Suicide
Suicide is the act of intentionally causing one's own death. Risk factors for suicide include mental disorders, neurodevelopmental disorders, physical disorders, and substance abuse. Some suicides are impulsive acts driven by stress, relationship problems, or harassment and bullying. Those who have previously attempted suicide are at a higher risk for future attempts. Effective suicide prevention efforts include limiting access to methods of suicide such as firearms, drugs, and poisons; treating mental disorders and substance abuse; careful media reporting about suicide; improving economic conditions; and psychotherapy, primarily dialectical behaviour therapy and cognitive behavioural therapy. Although crisis hotlines, like 988 in North America and 13 11 14 in Australia, are common resources, their effectiveness has not been well studied.
Suicide is the 10th-leading cause of death worldwide, accounting for about 1.5% of deaths. In a given year, this is roughly 12 per 100,000 people. Though suicides resulted in 828,000 deaths globally in 2015, up from 712,000 deaths in 1990, the age-standardized death rate decreased by 23.3%. By gender, suicide rates are generally higher among men than women, ranging from 1.5 times higher in the developing world to 3.5 times higher in the developed world; in the Western world, non-fatal suicide attempts are more common among young people and women. Suicide is generally most common among those over the age of 70; however, in certain countries, those aged between 15 and 30 are at the highest risk. Europe had the highest rates of suicide by region in 2015.
There are an estimated 10 to 20 million non-fatal attempted suicides every year. Non-fatal suicide attempts may lead to injury and long-term disabilities. The most commonly adopted method of suicide varies from country to country and is partly related to the availability of effective means. Assisted suicide, sometimes done when a person is in severe pain or facing an imminent death, is legal in many countries and increasing in numbers.
Views on suicide have been influenced by broad existential themes such as religion, honor, and the meaning of life. The Abrahamic religions traditionally consider suicide as an offense towards God due to belief in the sanctity of life. During the samurai era in Japan, a form of suicide known as seppuku was respected as a means of making up for failure or as a form of protest. Suicide and attempted suicide, while previously illegal, are no longer so in most Western countries. It remains a criminal offense in some countries. In the 20th and 21st centuries, suicide has been used on rare occasions as a form of protest; it has also been committed while or after murdering others, a tactic that has been used both militarily and by terrorists. Suicide is often seen as a major catastrophe, causing significant grief to the deceased's relatives, friends and community members, and it is viewed negatively almost everywhere around the world.
Definitions
Suicide, derived from Latin suicidium, is "the act of taking one's own life". Attempted suicide, or non-fatal suicidal behavior, amounts to self-injury with at least some desire to end one's life that does not result in death. Assisted suicide occurs when one individual helps another bring about their own death indirectly by providing either advice or the means to the end. Euthanasia, more specifically voluntary euthanasia, is where another person takes a more active role in bringing about a person's death.Suicidal ideation is thoughts of ending one's life but not taking any active efforts to do so. It may or may not involve exact planning or intent. Suicidality is defined as "the risk of suicide, usually indicated by suicidal ideation or intent, especially as evident in the presence of a well-elaborated suicidal plan."
In a murder–suicide, the individual aims at taking the lives of others at the same time. A special case of this is extended suicide, where the murder is motivated by seeing the murdered persons as an extension of their self. Suicide in which the reason is that the person feels that they are not part of society is known as egoistic suicide.
The Centre for Suicide Prevention in Canada found that the normal verb in scholarly research and journalism for the act of suicide was commit, and argued for destigmatizing terminology related to suicide; in 2011, they published an article calling for changing the language used around suicide entitled "Suicide and language: Why we shouldn't use the 'C' word". The American Psychological Association lists "committed suicide" as a term to avoid because it "frame suicide as a crime." Some advocacy groups recommend using the terms took his/her own life, died by suicide, or killed him/herself instead of committed suicide. The Associated Press Stylebook recommends avoiding "committed suicide" except in direct quotes from authorities. The Guardian and Observer style guides deprecate the use of "committed", as does CNN. Opponents of commit argue that it implies that suicide is criminal, sinful, or morally wrong.
Suicide may involve more than one method or result in unintended secondary trauma, such as in the case of complex and complicated suicides. Complex suicides involve the use of more than one method either simultaneously or successively; a rare type that may be further decomposed into secondary or primary types. Complicated suicide describes a poorly understood process that results in secondary unintentional trauma as a result of using a single method.
Pathophysiology
There is no known unifying underlying pathophysiology for suicide; it is believed to result from an interplay of behavioral, socio-economic and psychological factors.Low levels of brain-derived neurotrophic factor are directly associated with suicide and indirectly associated through its role in major depression, post-traumatic stress disorder, schizophrenia and obsessive–compulsive disorder. Post-mortem studies have found reduced levels of BDNF in the hippocampus and prefrontal cortex, in those with and without psychiatric conditions. Serotonin, a brain neurotransmitter, is believed to be low in those who die by suicide. This is partly based on evidence of increased levels of 5-HT2A receptors found after death. Other evidence includes reduced levels of a breakdown product of serotonin, 5-hydroxyindoleacetic acid, in the cerebral spinal fluid. However, direct evidence is hard to obtain. Epigenetics, the study of changes in genetic expression in response to environmental factors which do not alter the underlying DNA, is also believed to play a role in determining suicide risk.
Risk factors
Factors that affect the risk of suicide include mental disorders, drug misuse, psychological states, cultural, family and social situations, genetics, experiences of trauma or loss, and nihilism. Mental disorders and substance misuse frequently co-exist. Other risk factors include having previously attempted suicide, the ready availability of a means to take one's life, a family history of suicide, or the presence of traumatic brain injury. For example, suicide rates have been found to be greater in households with firearms than those without them. Research examining 3,018 US counties found that "the distribution of suicide rates across US states corresponded to variations in cluster distribution in each state."Socio-economic problems such as unemployment, poverty, homelessness, and discrimination may trigger suicidal thoughts. Suicide might be rarer in societies with high social cohesion and moral objections against suicide. Genetics appears to account for between 38% and 55% of suicidal behaviors. Suicides may also occur as a local cluster of cases.
Most research does not distinguish between risk factors that lead to thinking about suicide and risk factors that lead to suicide attempts. Risks for suicide attempt, rather than just thoughts of suicide, include a high pain tolerance and a reduced fear of death.
Autism
Autistic individuals, on average, face more mental health and social challenges than non-autistic individuals, including higher rates of anxiety, depression, and social isolation. They attempt and consider suicide more frequently than the general population. Autistic people are about three times as likely as non-autistic people to attempt suicide. Suicide is a leading cause of early death for autistic people without co-occurring learning disabilities.Environmental exposures
Some environmental exposures, including air pollution, intense sunlight, sunlight duration, hot weather, and high altitude, are associated with suicide. There is a possible association between short-term PM10 exposure and suicide. These factors might affect certain high-risk individuals more than others.The time of year may also affect suicide rates. There appears to be a decrease around Christmas, but an increase in rates during spring and summer, which might be related to exposure to sunshine. Another study found that the risk may be greater for males on their birthday.
Genetics might influence rates of suicide. A family history of suicide, especially in the mother, affects children more than adolescents or adults. Adoption studies have shown that this is the case for biological relatives, but not adopted relatives. This makes familial risk factors unlikely to be due to imitation. Once mental disorders are accounted for, the estimated heritability rate is 36% for suicidal ideation and 17% for suicide attempts. An evolutionary explanation for suicide is that it may improve inclusive fitness. This may occur if the person dying by suicide cannot have more children and takes resources away from relatives by staying alive. An objection to this explanation is that deaths by healthy adolescents likely do not increase inclusive fitness. Adaptation to a very different ancestral environment may be maladaptive in the current one.