Epidemiology of suicide

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The examples and perspective in this article deal primarily with the United States and do not represent a worldwide view of the subject. Please improve this article or discuss the issue on the talk page.

World map of suicide rates.

Incidence of suicide is under-reported due to both religious and social pressures, and possibly completely unreported in some areas. Nevertheless, from reported cases, certain trends are apparent. Since the data is skewed, comparing suicide rates between nations is statistically unsound. The trends themselves are not the cause, but may be indicative of a root cause.^{[clarification needed]}

[edit] Epidemiology

A 2006 report by the World Health Organisation (WHO) states that nearly a million people take their own lives every year, more than those murdered or killed in war.^[3] WHO figures show a suicide takes place somewhere in the world every 40 seconds. Suicide rates are highest in Europe's Baltic states, where around 40 people per 100,000 die by suicide each year, second in line is in the Sub-Saharan Africa where 32 people per 100,000 die by suicide each year. The lowest rates are found mainly in Latin America and a few countries in Asia.^[4]

In 1998, the World Health Organization ranked suicide as the twelfth leading cause of death worldwide.^[5]

In most countries the incidence of suicides is higher than the incidence of intentional homicides.

As many as 60,000 people commit suicide in Russia every year;^[6] approximately 30,000 people die by suicide each year in the United States;^[7] over 30,000 kill themselves in Japan;^[8] and about 250,000 commit suicide each year in China.^[9] In western countries men commit suicide at four times the rate of women. Women are more likely to attempt suicide than men.^[10] The countries of the former Soviet Bloc have the highest suicide rate in the world.^[11] The region with the lowest suicide rate is Latin America.^[12] Up to at least the 1950s, it was the Republic of Ireland which had the lowest suicide rate in the world, as reported by an Irish TV news report in 2007. In India, suicide rates for women are nearly three times higher than those for men. Higher suicide rates among women have been reported in China.^[13]

According to the National Institute of Mental Health, suicide contagion is a serious problem, especially for young people. Suicide can be facilitated in vulnerable teens by exposure to real or fictional accounts of suicide, including media coverage of suicide, such as intensive reporting of the suicide of a celebrity or idol.^[14]

U.S. Suicides by age, gender, and racial or ethnic group, 1999–2005. Data from the CDC [1]. Racial and ethnic groups defined by the U.S. Office of Management and Budget.

[edit] Gender and suicide

In the United States, males are four times more likely to die by suicide than females. Male suicide rates are higher than females in all age groups (the ratio varies from 3:1 to 10:1). In other western countries, males are also much more likely to die by suicide than females (usually by a factor of 3–4:1). It was the 8th leading cause of death for males, and 19th leading cause of death for females.^[15]

Excess male mortality from suicide is also evident from data from non-Western countries. In 1979-81, out of 74 countries with a non-zero suicide rate, two reported equal rates for the sexes (Seychelles and Kenya), three reported female rates exceeding male rates (Papua-New Guinea, Macau, and French Guiana), while the remaining 69 countries had male suicide rates greater than female suicide rates.^[16]

While there are more completed male suicides than female, females are more likely to attempt suicide. One possible explanation of this statistical phenomenon, supported by a study by Rich, Ricketts, Fowler, and Young, is that males tend to use more "violent, immediately lethal methods of suicide" than females.^[17]

[edit] Race and suicide

By race, in the United States, caucasians are nearly 2.5 times more likely to kill themselves than are people of original descent or Hispanics.^[18] There is a marked divergence by age as seen in the chart below. In the eastern portion of the world (primarily in Asian or Pacific-Island countries) the growing numbers of reported suicides is growing exponentially every year.^[19] Suicide rates for younger people of original descent and caucasians are approximately equal, but older caucasians, elderly caucasian men especially, commit suicide far more often than older men of original descent. However, of all ethnic groups in the United States, Native Americans, people of mixed race, and Filipino Americans have the highest risk of suicide.

United States suicide rates for white men, by Health Service Area, 1988–1992. This map and the map below use the same color scale: note the large difference in rates between men and women. The regional patterns for men and women are similar, but not the same.

United States suicide rates for white women, by Health Service Area, 1988–1992.

[edit] Social factors and suicide

Higher levels of social and national cohesion reduce suicide rates. Suicide levels are highest among the retired, unemployed, impoverished, divorced, the childless, urbanites, empty nesters, and other people who live alone. Suicide rates also rise during times of economic uncertainty (although poverty is not a direct cause, it can contribute to the risk of suicide). Epidemiological studies generally show a relationship between suicide or suicidal behaviors and socio-economic disadvantage, including limited educational achievement, homelessness, unemployment, economic dependence and contact with the police or justice system.^[20] War is always associated with a steep fall in suicides; for example, during World War I and World War II the rate fell markedly, even in neutral countries.^{[citation needed]}

[edit] Health and suicide

Mental disorders (particularly depression and substance abuse) are associated with more than 90% of all cases of suicide.^[5]

Depression, either unipolar or as part of bipolar disorder, is an especially common cause. Substance abuse, severe physical disease or infirmity are also recognized causes.

An unknown amount of suicide fatalities are misdiagnosed as consequences of severe illness.

Suicides by month and day of week for the United States, 1999–2004. Data from the CDC [2].

[edit] Season and suicide

The idea that suicide is more common during the winter holidays (including Christmas in the northern hemisphere) is actually a myth, generally reinforced by media coverage associating suicide with the holiday season. The National Center for Health Statistics found that suicides drop during the winter months, and peak during spring and early summer.^[21] Considering that there is a correlation between the winter season and rates of depression,^[22] there are theories that this might be accounted for by capability to commit suicide ^[23] and relative cheerfulness.^[24] Suicide has also been linked to other seasonal factors.^[25]

The variation in suicides by day of week is actually greater than any seasonal variation. In the United States, more people die by suicide on Monday than any other day; Saturday is the day with the least number of suicides.

[edit] Suicide trends

Certain time trends can be related to the type of death. In the United Kingdom, for example, the steady rise in suicides from 1945 to 1965 was curtailed following the removal of carbon monoxide from domestic gas supplies which occurred with the change from coal gas to natural gas. Methods vary across cultures, and the easy availability of lethal agents and materials plays a role.

It is estimated that global annual suicide fatalities could rise to 1.5 million by 2020. Worldwide, suicide ranks among the three leading causes of death among those aged 15-44 years. Suicide attempts are up to 20 times more frequent than completed suicides.^[26]

[edit] Causes

There is no single cause for which suicide can be directly attributed. Environmental factors, childhood upbringing, and mental illness each play a large role. Sociologists today consider external circumstances, such as a traumatic event, as a trigger instead of an actual independent cause. Suicides are more likely to occur during periods of socioeconomic, family and individual crisis. Most people with suicidal tendencies tend to suffer from some mental illness such as depression, bipolar disorder, or some degree of anxiety disorder. These diagnosable mental disorders are associated with more than 90% of suicide victims. As a result, many researchers study the causes of depression to understand the causes of suicide.^[27]

Many theories have been developed to explain the causes of suicide. Psychiatric theories emphasize mental illness. Psychological theories emphasise personality and poor coping skills, while sociological theories stress the influence of social and environmental pressures.

[edit] Biological Causes

Genetic and biological factors play a large role in suicide likelihood. Research has shown that suicidal behaviour runs in families. A notable example are the suicides of the Hemingway family in which five members committed suicide. In 1985, the American Journal of Medical Genetics studied an Amish community in Pennsylvania. The studies revealed that four families, representing only 16 percent of the total Amish population, accounted for 73 percent of all Amish suicides. Some scientists claim 10 to 15 genes account for triggering suicide attempts. Similarly how depression is linked genetically, family ties may also have a large effect on one's suicide risk.^[28]

[edit] Motivations

Socio-economic factors such as unemployment, poverty, homelessness, and even discrimination trigger such suicidal thoughts.^[29][30] It is also noted that poverty may not be a direct cause but it can increase the risk of suicide, as it is a major risk group for depression.^[31]

[edit] See also

• List of countries by suicide rate

[edit] References