Suicide is a tragic and potentially preventable
public health problem. In 2000, suicide was the 11th leading cause of death in
the U.S.1 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.2 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.2,3
Also, research indicates that alterations in neurotransmitters such as serotonin
are associated with the risk for suicide.4 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.2
Gender Differences
Suicide was the eighth leading cause of death for males and the 19th leading
cause of death for females in 2000.1 More than four times as many men as women
die by suicide,1 although women report attempting suicide during their lifetime
about three times as often as men.5 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.1,6
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 100,000.1,6
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.7,8 Risk factors for attempted suicide in
youth include depression, alcohol or other drug use disorder, physical or sexual
abuse, and disruptive behavior.8,9 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.
U.S. Suicide Rates by Age, Gender, and Racial Group
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.10
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.11 Improving outreach to men at
risk for suicide is a major challenge in need of investigation.
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.12 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.
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For More Information
Please visit the following link for more information about organizations that
focus on suicide prevention.
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All material in this fact sheet is in the public domain and may be copied or
reproduced without permission from the Institute. Citation of the source is
appreciated.
NIH Publication No. 03-4594
Printed January 2001; Revised April 2003
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References
1Miniño AM, Arias E, Kochanek KD, Murphy SL, Smith BL. Deaths: final data for
2000. National Vital Statistics Reports, 50(15). Hyattsville, MD: National
Center for Health Statistics, 2002.
2Moscicki EK. Epidemiology of completed and attempted suicide: toward a
framework for prevention. Clinical Neuroscience Research, 2001; 1: 310-23.
3Conwell Y, Brent D. Suicide and aging. I: patterns of psychiatric diagnosis.
International Psychogeriatrics, 1995; 7(2): 149-64.
4Mann JJ, Oquendo M, Underwood MD, Arango V. The neurobiology of suicide risk: a
review for the clinician. Journal of Clinical Psychiatry, 1999; 60(Suppl 2):
7-11; discussion 18-20, 113-6.
5Weissman MM, Bland RC, Canino GJ, Greenwald S, Hwu HG, Joyce PR, Karam EG, Lee
CK, Lellouch J, Lepine JP, Newman SC, Rubio-Stipec M, Wells JE, Wickramaratne PJ,
Wittchen HU, Yeh EK. Prevalence of suicide ideation and suicide attempts in nine
countries. Psychological Medicine, 1999; 29(1): 9-17.
6Office of Statistics and Programming, NCIPC, CDC. Web-based Injury Statistics
Query and Reporting System (WISQARSTM): http://www.cdc.gov/ncipc/wisqars/default.htm
7Kessler RC, Borges G, Walters EE. Prevalence of and risk factors for lifetime
suicide attempts in the National Comorbidity Survey. Archives of General
Psychiatry, 1999; 56(7): 617-26.
8Petronis KR, Samuels JF, Moscicki EK, Anthony JC. An epidemiologic
investigation of potential risk factors for suicide attempts. Social Psychiatry
and Psychiatric Epidemiology, 1990; 25(4): 193-9.
9Gould MS, Greenberg T, Velting DM, Shaffer D. Youth suicide risk and preventive
interventions: a review of the past 10 years. Journal of the American Academy of
Child and Adolescent Psychiatry, 2003; 42(4): 386-405.
10U.S. Public Health Service. National strategy for suicide prevention: goals
and objectives for action. Rockville, MD: USDHHS, 2001.
11Luoma JB, Pearson JL, Martin CE. Contact with mental health and primary care
prior to suicide: a review of the evidence. American Journal of Psychiatry,
2002; 159: 909-16.
12Meltzer HY, Alphs L, Green AI, Altamura AC, Anand R, Bertoldi A, Bourgeois M,
Chouinard G, Islam MZ, Kane J, Krishnan R, Lindenmayer JP, Potkin S;
International Suicide Prevention Trial Study Group. Clozapine treatment for
suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT).
Archives of General Psychiatry, 2003; 60(1): 82-91.
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