Suicide: Who are prone?

Since comedian Robin Williams, 63, hanged himself on August 11, 2014, people have been wondering how a person could kill himself, what triggers suicide, and how this disease of the mind could be prevented.
Every year, an estimated one million people around the world commit suicide, causing more fatalities than murder or war. The WHO reports that every 40 seconds, one person dies of suicide. By 2020, it is postulated that the prevalence could rise to 1.5 million. This is the third leading cause of death among people aged 15 to 44 years. Eastern Europe and East Asia have the highest suicide rate. Latin America has the lowest.
Annually, in Russia, about 60,000 commit suicide, compared to about 30,000 in the United States, 30,000 in Japan, and 250,000 in China.
How prevalent is teen suicide?
Statistics gathered between 1952 and 1992 in the United States show adolescent suicide among those 15-19 years of age has tripled (386% increase the past 40 years). Adolescent suicide is the third leading cause of death in the 15-24 age group, accounting for 13.7% (4,849) of all deaths, accident and homicide being the first top two causes. Among those ages 10-14, it has increased five times during the same period. Male to female ratio is 6:1, though females attempt suicide more frequently. Estimates of attempted versus completed (successful) suicide range from 50:1 to 200:1.
What is the most common method used?
There are 32,000 people (all age group) who commit suicide in the United States every year. Drug overdose is the most common method used, particularly among females. The most common one used in completed or successful suicide among adolescents is by firearms. In twelve years (1980 to 1992), the use of firearms accounted for 81% of the increase in overall suicide rates for those ages 15-19, and 64.9% among those 25 and younger. Most of the females who succeeded in killing themselves used firearms. Fifty percent of households in the USA own a gun.
What are the risk factors in suicide?
Mental problem is a risk factor, especially major depressive, psychosis, etc. Other factors include substance abuse, family history of suicide, sexual abuse, delinquency, gay and lesbian youth, runaways, juveniles in detention centers, halfway houses, prisons, group homes. Those high-achievers, who may have rigid perfectionist personalities and impulsive behavior are also at an increased risk.
What are the stressor events?
Stressors or precipitants that contribute to suicide are loss of a loved one through divorce, death or break-up of a relationship; interpersonal or family conflicts. School or career/job problems, financial dilemma, family violence, impending divorce and divorce are stressors that aggravate the situation because they lessen the much-needed support responses to the crisis.
Is pregnancy a risk factor?
Previously thought of as a possible risk factor in suicide among adolescents, pregnancy has been ruled out as a risk factor. In fact, fewer than expected happened during or following teen pregnancy. On the other hand, divorced teen girls, facing the harsh reality of financial and other unanticipated dilemma, are at an increased risk of self-destruction.
Can media coverage of suicide trigger one?
Yes, television, newspaper or radio coverage of suicide (or exposure to a recent suicide or suicide attempt in the community) can serve as a trigger for vulnerable adolescents to act on suicidal thoughts and plans. This is what is termed as “cluster suicides.”
Is depression associated with suicide? Clinical evidences show that depression is very strongly associated with suicide, as in the case of Robin Williams. The symptoms and signs include depressive mood, reduced interest or pleasure, isolation from family and friends, weight loss when not dieting, or weight gain, insomnia or hypersomnia (sleeping a lot), fatigue, diminished ability to think or concentrate, indecisiveness, irritability, unusually argumentative and temperamental behavior, hyperactivity, delinquency, school failure, repeated accidents or injuries, sexual acting out, etc.
Do potential victims talk about it?
No, they do not volunteer information on their suicidal thoughts or intention but these adolescents feel relieved when a confidant or a medical professional brings up the subject. When this comes up, it is best to ask questions in a non-judgmental, non-threatening and direct manner, like, “Have you thought of suicide?” “Are you thinking about suicide now?” “Do you have a plan for doing it?” If answer is affirmative, “What is your plan for committing suicide?” A positive response indicates the need for more professional questioning and assessment of risk factors, and the plan of counseling or therapy is based on the degree of risk.

Does suicide run in the family?
While genetic predisposition to suicide has a role in its etiology, the environmental factors (home, school, workplace, etc), or so called stressors and precipitants, appear to weigh a lot heavier in the equation, even in multiple suicide cases in the same family. Siblings from the same parents but exposed to different environment, stressors and precipitants, react and behave differently to various dilemmas in life.
What can friends and family members do?
Family members and friends, who notice signs of depression and/or suspect suicidal tendency should show understanding and compassion without anger or condescension to the individual in distress. They should reassure the person that his/her current emotional condition is temporary and treatable. They should suggest professional help but this should be done without intimidation or coercion. A “no-suicide” contract, where the adolescent pledges not to attempt self-destruction, is often helpful but cannot be totally and solely relied upon.
Should suicide info be kept confidential?
Most usually, the adolescent will swear to secrecy a friend or a family member, or a professional, about their suicidal tendency or thoughts. The temptation to accede to this request should be avoided, because suicidal intent is not something that should, or can, be kept confidential, if suicide is to be prevented. As a matter of fact, the family members should be advised as soon as the information is known in order for them to remove all medications, firearms, etc. from the home and make these inaccessible to the adolescent. This knowledge will also make the family members more understanding and supportive of the adolescent in crisis, who is hurting badly and really crying for help inside.
What is the best plan for treatment?
If depression or suicidal tendency is suspected, a family member or a friend, who is close to the individual, may suggest professional help. Nowadays, a visit to the psychologist or psychiatrist is commonplace. One does not have to be “crazy” to see psychiatrist. Many politicians, head of states, businessmen, actors and actresses routinely seek counseling for prophylaxis, to prevent, minimize or learn how to handle stressors in life. The counselor will have interview sessions with the adolescent, the family members and friends, most often separately, and make an assessment of the case, and tailor the specific management regimen for the individual. Today, more than ever before, medical science has the mind-boggling sophistication to perform “wonderful miracles,” heretofore unknown to man.
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