Suicide is death caused by an act of self-harm that is intended to be lethal. Suicidal behavior includes completed suicide, attempted suicide, and suicidal ideation (thoughts and ideas about attempting suicide).
Suicide usually results from the interaction of many factors, depression is the most common and significant but not the only risk factor for suicide.
Some methods, such as using firearms, are more likely to result in death, but choice of a less lethal method does not necessarily mean that the intent was less serious.
Any expression of suicidal thoughts or a suicide attempt must be taken seriously, and help and support should be provided.
In the United States, people in crisis or considering suicide can dial or text 988, which connects them to the Suicide & Crisis Lifeline. Additional support is available at the following websites: 988 Suicide and Crisis Lifeline and American Foundation for Suicide Prevention.
(See also Suicide Prevention and Suicidal Behavior in Children and Adolescents.)
The terminology used to describe suicide has evolved over time to reflect advances in the scientific study of suicidal behavior, growing advocacy for the victims and survivors of suicide, and reduction of the stigma associated with suicide.
Suicidal behavior includes the following:
Suicidal ideation: The process of thinking about, considering, or planning suicide
Suicidal intent: The intention to end one's life by suicide
Attempted suicide: An act of self-harm that is intended to result in death but does not. A suicide attempt may or may not result in injury.
Suicidality: The spectrum of possible suicidal experiences; including ideation, intent, and attempt(s)
Suicide attempt survivors: People with their own personal experience with suicidal thoughts or attempt(s)
Suicide loss survivors or suicide bereaved: Family members, friends, or colleagues of a person who died by suicide
Died by suicide: Recommended language preferred over the phrase “committed suicide;” other acceptable plain language phrases include “killed himself,” “ended her life,” “took his life”
Nonsuicidal self-injury (NSSI) is an act of self-harm that is not intended to result in death. Such acts include inflicting scratches or cuts, burning oneself with a cigarette, and overdosing on vitamins. Nonsuicidal self-injury may be a way to reduce tension because physical pain may relieve psychological pain. It may also be a plea for help from people who still wish to live. These acts should not be dismissed lightly, because people with a history of NSSI have a higher risk of suicide over the long term.
Suicidal behavior is an all-too-common mental health problem. It occurs in people of all ages, genders, races, ethnicities, religions, incomes, educational levels, and sexual orientations. There is no typical suicide profile, although some examples of groups of people with higher rates of suicide are middle-aged and older males, people with other psychiatric disease (including depression, borderline personality disorder, and bipolar disorder), people with a history of childhood or recent trauma, and people whose family members have died by suicide.
Viwango vya tabia ya kutaka kujiua
Worldwide, over 720,000 people die yearly from suicide, which is the leading cause of death in people from 15 to 29 years old. (See also World Health Organization: Suicide Fact Sheet.)
Suicide is an important and common health issue. In the United States in 2023, an estimated 12.8 million people seriously thought about suicide, 3.7 million made a suicide plan, 1.5 million attempted suicide, and just under 50,000 died by suicide. The age groups with the highest suicide rates were older adults ages 75-84 years and 85 or older. Suicide was the 11th leading cause of death for all people and the second leading cause of death for people ages 10 to 34. The racial/ethnic group with the highest suicide rate were non-Hispanic American Indian and Alaska Native people. White males, who make up approximately one-third of the U.S. population, account for 7 in every 10 suicides in the United States. (See also Centers for Disease Control and Prevention: Suicide Data and Statistics.)
In all age groups, among people who die by suicide, males outnumber females by more than 2 to 1. The reasons are unclear, but the following may be involved:
Males tend to be more aggressive and use more lethal means when they attempt suicide.
Males have been taught to be stoic when faced with problems and are traditionally less likely to seek help—from friends and/or health care practitioners.
Alcohol use and substance use disorders, which contribute to suicidal behavior, are more common among men.
The number of suicides in men includes suicides in the military and among veterans. Both groups have a higher proportion of males to females.
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The choice of method for suicide is often influenced by cultural factors and availability of lethal means (for example, firearms). It may or may not reflect the seriousness of intent. Some methods (such as jumping from a tall building) make survival less likely, whereas other methods (such as overdosing on drugs) make rescue more possible. However, even if a person uses a method that proves not to be fatal, the intent may have been just as serious as that of a person whose method was fatal.
Suicide attempts, in which the person attempts suicide but survives, most often involve drug overdose and self-poisoning. Violent methods, such as shooting and hanging, are uncommon among suicide attempts because they usually result in death.
In 2023, about 50% of completed suicides in the United States involved guns. Males use this method more than females. The next most common methods were suffocation and poisoning.
There are several other categories of suicide that are extremely rare:
Group suicides
Murder/suicides
"Suicide by cop" (the result of the victim deliberately provoking law enforcement officers to use deadly force)
Tabia ya kutaka kujiua
Research has shown that many people who complete suicide were experiencing multiple risk factors at the time of death. Almost 90% of people who die by suicide have a mental illness at the time of their death.
The most common mental illness that contributes to suicidal behavior is depression.
Depression, including the depression that is part of bipolar disorder, is involved in over 50% of attempted suicides and an even higher percentage of completed suicides. Depression can occur for no identifiable reason, be triggered by a recent loss or other distressing event, or result from a combination of factors. In people with depression, marital problems or issues with other romantic relationships, recent arrest or trouble with the law, disputes with parents or bullying (among adolescents), or the recent loss of a loved one (particularly among older adults) may trigger a suicide attempt. The risk of suicide is higher if people with depression also have significant anxiety, impulsive behavior, substance use disorders, and sleep disorders.
Other factors that increase the risk of attempted suicide are traumatic childhood experiences, particularly including physical and sexual abuse, and social isolation.
Use of alcohol may intensify depression, which, in turn, makes suicidal behavior more likely. Alcohol also reduces self-control and increases impulsivity. Between 30 and 40% of people who die by suicide drink alcohol before the attempt, and about half of them are intoxicated at the time. However, people with an alcohol use disorder are at increased risk of suicide even when they are sober.
Almost all other mental health issues also put people at higher risk of suicide.
People with schizophrenia or other psychotic disorders may have delusions (fixed false beliefs) that they find impossible to cope with, or they may hear voices (auditory hallucinations) commanding them to kill themselves. Also, people with schizophrenia are prone to depression. As a result, they die by suicide at a much higher rate than the general population.
People with borderline personality disorder or antisocial personality disorder, especially those with a history of impulsivity, aggression or violent behavior, are also at higher risk of suicide. People with these personality disorders tend to have decreased frustration tolerance and tend to react to stress impetuously, sometimes leading to self-harm or aggressive behavior.
People who have been recently diagnosed with a serious medical condition may have an increased risk of suicide, such as a diagnosis ofdiabetes, multiple sclerosis, cancer, and infection. This may be due to the psychological effects of disability, pain, or other stressors that accompany a serious medical issue. Also, some health conditions can directly affect people's brain functioning and, thus, increase suicide risk. General medical conditions, especially those that are painful and chronic, contribute to about 20% of suicides in older adults.
About 1 in 6 people who kill themselves leave a suicide note, which sometimes provides clues about why they did it. Reasons given include mental illness, feelings of hopelessness, feeling like a burden to others, and inability to cope with various life stresses.
Dawa za kuzuia mfadhaiko na hatari ya kujiua
The risk of suicide attempts is greatest in the month before starting antidepressant treatment, and antidepressant treatment generally decreases the risk of suicide. However, antidepressants sometimes slightly increase the frequency of suicidal thoughts and attempts (but not of completed suicide) in children, adolescents, and young adults below age 25.
Mental health professionals, patients, and families should bear in mind that suicidality (thoughts and ideas about and preoccupation with death, particularly by suicide) is a core feature of depression. Treatments that alleviate depression reduce the risk of suicide.
Because of public health warnings about the possible association between taking antidepressants and an increased risk of suicide, doctors began diagnosing depression less and prescribed antidepressants less often for children and young adults. However, as fewer antidepressants were prescribed, suicide rates among young people temporarily increased. Thus, it is possible that by discouraging the use of medications for the treatment of depression, these warnings resulted in more, not fewer, deaths by suicide.
When people with depression are given antidepressants, doctors take certain precautions to reduce the risk of suicidal behavior by doing the following:
Giving people antidepressants in amounts that would not cause death
Scheduling more frequent visits when treatment is first started
Clearly warning people and their family members and significant others to be alert for worsening symptoms: increased anxiety, agitation, insomnia, restlessness, irritability, anger, or suicidal ideation, especially during the first 2 weeks after they start taking the medication
Instructing people and their family members and significant others to immediately call the doctor who prescribed the antidepressant or to seek care elsewhere if symptoms worsen or suicidal thoughts occur
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In the 1990s, suicide rates in adolescents decreased after having climbed steadily for more than a decade, only to start climbing again in the early 2000s. This upward trend included an increase in deaths by firearms. Many influences contribute to this increase, including the following:
Unaddressed mental illnesses (including major depressive disorder, bipolar disorder, substance use disorders, psychosis, eating disorders, attention-deficit hyperactivity disorder [ADHD], anxiety disorders, and/or trauma)
General medical conditions such as brain injury or autism spectrum disorders
Adverse childhood events (including abuse, neglect)
Experiences of trauma or loss (including unstable home environment; growing up with a parent with mental illness; exposure to peer suicide and/or relative who died by suicide; or experience of bullying or discrimination based on race, gender, or sexual orientation)
The complex role of social media in risk of suicide is not fully understood, ranging from potential negative effects on mood, sleep, and suicidal thoughts to positive interpersonal connectedness for some people, which may play a protective role against suicide.
Kuambukiza kujiua
Suicide contagion refers to a phenomenon in which one suicide seems to lead to others in a community, school, or workplace. Highly publicized suicides may have a very wide effect. Children, adolescents, and young adults are especially vulnerable to suicide contagion. They may be exposed directly because they know someone who attempts or dies by suicide. They may also be indirectly exposed by round-the-clock, sensationalized, graphic media coverage of a celebrity's death by suicide. Conversely, media coverage with positive messaging about a suicide death can decrease the risk of suicide contagion for vulnerable youth. Positive messaging typically communicates clearly about the tragic loss of a community member and goes on to express support for the grieving community. Messaging should describe mental health struggles as part of life and point out there is no stigma related to seeking help and treatment. Such portrayal of mental health issues and suicide can have a positive public health impact, rather than endanger vulnerable viewers.
Suicide contagion may be a factor in an estimated 1 to 5% of all adolescent suicides. School administrators, mental health professionals, and other community leaders can learn to use the media and social platforms to stop the spread of suicide contagion. Sensitive reporting and the enforcement of postvention (an intervention conducted after a suicide) guidelines in schools and workplaces are 2 strategies for preventing additional suicides.
Matibabu ya Tabia ya Kutaka Kujiua
Suicide risk assessment
Safety planning
Close follow-up and monitoring
Psychotherapy
Medications
Health care professionals take any suicidal act seriously. The plan for safety and treatment is customized to the person's situation and typically involves brief interventions.
If people seriously injure themselves, doctors evaluate and treat the injury and typically admit the person to the hospital. If people have taken an overdose of a potentially lethal drug, doctors immediately take steps to prevent absorption of the drug and speed its elimination from the body. People are also given any available antidote and provided with supportive care, such as a breathing tube.
After the initial evaluation, people who have attempted suicide are referred to a psychiatrist, who tries to identify problems that contributed to the attempt and plan appropriate treatment.
To identify problems, psychiatrists do the following:
Listen to the person's story and history leading up to the attempt or crisis
Try to understand what some of the underlying risk factors for suicide are, what specific events led up to the attempt, and where and how it occurred
Ask about symptoms of mental health problems that may increase the risk of suicidal behavior
Ask whether the person is being treated for a mental illness, including whether the person is taking any drugs to treat it, has been in therapy or undergone any other treatment modalities
Evaluate the person's mental state, looking for signs of depression, anxiety, agitation, panic attacks, psychosis, severe insomnia, other mental illnesses, and alcohol or substance use
Take a thorough medical and family history
Ask about personal and family relationships as well as social networks, because they are often relevant to the suicide attempt and the follow-up treatment
Talk to close family members and friends, and ask them about the person's use of alcohol, marijuana, pain medications or illicit drugs
Help the person identify situations, events, places, thoughts, or emotional states that trigger thoughts of suicide and help the person plan ways to deal with the triggers
Because depression increases the risk of suicidal behavior, doctors carefully monitor people with depression for suicidal behavior and thoughts. For people with depression, suicide risk can increase during periods when depression is more severe, as well as when several other risk factors are also present. Doctors may be able to treat depression effectively with medications and/or psychotherapy, and thereby reduce suicide risk overall.
The risk of suicide changes over time, with the most serious acute risk lasting from hours to days. In a majority of suicides, people had been seen in a variety of health care settings before their suicide, but their suicide risk was not detected. These findings highlight the importance of adopting public health strategies to reduce the risk of suicide in these people. For example, doctors should do the following:
Routinely screen patients for suicidal thoughts, depression, and other symptoms of distress
Use a caring, supportive, nonjudgmental response
Provide interventions to ensure the person's safety, such as using a safety plan and counseling on lethal means
Communicate with the person's family
Other interventions that can reduce the risk of suicide in high-risk individuals include cognitive-behavioral therapy, dialectical behavior therapy, and some forms of family therapy such as attachment-based family therapy. People who are identified to be at risk for suicide should be encouraged to pursue one of these types of therapy and to consider taking medications individualized to their needs. As with any health condition, adjusting treatment when needed and providing follow-up care are important ways to optimize treatment.
