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Suicide Awareness Month

As many of you know, September is Suicide Awareness Month. As someone who lost a former family member to suicide, the pain is very real, especially when there are no answers as to WHY. The pain my family has been in for these last 4 months has been almost debilitating.

Every year, suicide is among the top 20 leading causes of death globally for all ages. Unfortunately, suicide is difficult to prevent, in large part because the prevalence of risk factors is high among the general population. Prevention strategies found to be effective in suicide prevention include means restriction, responsible media coverage, and general public education, as well identification methods such as screening, gatekeeper training, and primary care physician education. Although the treatment for preventing suicide is difficult, follow-up that includes pharmacotherapy, psychotherapy, or both may be useful. However, prevention methods cannot be restricted to the individual. Community, social, and policy interventions will also be essential.

The World Health Organization (WHO) defines suicide as the act of killing oneself. The act must be deliberately initiated and performed by the person concerned in the full knowledge, or expectation, of its fatal outcome1. Suicide is among the top 20 leading causes of death globally for all ages and every year, nearly one million people die from suicide. Worldwide, suicide ranks among the three leading causes of death among those aged 15–44 years, and the second leading cause of death in the 10–24 years age group2. The global suicide rate is 16 suicides per 100,000 inhabitants: more specifically 18 suicides per 100,000 males and 11 suicides per 100,000 females 2. Clinical studies have demonstrated that in most countries, suicide predominates in males, although there are important exceptions such as China. Of note, the suicide rate increases with age, although suicide rates among young people have been increasing to such an extent that they are now the group at highest risk in a third of countries, in both developed and developing countries. As well, there are marked differences in suicide rates between some ethnic groups and individual countries, and also within different regions of one country.

A suicide attempt is a self-inflicted, potentially injurious behavior with a nonfatal outcome for which there is evidence (either explicit or implicit) of intent to die 34. It is estimated that for every suicide, there are 50 suicide attempts, and thus attempts are a source of significant morbidity. Moreover, the Youth Risk Behavior Surveillance study suggests that as many as 7% of adolescents in the United States acknowledge having attempted suicide.

Identifying individuals at imminent risk for suicidal behavior is a major challenge for clinicians. In general, suicide is hard to predict because the prevalence of risk factors is high among the population, while suicide is rare. Indeed, only a minority of those with risk factors will commit suicide. Furthermore, some of the risk factors are not specific and of those who die by suicide, some are not in any risk group. Nonetheless, up to 90% of the people who commit suicide, and a similar rate of those who attempt suicide, suffer from a psychiatric disorder (affective illnesses, drugs/alcohol abuse, psychosis or personality disorders (5, 6, 7, 8). On the other hand, among psychiatric populations, suicidal behavior is not rare and the rate of attempts among psychiatric patients ranges between 15–50% 9.

Despite the challenges in identifying those at risk for suicidal behavior, opportunities for prevention do exist. In many cases, suicidal persons have been in contact with general practitioners in the month prior to their death (10, 11, 12), although, up to 80% of them were not treated for their psychiatric condition near the time of death 13,14,15. This contact with the medical profession may afford an opportunity for intervention.

Curr Psychiatry Rep. 2012 Dec; 14(6): 624–633.

doi: 10.1007/s11920-012-0318-3

PMCID: PMC3492539

NIHMSID: NIHMS409310

PMID: 22996297