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Suicide is the act of intentionally causing one's own
death Death is the irreversible cessation of all biological functions that sustain an organism. For organisms with a brain, death can also be defined as the irreversible cessation of functioning of the whole brain, including brainstem, and brain ...
.
Mental disorder A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...
s (including depression,
bipolar disorder Bipolar disorder, previously known as manic depression, is a mental disorder characterized by periods of depression and periods of abnormally elevated mood that last from days to weeks each. If the elevated mood is severe or associated with ...
,
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
,
personality disorder Personality disorders (PD) are a class of mental disorders characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the individual's culture ...
s,
anxiety disorder Anxiety disorders are a cluster of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal function are significantly impaired. Anxiety may cause physi ...
s), physical disorders (such as
chronic fatigue syndrome Chronic fatigue syndrome (CFS), also called myalgic encephalomyelitis (ME) or ME/CFS, is a complex, debilitating, long-term medical condition. The causes and mechanisms of the disease are not fully understood. Distinguishing core symptoms are ...
), and
substance abuse Substance abuse, also known as drug abuse, is the use of a drug in amounts or by methods which are harmful to the individual or others. It is a form of substance-related disorder. Differing definitions of drug abuse are used in public health, ...
(including
alcoholism Alcoholism is, broadly, any drinking of alcohol (drug), alcohol that results in significant Mental health, mental or physical health problems. Because there is disagreement on the definition of the word ''alcoholism'', it is not a recognize ...
and the use of and
withdrawal Withdrawal means "an act of taking out" and may refer to: * Anchoresis (withdrawal from the world for religious or ethical reasons) * ''Coitus interruptus'' (the withdrawal method) * Drug withdrawal * Social withdrawal * Taking of money from a ban ...
from
benzodiazepine Benzodiazepines (BZD, BDZ, BZs), sometimes called "benzos", are a class of depressant drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. They are prescribed to treat conditions such as anxiety disorders, ...
s) are risk factors. Some suicides are impulsive acts due to stress (such as from financial or academic difficulties), relationship problems (such as
breakup A relationship breakup, breakup, or break-up is the termination of a relationship. The act is commonly termed "dumping omeone in slang when it is initiated by one partner. The term is less likely to be applied to a married couple, where a brea ...
s or
divorce Divorce (also known as dissolution of marriage) is the process of terminating a marriage or marital union. Divorce usually entails the canceling or reorganizing of the legal duties and responsibilities of marriage, thus dissolving the ...
s), or harassment and bullying. Those who have previously attempted suicide are at a higher risk for future attempts. Effective
suicide prevention Suicide prevention is a collection of efforts to reduce the risk of suicide. Suicide is often preventable, and the efforts to prevent it may occur at the individual, relationship, community, and society level. Suicide is a serious public health ...
efforts include limiting access to methods of suicide such as
firearms A firearm is any type of gun designed to be readily carried and used by an individual. The term is legally defined further in different countries (see Legal definitions). The first firearms originated in 10th-century China, when bamboo tubes c ...
, drugs, and poisons; treating mental disorders and substance abuse; careful
media Media may refer to: Communication * Media (communication), tools used to deliver information or data ** Advertising media, various media, content, buying and placement for advertising ** Broadcast media, communications delivered over mass el ...
reporting about suicide; and improving economic conditions. Although
crisis hotline A crisis hotline is a phone number people can call to get immediate emergency telephone counseling, usually by trained volunteers. The first such service was founded in England in 1951 and such hotlines have existed in most major cities of the E ...
s are common resources, their effectiveness has not been well studied. The most commonly adopted method of suicide varies from country to country and is partly related to the availability of effective means. Common methods of suicide include hanging,
pesticide poisoning A pesticide poisoning occurs when pesticides, chemicals intended to control a pest, affect non-target organisms such as humans, wildlife, plant, or bees. There are three types of pesticide poisoning. The first of the three is a single and short- ...
, and firearms. Suicides resulted in 828,000 deaths globally in 2015, an increase from 712,000 deaths in 1990.. For the number 828,000, see Table 5, line "Self-harm", second column (year 2015). For the number 712,000, see Table 2, line "Self-harm", first column (year 1990) This makes suicide the 10th
leading cause of death The following is a list of the causes of human deaths worldwide for different years arranged by their associated mortality rates. In 2002, there were about 57 million deaths. In 2005, according to the World Health Organization (WHO) using the I ...
worldwide. Approximately 1.5% of all deaths worldwide are by suicide. In a given year, this is roughly 12 per 100,000 people. Rates of suicide are generally higher among men than women, ranging from 1.5 times higher in the
developing world A developing country is a sovereign state with a lesser developed industrial base and a lower Human Development Index (HDI) relative to other countries. However, this definition is not universally agreed upon. There is also no clear agreem ...
to 3.5 times higher in the
developed world A developed country (or industrialized country, high-income country, more economically developed country (MEDC), advanced country) is a sovereign state that has a high quality of life, developed economy and advanced technological infrastruct ...
. 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. In the
Western world The Western world, also known as the West, primarily refers to the various nations and state (polity), states in the regions of Europe, North America, and Oceania.
, attempts are more common among young people and women. Views on suicide have been influenced by broad existential themes such as religion, honor, and the meaning of life. The
Abrahamic religions The Abrahamic religions are a group of religions centered around worship of the God of Abraham. Abraham, a Hebrew patriarch, is extensively mentioned throughout Abrahamic religious scriptures such as the Bible and the Quran. Jewish tradition ...
traditionally consider suicide as an offense towards God due to the belief in the
sanctity of life In religion and ethics, the inviolability of life, or sanctity of life, is a principle of implied protection regarding aspects of sentient life that are said to be holy, sacred, or otherwise of such value that they are not to be violated. This ca ...
. During the
samurai were the hereditary military nobility and officer caste of medieval and early-modern Japan from the late 12th century until their abolition in 1876. They were the well-paid retainers of the '' daimyo'' (the great feudal landholders). They h ...
era in Japan, a form of suicide known as
seppuku , sometimes referred to as hara-kiri (, , a native Japanese kun reading), is a form of Japanese ritual suicide by disembowelment. It was originally reserved for samurai in their code of honour but was also practised by other Japanese people ...
(, ) was respected as a means of making up for failure or as a form of protest.
Sati Sati or SATI may refer to: Entertainment * ''Sati'' (film), a 1989 Bengali film by Aparna Sen and starring Shabana Azmi * ''Sati'' (novel), a 1990 novel by Christopher Pike *Sati (singer) (born 1976), Lithuanian singer *Sati, a character in ''Th ...
, a practice outlawed by the
British British may refer to: Peoples, culture, and language * British people, nationals or natives of the United Kingdom, British Overseas Territories, and Crown Dependencies. ** Britishness, the British identity and common culture * British English, ...
in India, expected a Hindu widow to immolate herself on her husband's
funeral pyre A pyre ( grc, πυρά; ''pyrá'', from , ''pyr'', "fire"), also known as a funeral pyre, is a structure, usually made of wood, for burning a body as part of a funeral rite or execution. As a form of cremation, a body is placed upon or under the ...
, either willingly or under pressure from her family and society. 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, and
kamikaze , officially , were a part of the Japanese Special Attack Units of military aviators who flew suicide attacks for the Empire of Japan against Allied naval vessels in the closing stages of the Pacific campaign of World War II, intending to d ...
and
suicide bombings A suicide attack is any violent attack, usually entailing the attacker detonating an explosive, where the attacker has accepted their own death as a direct result of the attacking method used. Suicide attacks have occurred throughout histor ...
have been used as a military or terrorist tactic. Suicide is often seen as a major catastrophe for families, relatives, and other nearby supporters, and it is viewed negatively almost everywhere around the world.


Definitions

Suicide, derived from Latin , is "the act of taking one's own life". Attempted suicide or non-fatal suicidal behavior amounts to
self-injury Self-harm is intentional behavior that is considered harmful to oneself. This is most commonly regarded as direct injury of one's own skin tissues usually without a suicidal intention. Other terms such as cutting, self-injury and self-mutilatio ...
with at least some desire to end one's life that does not result in death.
Assisted suicide Assisted suicide is suicide undertaken with the aid of another person. The term usually refers to physician-assisted suicide (PAS), which is suicide that is assisted by a physician or other healthcare provider. Once it is determined that the p ...
occurs when one individual helps another bring about their own death indirectly via providing either advice or the means to the end. This is in contrast to
euthanasia Euthanasia (from el, εὐθανασία 'good death': εὖ, ''eu'' 'well, good' + θάνατος, ''thanatos'' 'death') is the practice of intentionally ending life to eliminate pain and suffering. Different countries have different eut ...
, where another person takes a more active role in bringing about a person's death.
Suicidal ideation Suicidal ideation, or suicidal thoughts, means having thoughts, ideas, or ruminations about the possibility of ending one's own life.World Health Organization, ''ICD-11 for Mortality and Morbidity Statistics'', ver. 09/2020MB26.A Suicidal ideatio ...
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. In a
murder–suicide A murder-suicide is an act in which an individual murder, kills one or more persons either before or while suicide, killing themselves. The combination of murder and suicide can take various forms: * Murder linked with suicide of a person with a ...
(or homicide–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. In 2011, the Centre for Suicide Prevention in Canada found that the normal verb in scholarly research and journalism for the act of suicide was ''commit''. On the other hand, 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 The ''AP Stylebook'', also known by its full name ''The Associated Press Stylebook and Briefing on Media Law'', is an American English grammar style and usage guide created by American journalists working for or connected with the Associated Pr ...
recommends avoiding "committed suicide" except in direct quotes from authorities. The ''
Guardian Guardian usually refers to: * Legal guardian, a person with the authority and duty to care for the interests of another * ''The Guardian'', a British daily newspaper (The) Guardian(s) may also refer to: Places * Guardian, West Virginia, Unite ...
'' and ''
Observer An observer is one who engages in observation or in watching an experiment. Observer may also refer to: Computer science and information theory * In information theory, any system which receives information from an object * State observer in con ...
'' style guides deprecate the use of "committed", as does
CNN CNN (Cable News Network) is a multinational cable news channel headquartered in Atlanta, Georgia, U.S. Founded in 1980 by American media proprietor Ted Turner and Reese Schonfeld as a 24-hour cable news channel, and presently owned by the M ...
. Opponents of ''commit'' argue that it implies that suicide is criminal, sinful, or morally wrong.


Risk factors

Factors that affect the risk of suicide include mental disorders, drug misuse,
psychological state A mental state, or a mental property, is a state of mind of a person. Mental states comprise a diverse class, including perception, pain experience, belief, desire, intention, emotion, and memory. There is controversy concerning the exact definitio ...
s, cultural, family and social situations, genetics, experiences of trauma or loss, and
nihilism Nihilism (; ) is a philosophy, or family of views within philosophy, that rejects generally accepted or fundamental aspects of human existence, such as objective truth, knowledge, morality, values, or meaning. The term was popularized by Ivan ...
. 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 A traumatic brain injury (TBI), also known as an intracranial injury, is an injury to the brain caused by an external force. TBI can be classified based on severity (ranging from mild traumatic brain injury TBI/concussionto severe traumatic b ...
. For example, suicide rates have been found to be greater in households with firearms than those without them.
Socio-economic Socioeconomics (also known as social economics) is the social science that studies how economic activity affects and is shaped by social processes. In general it analyzes how modern societies progress, stagnate, or regress because of their local ...
problems such as unemployment, poverty, homelessness, and
discrimination Discrimination is the act of making unjustified distinctions between people based on the groups, classes, or other categories to which they belong or are perceived to belong. People may be discriminated on the basis of race, gender, age, relig ...
may trigger suicidal thoughts. Suicide might be rarer in societies with high
social cohesion Group cohesiveness (also called group cohesion and social cohesion) arises when bonds link members of a social group to one another and to the group as a whole. Although cohesion is a multi-faceted process, it can be broken down into four main co ...
and moral objections against suicide. About 15–40% of people leave a
suicide note A suicide note or death note is a message left behind by a person who dies or intends to die by suicide. A study examining Japanese suicide notes estimated that 25–30% of suicides are accompanied by a note. However, incidence rates may depe ...
. War veterans have a higher risk of suicide due in part to higher rates of mental illness, such as
post-traumatic stress disorder Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that can develop because of exposure to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on ...
, and physical health problems related to war. Genetics appears to account for between 38% and 55% of suicidal behaviors. Suicides may also occur as a local
cluster may refer to: Science and technology Astronomy * Cluster (spacecraft), constellation of four European Space Agency spacecraft * Asteroid cluster, a small asteroid family * Cluster II (spacecraft), a European Space Agency mission to study t ...
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.


Mental illness

Mental illness is present at the time of suicide 27% to more than 90% of the time. Of those who have been hospitalized for suicidal behavior, the lifetime risk of suicide is 8.6%. Comparatively, non-suicidal people hospitalized for affective disorders have a 4% lifetime risk of suicide. Half of all people who die by suicide may have
major depressive disorder Major depressive disorder (MDD), also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. Introdu ...
; having this or one of the other
mood disorder A mood disorder, also known as an affective disorder, is any of a group of conditions of mental and behavioral disorder where a disturbance in the person's mood is the main underlying feature. The classification is in the ''Diagnostic and Stat ...
s such as
bipolar disorder Bipolar disorder, previously known as manic depression, is a mental disorder characterized by periods of depression and periods of abnormally elevated mood that last from days to weeks each. If the elevated mood is severe or associated with ...
increases the risk of suicide 20-fold. Other conditions implicated include
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
(14%),
personality disorder Personality disorders (PD) are a class of mental disorders characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the individual's culture ...
s (8%),
obsessive–compulsive disorder Obsessive–compulsive disorder (OCD) is a mental and behavioral disorder in which an individual has intrusive thoughts and/or feels the need to perform certain routines repeatedly to the extent where it induces distress or impairs general ...
, and
post-traumatic stress disorder Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that can develop because of exposure to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on ...
. Those with
autism The autism spectrum, often referred to as just autism or in the context of a professional diagnosis autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental condition (or conditions) characterized by difficulti ...
also attempt and consider suicide more frequently. Others estimate that about half of people who die by suicide could be diagnosed with a personality disorder, with
borderline personality disorder Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD), is a personality disorder characterized by a long-term pattern of unstable interpersonal relationships, distorted sense of self, and strong ...
being the most common. About 5% of people with
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
die of suicide.
Eating disorder An eating disorder is a mental disorder defined by abnormal eating behaviors that negatively affect a person's physical or mental health. Only one eating disorder can be diagnosed at a given time. Types of eating disorders include binge eating d ...
s are another high risk condition. Around 22% to 50% of people suffering with gender dysphoria have attempted suicide, however this greatly varies by region. Among approximately 80% of suicides, the individual has seen a physician within the year before their death, including 45% within the prior month. Approximately 25–40% of those who died by suicide had contact with mental health services in the prior year.
Antidepressant Antidepressants are a class of medication used to treat major depressive disorder, anxiety disorders, chronic pain conditions, and to help manage addictions. Common side-effects of antidepressants include dry mouth, weight gain, dizziness, hea ...
s of the
SSRI Selective serotonin reuptake inhibitors (SSRIs) are a class of drugs that are typically used as antidepressants in the treatment of major depressive disorder, anxiety disorders, and other psychological conditions. SSRIs increase the extracellul ...
class appear to increase the frequency of suicide among children but do not change the risk among adults. An unwillingness to get help for mental health problems also increases the risk.


Previous attempts

A previous history of
suicide attempts A suicide attempt is an attempt to die by suicide that results in survival. It may be referred to as a "failed" or "unsuccessful" suicide attempt, though these terms are discouraged by mental health professionals for implying that a suicide resu ...
is the most accurate predictor of suicide. Approximately 20% of suicides have had a previous attempt, and of those who have attempted suicide, 1% die by suicide within a year and more than 5% die by suicide within 10 years.


Self-harm

Non-suicidal self-harm is common with 18% of people engaging in self-harm over the course of their life. Acts of self-harm are not usually suicide attempts and most who self-harm are not at high risk of suicide. Some who self-harm, however, do still end their life by suicide, and risk for self-harm and suicide may overlap. Individuals who have been identified as self-harming after being admitted to hospital are more likely to die by suicide.


Psychosocial factors

A number of psychological factors increase the risk of suicide including: hopelessness, loss of pleasure in life, depression, anxiousness, agitation, rigid thinking, rumination,
thought suppression Thought suppression is a psychological defence mechanism. It is a type of motivated forgetting in which an individual consciously attempts to stop thinking about a particular thought. It is often associated with obsessive–compulsive disorder (OC ...
, and poor
coping Coping refers to conscious strategies used to reduce unpleasant emotions. Coping strategies can be cognitions or behaviours and can be individual or social. Theories of coping Hundreds of coping strategies have been proposed in an attempt to ...
skills. A poor ability to solve problems, the loss of abilities one used to have, and poor
impulse control Inhibitory control, also known as response inhibition, is a cognitive process – and, more specifically, an executive function – that permits an individual to inhibit their impulses and natural, habitual, or dominant behavioral re ...
also play a role. In older adults, the perception of being a burden to others is important. Those who have never married are also at greater risk. Recent life stresses, such as a loss of a family member or friend or the loss of a job, might be a contributing factor. Certain personality factors, especially high levels of
neuroticism In the study of psychology, neuroticism has been considered a fundamental personality trait. For example, in the Big Five approach to personality trait theory, individuals with high scores for neuroticism are more likely than average to be moody ...
and
introverted The traits of extraversion (also spelled extroversion Retrieved 2018-02-21.) and introversion are a central dimension in some human personality theories. The terms ''introversion'' and ''extraversion'' were introduced into psychology by Carl J ...
ness, have been associated with suicide. This might lead to people who are isolated and sensitive to distress to be more likely to attempt suicide. On the other hand,
optimism Optimism is an attitude reflecting a belief or hope that the outcome of some specific endeavor, or outcomes in general, will be positive, favorable, and desirable. A common idiom used to illustrate optimism versus pessimism is a glass filled wi ...
has been shown to have a protective effect. Other psychological risk factors include having few reasons for living and feeling trapped in a stressful situation. Changes to the stress response system in the brain might be altered during suicidal states. Specifically, changes in the
polyamine A polyamine is an organic compound having more than two amino groups. Alkyl polyamines occur naturally, but some are synthetic. Alkylpolyamines are colorless, hygroscopic, and water soluble. Near neutral pH, they exist as the ammonium derivatives. ...
system and
hypothalamic–pituitary–adrenal axis The hypothalamic–pituitary–adrenal axis (HPA axis or HTPA axis) is a complex set of direct influences and feedback interactions among three components: the hypothalamus (a part of the brain located below the thalamus), the pituitary gland (a ...
.
Social isolation Social isolation is a state of complete or near-complete lack of contact between an individual and society. It differs from loneliness, which reflects temporary and involuntary lack of contact with other humans in the world. Social isolation c ...
and the lack of
social support Social support is the perception and actuality that one is cared for, has assistance available from other people, and most popularly, that one is part of a supportive social network. These supportive resources can be emotional (e.g., nurturance), ...
has been associated with an increased risk of suicide.
Poverty Poverty is the state of having few material possessions or little income. Poverty can have diverse social, economic, and political causes and effects. When evaluating poverty in ...
is also a factor, with heightened relative poverty compared to those around a person increasing suicide risk. Over 200,000 farmers in India have died by suicide since 1997, partly due to issues of debt. In China, suicide is three times as likely in rural regions as urban ones, partly, it is believed, due to financial difficulties in this area of the country. 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. Being religious may reduce one's risk of suicide while beliefs that suicide is noble may increase it. This has been attributed to the negative stance many religions take against suicide and to the greater connectedness religion may give.
Muslim Muslims ( ar, المسلمون, , ) are people who adhere to Islam, a monotheistic religion belonging to the Abrahamic tradition. They consider the Quran, the foundational religious text of Islam, to be the verbatim word of the God of Abrah ...
s, among religious people, appear to have a lower rate of suicide; however, the data supporting this is not strong. There does not appear to be a difference in rates of attempted suicide. Young women in the
Middle East The Middle East ( ar, الشرق الأوسط, ISO 233: ) is a geopolitical region commonly encompassing Arabian Peninsula, Arabia (including the Arabian Peninsula and Bahrain), Anatolia, Asia Minor (Asian part of Turkey except Hatay Pro ...
may have higher rates.


Substance misuse

Substance misuse Substance abuse, also known as drug abuse, is the use of a drug in amounts or by methods which are harmful to the individual or others. It is a form of substance-related disorder. Differing definitions of drug abuse are used in public health, ...
is the second most common risk factor for suicide after major depression and bipolar disorder. Both chronic substance misuse as well as acute intoxication are associated. When combined with personal grief, such as
bereavement Grief is the response to loss, particularly to the loss of someone or some living thing that has died, to which a bond or affection was formed. Although conventionally focused on the emotional response to loss, grief also has physical, cogniti ...
, the risk is further increased. Substance misuse is also associated with mental health disorders. Most people are under the influence of sedative-hypnotic drugs (such as alcohol or benzodiazepines) when they die by suicide, with alcoholism present in between 15% and 61% of cases. Use of prescribed benzodiazepines is associated with an increased rate of suicide and attempted suicide. The pro-suicidal effects of benzodiazepines are suspected to be due to a psychiatric disturbance caused by side effects, such as
disinhibition In psychology, disinhibition is a lack of restraint manifested in disregard of social conventions, impulsivity, and poor risk assessment. Disinhibition affects motor, instinctual, emotional, cognitive, and perceptual aspects with signs and symptom ...
, or withdrawal symptoms. Countries that have higher rates of alcohol use and a greater density of bars generally also have higher rates of suicide. About 2.2–3.4% of those who have been treated for alcoholism at some point in their life die by suicide. Alcoholics who attempt suicide are usually male, older, and have tried to take their own lives in the past. Between 3 and 35% of deaths among those who use
heroin Heroin, also known as diacetylmorphine and diamorphine among other names, is a potent opioid mainly used as a recreational drug for its euphoric effects. Medical grade diamorphine is used as a pure hydrochloride salt. Various white and brow ...
are due to suicide (approximately fourteenfold greater than those who do not use). In adolescents who misuse alcohol, neurological and psychological dysfunctions may contribute to the increased risk of suicide. The misuse of
cocaine Cocaine (from , from , ultimately from Quechuan languages, Quechua: ''kúka'') is a central nervous system (CNS) stimulant mainly recreational drug use, used recreationally for its euphoria, euphoric effects. It is primarily obtained from t ...
and
methamphetamine Methamphetamine (contracted from ) is a potent central nervous system (CNS) stimulant that is mainly used as a recreational drug and less commonly as a second-line treatment for attention deficit hyperactivity disorder and obesity. Methamph ...
has a high correlation with suicide. In those who use cocaine, the risk is greatest during the withdrawal phase. Those who used
inhalants Inhalants are a broad range of household and industrial chemicals whose volatile vapors or pressurized gases can be concentrated and breathed in via the nose or mouth to produce intoxication, in a manner not intended by the manufacturer. They ...
are also at significant risk with around 20% attempting suicide at some point and more than 65% considering it. Smoking cigarettes is associated with risk of suicide. There is little evidence as to why this association exists; however, it has been hypothesized that those who are predisposed to smoking are also predisposed to suicide, that smoking causes health problems which subsequently make people want to end their life, and that smoking affects brain chemistry causing a propensity for suicide.
Cannabis ''Cannabis'' () is a genus of flowering plants in the family Cannabaceae. The number of species within the genus is disputed. Three species may be recognized: ''Cannabis sativa'', '' C. indica'', and '' C. ruderalis''. Alternatively ...
, however, does not appear to independently increase the risk.


Medical conditions

There is an association between suicidality and physical health problems such as chronic pain, traumatic brain injury, cancer,
chronic fatigue syndrome Chronic fatigue syndrome (CFS), also called myalgic encephalomyelitis (ME) or ME/CFS, is a complex, debilitating, long-term medical condition. The causes and mechanisms of the disease are not fully understood. Distinguishing core symptoms are ...
, kidney failure (requiring
hemodialysis Hemodialysis, also spelled haemodialysis, or simply dialysis, is a process of purifying the blood of a person whose kidneys are not working normally. This type of dialysis achieves the extracorporeal removal of waste products such as creatinin ...
),
HIV The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immune ...
, and
systemic lupus erythematosus Lupus, technically known as systemic lupus erythematosus (SLE), is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body. Symptoms vary among people and may be mild to severe. Comm ...
. The diagnosis of cancer approximately doubles the subsequent frequency of suicide. The prevalence of increased suicidality persisted after adjusting for depressive illness and alcohol abuse. Among people with more than one medical condition the frequency was particularly high. In Japan, health problems are listed as the primary justification for suicide. Sleep disturbances, such as
insomnia Insomnia, also known as sleeplessness, is a sleep disorder in which people have trouble sleeping. They may have difficulty falling asleep, or staying asleep as long as desired. Insomnia is typically followed by daytime sleepiness, low energy, ...
and
sleep apnea Sleep apnea, also spelled sleep apnoea, is a sleep disorder in which pauses in breathing or periods of shallow breathing during sleep occur more often than normal. Each pause can last for a few seconds to a few minutes and they happen many times ...
, are risk factors for depression and suicide. In some instances, the sleep disturbances may be a risk factor independent of depression. A number of other medical conditions may present with symptoms similar to mood disorders, including
hypothyroidism Hypothyroidism (also called ''underactive thyroid'', ''low thyroid'' or ''hypothyreosis'') is a disorder of the endocrine system in which the thyroid gland does not produce enough thyroid hormone. It can cause a number of symptoms, such as po ...
,
Alzheimer's Alzheimer's disease (AD) is a neurodegenerative disease that usually starts slowly and progressively worsens. It is the cause of 60–70% of cases of dementia. The most common early symptom is difficulty in remembering recent events. As t ...
,
brain tumor A brain tumor occurs when abnormal cells form within the brain. There are two main types of tumors: malignant tumors and benign (non-cancerous) tumors. These can be further classified as primary tumors, which start within the brain, and seconda ...
s, systemic lupus erythematosus, and adverse effects from a number of medications (such as
beta blocker Beta blockers, also spelled β-blockers, are a class of medications that are predominantly used to manage cardiac arrhythmia, abnormal heart rhythms, and to protect the heart from a second myocardial infarction, heart attack after a first heart ...
s and
steroids A steroid is a biologically active organic compound with four rings arranged in a specific molecular configuration. Steroids have two principal biological functions: as important components of cell membranes that alter membrane fluidity; and a ...
).


Occupational factors

Certain occupations carry an elevated risk of self-harm and suicide, such as military careers. Research in several countries has found that the rate of suicide among former armed forces personnel in particular, and young veterans especially, is markedly higher than that found in the general population.


Media

The media, including the Internet, plays an important role. Certain depictions of suicide may increase its occurrence, with high-volume, prominent, repetitive coverage glorifying or romanticizing suicide having the most impact. When detailed descriptions of how to kill oneself by a specific means are portrayed, this method of suicide can be imitated in vulnerable people. This phenomenon has been observed in several cases after press coverage. In a bid to reduce the adverse effect of media portrayals concerning suicide report, one of the effective methods is to educate journalists on how to report suicide news in a manner that might reduce that possibility of imitation and encourage those at risk to seek for help. When journalists follow certain reporting guidelines the risk of suicides can be decreased. Getting buy-in from the media industry, however, can be difficult, especially in the long term. This trigger of suicide contagion or
copycat suicide A copycat suicide is defined as an emulation of another suicide that the person attempting suicide knows about either from local knowledge or due to accounts or depictions of the original suicide on television and in other media. The publicized ...
is known as the "Werther effect", named after the protagonist in
Goethe Johann Wolfgang von Goethe (28 August 1749 – 22 March 1832) was a German poet, playwright, novelist, scientist, statesman, theatre director, and critic. His works include plays, poetry, literature, and aesthetic criticism, as well as treat ...
's ''
The Sorrows of Young Werther ''The Sorrows of Young Werther'' (; german: Die Leiden des jungen Werthers) is a 1774 epistolary novel by Johann Wolfgang von Goethe, Johann Wolfgang Goethe, which appeared as a revised edition in 1787. It was one of the main novels in the ''Sturm ...
'' who killed himself and then was emulated by many admirers of the book. This risk is greater in adolescents who may romanticize death. It appears that while news media has a significant effect, that of the entertainment media is equivocal. It is unclear if searching for information about suicide on the Internet relates to the risk of suicide. The opposite of the Werther effect is the proposed "Papageno effect", in which coverage of effective coping mechanisms may have a protective effect. The term is based upon a character in
Mozart Wolfgang Amadeus Mozart (27 January 17565 December 1791), baptised as Joannes Chrysostomus Wolfgangus Theophilus Mozart, was a prolific and influential composer of the Classical period (music), Classical period. Despite his short life, his ra ...
's opera ''
The Magic Flute ''The Magic Flute'' (German: , ), K. 620, is an opera in two acts by Wolfgang Amadeus Mozart to a German libretto by Emanuel Schikaneder. The work is in the form of a ''Singspiel'', a popular form during the time it was written that inclu ...
''—fearing the loss of a loved one, he had planned to kill himself until his friends helped him out. As a consequence, fictional portrayals of suicide, showing alternative consequences or negative consequences, might have a preventive effect, for instance fiction might normalize mental health problems and encourage help-seeking.


Other factors

Trauma is a risk factor for suicidality in both children and adults. Some may take their own lives to escape
bullying Bullying is the use of force, coercion, hurtful teasing or threat, to abuse, aggressively dominate or intimidate. The behavior is often repeated and habitual. One essential prerequisite is the perception (by the bully or by others) of an imba ...
or
prejudice Prejudice can be an affective feeling towards a person based on their perceived group membership. The word is often used to refer to a preconceived (usually unfavourable) evaluation or classification of another person based on that person's per ...
. A history of
childhood sexual abuse Child sexual abuse (CSA), also called child molestation, is a form of child abuse in which an adult or older adolescent uses a child for sexual stimulation. Forms of child sexual abuse include engaging in sexual activities with a child (whether ...
and time spent in
foster care Foster care is a system in which a minor has been placed into a ward, group home (residential child care community, treatment center, etc.), or private home of a state-certified caregiver, referred to as a "foster parent" or with a family mem ...
are also risk factors. Sexual abuse is believed to contribute to approximately 20% of the overall risk. Significant adversity early in life has a negative effect on problem-solving skills and memory, both of which are implicated in suicidality.
Problem gambling Problem gambling or ludomania is repetitive gambling behavior despite harm and negative consequences. Problem gambling may be diagnosed as a mental disorder according to ''DSM-5'' if certain diagnostic criteria are met. Pathological gambling is ...
is associated with increased suicidal ideation and attempts compared to the general population. Between 12 and 24% of pathological gamblers attempt suicide. The rate of suicide among their spouses is three times greater than that of the general population. Other factors that increase the risk in problem gamblers include concomitant mental illness, alcohol, and drug misuse. 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 Imitation (from Latin ''imitatio'', "a copying, imitation") is a behavior whereby an individual observes and replicates another's behavior. Imitation is also a form of that leads to the "development of traditions, and ultimately our culture. I ...
. Once mental disorders are accounted for, the estimated
heritability Heritability is a statistic used in the fields of breeding and genetics that estimates the degree of ''variation'' in a phenotypic trait in a population that is due to genetic variation between individuals in that population. The concept of h ...
rate is 36% for suicidal ideation and 17% for suicide attempts. An
evolutionary Evolution is change in the heredity, heritable Phenotypic trait, characteristics of biological populations over successive generations. These characteristics are the Gene expression, expressions of genes, which are passed on from parent to ...
explanation for suicide is that it may improve
inclusive fitness In evolutionary biology, inclusive fitness is one of two metrics of evolutionary success as defined by W. D. Hamilton in 1964: * Personal fitness is the number of offspring that an individual begets (regardless of who rescues/rears/supports them ...
. This may occur if the person dying by suicide cannot have more children and takes resources away from relatives by staying alive. An objection is that deaths by healthy adolescents likely does not increase inclusive fitness.
Adaptation In biology, adaptation has three related meanings. Firstly, it is the dynamic evolutionary process of natural selection that fits organisms to their environment, enhancing their evolutionary fitness. Secondly, it is a state reached by the po ...
to a very different ancestral environment may be maladaptive in the current one. Infection by the parasite ''
Toxoplasma gondii ''Toxoplasma gondii'' () is an obligate intracellular parasitic protozoan (specifically an apicomplexan) that causes toxoplasmosis. Found worldwide, ''T. gondii'' is capable of infecting virtually all warm-blooded animals, but felids, such as d ...
'', more commonly known as
toxoplasmosis Toxoplasmosis is a parasitic disease caused by ''Toxoplasma gondii'', an apicomplexan. Infections with toxoplasmosis are associated with a variety of neuropsychiatric and behavioral conditions. Occasionally, people may have a few weeks or months ...
, has been linked with suicide risk. One explanation states that this is caused by altered
neurotransmitter A neurotransmitter is a signaling molecule secreted by a neuron to affect another cell across a synapse. The cell receiving the signal, any main body part or target cell, may be another neuron, but could also be a gland or muscle cell. Neuro ...
activity due to the immunological response. There appears to be a link between
air pollution Air pollution is the contamination of air due to the presence of substances in the atmosphere that are harmful to the health of humans and other living beings, or cause damage to the climate or to materials. There are many different types ...
and depression and suicide.


Rational

Rational suicide The right to die is a concept based on the opinion that human beings are entitled to end their life or undergo voluntary euthanasia. Possession of this right is often understood that a person with a terminal illness, incurable pain, or without t ...
is the reasoned taking of one's own life. However, some consider suicide as never being rational. Euthanasia and assisted suicide are accepted practices in a number of countries among those who have a poor quality of life without the possibility of getting better. They are supported by the legal arguments for a
right to die The right to die is a concept based on the opinion that human beings are entitled to end their life or undergo voluntary euthanasia. Possession of this right is often understood that a person with a terminal illness, incurable pain, or without t ...
. The act of taking one's life for the benefit of others is known as
altruistic suicide Altruistic suicide is the sacrifice of one's life in order to save or benefit others, for the good of the group, or to preserve the traditions and honor of a society. It is always intentional. Benevolent suicide refers to the Self-denial, self sac ...
. An example of this is an elder ending his or her life to leave greater amounts of food for the younger people in the community. Suicide in some Inuit cultures has been seen as an act of respect, courage, or wisdom. A
suicide attack A suicide attack is any violent Strike (attack), attack, usually entailing the attacker detonating an explosive, where the attacker has suicide, accepted their own death as a direct result of the attacking method used. Suicide attacks have oc ...
is a political or religious action where an attacker carries out violence against others which they understand will result in their own death. Some suicide bombers are motivated by a desire to obtain
martyrdoms A martyr (, ''mártys'', "witness", or , ''marturia'', stem , ''martyr-'') is someone who suffers persecution and death for advocating, renouncing, or refusing to renounce or advocate, a religious belief or other cause as demanded by an external ...
or are religiously motivated.
Kamikaze , officially , were a part of the Japanese Special Attack Units of military aviators who flew suicide attacks for the Empire of Japan against Allied naval vessels in the closing stages of the Pacific campaign of World War II, intending to d ...
missions were carried out as a duty to a higher cause or moral obligation.
Murder–suicide A murder-suicide is an act in which an individual murder, kills one or more persons either before or while suicide, killing themselves. The combination of murder and suicide can take various forms: * Murder linked with suicide of a person with a ...
is an act of
homicide Homicide occurs when a person kills another person. A homicide requires only a volitional act or omission that causes the death of another, and thus a homicide may result from accidental, reckless, or negligent acts even if there is no inten ...
followed within a week by suicide of the person who carried out the act.
Mass suicide Mass suicide is a form of suicide, occurring when a group of people simultaneously kill themselves. Overview Mass suicide sometimes occurs in religious settings. In war, defeated groups may resort to mass suicide rather than being captured. Su ...
s are often performed under
social pressure Peer pressure is the direct or indirect influence on peers, i.e., members of social groups with similar interests, experiences, or social statuses. Members of a peer group are more likely to influence a person's beliefs, values, and behavior. A g ...
where members give up
autonomy In developmental psychology and moral, political, and bioethical philosophy, autonomy, from , ''autonomos'', from αὐτο- ''auto-'' "self" and νόμος ''nomos'', "law", hence when combined understood to mean "one who gives oneself one's ...
to a leader. Mass suicides can take place with as few as two people, often referred to as a
suicide pact A suicide pact is an agreed plan between two or more individuals to die by suicide. The plan may be to die together, or separately and closely timed. General considerations Suicide pacts are an important concept in the study of suicide, and h ...
. In extenuating situations where continuing to live would be intolerable, some people use suicide as a means of escape. Some inmates in
Nazi concentration camps From 1933 to 1945, Nazi Germany operated more than a thousand concentration camps, (officially) or (more commonly). The Nazi concentration camps are distinguished from other types of Nazi camps such as forced-labor camps, as well as concen ...
are known to have killed themselves during the
Holocaust The Holocaust, also known as the Shoah, was the genocide of European Jews during World War II. Between 1941 and 1945, Nazi Germany and its collaborators systematically murdered some six million Jews across German-occupied Europe; a ...
by deliberately touching the electrified fences.


Methods

The leading method of suicide varies among countries. The leading methods in different regions include
hanging Hanging is the suspension of a person by a noose or ligature around the neck.Oxford English Dictionary, 2nd ed. Hanging as method of execution is unknown, as method of suicide from 1325. The ''Oxford English Dictionary'' states that hanging i ...
,
pesticide poisoning A pesticide poisoning occurs when pesticides, chemicals intended to control a pest, affect non-target organisms such as humans, wildlife, plant, or bees. There are three types of pesticide poisoning. The first of the three is a single and short- ...
, and firearms. These differences are believed to be in part due to availability of the different methods. A review of 56 countries found that hanging was the most common method in most of the countries, accounting for 53% of male suicides and 39% of female suicides. Worldwide, 30% of suicides are estimated to occur from pesticide poisoning, most of which occur in the developing world. The use of this method varies markedly from 4% in Europe to more than 50% in the Pacific region. It is also common in
Latin America Latin America or * french: Amérique Latine, link=no * ht, Amerik Latin, link=no * pt, América Latina, link=no, name=a, sometimes referred to as LatAm is a large cultural region in the Americas where Romance languages — languages derived f ...
due to the ease of access within the farming populations. In many countries, drug overdoses account for approximately 60% of suicides among women and 30% among men. Many are unplanned and occur during an acute period of
ambivalence Ambivalence is a state of having simultaneous conflicting reactions, beliefs, or feelings towards some object. Stated another way, ambivalence is the experience of having an attitude towards someone or something that contains both positively and neg ...
. The death rate varies by method: firearms 80–90%, drowning 65–80%, hanging 60–85%, jumping 35–60%,
charcoal burning A charcoal burner is someone whose occupation is to manufacture charcoal. Traditionally this is achieved by carbonising wood in a charcoal pile or kiln. Charcoal burning is one of the oldest human crafts. The knowledge gained from this indust ...
40–50%, pesticides 60–75%, and medication overdose 1.5–4.0%. The most common attempted methods of suicide differ from the most common methods of completion; up to 85% of attempts are via drug overdose in the developed world. In China, the consumption of pesticides is the most common method. In Japan, self-disembowelment known as
seppuku , sometimes referred to as hara-kiri (, , a native Japanese kun reading), is a form of Japanese ritual suicide by disembowelment. It was originally reserved for samurai in their code of honour but was also practised by other Japanese people ...
(''harakiri'') still occurs; however, hanging and jumping are the most common. Jumping to one's death is common in both Hong Kong and Singapore at 50% and 80% respectively. In Switzerland, firearms are the most frequent suicide method in young males, although this method has decreased since guns have become less common. In the United States, 50% of suicides involve the use of firearms, with this method being somewhat more common in men (56%) than women (31%). The next most common cause was hanging in males (28%) and self-poisoning in females (31%). Together, hanging and poisoning constituted about 42% of U.S. suicides ().


Pathophysiology

There is no known unifying underlying
pathophysiology Pathophysiology ( physiopathology) – a convergence of pathology with physiology – is the study of the disordered physiological processes that cause, result from, or are otherwise associated with a disease or injury. Pathology is the ...
for suicide; it is believed to result from an interplay of behavioral, socio-economic and psychological factors. Low levels of
brain-derived neurotrophic factor Brain-derived neurotrophic factor (BDNF), or abrineurin, is a protein found in the and the periphery. that, in humans, is encoded by the ''BDNF'' gene. BDNF is a member of the neurotrophin family of growth factors, which are related to the cano ...
(BDNF) are both directly associated with suicide and indirectly associated through its role in major depression, posttraumatic stress disorder, schizophrenia and
obsessive–compulsive disorder Obsessive–compulsive disorder (OCD) is a mental and behavioral disorder in which an individual has intrusive thoughts and/or feels the need to perform certain routines repeatedly to the extent where it induces distress or impairs general ...
.
Post-mortem An autopsy (post-mortem examination, obduction, necropsy, or autopsia cadaverum) is a surgical procedure that consists of a thorough examination of a corpse by dissection to determine the cause, mode, and manner of death or to evaluate any dis ...
studies have found reduced levels of BDNF in the
hippocampus The hippocampus (via Latin from Greek , 'seahorse') is a major component of the brain of humans and other vertebrates. Humans and other mammals have two hippocampi, one in each side of the brain. The hippocampus is part of the limbic system, a ...
and
prefrontal cortex In mammalian brain anatomy, the prefrontal cortex (PFC) covers the front part of the frontal lobe of the cerebral cortex. The PFC contains the Brodmann areas BA8, BA9, BA10, BA11, BA12, BA13, BA14, BA24, BA25, BA32, BA44, BA45, BA46, ...
, in those with and without psychiatric conditions.
Serotonin Serotonin () or 5-hydroxytryptamine (5-HT) is a monoamine neurotransmitter. Its biological function is complex and multifaceted, modulating mood, cognition, reward, learning, memory, and numerous physiological processes such as vomiting and vas ...
, a brain
neurotransmitter A neurotransmitter is a signaling molecule secreted by a neuron to affect another cell across a synapse. The cell receiving the signal, any main body part or target cell, may be another neuron, but could also be a gland or muscle cell. Neuro ...
, is believed to be low in those who die by suicide. This is partly based on evidence of increased levels of
5-HT2A receptor The 5-HT2A receptor is a subtype of the 5-HT2 receptor that belongs to the serotonin receptor family and is a G protein-coupled receptor (GPCR). The 5-HT2A receptor is a cell surface receptor, but has several intracellular locations. 5-HT is s ...
s found after death. Other evidence includes reduced levels of a breakdown product of serotonin,
5-hydroxyindoleacetic acid 5-Hydroxyindoleacetic acid (5-HIAA) is the main metabolite of serotonin. In chemical analysis of urine samples, 5-HIAA is used to determine serotonin levels in the body. Clinical significance 5-HIAA is tested by 24-hour urine samples combin ...
, in the
cerebral spinal fluid Cerebrospinal fluid (CSF) is a clear, colorless body fluid found within the tissue that surrounds the brain and spinal cord of all vertebrates. CSF is produced by specialised ependymal cells in the choroid plexus of the ventricles of the bra ...
. However, direct evidence is hard to obtain.
Epigenetics In biology, epigenetics is the study of stable phenotypic changes (known as ''marks'') that do not involve alterations in the DNA sequence. The Greek prefix '' epi-'' ( "over, outside of, around") in ''epigenetics'' implies features that are "o ...
, the study of changes in
genetic expression Gene expression is the process by which information from a gene is used in the synthesis of a functional gene product that enables it to produce end products, protein or non-coding RNA, and ultimately affect a phenotype, as the final effect. The ...
in response to
environmental factor An environmental factor, ecological factor or eco factor is any factor, abiotic or biotic, that influences living organisms. Abiotic factors include ambient temperature, amount of sunlight, and pH of the water soil in which an organism lives. Bi ...
s which do not alter the underlying DNA, is also believed to play a role in determining suicide risk.


Prevention

Suicide prevention is a term used for the collective efforts to reduce the incidence of suicide through preventive measures. Protective factors for suicide include support, and access to therapy. About 60% of people with suicidal thoughts do not seek help. Reasons for not doing so include low perceived need, and wanting to deal with the problem alone. Despite these high rates, there are few established treatments available for suicidal behavior. Reducing access to certain methods, such as firearms or toxins such as
opioids Opioids are substances that act on opioid receptors to produce morphine-like effects. Medically they are primarily used for pain relief, including anesthesia. Other medical uses include suppression of diarrhea, replacement therapy for opioid use ...
and pesticides, can reduce risk of suicide by that method. This may be in part because suicide is often an impulsive decision, with up to 70% of near-fatal suicide attempts made after less than one hour of deliberation—thus, reducing access to easily-accessible methods of suicide may make impulsive attempts less likely to succeed. Other measures include reducing access to charcoal (for burning) and adding barriers on bridges and subway platforms. Treatment of drug and alcohol addiction, depression, and those who have attempted suicide in the past, may also be effective. Some have proposed reducing access to alcohol as a preventive strategy (such as reducing the number of bars). In young adults who have recently thought about suicide,
cognitive behavioral therapy Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (suc ...
appears to improve outcomes. School-based programs that increase
mental health literacy Mental health literacy has been defined as "knowledge and beliefs about mental disorders which aid their recognition, management and prevention. Mental health literacy includes the ability to recognize specific disorders; knowing how to seek ment ...
and train staff have shown mixed results on suicide rates.
Economic development In the economics study of the public sector, economic and social development is the process by which the economic well-being and quality of life of a nation, region, local community, or an individual are improved according to targeted goals and o ...
through its ability to reduce poverty may be able to decrease suicide rates. Efforts to increase
social connection Social connection is the experience of feeling close and connected to others. It involves feeling loved, cared for, and valued, and forms the basis of interpersonal relationships."Connection is the energy that exists between people when they feel ...
, especially in elderly males, may be effective. In people who have attempted suicide, following up on them might prevent repeat attempts. Although
crisis hotline A crisis hotline is a phone number people can call to get immediate emergency telephone counseling, usually by trained volunteers. The first such service was founded in England in 1951 and such hotlines have existed in most major cities of the E ...
s are common, there is little evidence to support or refute their effectiveness. Preventing childhood trauma provides an opportunity for suicide prevention. The
World Suicide Prevention Day World Suicide Prevention Day (WSPD) is an awareness day observed on 10 September every year, in order to provide worldwide commitment and action to prevent suicides, with various activities around the world since 2003. The International Associati ...
is observed annually on 10 September with the support of the
International Association for Suicide Prevention The International Association for Suicide Prevention (IASP) is an international suicide prevention organization. Founded by Erwin Ringel and Norman Farberow in 1960, IASP, which is in an official relationship with the World Health Organization, i ...
and the
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
.


Screening

There is little data on the effects of screening the general population on the ultimate rate of suicide. Screening those who come to the emergency departments with injuries from self-harm have been shown to help identify suicide ideation and suicide intention.
Psychometric tests Psychometrics is a field of study within psychology concerned with the theory and technique of measurement. Psychometrics generally refers to specialized fields within psychology and education devoted to testing, measurement, assessment, and ...
such as the
Beck Depression Inventory The Beck Depression Inventory (BDI, BDI-1A, BDI-II), created by Aaron T. Beck, is a 21-question multiple-choice self-report inventory, one of the most widely used psychometric tests for measuring the severity of depression. Its development mark ...
or the
Geriatric Depression Scale The Geriatric Depression Scale (GDS) is a 30-item self-report assessment used to identify depression in the elderly. The scale was first developed in 1982 by J.A. Yesavage and others. Description In the Geriatric Depression Scale, questions are ...
for older people are being used. As there is a high rate of people who test positive via these tools that are not at risk of suicide, there are concerns that screening may significantly increase mental health care resource utilization. Assessing those at high risk, though, is recommended. Asking about suicidality does not appear to increase the risk.


Mental illness

In those with mental health problems, a number of treatments may reduce the risk of suicide. Those who are actively suicidal may be admitted to psychiatric care either voluntarily or involuntarily. Possessions that may be used to harm oneself are typically removed. Some clinicians get patients to sign
suicide prevention contract A suicide prevention contract is a contract that contains an agreement not to die by suicide. It was historically used by health professionals dealing with depressive clients. Typically, the client was asked to agree to talk with the professional p ...
s where they agree to not harm themselves if released. However, evidence does not support a significant effect from this practice. If a person is at low risk, outpatient mental health treatment may be arranged. Short-term hospitalization has not been found to be more effective than community care for improving outcomes in those with borderline personality disorder who are chronically suicidal. There is tentative evidence that
psychotherapy Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome pro ...
, specifically dialectical behaviour therapy, reduces suicidality in adolescents as well as in those with borderline personality disorder. It may also be useful in decreasing suicide attempts in adults at high risk. However, a decrease in suicide has not been observed. There is controversy around the benefit-versus-harm of
antidepressant Antidepressants are a class of medication used to treat major depressive disorder, anxiety disorders, chronic pain conditions, and to help manage addictions. Common side-effects of antidepressants include dry mouth, weight gain, dizziness, hea ...
s. In young persons, some antidepressants, such as
SSRIs Selective serotonin reuptake inhibitors (SSRIs) are a class of drugs that are typically used as antidepressants in the treatment of major depressive disorder, anxiety disorders, and other psychological conditions. SSRIs increase the extracellul ...
, appear to increase the risk of suicidality from 25 per 1000 to 40 per 1000. In older persons, however, they may decrease the risk.
Lithium Lithium (from el, λίθος, lithos, lit=stone) is a chemical element with the symbol Li and atomic number 3. It is a soft, silvery-white alkali metal. Under standard conditions, it is the least dense metal and the least dense solid el ...
appears effective at lowering the risk in those with bipolar disorder and major depression to nearly the same levels as that of the general population.
Clozapine Clozapine is a psychiatric medication and is the first atypical antipsychotic (also called second-generation antipsychotic). It is primarily used to treat people with schizophrenia and schizoaffective disorders who have had an inadequate respo ...
may decrease the thoughts of suicide in some people with schizophrenia.
Ketamine Ketamine is a dissociative anesthetic used medically for induction and maintenance of anesthesia. It is also used as a recreational drug. It is one of the safest anesthetics, as, in contrast with opiates, ether, and propofol, it suppresses ne ...
, which is a
dissociative anaesthetic Dissociatives, colloquially dissos, are a subclass of hallucinogens which distort perception of sight and sound and produce feelings of detachment – dissociation – from the environment and/or self. Although many kinds of drugs are capable of ...
, seems to lower the rate of suicidal ideation. In the United States, health professionals are legally required to take reasonable steps to try to prevent suicide.


Epidemiology

Approximately 1.4% of people die by suicide, a mortality rate of 11.6 per 100,000 persons per year. Suicide resulted in 842,000 deaths in 2013 up from 712,000 deaths in 1990. Rates of suicide have increased by 60% from the 1960s to 2012, with these increases seen primarily in the developing world. Globally, /2009, suicide is the tenth leading cause of death. For every suicide that results in death there are between 10 and 40 attempted suicides. Suicide rates differ significantly between countries and over time. As a percentage of deaths in 2008 it was: Africa 0.5%, South-East Asia 1.9%, Americas 1.2% and Europe 1.4%. Rates per 100,000 were: Australia 8.6, Canada 11.1, China 12.7, India 23.2, United Kingdom 7.6, United States 11.4 and South Korea 28.9. It was ranked as the 10th leading cause of death in the United States in 2016 with about 45,000 cases that year. Rates have increased in the United States in the last few years, with the highest value being in 2017 (the most recent data). In the United States, about 650,000 people are seen in emergency departments yearly due to attempting suicide. The United States rate among men in their 50s rose by nearly half in the decade 1999–2010. Greenland, Lithuania, Japan, and Hungary have the highest rates of suicide. Around 75% of suicides occur in the developing world. The countries with the greatest absolute numbers of suicides are China and India, partly due to their large population size, accounting for over half the total. In China, suicide is the 5th leading cause of death. File:Death rate from suicides (IHME (1990 to 2016)), OWID.svg, Death rate from suicide per 100,000 as of 2017 File:Share of deaths from suicide, OWID.svg, Share of deaths from suicide, 2017


Sex and gender

Globally , death by suicide occurs about 1.8 times more often in males than females. In the
Western world The Western world, also known as the West, primarily refers to the various nations and state (polity), states in the regions of Europe, North America, and Oceania.
, males die three to four times more often by means of suicide than do females. This difference is even more pronounced in those over the age of 65, with tenfold more males than females dying by suicide. Suicide attempts and self-harm are between two and four times more frequent among females. Researchers have attributed the difference between suicide and attempted suicide among the sexes to males using more lethal means to end their lives. However, separating intentional suicide attempts from non-suicidal self-harm is not currently done in places like the United States when gathering statistics at the national level. China has one of the highest female suicide rates in the world and is the only country where it is higher than that of men (ratio of 0.9). In the
Eastern Mediterranean Eastern Mediterranean is a loose definition of the eastern approximate half, or third, of the Mediterranean Sea, often defined as the countries around the Levantine Sea. It typically embraces all of that sea's coastal zones, referring to communi ...
, suicide rates are nearly equivalent between males and females. The highest rate of female suicide is found in South Korea at 22 per 100,000, with high rates in
South-East Asia Southeast Asia, also spelled South East Asia and South-East Asia, and also known as Southeastern Asia, South-eastern Asia or SEA, is the geographical south-eastern region of Asia, consisting of the regions that are situated south of mainland ...
and the Western Pacific generally. A number of reviews have found an increased risk of suicide among
lesbian A lesbian is a Homosexuality, homosexual woman.Zimmerman, p. 453. The word is also used for women in relation to their sexual identity or sexual behavior, regardless of sexual orientation, or as an adjective to characterize or associate n ...
,
gay ''Gay'' is a term that primarily refers to a homosexual person or the trait of being homosexual. The term originally meant 'carefree', 'cheerful', or 'bright and showy'. While scant usage referring to male homosexuality dates to the late 1 ...
,
bisexual Bisexuality is a romantic or sexual attraction or behavior toward both males and females, or to more than one gender. It may also be defined to include romantic or sexual attraction to people regardless of their sex or gender identity, whi ...
, and
transgender A transgender (often abbreviated as trans) person is someone whose gender identity or gender expression does not correspond with their sex assigned at birth. Many transgender people experience dysphoria, which they seek to alleviate through tr ...
people. Among transgender persons, rates of attempted suicide are about 40% compared to a general population rate of 5%. This is believed to in part be due to social stigmatisation.


Age

In many countries, the rate of suicide is highest in the middle-aged or elderly. The absolute number of suicides, however, is greatest in those between 15 and 29 years old, due to the number of people in this age group. Worldwide, the average age of suicide is between age 30 and 49 for both men and women. This means that half of people who died by suicide were approximately age 40 or younger, and half were older. Suicidality is rare in children, but increases during the transition to adolescence. In the United States, the suicide death rate is greatest in Caucasian men older than 80 years, even though younger people more frequently attempt suicide. It is the second most common cause of death in adolescents and in young males is second only to accidental death. In young males in the developed world, it is the cause of nearly 30% of mortality. In the developing world rates are similar, but it makes up a smaller proportion of overall deaths due to higher rates of death from other types of
trauma Trauma most often refers to: *Major trauma, in physical medicine, severe physical injury caused by an external source *Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event *Traumatic inju ...
. In South-East Asia, in contrast to other areas of the world, deaths from suicide occur at a greater rate in young females than elderly females.


History

In
ancient Athens Athens is one of the oldest named cities in the world, having been continuously inhabited for perhaps 5,000 years. Situated in southern Europe, Athens became the leading city of Ancient Greece in the first millennium BC, and its cultural achieve ...
, a person who died by suicide without the approval of the state was denied the honors of a normal burial. The person would be buried alone, on the outskirts of the city, without a headstone or marker. However, it was deemed to be an acceptable method to deal with military defeat. In
Ancient Rome In modern historiography, ancient Rome refers to Roman civilisation from the founding of the city of Rome in the 8th century BC to the collapse of the Western Roman Empire in the 5th century AD. It encompasses the Roman Kingdom (753–509 B ...
, while suicide was initially permitted, it was later deemed a crime against the state due to its economic costs.
Aristotle Aristotle (; grc-gre, Ἀριστοτέλης ''Aristotélēs'', ; 384–322 BC) was a Greek philosopher and polymath during the Classical period in Ancient Greece. Taught by Plato, he was the founder of the Peripatetic school of phil ...
condemned all forms of suicide while
Plato Plato ( ; grc-gre, Πλάτων ; 428/427 or 424/423 – 348/347 BC) was a Greek philosopher born in Athens during the Classical period in Ancient Greece. He founded the Platonist school of thought and the Academy, the first institution ...
was ambivalent. In Rome, some reasons for suicide included volunteering death in a
gladiator A gladiator ( la, gladiator, "swordsman", from , "sword") was an armed combatant who entertained audiences in the Roman Republic and Roman Empire in violent confrontations with other gladiators, wild animals, and condemned criminals. Some gla ...
combat, guilt over murdering someone, to save the life of another, as a result of mourning, from shame from being raped, and as an escape from intolerable situations like physical suffering, military defeat, or criminal pursuit. Suicide came to be regarded as a
sin In a religious context, sin is a transgression against divine law. Each culture has its own interpretation of what it means to commit a sin. While sins are generally considered actions, any thought, word, or act considered immoral, selfish, s ...
in
Christian Europe Christendom historically refers to the Christian states, Christian-majority countries and the countries in which Christianity dominates, prevails,SeMerriam-Webster.com : dictionary, "Christendom"/ref> or is culturally or historically intertwine ...
and was condemned at the
Council of Arles (452) Arles (ancient Arelate) in the south of Roman Gaul (modern France) hosted several councils or synods referred to as ''Concilium Arelatense'' in the history of the early Christian church. Council of Arles in 314 The first council of Arles"Arles, ...
as the work of the
Devil A devil is the personification of evil as it is conceived in various cultures and religious traditions. It is seen as the objectification of a hostile and destructive force. Jeffrey Burton Russell states that the different conceptions of t ...
. In the
Middle Ages In the history of Europe, the Middle Ages or medieval period lasted approximately from the late 5th to the late 15th centuries, similar to the post-classical period of global history. It began with the fall of the Western Roman Empire a ...
, the Church had drawn-out discussions as to when the desire for
martyrdom A martyr (, ''mártys'', "witness", or , ''marturia'', stem , ''martyr-'') is someone who suffers persecution and death for advocating, renouncing, or refusing to renounce or advocate, a religious belief or other cause as demanded by an external ...
was suicidal, as in the case of
martyrs of Córdoba The Martyrs of Córdoba were forty-eight Christian martyrs who were executed under the rule of Muslim administration in Al-Andalus (name of the Iberian Peninsula under the Islamic rule). The hagiographical treatise written by the Iberian Christ ...
. Despite these disputes and occasional official rulings, Catholic doctrine was not entirely settled on the subject of suicide until the later 17th century. A criminal ordinance issued by
Louis XIV of France , house = Bourbon , father = Louis XIII , mother = Anne of Austria , birth_date = , birth_place = Château de Saint-Germain-en-Laye, Saint-Germain-en-Laye, France , death_date = , death_place = Palace of Versa ...
in 1670 was extremely severe, even for the times: the dead person's body was drawn through the streets, face down, and then hung or thrown on a garbage heap. Additionally, all of the person's property was confiscated. Attitudes towards suicide slowly began to shift during the
Renaissance The Renaissance ( , ) , from , with the same meanings. is a period in European history marking the transition from the Middle Ages to modernity and covering the 15th and 16th centuries, characterized by an effort to revive and surpass ideas ...
.
John Donne John Donne ( ; 22 January 1572 – 31 March 1631) was an English poet, scholar, soldier and secretary born into a recusant family, who later became a clergy, cleric in the Church of England. Under royal patronage, he was made Dean of St Paul's ...
's work ''
Biathanatos ''Biathanatos'' (from Greek ''Βιαθανατος'' meaning "violent death") is a work by the English writer and clergyman John Donne. Written in 1608 and published after his death,. it contains a heterodox defense of "self-homicide" (suicide), l ...
'' contained one of the first modern defences of suicide, bringing proof from the conduct of Biblical figures, such as
Jesus Jesus, likely from he, יֵשׁוּעַ, translit=Yēšūaʿ, label=Hebrew/Aramaic ( AD 30 or 33), also referred to as Jesus Christ or Jesus of Nazareth (among other names and titles), was a first-century Jewish preacher and religious ...
,
Samson Samson (; , '' he, Šīmšōn, label= none'', "man of the sun") was the last of the judges of the ancient Israelites mentioned in the Book of Judges (chapters 13 to 16) and one of the last leaders who "judged" Israel before the institution o ...
and
Saul Saul (; he, , ; , ; ) was, according to the Hebrew Bible, the first monarch of the United Kingdom of Israel. His reign, traditionally placed in the late 11th century BCE, supposedly marked the transition of Israel and Judah from a scattered tri ...
, and presenting arguments on grounds of reason and nature to sanction suicide in certain circumstances. The
secularization In sociology, secularization (or secularisation) is the transformation of a society from close identification with religious values and institutions toward non-religious values and secular institutions. The ''secularization thesis'' expresses the ...
of society that began during the
Enlightenment Enlightenment or enlighten may refer to: Age of Enlightenment * Age of Enlightenment, period in Western intellectual history from the late 17th to late 18th century, centered in France but also encompassing (alphabetically by country or culture): ...
questioned traditional religious attitudes (such as
Christian views on suicide There has been much debate over the Christian views on suicide, with early Christians believing that suicide is sinful and an act of blasphemy. Modern Christians do not consider suicide an unforgivable sin (though still wrong and sinful) or someth ...
) toward suicide and brought a more modern perspective to the issue.
David Hume David Hume (; born David Home; 7 May 1711 NS (26 April 1711 OS) – 25 August 1776) Cranston, Maurice, and Thomas Edmund Jessop. 2020 999br>David Hume" ''Encyclopædia Britannica''. Retrieved 18 May 2020. was a Scottish Enlightenment philo ...
denied that suicide was a crime as it affected no one and was potentially to the advantage of the individual. In his 1777 ''Essays on Suicide and the Immortality of the Soul'' he rhetorically asked, "Why should I prolong a miserable existence, because of some frivolous advantage which the public may perhaps receive from me?" Hume's analysis was criticized by philosopher Philip Reed as being "uncharacteristically (for him) bad", since Hume took an unusually narrow conception of duty and his conclusion depended upon the suicide producing no harm to others – including causing no grief, feelings of guilt, or emotional pain to any surviving friends and family – which is almost never the case. A shift in public opinion at large can also be discerned; ''
The Times ''The Times'' is a British daily national newspaper based in London. It began in 1785 under the title ''The Daily Universal Register'', adopting its current name on 1 January 1788. ''The Times'' and its sister paper ''The Sunday Times'' (fou ...
'' in 1786 initiated a spirited debate on the motion "Is suicide an act of courage?". By the 19th century, the act of suicide had shifted from being viewed as caused by sin to being caused by
insanity Insanity, madness, lunacy, and craziness are behaviors performed by certain abnormal mental or behavioral patterns. Insanity can be manifest as violations of societal norms, including a person or persons becoming a danger to themselves or to ...
in Europe. Although suicide remained illegal during this period, it increasingly became the target of satirical comments, such as the
Gilbert and Sullivan Gilbert and Sullivan was a Victorian era, Victorian-era theatrical partnership of the dramatist W. S. Gilbert (1836–1911) and the composer Arthur Sullivan (1842–1900), who jointly created fourteen comic operas between 1871 and 1896, of which ...
comic opera Comic opera, sometimes known as light opera, is a sung dramatic work of a light or comic nature, usually with a happy ending and often including spoken dialogue. Forms of comic opera first developed in late 17th-century Italy. By the 1730s, a ne ...
''
The Mikado ''The Mikado; or, The Town of Titipu'' is a comic opera in two acts, with music by Arthur Sullivan and libretto by W. S. Gilbert, their ninth of fourteen Gilbert and Sullivan, operatic collaborations. It opened on 14 March 1885, in London, whe ...
'', which satirized the idea of executing someone who had already killed himself. By 1879, English law began to distinguish between suicide and homicide, although suicide still resulted in forfeiture of estate. In 1882, the deceased were permitted daylight burial in England and by the middle of the 20th century, suicide had become legal in much of the Western world. The term ''suicide'' first emerged shortly before 1700 to replace expressions on self-death which were often characterized as a form of self-murder in the West.


Social and culture


Legislation

No country in Europe currently considers suicide or attempted suicide to be a crime. It was, however, in most Western European countries from the Middle Ages until at least the 19th century. The Netherlands was the first country to legalize both physician-assisted suicide and euthanasia, which took effect in 2002, although only doctors are allowed to assist in either of them, and have to follow a protocol prescribed by Dutch law. If such protocol is not followed, it is an offence punishable by law. In Germany, active euthanasia is illegal and anyone present during suicide may be prosecuted for failure to render aid in an emergency. Switzerland has taken steps to legalize assisted suicide for the chronically mentally ill. The high court in
Lausanne , neighboring_municipalities= Bottens, Bretigny-sur-Morrens, Chavannes-près-Renens, Cheseaux-sur-Lausanne, Crissier, Cugy, Écublens, Épalinges, Évian-les-Bains (FR-74), Froideville, Jouxtens-Mézery, Le Mont-sur-Lausanne, Lugrin (FR-74), ...
, Switzerland, in a 2006 ruling, granted an anonymous individual with longstanding psychiatric difficulties the right to end his own life. England and Wales decriminalized suicide via the
Suicide Act 1961 The Suicide Act 1961 (9 & 10 Eliz 2 c 60) is an Act of the Parliament of the United Kingdom. It decriminalised the act of suicide in England and Wales so that those who failed in the attempt to kill themselves would no longer be prosecuted. Th ...
and the Republic of Ireland in 1993. The word "commit" was used in reference to its being illegal, but many organisations have stopped it because of the negative connotation. In the United States, suicide is not illegal, but may be associated with penalties for those who attempt it. Physician-assisted suicide is legal in the state of
Washington Washington commonly refers to: * Washington (state), United States * Washington, D.C., the capital of the United States ** A metonym for the federal government of the United States ** Washington metropolitan area, the metropolitan area centered on ...
for people with terminal diseases. In
Oregon Oregon () is a U.S. state, state in the Pacific Northwest region of the Western United States. The Columbia River delineates much of Oregon's northern boundary with Washington (state), Washington, while the Snake River delineates much of it ...
, people with terminal diseases may request medications to help end their life. Canadians who have attempted suicide may be barred from entering the United States. U.S. laws allow border guards to deny access to people who have a mental illness, including those with previous suicide attempts. In Australia, suicide is not a crime. However, it is a crime to counsel, incite, or
aid and abet Aiding and abetting is a legal doctrine related to the guilt of someone who aids or abets (encourages, incites) another person in the commission of a crime (or in another's suicide). It exists in a number of different countries and generally all ...
another in attempting to die by suicide, and the law explicitly allows any person to use "such force as may reasonably be necessary" to prevent another from taking their own life. The
Northern Territory The Northern Territory (commonly abbreviated as NT; formally the Northern Territory of Australia) is an states and territories of Australia, Australian territory in the central and central northern regions of Australia. The Northern Territory ...
of Australia briefly had legal physician-assisted suicide from 1996 to 1997. In India, suicide was illegal until 2014, and surviving family members used to face legal difficulties. It remains a criminal offense in most Muslim-majority nations.


Religious views


Christianity

Most forms of Christianity consider suicide sinful, based mainly on the writings of influential Christian thinkers of the Middle Ages, such as
St. Augustine Augustine of Hippo ( , ; la, Aurelius Augustinus Hipponensis; 13 November 354 – 28 August 430), also known as Saint Augustine, was a theologian and philosopher of Berber origin and the bishop of Hippo Regius in Numidia, Roman North Afri ...
and
St. Thomas Aquinas Thomas Aquinas, OP (; it, Tommaso d'Aquino, lit=Thomas of Aquino; 1225 – 7 March 1274) was an Italian Dominican friar and priest who was an influential philosopher, theologian and jurist in the tradition of scholasticism; he is known ...
, but suicide was not considered a sin under the
Byzantine The Byzantine Empire, also referred to as the Eastern Roman Empire or Byzantium, was the continuation of the Roman Empire primarily in its eastern provinces during Late Antiquity and the Middle Ages, when its capital city was Constantinopl ...
Christian
code of Justinian The Code of Justinian ( la, Codex Justinianus, or ) is one part of the ''Corpus Juris Civilis'', the codification of Roman law ordered early in the 6th century AD by Justinian I, who was Eastern Roman emperor in Constantinople. Two other units, t ...
, for instance. In
Catholic The Catholic Church, also known as the Roman Catholic Church, is the largest Christian church, with 1.3 billion baptized Catholics worldwide . It is among the world's oldest and largest international institutions, and has played a ...
and Orthodox doctrine, suicide is considered to be murder, violating the
commandment Commandment may refer to: * The Ten Commandments * One of the 613 mitzvot of Judaism * The Great Commandment * The New Commandment * ''Commandment'' (album), a 2007 album by Six Feet Under * ''Commandments'' (film), a 1997 film starring Aidan Qui ...
"Thou shalt not kill," and historically neither church would even hold a burial service for a member that died by suicide, deeming it an act that condemned the person to hell, since they died in a state of mortal sin. The basic idea being that life is a gift given by God which should not be spurned, and that suicide is against the "natural order" and thus interferes with God's master plan for the world. However, it is believed that mental illness or grave fear of suffering diminishes the responsibility of the one completing suicide.


Judaism

Judaism focuses on the importance of valuing this life, and as such, suicide is tantamount to denying God's goodness in the world. Despite this, under extreme circumstances when there has seemed no choice but to either be killed or forced to betray their religion, there are several accounts of Jews having died by suicide, either individually or in groups (see
Holocaust The Holocaust, also known as the Shoah, was the genocide of European Jews during World War II. Between 1941 and 1945, Nazi Germany and its collaborators systematically murdered some six million Jews across German-occupied Europe; a ...
,
Masada Masada ( he, מְצָדָה ', "fortress") is an ancient fortification in the Southern District of Israel situated on top of an isolated rock plateau, akin to a mesa. It is located on the eastern edge of the Judaean Desert, overlooking the Dea ...
, First French persecution of the Jews and
York Castle York Castle is a fortified complex in the city of York, England. It consists of a sequence of castles, prisons, law courts and other buildings, which were built over the last nine centuries on the south side of the River Foss. The now-ruined ...
for examples), and as a grim reminder there is even a prayer in the Jewish liturgy for "when the knife is at the throat", for those dying "to sanctify God's Name" (see
Martyrdom A martyr (, ''mártys'', "witness", or , ''marturia'', stem , ''martyr-'') is someone who suffers persecution and death for advocating, renouncing, or refusing to renounce or advocate, a religious belief or other cause as demanded by an external ...
). These acts have received mixed responses by Jewish authorities, regarded by some as examples of heroic martyrdom, while others state that it was wrong for them to take their own lives in anticipation of martyrdom.


Islam

Islamic religious views are against suicide. The
Quran The Quran (, ; Standard Arabic: , Classical Arabic, Quranic Arabic: , , 'the recitation'), also romanized Qur'an or Koran, is the central religious text of Islam, believed by Muslims to be a revelation in Islam, revelation from God in Islam, ...
forbids it by stating "do not kill or destroy yourself". The
hadith Ḥadīth ( or ; ar, حديث, , , , , , , literally "talk" or "discourse") or Athar ( ar, أثر, , literally "remnant"/"effect") refers to what the majority of Muslims believe to be a record of the words, actions, and the silent approval ...
s also state individual suicide to be unlawful and a sin. Stigma is often associated with suicide in Islamic countries.


Hinduism and Jainism

In Hinduism, suicide is generally disdained and is considered equally sinful as murdering another in contemporary Hindu society.
Hindu Scriptures Hindu texts are manuscripts and voluminous historical literature which are related to any of the diverse traditions within Hinduism. A few of these texts are shared across these traditions and they are broadly considered Hindu scriptures. These ...
state that one who dies by suicide will become part of the spirit world, wandering earth until the time one would have otherwise died, had one not taken one's own life. However, Hinduism accepts a man's right to end one's life through the non-violent practice of fasting to death, termed ''
Prayopavesa Prayopavesa ( sa, प्रायोपवेशनम्, IAST prāyopaveśanam, literally ''resolving to die through fasting'') is a practice in Hinduism that denotes the death by fasting of a person who has no desire or ambition left, and no r ...
''; but ''Prayopavesa'' is strictly restricted to people who have no desire or ambition left, and no responsibilities remaining in this life.
Jainism Jainism ( ), also known as Jain Dharma, is an Indian religions, Indian religion. Jainism traces its spiritual ideas and history through the succession of twenty-four tirthankaras (supreme preachers of ''Dharma''), with the first in the current ...
has a similar practice named ''
Santhara ''Sallekhana'' (IAST: ), also known as ''samlehna'', ''santhara'', ''samadhi-marana'' or ''sanyasana-marana'', is a supplementary vow to the ethical code of conduct of Jainism. It is the religious practice of voluntarily fasting to death by ...
''.
Sati Sati or SATI may refer to: Entertainment * ''Sati'' (film), a 1989 Bengali film by Aparna Sen and starring Shabana Azmi * ''Sati'' (novel), a 1990 novel by Christopher Pike *Sati (singer) (born 1976), Lithuanian singer *Sati, a character in ''Th ...
, or
self-immolation The term self-immolation broadly refers to acts of altruistic suicide, otherwise the giving up of one's body in an act of sacrifice. However, it most often refers specifically to autocremation, the act of sacrificing oneself by setting oneself o ...
by widows, is a rare and illegal practice in Hindu society.


Ainu

Within the
Ainu religion The Ainu are the indigenous people of the lands surrounding the Sea of Okhotsk, including Hokkaido Island, Tōhoku region, Northeast Honshu Island, Sakhalin Island, the Kuril Islands, the Kamchatka Peninsula and Khabarovsk Krai, before the arri ...
, someone who dies by suicide is believed to become a
ghost A ghost is the soul or spirit of a dead person or animal that is believed to be able to appear to the living. In ghostlore, descriptions of ghosts vary widely from an invisible presence to translucent or barely visible wispy shapes, to rea ...
(tukap) who would haunt the living,Takako Yamada: ''The Worldview of the Ainu. Nature and Cosmos Reading from Language'', p. 25–37, p. 123. to come to fulfillment from which they were excluded during life.Norbert Richard Adami: ''Religion und Schaminismus der Ainu auf Sachalin (Karafuto)'', Bonn 1989, p. 45. Also, someone who insults another so they kill themselves is regarded as co-responsible for their death.Adami: ''Religion und Schaminismus der Ainu auf Sachalin (Karafuto)'', p. 79, p. 119. According to Norbert Richard Adami, this ethic exists due to the case that solidarity within the community is much more important to Ainu culture than it is to the
Western world The Western world, also known as the West, primarily refers to the various nations and state (polity), states in the regions of Europe, North America, and Oceania.
.


Philosophy

A number of questions are raised within the philosophy of suicide, including what constitutes suicide, whether or not suicide can be a rational choice, and the moral permissibility of suicide. Arguments as to acceptability of suicide in moral or social terms range from the position that the act is inherently immoral and unacceptable under any circumstances, to a regard for suicide as a sacrosanct right of anyone who believes they have rationally and conscientiously come to the decision to end their own lives, even if they are young and healthy. Opponents to suicide include philosophers such as
Augustine of Hippo Augustine of Hippo ( , ; la, Aurelius Augustinus Hipponensis; 13 November 354 – 28 August 430), also known as Saint Augustine, was a theologian and philosopher of Berber origin and the bishop of Hippo Regius in Numidia, Roman North Af ...
,
Thomas Aquinas Thomas Aquinas, OP (; it, Tommaso d'Aquino, lit=Thomas of Aquino; 1225 – 7 March 1274) was an Italian Dominican friar and priest who was an influential philosopher, theologian and jurist in the tradition of scholasticism; he is known wi ...
,
Immanuel Kant Immanuel Kant (, , ; 22 April 1724 – 12 February 1804) was a German philosopher and one of the central Enlightenment thinkers. Born in Königsberg, Kant's comprehensive and systematic works in epistemology, metaphysics, ethics, and ...
and, arguably,
John Stuart Mill John Stuart Mill (20 May 1806 – 7 May 1873) was an English philosopher, political economist, Member of Parliament (MP) and civil servant. One of the most influential thinkers in the history of classical liberalism, he contributed widely to ...
– Mill's focus on the importance of liberty and autonomy meant that he rejected choices which would prevent a person from making future autonomous decisions. Others view suicide as a legitimate matter of personal choice. Supporters of this position maintain that no one should be forced to suffer against their will, particularly from conditions such as incurable disease, mental illness, and old age, with no possibility of improvement. They reject the belief that suicide is always irrational, arguing instead that it can be a valid last resort for those enduring major pain or trauma. A stronger stance would argue that people should be allowed to autonomously choose to die regardless of whether they are suffering. Notable supporters of this
school of thought A school of thought, or intellectual tradition, is the perspective of a group of people who share common characteristics of opinion or outlook of a philosophy, discipline, belief, social movement, economics, cultural movement, or art movement. H ...
include Scottish empiricist
David Hume David Hume (; born David Home; 7 May 1711 NS (26 April 1711 OS) – 25 August 1776) Cranston, Maurice, and Thomas Edmund Jessop. 2020 999br>David Hume" ''Encyclopædia Britannica''. Retrieved 18 May 2020. was a Scottish Enlightenment philo ...
, who accepted suicide so long as it did not harm or violate a duty to God, other people, or the self, and American bioethicist Jacob Appel.


Advocacy

Advocacy of suicide has occurred in many cultures and
subculture A subculture is a group of people within a culture that differentiates itself from the parent culture to which it belongs, often maintaining some of its founding principles. Subcultures develop their own norms and values regarding cultural, poli ...
s. The Japanese military during World War II encouraged and glorified kamikaze attacks, which were suicide attacks by military aviators from the
Empire of Japan The also known as the Japanese Empire or Imperial Japan, was a historical nation-state and great power that existed from the Meiji Restoration in 1868 until the enactment of the post-World War II 1947 constitution and subsequent fo ...
against
Allied An alliance is a relationship among people, groups, or states that have joined together for mutual benefit or to achieve some common purpose, whether or not explicit agreement has been worked out among them. Members of an alliance are called ...
naval vessels in the closing stages of the
Pacific Theater The Pacific Ocean is the largest and deepest of Earth's five oceanic divisions. It extends from the Arctic Ocean in the north to the Southern Ocean (or, depending on definition, to Antarctica) in the south, and is bounded by the continen ...
of World War II. Japanese society as a whole has been described as "suicide-tolerant" (see
Suicide in Japan In Japan, is considered a major social issue. In 2017, the country had the seventh highest suicide rate in the OECD, at 14.9 per 100,000 persons, and in 2019 the country had the second highest suicide rate among the G7 developed nations. Ho ...
). Internet searches for information on suicide return webpages that 10–30% of the time encourage or facilitate suicide attempts. There is some concern that such sites may push those predisposed over the edge. Some people form suicide pacts online, either with pre-existing friends or people they have recently encountered in chat rooms or
message boards An Internet forum, or message board, is an online discussion site where people can hold conversations in the form of posted messages. They differ from chat rooms in that messages are often longer than one line of text, and are at least temporar ...
. The Internet, however, may also help prevent suicide by providing a social group for those who are isolated.


Locations

Some landmarks have become known for high levels of suicide attempts. These include China's
Nanjing Yangtze River Bridge The Nanjing Yangtze River Bridge (), previously called the First Nanjing Yangtze Bridge, is a double-decked road-rail truss bridge across the Yangtze River in Nanjing, Jiangsu, connecting the city's Pukou and Gulou districts. Its upper deck i ...
, San Francisco's
Golden Gate Bridge The Golden Gate Bridge is a suspension bridge spanning the Golden Gate, the strait connecting San Francisco Bay and the Pacific Ocean. The structure links the U.S. city of San Francisco, California—the northern tip of the San Francisco Pen ...
, Japan's
Aokigahara Forest Aokigahara (), also known as the , is a forest on the northwestern flank of Mount Fuji on the island of Honshu in Japan, thriving on of hardened lava laid down by the last major eruption of Mount Fuji in 864 CE. The western edge of Aokigaha ...
, England's
Beachy Head Beachy Head is a chalk headland in East Sussex, England. It is situated close to Eastbourne, immediately east of the Seven Sisters. Beachy Head is located within the administrative area of Eastbourne Borough Council which owns the land, formin ...
, and
Toronto Toronto ( ; or ) is the capital city of the Canadian province of Ontario. With a recorded population of 2,794,356 in 2021, it is the most populous city in Canada and the fourth most populous city in North America. The city is the ancho ...
's
Bloor Street Viaduct The Prince Edward Viaduct System, commonly referred to as the Bloor Viaduct, is the name of a truss arch bridge system in Toronto, Ontario, Canada, connecting Bloor Street East, on the west side of the system, with Danforth Avenue on the east. The ...
. , the Golden Gate Bridge has had more than 1,300 suicides by jumping since its construction in 1937. Many locations where suicide is common have constructed barriers to prevent it; this includes the
Luminous Veil The Prince Edward Viaduct System, commonly referred to as the Bloor Viaduct, is the name of a truss arch bridge system in Toronto, Ontario, Canada, connecting Bloor Street East, on the west side of the system, with Danforth Avenue on the east. The ...
in Toronto, the
Eiffel Tower The Eiffel Tower ( ; french: links=yes, tour Eiffel ) is a wrought-iron lattice tower on the Champ de Mars in Paris, France. It is named after the engineer Gustave Eiffel, whose company designed and built the tower. Locally nicknamed "'' ...
in Paris, the
West Gate Bridge The West Gate Bridge is a steel, box girder, cable-stayed bridge in Melbourne, Victoria, Australia, spanning the Yarra River just north of its mouth into Port Phillip. It carries the West Gate Freeway and is a vital link between the inner ci ...
in Melbourne, and
Empire State Building The Empire State Building is a 102-story Art Deco skyscraper in Midtown Manhattan, New York City. The building was designed by Shreve, Lamb & Harmon and built from 1930 to 1931. Its name is derived from "Empire State", the nickname of the st ...
in New York City. They generally appear to be effective.


Notable cases

An example of
mass suicide Mass suicide is a form of suicide, occurring when a group of people simultaneously kill themselves. Overview Mass suicide sometimes occurs in religious settings. In war, defeated groups may resort to mass suicide rather than being captured. Su ...
is the 1978 Jonestown mass murder/suicide in which 909 members of the
Peoples Temple The Peoples Temple of the Disciples of Christ, originally Peoples Temple Full Gospel Church and commonly shortened to Peoples Temple, was an American new religious organization which existed between 1954 and 1978. Founded in Indianapolis, Ind ...
, an American
new religious movement A new religious movement (NRM), also known as alternative spirituality or a new religion, is a religious or spiritual group that has modern origins and is peripheral to its society's dominant religious culture. NRMs can be novel in origin or th ...
led by
Jim Jones James Warren Jones (May 13, 1931 – November 18, 1978) was an American preacher, political activist and mass murderer. He led the Peoples Temple, a new religious movement, between 1955 and 1978. In what he called "revolutionary suicide", ...
, ended their lives by drinking grape
Flavor Aid Flavor Aid is a non-carbonated soft drink beverage made by The Jel Sert Company in West Chicago, Illinois. It was introduced in 1929. It is sold throughout the United States as an unsweetened, powdered concentrate drink mix, similar to Kool-Ai ...
laced with
cyanide Cyanide is a naturally occurring, rapidly acting, toxic chemical that can exist in many different forms. In chemistry, a cyanide () is a chemical compound that contains a functional group. This group, known as the cyano group, consists of ...
and various prescription drugs. Thousands of Japanese civilians took their own lives in the last days of the
Battle of Saipan The Battle of Saipan was a battle of the Pacific campaign of World War II, fought on the island of Saipan in the Mariana Islands from 15 June to 9 July 1944 as part of Operation Forager. It has been referred to as the "Pacific D-Day" with th ...
in 1944, some jumping from "
Suicide Cliff Suicide Cliff is a cliff above Marpi Point Field near the northern tip of Saipan, Northern Mariana Islands, which achieved historic significance late in World War II. Also known as Laderan Banadero, it is a location where numerous Japanese civil ...
" and "
Banzai Cliff Banzai Cliff is a historical site at the northern tip of Saipan island in the Northern Mariana Islands, overlooking the Pacific Ocean. Towards the end of the Battle of Saipan in 1944, hundreds of Japanese civilians and soldiers (of the Imperial Ja ...
". The
1981 Irish hunger strike The 1981 Irish hunger strike was the culmination of a five-year protest during the Troubles by Irish republicanism, Irish republican prisoners in Northern Ireland. The protest began as the blanket protest in 1976, when the British government ...
s, led by
Bobby Sands Robert Gerard Sands ( ga, Roibeárd Gearóid Ó Seachnasaigh; 9 March 1954 – 5 May 1981) was a member (and leader in the Maze prison) of the Provisional Irish Republican Army (IRA) who died on hunger strike while imprisoned at HM Prison Maze ...
, resulted in 10 deaths. The cause of death was recorded by the coroner as "starvation, self-imposed" rather than suicide; this was modified to simply "starvation" on the death certificates after protest from the dead strikers' families. During World War II,
Erwin Rommel Johannes Erwin Eugen Rommel () (15 November 1891 – 14 October 1944) was a German field marshal during World War II. Popularly known as the Desert Fox (, ), he served in the ''Wehrmacht'' (armed forces) of Nazi Germany, as well as servi ...
was found to have foreknowledge of the
20 July plot On 20 July 1944, Claus von Stauffenberg and other conspirators attempted to assassinate Adolf Hitler, Führer of Nazi Germany, inside his Wolf's Lair field headquarters near Rastenburg, East Prussia, now Kętrzyn, in present-day Poland. The ...
on Hitler's life; he was threatened with
public trial Public trial or open trial is a trial that is open to the public, as opposed to a secret trial. It should not be confused with a show trial. United States The Sixth Amendment to the United States Constitution establishes the right of the accused ...
, execution, and reprisals on his family unless he killed himself.


Other species

As suicide requires a willful attempt to die, some feel it therefore cannot be said to occur in non-human animals. Suicidal behavior has been observed in ''
Salmonella ''Salmonella'' is a genus of rod-shaped (bacillus) Gram-negative bacteria of the family Enterobacteriaceae. The two species of ''Salmonella'' are ''Salmonella enterica'' and ''Salmonella bongori''. ''S. enterica'' is the type species and is fur ...
'' seeking to overcome competing bacteria by triggering an
immune system The immune system is a network of biological processes that protects an organism from diseases. It detects and responds to a wide variety of pathogens, from viruses to parasitic worms, as well as cancer cells and objects such as wood splinte ...
response against them. Suicidal defenses by workers are also noted in the Brazilian ant ''
Forelius pusillus ''Forelius pusillus'' is a species of ant in the genus ''Forelius''. Described by Santschi in 1922, the species is endemic to South America South America is a continent entirely in the Western Hemisphere and mostly in the Southern Hem ...
'', where a small group of ants leaves the security of the nest after sealing the entrance from the outside each evening.
Pea aphid ''Acyrthosiphon pisum'', commonly known as the pea aphid (and colloquially known as the green dolphin, pea louse, and clover louse), is a sap-sucking insect in the family Aphididae. It feeds on several species of legumes (plant family Fabaceae) w ...
s, when threatened by a
ladybug Coccinellidae () is a widespread family of small beetles ranging in size from . They are commonly known as ladybugs in North America and ladybirds in Great Britain. Some entomologists prefer the names ladybird beetles or lady beetles as they ...
, can explode themselves, scattering and protecting their brethren and sometimes even killing the ladybug; this form of suicidal
altruism Altruism is the principle and moral practice of concern for the welfare and/or happiness of other human beings or animals, resulting in a quality of life both material and spiritual. It is a traditional virtue in many cultures and a core as ...
is known as autothysis. Some species of
termite Termites are small insects that live in colonies and have distinct castes (eusocial) and feed on wood or other dead plant matter. Termites comprise the infraorder Isoptera, or alternatively the epifamily Termitoidae, within the order Blattode ...
s (for example ''
Globitermes sulphureus ''Globitermes sulphureus'' (suicidal attack ants) is a species of termite that is very common in central and southern Vietnam and also present in other areas of South East Asia, including Cambodia, Thailand, and Peninsular Malaysia. They live in ...
'') have soldiers that explode, covering their enemies with sticky goo. There have been anecdotal reports of dogs, horses, and dolphins killing themselves, but little scientific study of animal suicide. Animal suicide is usually put down to romantic human interpretation and is not generally thought to be intentional. Some of the reasons animals are thought to unintentionally kill themselves include: psychological stress, infection by certain parasites or fungi, or disruption of a long-held social tie, such as the ending of a long association with an owner and thus not accepting food from another individual.


See also

*
List of suicide crisis lines Suicide crisis lines can be found in many countries worldwide. Many are geared to a general audience while others are specific to a select demographic such as LGBTQIA+ youth, Native American and Aboriginal Canadian youth. There have been stu ...
*
List of countries by suicide rate The following are lists of countries by suicide rate as published by the World Health Organization (WHO) and other sources. About one person in 5,000–15,000 dies by suicide every year, with an estimated global rate of 10.5 per 100,000 popula ...


References


Further reading

* *


External links

* * *
Freakonomics ''Freakonomics: A Rogue Economist Explores the Hidden Side of Everything'' is the debut non-fiction book by University of Chicago economist Steven Levitt and ''New York Times'' journalist Stephen J. Dubner. Published on April 12, 2005, by Will ...
podcast A podcast is a program made available in digital format for download over the Internet. For example, an episodic series of digital audio or video files that a user can download to a personal device to listen to at a time of their choosing ...

The Suicide Paradox
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