Since 1970 the death rate for suicide has decreased from 13.1 suicides per one hundred thousand resident population to 10.9 deaths per one hundred thousand in 2002. (See Table 8.8.) In 2002 suicide ranked as the eighth-leading cause of death among males in the United States. (See Table 1.9 in Chapter 1.)
Who Commits Suicide?
Suicide occurs among all age, sex, racial, occupational, religious, and social groups. Table 8.8 lists the suicide death rates by age, sex, and race/ethnicity from 1950 to 2002. In 2002 suicide was the third-leading cause of death among people age fifteen to twenty-four; more
TABLE 8.7 Grading the level of evidence for efficacy of psychotropic drugs in children
| TABLE 8.7 | ||||||
|---|---|---|---|---|---|---|
| Grading the level of evidence for efficacy of psychotropic drugs in children | ||||||
| Category | Indication | Level of supporting data | Estimated frequency of use | |||
| Short-term efficacy | Long-term efficacy | Shor-term safety | Long-term safety | Rank | ||
| Key: A = ≥ 2 randomized controlled trials (RCTs) B = At least 1 RCT. C = Clinical opinion, case reports, and uncontrolled trials |
||||||
| SOURCE: "Figure 3-2. Grading the Level of Evidence for Efficacy of Psychotropic Drugs in Children," in Mental Health: A Report of the Surgeon General, U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, with NIH, 1999, http://www.surgeongeneral.gov/library/mentalhealth/chapter3/sec4.html (accessed January 19, 2006) | ||||||
| Stimulants | Attention deficit/hyperactivity disorder (ADHD) | A | B | A | A | 1 |
| Selective serotonin reuptake inhibitors | Major depression | B | C | A | C | |
| Obsessive-compulsive disorder (OCD) | A | C | A | C | 2 | |
| Anxiety disorders | C | C | C | C | ||
| Central adrenergic agonists | Tourette syndrome | B | C | B | C | |
| Attention deficit/hyperactivity disorder (ADHD) | C | C | C | C | 3 | |
| Valporoate and carbamazepine | Bipolar disorders | C | C | A | A | |
| Aggressive conduct | C | C | A | A | 4 | |
| Tricyclic antidepressants | Major depression | C | C | B | B | |
| Attention deficit/hyperactivity disorder (ADHD) | B | C | B | B | 5 | |
| Benzodiazepines | Anxiety disorders | C | C | C | C | 6 |
| Antipsychotics | Childhood schizophrenia and psychoses | B | C | C | B | |
| Tourette syndrome | A | C | B | B | 7 | |
| Lithium | Bipolar disorders | B | C | B | C | |
| Aggressive conduct | B | C | C | C | 8 | |
The number of completed suicides does not give a complete picture of the problem, because for every completed suicide there are many unsuccessful suicide attempts. For example, during the 1990s death rates for suicide declined, but in some age groups the rate of suicide attempts actually increased. Usually suicide attempts outnumber completed suicides by about eight to one. Among teens, however, the ratio is twenty-five to thirty attempts for every successful suicide. According to the NIMH, approximately one million teens go through "suicide crises" each year. Depression, substance abuse, physical abuse, and sexual abuse are risk factors for attempted suicide by adolescents.
The NIMH states that approximately four times as many men die by suicide than women do. This is despite the fact that women attempt suicide three times as often as men. Men make up about three-fourths of total suicides, and white males account for most of that number. Men use more deadly weapons than women—more than half shoot themselves (80% percent of all suicide deaths by firearm are white males), but gun use is increasing rapidly among people of both genders. In the younger age brackets for women (ages fifteen to twenty-four), more than half of those who completed a suicide used a gun.
In 2002 the suicide rate for white non-Hispanic males in the "all ages" category (21.4 per one hundred thousand population) was higher than the rate for males of other races and ethnicities in that age category. It was more than double the rate of African-American males (9.8 per one hundred thousand). American Indian/Alaska Native males had a suicide rate almost as high as that of white males (16.4 per one hundred thousand). This reflects the high suicide rate (27.9 per one hundred thousand) among the youngest (ages fifteen to twenty-four) and young to middle-aged (twenty-five to forty-four years) American Indian/Alaska Native males (26.8 per one hundred thousand). Although still relatively high, the suicide rate among the youngest American Indian/Alaska Native males (ages fifteen to twenty-four) has decreased by almost half from its peak of 49.1 per one hundred thousand in 1990. Between 1950 and 2002, suicide rates among young (fifteen to twenty-four years old) white and African-American men increased dramatically—from 4.9 to 11.3 per one hundred thousand population for African-American males. (See Table 8.8.)
Among older white males, the suicide rate in 2002 was far higher than for any other racial group. Non-Hispanic white males age sixty-five and older had death rates from suicide (35.1 per one hundred thousand) three times higher than the rates for African-American males (11.7 per one hundred thousand). (See Table 8.8.)
For white and African-American women, the suicide rates were far lower than those for men in all age groups.
TABLE 8.8 Death rates for suicide, by sex, race, Hispanic origin, and age, selected years 1950–2002
| TABLE 8.8 | ||||||||
|---|---|---|---|---|---|---|---|---|
| Death rates for suicide, by sex, race, Hispanic origin, and age, selected years 1950–2002 | ||||||||
| [Data are based on death certificates] | ||||||||
| Sex, race, Hispanic origin, and age | 1950a | 1960a | 1970 | 1980 | 1990 | 2000 | 2001 | 2002 |
| All persons | Deaths per100,000 resident population | |||||||
| All ages, age adjustedb | 13.2 | 12.5 | 13.1 | 12.2 | 12.5 | 10.4 | 10.7 | 10.9 |
| All ages, crude | 11.4 | 10.6 | 11.6 | 11.9 | 12.4 | 10.4 | 10.8 | 11.0 |
| Under 1 year | … | … | … | … | … | … | … | … |
| 1-4 years | … | … | … | … | … | … | … | … |
| 5-14 years | 0.2 | 0.3 | 0.3 | 0.4 | 0.8 | 0.7 | 0.7 | 0.6 |
| 15-24 years | 4.5 | 5.2 | 8.8 | 12.3 | 13.2 | 10.2 | 9.9 | 9.9 |
| 15-19 years | 2.7 | 3.6 | 5.9 | 8.5 | 11.1 | 8.0 | 7.9 | 7.4 |
| 20-24 years | 6.2 | 7.1 | 12.2 | 16.1 | 15.1 | 12.5 | 12.0 | 12.4 |
| 25-44 years | 11.6 | 12.2 | 15.4 | 15.6 | 15.2 | 13.4 | 13.8 | 14.0 |
| 25-34 years | 9.1 | 10.0 | 14.1 | 16.0 | 15.2 | 12.0 | 12.8 | 12.6 |
| 35-44 years | 14.3 | 14.2 | 16.9 | 15.4 | 15.3 | 14.5 | 14.7 | 15.3 |
| 45-64 years | 23.5 | 22.0 | 20.6 | 15.9 | 15.3 | 13.5 | 14.4 | 14.9 |
| 45-54 years | 20.9 | 20.7 | 20.0 | 15.9 | 14.8 | 14.4 | 15.2 | 15.7 |
| 55-64 years | 26.8 | 23.7 | 21.4 | 15.9 | 16.0 | 12.1 | 13.1 | 13.6 |
| 65 years and over | 30.0 | 24.5 | 20.8 | 17.6 | 20.5 | 15.2 | 15.3 | 15.6 |
| 65-74 years | 29.6 | 23.0 | 20.8 | 16.9 | 17.9 | 12.5 | 13.3 | 13.5 |
| 75-84 years | 31.1 | 27.9 | 21.2 | 19.1 | 24.9 | 17.6 | 17.4 | 17.7 |
| 85 years and over | 28.8 | 26.0 | 19.0 | 19.2 | 22.2 | 19.6 | 17.5 | 18.0 |
| Male | ||||||||
| All ages, age adjustedb | 21.2 | 20.0 | 19.8 | 19.9 | 21.5 | 17.7 | 18.2 | 18.4 |
| All ages, crude | 17.8 | 16.5 | 16.8 | 18.6 | 20.4 | 17.1 | 17.6 | 17.9 |
| Under 1 year | … | … | … | … | … | … | … | … |
| 1-4 years | … | … | … | … | … | … | … | … |
| 5-14 years | 0.3 | 0.4 | 0.5 | 0.6 | 1.1 | 1.2 | 1.0 | 0.9 |
| 15-24 years | 6.5 | 8.2 | 13.5 | 20.2 | 22.0 | 17.1 | 16.6 | 16.5 |
| 15-19 years | 3.5 | 5.6 | 8.8 | 13.8 | 18.1 | 13.0 | 12.9 | 12.2 |
| 20-24 years | 9.3 | 11.5 | 19.3 | 26.8 | 25.7 | 21.4 | 20.5 | 20.8 |
| 25-44 years | 17.2 | 17.9 | 20.9 | 24.0 | 24.4 | 21.3 | 22.1 | 22.2 |
| 25-34 years | 13.4 | 14.7 | 19.8 | 25.0 | 24.8 | 19.6 | 21.0 | 20.5 |
| 35-44 years | 21.3 | 21.0 | 22.1 | 22.5 | 23.9 | 22.8 | 23.1 | 23.7 |
| 45-64 years | 37.1 | 34.4 | 30.0 | 23.7 | 24.3 | 21.3 | 22.5 | 23.5 |
| 45-54 years | 32.0 | 31.6 | 27.9 | 22.9 | 23.2 | 22.4 | 23.4 | 24.4 |
| 55-64 years | 43.6 | 38.1 | 32.7 | 24.5 | 25.7 | 19.4 | 21.1 | 22.2 |
| 65 years and over | 52.8 | 44.0 | 38.4 | 35.0 | 41.6 | 31.1 | 31.5 | 31.8 |
| 65-74 years | 50.5 | 39.6 | 36.0 | 30.4 | 32.2 | 22.7 | 24.6 | 24.7 |
| 75-84 years | 58.3 | 52.5 | 42.8 | 42.3 | 56.1 | 38.6 | 37.8 | 38.1 |
| 85 years and over | 58.3 | 57.4 | 42.4 | 50.6 | 65.9 | 57.5 | 51.1 | 50.7 |
| Female | ||||||||
| All ages, age adjustedb | 5.6 | 5.6 | 7.4 | 5.7 | 4.8 | 4.0 | 4.0 | 4.2 |
| All ages, crude | 5.1 | 4.9 | 6.6 | 5.5 | 4.8 | 4.0 | 4.1 | 4.3 |
| Under 1 year | … | … | … | … | … | … | … | … |
| 1-4 years | … | … | … | … | … | … | … | … |
| 5-14 years | 0.1 | 0.1 | 0.2 | 0.2 | 0.4 | 0.3 | 0.3 | 0.3 |
| 15-24 years | 2.6 | 2.2 | 4.2 | 4.3 | 3.9 | 3.0 | 2.9 | 2.9 |
| 15-19 years | 1.8 | 1.6 | 2.9 | 3.0 | 3.7 | 2.7 | 2.7 | 2.4 |
| 20-24 years | 3.3 | 2.9 | 5.7 | 5.5 | 4.1 | 3.2 | 3.1 | 3.5 |
| 25-44 years | 6.2 | 6.6 | 10.2 | 7.7 | 6.2 | 5.4 | 5.5 | 5.8 |
| 25-34 years | 4.9 | 5.5 | 8.6 | 7.1 | 5.6 | 4.3 | 4.4 | 4.6 |
| 35-44 years | 7.5 | 7.7 | 11.9 | 8.5 | 6.8 | 6.4 | 6.4 | 6.9 |
| 45-64 years | 9.9 | 10.2 | 12.0 | 8.9 | 7.1 | 6.2 | 6.6 | 6.7 |
| 45-54 years | 9.9 | 10.2 | 12.6 | 9.4 | 6.9 | 6.7 | 7.2 | 7.4 |
| 55-64 years | 9.9 | 10.2 | 11.4 | 8.4 | 7.3 | 5.4 | 5.7 | 5.7 |
| 65 years and over | 9.4 | 8.4 | 8.1 | 6.1 | 6.4 | 4.0 | 3.9 | 4.1 |
| 65-74 years | 10.1 | 8.4 | 9.0 | 6.5 | 6.7 | 4.0 | 3.9 | 4.1 |
| 75-84 years | 8.1 | 8.9 | 7.0 | 5.5 | 6.3 | 4.0 | 4.0 | 4.2 |
| 85 years and over | 8.2 | 6.0 | 5.9 | 5.5 | 5.4 | 4.2 | 3.4 | 3.8 |
| White malec | ||||||||
| All ages, age adjustedb | 22.3 | 21.1 | 20.8 | 20.9 | 22.8 | 19.1 | 19.6 | 20.0 |
| All ages, crude | 19.0 | 17.6 | 18.0 | 19.9 | 22.0 | 18.8 | 19.5 | 19.9 |
| 15-24 years | 6.6 | 8.6 | 13.9 | 21.4 | 23.2 | 17.9 | 17.6 | 17.7 |
| 25-44 years | 17.9 | 18.5 | 21.5 | 24.6 | 25.4 | 22.9 | 24.0 | 24.0 |
| 45-64 years | 39.3 | 36.5 | 31.9 | 25.0 | 26.0 | 23.2 | 24.7 | 25.9 |
| 65 years and over | 55.8 | 46.7 | 41.1 | 37.2 | 44.2 | 33.3 | 33.7 | 34.2 |
| 65-74 years | 53.2 | 42.0 | 38.7 | 32.5 | 34.2 | 24.3 | 26.3 | 26.8 |
| 75-84 years | 61.9 | 55.7 | 45.5 | 45.5 | 60.2 | 41.1 | 40.2 | 40.6 |
| 85 years and over | 61.9 | 61.3 | 45.8 | 52.8 | 70.3 | 61.6 | 55.0 | 53.9 |
| TABLE 8.8 | ||||||||
|---|---|---|---|---|---|---|---|---|
| Death rates for suicide, by sex, race, Hispanic origin, and age, selected years 1950–2002 [CONTINUED] | ||||||||
| [Data are based on death certificates] | ||||||||
| Sex, race, Hispanic origin, and age | 1950a | 1960a | 1970 | 1980 | 1990 | 2000 | 2001 | 2002 |
| Black or African American malec | Deaths per100,000 resident population | |||||||
| All ages, age adjustedb | 7.5 | 8.4 | 10.0 | 11.4 | 12.8 | 10.0 | 9.8 | 9.8 |
| All ages, crude | 6.3 | 6.4 | 8.0 | 10.3 | 12.0 | 9.4 | 9.2 | 9.1 |
| 15-24 years | 4.9 | 4.1 | 10.5 | 12.3 | 15.1 | 14.2 | 13.0 | 11.3 |
| 25-44 years | 9.8 | 12.6 | 16.1 | 19.2 | 19.6 | 14.3 | 14.4 | 15.1 |
| 45-64 years | 12.7 | 13.0 | 12.4 | 11.8 | 13.1 | 9.9 | 9.7 | 9.6 |
| 65 years and over | 9.0 | 9.9 | 8.7 | 11.4 | 14.9 | 11.5 | 11.5 | 11.7 |
| 65-74 years | 10.0 | 11.3 | 8.7 | 11.1 | 14.7 | 11.1 | 10.7 | 9.7 |
| 75-84 yearse | f | f | f | 10.5 | 14.4 | 12.1 | 13.5 | 13.8 |
| 85 years and over | — | f | f | f | f | f | f | f |
| American Indian or Alaska Native malec | ||||||||
| All ages, age adjustedb | — | — | — | 19.3 | 20.1 | 16.0 | 17.4 | 16.4 |
| All ages, crude | — | — | — | 20.9 | 20.9 | 15.9 | 17.0 | 16.8 |
| 15-24 years | 45.3 | 49.1 | 26.2 | 24.7 | 27.9 | |||
| 25-44 years | — | — | — | 31.2 | 27.8 | 24.5 | 27.6 | 26.8 |
| 45-64 years | — | — | — | f | f | 15.4 | 17.0 | 14.1 |
| 65 years and over | — | — | — | f | f | f | f | f |
| Asian or Pacific Islander malec | ||||||||
| All ages, age adjustedb | — | — | — | 10.7 | 9.6 | 8.6 | 8.4 | 8.0 |
| All ages, crude | — | — | — | 8.8 | 8.7 | 7.9 | 7.7 | 7.6 |
| 15-24 years | — | — | — | 10.8 | 13.5 | 9.1 | 9.1 | 8.7 |
| 25-44 years | — | — | — | 11.0 | 10.6 | 9.9 | 9.3 | 9.3 |
| 45-64 years | — | — | — | 13.0 | 9.7 | 9.7 | 8.2 | 9.1 |
| 65 years and over | — | — | — | 18.6 | 16.8 | 15.4 | 18.3 | 14.4 |
| Hispanic or Latino malec,e | ||||||||
| All ages, age adjustedb | — | — | — | — | 13.7 | 10.3 | 10.1 | 9.9 |
| All ages, crude | — | — | — | — | 11.4 | 8.4 | 8.3 | 8.3 |
| 15-24 years | — | — | — | — | 14.7 | 10.9 | 9.5 | 10.6 |
| 25-44 years | — | — | — | — | 16.2 | 11.2 | 11.8 | 10.9 |
| 45-64 years | — | — | — | — | 16.1 | 12.0 | 11.4 | 11.9 |
| 65 years and over | — | — | — | — | 23.4 | 19.5 | 18.5 | 17.5 |
| White, not Hispanic or Latino malee | ||||||||
| All ages, age adjustedb | — | — | — | — | 23.5 | 20.2 | 21.0 | 21.4 |
| All ages, crude | — | — | — | — | 23.1 | 20.4 | 21.4 | 21.9 |
| 15-24 years | 24.4 | 19.5 | 19.6 | 19.3 | ||||
| 25-44 years | — | — | — | — | 26.4 | 25.1 | 26.4 | 26.9 |
| 45-64 years | — | — | — | — | 26.8 | 24.0 | 25.9 | 27.2 |
| 65 years and over | — | — | — | — | 45.4 | 33.9 | 34.4 | 35.1 |
| White femalec | ||||||||
| All ages, age adjustedb | 6.0 | 5.9 | 7.9 | 6.1 | 5.2 | 4.3 | 4.5 | 4.7 |
| All ages, crude | 5.5 | 5.3 | 7.1 | 5.9 | 5.3 | 4.4 | 4.6 | 4.8 |
| 15-24 years | 2.7 | 2.3 | 4.2 | 4.6 | 4.2 | 3.1 | 3.1 | 3.1 |
| 25-44 years | 6.6 | 7.0 | 11.0 | 8.1 | 6.6 | 6.0 | 6.2 | 6.6 |
| 45-64 years | 10.6 | 10.9 | 13.0 | 9.6 | 7.7 | 6.9 | 7.3 | 7.5 |
| 65 years and over | 9.9 | 8.8 | 8.5 | 6.4 | 6.8 | 4.3 | 4.1 | 4.3 |
| Black or African American femalec | ||||||||
| All ages, age adjustedb | 1.8 | 2.0 | 2.9 | 2.4 | 2.4 | 1.8 | 1.8 | 1.6 |
| All ages, crude | 1.5 | 1.6 | 2.6 | 2.2 | 2.3 | 1.7 | 1.7 | 1.5 |
| 15-24 years | 1.8 | f | 3.8 | 2.3 | 2.3 | 2.2 | 1.3 | 1.7 |
| 25-44 years | 2.3 | 3.0 | 4.8 | 4.3 | 3.8 | 2.6 | 2.6 | 2.4 |
| 45-64 years | 2.7 | 3.1 | 2.9 | 2.5 | 2.9 | 2.1 | 2.6 | 2.1 |
| 65 years and over | f | f | 2.6 | f | 1.9 | 1.3 | 1.6 | 1.1 |
| American Indian or Alaska Native femalec | ||||||||
| All ages, age adjustedb | — | — | — | 4.7 | 3.6 | 3.8 | 4.0 | 4.1 |
| All ages, crude | — | — | — | 4.7 | 3.7 | 4.0 | 4.1 | 4.3 |
| 15-24 years | — | — | — | f | f | f | f | f |
| 25-44 years | — | — | — | 10.7 | f | 7.2 | 6.1 | 5.6 |
| 45-64 years | — | — | — | f | f | f | f | f |
| 65 years and over | — | — | — | f | f | f | f | f |
| TABLE 8.8 | ||||||||
|---|---|---|---|---|---|---|---|---|
| Death rates for suicide, by sex, race, Hispanic origin, and age, selected years 1950–2002 [CONTINUED] | ||||||||
| [Data are based on death certificates] | ||||||||
| Sex, race, Hispanic origin, and age | 1950a | 1960a | 1970 | 1980 | 1990 | 2000 | 2001 | 2002 |
| aIncludes deaths of persons who were not residents of the 50 states and the District of Columbia. | ||||||||
| bAge-adjusted rates are calculated using the year 2000 standard population. | ||||||||
| cThe race groups, white, block, Asian or Pacific Islander, and American Indian or Alaska Native, include persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race. Death rates for the American Indian or Alaska Native and Asian or Pacific Islander populations are known to be underestimated. | ||||||||
| dIn 1950 rate is for the age group 75 years and ove. | ||||||||
| ePrior to 1997, excludes data from states lacking an Hispanic-origin item on the death certificate. | ||||||||
| fRates based on fewer than 20 deaths are considered unreliable and are not shown. | ||||||||
| Notes: "…" = Category not applicable. "—" = Data not available. Figures for 2001 include September 11-related deaths for which death certificates were filed as of October 24, 2002. Age groups were selected to minimize the presentation of unstable age-specific death rates based on small numbers of deaths and for consistency among comparison groups. | ||||||||
| SOURCE: "Table 46. Death Rates for Suicide according to Sex, Race, Hispanic Origin, and Age: United States, Selected Years 1950–2002," in Health, United States, 2005, Centers for Disease Control and Prevention, National Center for Health Statistics, November 2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf (accessed January 3, 2006) | ||||||||
| Asian or Pacific Islander femalec | Deaths per100,000 resident population | |||||||
| All ages, age adjustedb | — | — | — | 5.5 | 4.1 | 2.8 | 2.9 | 3.0 |
| All ages, crude | — | — | — | 4.7 | 3.4 | 2.7 | 2.8 | 2.9 |
| 15-24 years | — | — | — | f | 3.9 | 2.7 | 3.6 | f |
| 25-44 years | — | — | — | 5.4 | 3.8 | 3.3 | 2.9 | 3.3 |
| 45-64 years | — | — | — | 7.9 | 5.0 | 3.2 | 3.8 | 3.8 |
| 65 years and over | — | — | — | f | 8.5 | 5.2 | 4.9 | 6.8 |
| Hispanic or Latino femalec,e | ||||||||
| All ages, age adjustedb | — | — | — | — | 2.3 | 1.7 | 1.6 | 1.8 |
| All ages, crude | ||||||||
| 15-24 years | — | — | — | — | 3.1 | 2.0 | 2.3 | 2.1 |
| 25-44 years | — | — | — | — | 3.1 | 2.1 | 2.0 | 2.0 |
| 45-64 years | — | — | — | — | 2.5 | 2.5 | 2.3 | 2.5 |
| 65 years and over | — | — | — | — | f | f | f | 1.9 |
| White, not Hispanic or Latino femalee | ||||||||
| All ages, age adjustedb | — | — | — | — | 5.4 | 4.7 | 4.9 | 5.1 |
| All ages, crude | — | — | — | — | 5.6 | 4.9 | 5.0 | 5.3 |
| 15-24 years | — | — | — | — | 4.3 | 3.3 | 3.3 | 3.4 |
| 25-44 years | — | — | — | — | 7.0 | 6.7 | 6.9 | 7.5 |
| 45-64 years | — | — | — | — | 8.0 | 7.3 | 7.8 | 8.0 |
| 65 years and over | — | — | — | — | 7.0 | 4.4 | 4.3 | 4.5 |
The death rate from suicide for non-Hispanic white women was 5.1 per one hundred thousand in 2002, and for African-American women the rate was less than a third that at 1.6 per one hundred thousand. Young non-Hispanic white women ages fifteen to twenty-four had a suicide rate (3.4 per one hundred thousand) about one-sixth the rate for non-Hispanic white men (19.3 per one hundred thousand) in the same age group. For African-American women of all ages, the rate (1.6 per one hundred thousand) was about one-sixth the African-American male rate (9.8 per one hundred thousand). (See Table 8.8.)
Female suicide rates do not change as drastically as men's do as they age. African-American women age sixty-five years and older had a suicide rate in 2002 of 1.1 per one hundred thousand, compared with 11.7 per one hundred thousand African-American men. For non-Hispanic white women age sixty-five and older, the rate was 4.5 per one hundred thousand in 2002, compared with the non-Hispanic white male rate of 35.1 per one hundred thousand. (See Table 8.8.) One widely held theory about the high rates among white men older than age sixty-five years is that these men, who traditionally have been in positions of power, have great difficulty adjusting to lives they may consider useless or diminished.
Other minority groups showed similar disparities between the suicide rates of women and men in 2002. American Indian/Alaska Native males (16.4 per one hundred thousand) had a suicide rate four times that of American Indian/Alaska Native females (4.1 per one hundred thousand). The suicide rate for Asian/Pacific Islander men was eight per one hundred thousand, whereas the rate for Asian/Pacific Islander women was three per one hundred thousand. Hispanic males had a rate of 9.9 per one hundred thousand. Hispanic females (1.8 per one hundred thousand) and African-American females (1.6 per one hundred thousand) had the lowest suicide rates. (See Table 8.8.)
Why Do People Commit Suicide?
People commit suicide for various reasons. Notes left by people who have killed themselves usually tell of life crises that they believed were unbearable. Many describe enduring chronic pain, losing loved ones, being unable to pay bills, or finding themselves incapable of living independently. Other commonly cited reasons are as follows:
- To punish loved ones
- To gain attention
- To join a deceased loved one
- To avoid punishment
- To express love
Some suicides are committed on an irrational, impulsive whim. Researchers observe that even among those most determined to commit suicide, the desire is not as much to die as it is to escape the lives they are leading and to end the pain they are suffering. Whatever the cause of their despair, they are desperately crying out for help.
Follow-up studies on suicide survivors reveal their intense ambivalence about actually dying. Not all survivors are glad to be alive, but for most, the attempted suicide marked a definite turning point. It was an urgent and dramatic signal that their problems demanded serious and immediate attention. Most of the survivors said that what they really wanted was to change their lives.
Suicide among the Terminally Ill
Not all suicides are categorized as the acts of people who are mentally ill. Some people consider suicides committed by people who are terminally ill as rational choices. They argue that a person who is terminally ill has the right to die, that is, the right to control the manner of their death. Until the late 1990s, people with cancer and AIDS were, of the terminally ill, the most likely to commit suicide. Patients with terminal diseases often worry that they will suffer long and painful deaths and that they stand a good chance of losing everything—health, independence, jobs, insurance, homes, and contact with loved ones and friends.
Researchers have found that factors with significant impact on the quality of life include security, family, love, pleasurable activity, and freedom from pain and suffering. Sufferers of debilitating disease may lose all of these. For some, suicide is a last recourse to relieve pain, suffering, insecurity, dependence, or hopelessness.
Suicide's Warning Signs
Researchers believe that most suicidal people convey their intentions to someone among their friends and family, either openly or indirectly. The people they signal are those who know them well and are in the best position to recognize the signs and give help. Comments such as "You'd be better off without me," "No one will have to worry about me much longer," or even a casual "I've had it" may be signals of upcoming attempts. Some people who are suicidal put their affairs in order. They draw up wills, give away prized possessions, or act as if they are preparing for a long trip. They may even talk about going away.
Often the indicator is a distinct change in personality or behavior. A normally happy person may become increasingly depressed. A regular churchgoer may stop attending services, or an avid runner may quit exercising. These types of changes, if added to expressions of worthlessness or hopelessness, can indicate not only that the person is seriously depressed but also that he or she may have decided on trying suicide. Although the vast majority of people who are depressed are not suicidal, most of the suicide-prone are depressed. Researchers and health care practitioners caution that suicide threats and attempts should not be discounted as harmless bids for attention. Anyone thinking, talking about, or planning suicide should receive immediate professional evaluation and treatment.
People who have a record of previous suicide attempts are at the highest risk of actually killing them-selves—more than six hundred times likelier than the general population. Between 20% and 50% of those who complete suicide have tried it before (Institute of Medicine, Reducing Suicide: A National Imperative, Washington, DC: National Academies Press, 2002).
The National Center for Injury Prevention and Control (NCIPC) of the CDC sponsors initiatives to raise public awareness of suicide and institutes strategies to reduce suicide deaths. Along with support for research about risk factors for suicide in the general population, NCIPC also addresses high-risk populations with programs such as the American Indian/Alaska Native Community Suicide Prevention Center and the Surgeon General's Call to Action—a blueprint for addressing suicide.
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