the emergency department against their will. An emergency physician will determine whether inpatient care at a mental health care facility is warranted.
This is sometimes referred to as being "committed". A court hearing may be held to determine the individual's competence. In most states, a psychiatrist may hold the person for a specific time period without a judicial order. If the psychiatrist determines the person to be a threat to himself or others, the person may be admitted involuntarily to a psychiatric treatment facility.
This period is usually of three days duration. After this time the person must be discharged or appear in front of a judge. As in any judicial proceeding this person has a right to legal counsel.
Switzerland has recently taken steps to legalize assisted suicide for the chronically mentally ill. The high court in Lausanne, in a 2006 ruling, granted an anonymous individual with longstanding psychiatric difficulties the right to end his own life.
At least one leading American bioethicist, Jacob Appel of Brown University, has argued that the American medical community ought to condone suicide in certain individuals with mental illness
