A suicide method is any means by which a person chooses to end their life. Suicide attempts do not always result in death, and a nonfatal suicide attempt can leave the person with serious physical injuries, long-term health problems, and brain damage.
Worldwide, three suicide methods predominate with the pattern varying in different countries. These are hanging, poisoning by pesticides, and firearms. Other common methods are jumping from a height, drug overdoses, and drowning.
Suicides are often impulse decisions that may be preventable by removing the means. Making common suicide methods less accessible leads to an overall reduction in the number of suicides. Some ways to do this include restricting access to pesticides, firearms, and known-used drugs. Other important measures are the introduction of policies that address the misuse of alcohol and the treatment of mental disorders. Gun-control measures in a number of countries have seen a reduction in suicides, and other gun-related deaths.
Purpose of studying suicide methods
The study of suicide methods aims to identify those commonly used, and the groups at risk of suicide; making methods less accessible may be useful in suicide prevention. Limiting the availability of means such as pesticides and firearms is recommended by a World Health Report on suicide and its prevention. The early identification of mental disorders and substance abuse disorders, follow-up care for those who have attempted suicide, and responsible reporting by the media are all seen to be key in reducing the number of deaths by suicide. National suicide prevention strategies are also advocated using a comprehensive and coordinated response to suicide prevention. This needs to include the registration and monitoring of suicides and attempted suicide, breaking figures down by age, sex, and method.
Such information allows public health resources to focus on the problems that are relevant in a particular place, or for a given population or subpopulation. For instance, if firearms are used in a significant number of suicides in one place, then public health policies there could focus on gun safety, such as keeping guns locked away, and the key inaccessible to at-risk family members. If young people are found to be at increased risk of suicide by overdosing on particular medications, then an alternative class of medication may be prescribed instead, a safety plan and monitoring of medication can be put in place, and parents can be educated about how to prevent the hoarding of medication for a future suicide attempt.
Media reporting of suicide methods
Media reporting of the methods used in suicides is "strongly discouraged" by the World Health Organization, government health agencies, universities, and the Associated Press among others. Detailed descriptions of suicides contribute to copycat suicides (suicide contagion). Writing for the New Yorker about celebrity suicides, Andrew Solomon wrote that "You who are reading this are at statistically increased risk of suicide right now."
Media reporting guidelines also apply to "online content including citizen-generated media coverage". The Recommendations for Reporting on Suicide include linking to resources such as the National Suicide Prevention Lifeline to reduce the risk of suicide contagion.
Method restriction, also called lethal means reduction, is an effective way to reduce the number of suicide deaths in the short and medium term.
Method substitution is the process of choosing a different suicide method when the first-choice method is inaccessible. Method substitution has been measured over the course of decades, so when a common method is restricted for example by making domestic gas less toxic, overall suicide rates may be suppressed for many years. If the first-choice suicide method is inaccessible, a method substitution may be made which may be less lethal, tending to result in fewer fatal suicide attempts.
List of methods
Suicide by suffocation involves restricting breathing or the amount of oxygen taken in, causing asphyxia and eventually hypoxia. This may involve the use of a plastic suicide bag. It is not possible to die simply by holding the breath, since a reflex causes the respiratory muscles to contract, forcing an in-breath, and the re-establishment of a normal breathing rhythm. Therefore inhaling an inert gas such as helium, nitrogen, and argon, or a toxic gas such as carbon monoxide, is used to bring about unconsciousness.
Suicide by strangulation is self-strangulation that may involve the partial suspension of the body rather than the full suspension used in hanging. Self-strangulation involves tightening a ligature around the neck. This compresses the carotid arteries, preventing the supply of oxygen to the brain, resulting in unconsciousness and death.
Hanging is a common method of suicide. Hanging involves the use of a ligature such as a rope or cord attached to an anchor point with the other end used to form a noose placed around the neck. The cause of death will either be due to strangulation or a broken neck. About half of attempted suicides by hanging result in death. People who favor this method are usually unaware that it is often a "slow, painful, and messy method that needed technical knowledge".
Hanging is the prevalent means of suicide in impoverished pre-industrial societies, and is more common in rural areas than in urban areas. It is also a common means of suicide in situations where other materials are not readily available, such as in prisons.
Hanging was the most common method in traditional Chinese culture, as it was believed that the rage involved in such a death permitted the person's spirit to haunt and torment survivors. In the Chinese culture, suicide by hanging was used as an act of revenge by women and of defiance by powerless officials, who used it as a "final, but unequivocal, way of standing still against and above oppressive authorities". Chinese people would often approach the act ceremonially, including the use of proper attire.
Suicide by poisoning, also called self-poisoning, is usually classed as a drug overdose when drugs such as painkillers or recreational drugs are used. The use of pesticides to self-poison is the most common method used in some countries. Inhalation of poisonous gases such as carbon monoxide may also be a cause of death by suicide. Fast-acting poison such as cyanide is also used. Many other natural substances have high levels of toxicity, including belladonna, castor beans, and Jatropha curcas. Poisoning through the means of toxic plants is usually slower and is relatively painful. The mass suicide of members of a cult led by Jim Jones in 1978 resulted from drinking a cocktail of diazepam and cyanide ("Drinking the Kool-Aid").
Worldwide, around 30% of suicides are from pesticide poisonings. The use of this method, however, varies markedly in different areas of the world, from 0.9% in Europe to just under 50% in the Pacific region. In the US, pesticide poisoning is used in about 12 suicides per year.
Poisoning by farm chemicals is very common among women in rural China, and is regarded as a major social problem in the country. Method restriction has been an effective way to reduce suicide by poisoning in many countries. In Finland, limiting access to parathion in the 1960s resulted in a rapid decline in both poisoning-related suicides and total suicide deaths for several years, and a slower decline in subsequent years. In Sri Lanka, both suicide by pesticide and total suicides declined after first toxicity class I and later class II endosulfan were banned. In Korea, banning paraquat reduced the total number of suicides.
A drug overdose involves taking a dose of a drug that exceeds safe levels. In the UK (England and Wales) until 2013 a drug overdose was the most common suicide method in females when this was then overtaken by the method of hanging. In 2019 in males the percentage is 16%. However self-poisoning accounts for the highest number of suicide attempts. Overdose attempts using painkillers are among the most common, due to their easy availability over-the-counter. Paracetamol is the most widely used analgesic worldwide and is commonly used in overdose. Paracetamol poisoning is a common cause of acute liver failure. In the United States drug overdoses represents about 60% of suicide attempts and 14% of deaths. The risk of death in overdose is about 2%. In the United States most deaths due to drug overdose are related to opioids. In 2018 only 7.2% of drug overdoses were suicides with another 5.2% undetermined. Barbiturate overdoses have also long been used for suicide.
Overdose may also take place when mixing medications in a cocktail with one another, or with alcohol or illegal drugs. This method may leave confusion over whether the death was a suicide or accidental, especially when alcohol or other judgment-impairing substances are also involved and no suicide note is left behind.
An overdose is often the expressed preferred method of dignified dying among members of right-to-die organizations. A poll among members of Exit International suggested that 89% would prefer to take a pill, rather than use a plastic exit bag, a CO generator, or use "slow euthanasia". Death by helium inhalation is the more common method preferred in practice, largely owing to its reliability. Dutch right-to-die society WOZZ proposed several safe alternatives to barbiturates for use in euthanasia.
A particular type of poisoning involves the inhalation of high levels of carbon monoxide (CO). Death usually occurs through hypoxia. In most cases carbon monoxide is used because it is easily available as a product of incomplete combustion. A nonfatal attempt can result in memory loss and other symptoms.
Carbon monoxide is a colorless and odorless gas, so its presence cannot be detected by sight or smell. It acts by binding preferentially to the hemoglobin in the bloodstream, displacing oxygen molecules and progressively deoxygenating the blood, eventually resulting in the failure of cellular respiration and death. Carbon monoxide is extremely dangerous to bystanders and people who may discover the body, so "Right to Die" advocates like Philip Nitschke recommend the use of safer alternatives like nitrogen, for example in his EXIT euthanasia device.
Before air quality regulations and catalytic converters, suicide by carbon monoxide poisoning was often achieved by running a car's engine in a closed space such as a garage, or by redirecting a running car's exhaust back inside the cabin with a hose. Motor car exhaust may have contained up to 25% carbon monoxide. However, catalytic converters found on all modern automobiles eliminate over 99% of carbon monoxide produced. As a further complication, the amount of unburned gasoline in emissions can make exhaust unbearable to breathe well before a person loses consciousness.
Charcoal-burning suicide induces death from carbon monoxide poisoning. Originally used in Hong Kong, this has been a growing practice in Japan, where small charcoal-burning heaters (hibachi) or stoves (shichirin) are used in a sealed room. By 2001 this method accounted for 25% of deaths from suicide. It has become the second most common suicide method in Hong Kong and is a growing trend in other countries. Nonfatal attempts can result in severe brain damage due to cerebral anoxia.
Detergent-related suicide involves mixing household chemicals to produce hydrogen sulfide or other poisonous gases. The suicide rates by domestic gas fell from 1960 to 1980, as changes were made to the formula to make it less lethal.
At the end of the 19th century in Britain, there were more suicides from carbolic acid than from any other poison since there was no restriction on its sale. Braxton Hicks and other coroners called for its sale to be prohibited.
Several creatures, such as spiders, snakes, and scorpions, produce venom that can easily and quickly kill a person. These substances can be used to conduct suicide. For example, Cleopatra supposedly had an asp bite her when she heard of Marc Antony's death.
In the United States suicide by firearm is the most lethal method of suicide resulting in 90% of suicide fatalities, and is thus the leading cause of death by suicide as of 2017. Worldwide, firearm prevalence in suicides varies widely, depending on the acceptance and availability of firearms in a culture. The use of firearms in suicides ranges from less than 10% in Australia to 50.5% in the U.S., where it is the most common method of suicide.
Generally, the bullet will be aimed at point-blank range. Surviving a self-inflicted gunshot may result in severe chronic pain as well as reduced cognitive abilities and motor function, subdural hematoma, foreign bodies in the head, pneumocephalus and cerebrospinal fluid leaks. For temporal bone directed bullets, temporal lobe abscess, meningitis, aphasia, hemianopsia, and hemiplegia are common late intracranial complications. As many as 50% of people who survive gunshot wounds directed at the temporal bone suffer facial nerve damage, usually due to a severed nerve.
Reducing access to guns at a population level decreases the risk of suicide by firearms. Fewer people die from suicide overall in places with stricter laws regulating the use, purchase, and trading of firearms. Suicide risk goes up when firearms are more available.
Gun control is a primary method of reducing suicide by people who live in a home with guns. Prevention measures include simple actions such as locking all firearms in a gun safe or installing gun locks. Some stores that sell guns provide temporary storage as a service; in other cases, a trusted friend or family member will offer to store the guns until the crisis has passed. When a person is going through a crisis, red flag laws in some places allow family members to petition the courts to have firearms temporarily removed and stored elsewhere.
More firearms are involved in suicide than are involved in homicides in the United States. A 1999 study of California and gun mortality found that a person is more likely to die by suicide if they have purchased a firearm, with a measurable increase of suicide by firearm beginning at most a week after the purchase and continuing for six years or more.
The United States has both the highest number of suicides and firearms in circulation in a developed country and when gun ownership rises so too does suicide involving the use of a firearm. A 2004 report by the National Academy of Sciences found an association between estimated household firearm ownership and gun suicide rates, though a study by two Harvard researchers did not find a statistically significant association between household firearms and gun suicide rates, except in the suicides of children aged 5–14. Another study found that gun prevalence rates were positively associated with suicide rates among people aged 15 to 24, and 65 to 84, but not among those aged 25 to 64. Case-control studies conducted in the United States have consistently shown an association between guns in the home and increased suicide risk, especially for loaded guns in the home. Numerous ecological and time series studies have also shown a positive association between gun ownership rates and suicide rates. This association tends to only exist for firearm-related and overall suicides, not for non-firearm suicides. A 2013 review found that studies consistently found a relationship between gun ownership and gun-related suicides, with few exceptions. A 2016 study found a positive association between gun ownership and both gun-related and overall suicides among men, but not among women; gun ownership was only strongly associated with gun-related suicides among women. During the 1980s and early 1990s, there was a strong upward trend in adolescent suicides with a gun, as well as a sharp overall increase in suicides among those age 75 and over. A 2014 systematic review and meta-analysis found that access to firearms was associated with a higher risk of suicide.
A 2006 study found an accelerated decline in firearm-related suicides in Australia after the introduction of nationwide gun control. The same study found no evidence of substitution to other methods. Multiple studies in Canada found that gun suicides declined after gun control, but methods like hanging rose leading to no change in the overall rates. Similarly, a study conducted in New Zealand found that gun suicides declined after more legislation, but overall suicide rates did not change. A case-control study in New Zealand found that household gun ownership was associated with gun suicides, but not overall suicide. A Canadian study found that gun ownership by province was not correlated to provincial overall suicide rates.
Jumping from height
Jumping from a dangerous location, such as from a high window, balcony, or roof, or from a cliff, dam, or bridge is an often used suicide method in some countries. Many countries have noted suicide bridges such as the Nanjing Yangtze River Bridge (China), and the Golden Gate Bridge (US). Other well known suicide sites for jumping from include the Eiffel Tower (France), and Niagara Falls (Canada). Nonfatal attempts in these situations can have severe consequences including paralysis, organ damage, and broken bones.
In the United States, jumping is among the least common methods of suicide (less than 2% of all reported suicides in 2005). However, in a 75 year period to 2012, there had been around 1,400 suicides at the Golden Gate Bridge. In New Zealand secure fencing at the Grafton Bridge has resulted in zero suicides.
In Hong Kong, jumping is the most common method of suicide, accounting for 52.1% of all reported suicide cases in 2006 and similar rates for the years prior to that. The Centre for Suicide Research and Prevention of the University of Hong Kong believes that it may be due to the abundance of easily accessible high-rise buildings in Hong Kong.
Less common methods
Self-inflicting a wound with a sharp instrument as a suicide method is usually to the wrists but can also be to the throat (or belly in harakiri). This is a relatively common method to the wrists, and the ready availability of knives is a noted factor. A fatal self-inflicted wound to the wrist is termed a deep wrist injury, and is often preceded by several tentative surface-breaking attempts known as hesitation wounds, indicating indecision or a self-harm tactic. For every suicide by wrist cutting, there are many more nonfatal attempts, so that the number of actual deaths using this method is very low.
Wounds from suicide attempts involve the non-dominant hand; with damage often done to the median nerve, ulnar nerve, radial artery, palmaris longus muscle, and flexor carpi radialis muscle. Such injuries can severely affect the function of the hand, and the inability caused to carry out work or interests increases the risk of further attempts.
Suicide by drowning is the act of deliberately submerging oneself in water or other liquid to prevent breathing. It accounts for less than 2% of all suicides in the United States. Of those who attempt suicide by drowning in the US, about half die.
Fasting and dehydration
A classification has been made of Voluntary Stopping Eating and Drinking (VSED) which is often resorted to in terminal illness. This includes fasting and dehydration, and has also been referred to as autoeuthanasia.
Fasting to death has been used by Hindu, Buddhist, and Jain ascetics and householders, as a ritual method of suicide known as Prayopavesa in Hinduism; Sokushinbutsu historically in Buddhism, and as Sallekhana in Jainism. Cathars also fasted to death after receiving the consolamentum sacrament, in order to die while in a morally perfect state. This method of death is also associated with the political protest of the hunger strike such as the 1981 Irish Hunger Strike in which ten prisoners died.
Death from dehydration can take from several days to a few weeks. This means that unlike many other suicide methods, it cannot be accomplished impulsively. Those who die by terminal dehydration typically lapse into unconsciousness before death, and may also experience delirium and deranged serum sodium.
Terminal dehydration has been described as having substantial advantages over physician-assisted suicide with respect to self-determination, access, professional integrity, and social implications. Specifically, a patient has a right to refuse treatment and it would be a personal assault for someone to force water on a patient, but such is not the case if a doctor merely refuses to provide lethal medication. But it also has distinctive drawbacks as a humane means of voluntary death. One survey of hospice nurses found that nearly twice as many had cared for patients who chose voluntary refusal of food and fluids to hasten death as had cared for patients who chose physician-assisted suicide. They also rated fasting and dehydration as causing less suffering and pain and being more peaceful than physician-assisted suicide. Other sources, however, have noted very painful side effects of dehydration, including seizures, skin cracking and bleeding, blindness, nausea, vomiting, cramping and severe headaches.
Another suicide method is to lie down, or throw oneself, in the path of a fast moving vehicle, either on the road or onto railway tracks. Sometimes a car may be driven onto the railway tracks. Nonfatal attempts may result in profound injuries, such as multiple bone fractures, amputations, concussion and severe mental and physical handicapping.
Rail and metro
On railway tracks above ground, somebody may simply lie down or stand on the tracks, as the speed of an approaching train prevents its easy stopping. This type of suicide may cause trauma for the train driver.
Jumping in front of an oncoming subway train has a 59% death rate, lower than the 90% death rate for rail-related suicides. This is most likely because trains traveling on open tracks travel relatively quickly, whereas trains arriving at a subway station are decelerating to stop and board passengers.
Data gathered to 2014 showed that there were 3,000 suicides and 800 trespass related accidents on the European railways each year. In the Netherlands, as many as 10% of all suicides are rail-related. In Belgium where rail service is frequently interrupted due to a high level of suicide by rail, families are expected to cover the substantial cost of rail network standstill.
Trains on Japanese railroads cause a large number of suicides every year. Suicide by train is seen as something of a social problem, especially in the larger cities such as Tokyo or Nagoya, because it disrupts train schedules and if one occurs during the morning rush-hour, causes numerous commuters to arrive late for work. However, suicide by train persists despite a common policy among life insurance companies to deny payment to the beneficiary in the event of suicide by train (payment is usually made in the event of most other forms of suicide). Suicides involving the high-speed bullet-train, or Shinkansen are extremely rare, as the tracks are usually inaccessible to the public (i.e. elevated and/or protected by tall fences with barbed wire) and legislation mandates additional fines against the family and next-of-kin of the person who died by suicide. As in Belgium, family members of the person who died by suicide may be expected to cover the cost of rail disruption, which can be significantly extensive. It has been argued this prevents possible suicide, as the person who is considering suicide would want to spare the family not only the trauma of a lost family member but also being sued in court; however there is insufficient evidence to support this assertion.
The Federal Railroad Administration, in the U.S., reports that there are 300 to 500 suicides by train per year. They also reported that those suicides on railway rights-of-ways were by people who tended to live near railroad tracks, were less likely to have access to firearms, and were significantly compromised by both severe mental disorder and substance abuse.
Railway-related suicides are rarely impulsive, and this view has led to research on behaviour analysis using CCTV at known hotspots. Some behaviour patterns are implicated such as station-hopping, platform switching, standing away from others, letting a number of trains go by, and standing close to where trains enter. Surveillance cameras are viewable by railway staff. Media reporting has been linked to increased rail suicide attempts.
Public access to rail tracks may be restricted by the erection of fences. Fencing on both sides of the rail lines are carried out. Other preventive measures are landscaping to create tree and bush hedging as a natural fencing, and the installation of prohibitive signage. Fencing and landscaping have shown significant reductions in suicide attempts, and signage a lesser reduction. Sometimes vegetation along the tracks can obscure the view of the train driver and the removal of this is also advocated.
The installation of platform screen doors in many stations and countries has significantly decreased the numbers of suicides, notably in Hong Kong. In Japan the use of calming blue lights on station platforms is estimated to have resulted in an 84 per cent reduction in suicide attempts.
Suicide by electrocution involves using a lethal electric shock, and is a rarely used method. This causes arrhythmias of the heart, meaning that the heart does not contract in synchrony between the different chambers, essentially causing elimination of blood flow. Furthermore, depending on the current, burns may also occur. In his opinion outlawing the electric chair as a method of execution, Justice William M. Connolly of the Nebraska Supreme Court stated that "electrocution inflicts intense pain and agonizing suffering", adding that it is “unnecessarily cruel in its purposeless infliction of physical violence and mutilation of the prisoner’s body.” Contact with 20 mA of current can result in death.
Some suicides are the result of intentional car crashes. This especially applies to single-occupant, single-vehicle accidents; although head-on collisions with heavier vehicles are becoming more common as road traffic safety measures like traffic barriers and impact attenuators limit damage potential from traditional targets like trees, boulders, and bridge abutments. Even single vehicle collisions may affect other road users; for example, a car that brakes abruptly or swerves to avoid a suicidal pedestrian may collide with something else on the road, and the driver could be harmed.
The real percentage of suicides among car accident fatalities is not reliably known as they may be under-reported as accident causes are often unknown. A study in Europe suggests that more than 2 per cent of crashes result from suicides.
Some researchers believe that suicides disguised as traffic accidents are far more prevalent than previously thought. One large-scale community survey in Australia among suicidal people provided the following numbers: "Of those who reported planning a suicide, 14.8% (19.1% of male planners and 11.8% of female planners) had conceived to have a motor vehicle "accident"... Of all attempters, 8.3% (13.3% of male attempters) had previously attempted via motor vehicle collision."
Self-immolation is suicide usually by fire. This method of suicide is rare due to its being long and painful. If the attempt is intervened severe burns, and scar tissue will prevail with subsequent emotional impact. It has been used as a protest tactic, by Thích Quảng Đức in 1963 to protest the South Vietnam's anti-Buddhist policies; by Malachi Ritscher in 2006 to protest the United States' involvement in the Iraq War; and by Mohamed Bouazizi in 2011 in Tunisia which gave rise to the Tunisian Revolution.; and historically as a ritual known as sati where a Hindu widow would immolate herself in her husband's funeral pyre.
Indirect suicide is the act of setting out on an obviously fatal course without directly carrying out the act upon oneself. Indirect suicide is differentiated from legally defined suicide by the fact that the actor does not pull the figurative (or literal) trigger. Examples of indirect suicide include a soldier enlisting in the army with the intention and expectation of being killed in combat, or someone could be provoking an armed law enforcement officer into using lethal force against them. The latter is generally called "suicide by cop".
Evidence exists for numerous examples of suicide by capital crime in colonial Australia. Convicts seeking to escape their brutal treatment would murder another individual. This was felt necessary due to a religious taboo against direct suicide. A person completing suicide was believed to be destined for hell, whereas a person committing murder could be absolved of their sins before execution. In its most extreme form, groups of prisoners on the extremely brutal penal colony of Norfolk Island would form suicide lotteries. Prisoners would draw straws with one prisoner murdering another. The remaining participants would witness the crime, and would be sent away to Sydney, as capital trials could not be held on Norfolk Island, thus earning a break from the Island. There is uncertainty as to the extent of suicide lotteries. While surviving contemporary accounts claim that the practice was common, such claims are probably exaggerated.
Some people have chosen to indirectly bring about their death by suicide by being attacked by predatory animals. In some cases, the person has been killed; for example, a few people have been killed and eaten by crocodiles.
Ritual suicide is performed in a prescribed way, usually involving fasting, and often as part of a religious or cultural practice. Seppuku also known as harakiri is a historical ritual suicide method involving inflicting a severe wound to the belly, that is still occasionally practiced. For example, Yukio Mishima died by seppuku in 1970 after a failed coup d'état intended to restore full power to the Japanese emperor. The ritual was seen as a means of preserving one's honor, and is part of bushido, a code of the samurai.
Jumping into a volcanic crater is a rare method of suicide. Mount Mihara in Japan became a notorious suicide site in 1933 following a reported story of a young person's suicide there. Over 1,200 copycat suicides followed in the ensuing two years, prompting the erection of a high protective fence surrounding the crater. This fence was replaced with a higher fence, topped with barbed wire, after another 619 people jumped in 1936.
Between 1983 and 2003, 36 pilots died by suicide by aircraft in the United States. There have been suicide attacks by aircraft, including Japanese Kamikaze attacks in the Second World War, and the terrorist initiated September 11 attacks in 2001. On 24 March 2015, a Germanwings co-pilot deliberately crashed Germanwings Flight 9525 into the French Alps to kill himself, killing 150 people with him.
Suicide by pilot has also been proposed as a potential cause for the disappearance and following destruction of Malaysian Airlines Flight 370 in 2014, with supporting evidence being found in a flight simulator application used by the flight's pilot.
There have been several documented cases of suicide by skydiving, by deliberately failing to open a parachute, or removing it during freefall. Expert skydiver and former 22 SAS Soldier Charles (Nish) Bruce QGM died by suicide following eight years of mental illness and periods under section by leaping from a private Cessna 172 at 5000 feet over Fyfield, Oxfordshire without a parachute whilst on a flight home from Spain.
- Advocacy of suicide
- List of suicides from antiquity to the present
- List of suicides in the 21st century
- Suicide legislation
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