Library Index :: Death and Dying: End-of-Life Controversies :: Euthanasia Suicide and Physician-Assisted Suicide - Background, Suicide, Euthanasia And Physician-assisted Suicide, Supporters Of Assisted Suicide, Assisted Suicide's Detractors

Euthanasia Suicide and Physician-Assisted Suicide - Suicide

Different Cultures and Religions

Different religions and cultures have viewed suicide in different ways. Ancient Romans who dishonored themselves or their families were expected to commit suicide in order to maintain their dignity and, frequently, the family property. Early Christians were quick to embrace martyrdom as a guarantee of eternal salvation, but during the fourth century St. Augustine discouraged the practice. He and later theologians were concerned that many Christians who were suffering in this world would see suicide as a reasonable and legitimate way to depart to a better place in the hereafter. The view of the Christian theologian St. Thomas Aquinas (circa 1225–74) is reflected in the contemporary Roman Catholic teaching that "suicide contradicts the natural inclination of the human being to preserve and perpetuate his life … and is contrary to love for the living God."

While Islam and Judaism also condemn the taking of one's own life, Buddhist monks and nuns have been known to commit suicide by self-immolation (burning themselves alive) as a form of social protest. In a ritual called suttee, which is now outlawed, widows in India showed devotion to their deceased husbands by being cremated with them, sometimes throwing themselves on the funeral pyres, although it was not always voluntary. Widowers (men whose wives had died), however, did not follow this custom.

Quasi-religious reasons sometimes motivate mass suicide. In 1978 more than nine hundred members of a group known as the People's Temple killed themselves in Jonestown, Guyana. In 1997 a group called Heaven's Gate also committed mass suicide in California. The devastating terrorist attacks of September 11, 2001, were the result of a suicidal plot enacted by religious extremist groups. Suicide bombings in other parts of the world have also been attributed to extremist groups that have twisted or misinterpreted the fundamental tenets of Islam to further their political objectives.

The Japanese people have traditionally associated a certain idealism with suicide. During the twelfth century, samurai warriors practiced voluntary seppuku (more commonly known as hara-kiri) or ritual self-disembowelment, to avoid dishonor at the hands of their enemies. Some samurai committed this form of slow suicide to atone for wrongdoing or to express devotion to a superior who had died. Even as recently as 1970, famed author Yukio Mishima publicly committed seppuku. During World War II, Japanese kamikaze pilots inflicted serious casualties with suicidal assaults in which they would purposely crash their planes into enemy ships, killing themselves along with enemy troops.

Suicide is still commonly practiced in modern Japan. In early 1998 several government officials and businessmen hanged themselves in separate incidents involving scandals that attracted public attention. The reasons given for the suicides ranged from proclaiming innocence to assuming responsibility for wrongdoing. In November 2005 the Daily Yomiuri newspaper (Tokyo) reported that government statistics showed that more than thirty thousand suicides had occurred in Japan each year from 1998 to 2004.

Suicide in America

With the exception of certain desperate medical situations, suicide in the United States is generally considered an unacceptable act, the end result of irrationality or severe depression. It is often referred to as a permanent solution to a short-term problem.

In spite of this generally held belief, suicide was the eleventh-leading cause of death in America in 2003. There were almost twice as many suicides as homicides that year. (See Table 4.1 in Chapter 4.) Nevertheless, since 1950 the national suicide rate has dropped from 13.2 suicides per one hundred thousand people to 10.9 per one hundred thousand in 2002. However, that rate is up from a low of 10.4 suicides per one hundred thousand in 2000. (See Table 6.1.)

TABLE 6.1 Death rates for suicide, by sex, race, Hispanic origin, and age, selected years 1950–2002

TABLE 6.1
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 per 100,000 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 6.1 Death rates for suicide, by sex, race, Hispanic origin, and age, selected years 1950–2002 [CONTINUED]

TABLE 6.1
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
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 yearsd * * * 10.5 14.4 12.1 13.5 13.8
    85 years and over * * * * * * *
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 * * 15.4 17.0 14.1
65 years and over * * * * *
Asian or Pacific 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
25-24 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 * 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 * * 2.6 * 1.9 1.3 1.6 1.1

The National Vital Statistics System (NVSS), which is a part of the Centers for Disease Control and Prevention (CDC), collects data from the fifty states, two cities (New York City and Washington, DC), and five territories (Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands). Each is responsible for registering vital events: births, deaths, marriages, divorces, and fetal deaths. Suicide data are compiled as part of the death data.

To add more specificity to violent death data, the CDC instituted the National Violent Death Reporting System (NVDRS) in 2003. The NVDRS is a state-based system that collects information on the numbers and

TABLE 6.1 Death rates for suicide, by sex, race, Hispanic origin, and age, selected years 1950–2002 [CONTINUED] "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 February 27, 2006)

TABLE 6.1
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
*Rates based on fewer than 20 deaths are considered unreliable and are not shown.
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, black, 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 over.
ePrior to 1997, excludes data from states lacking an Hispanic-origin item on the death certificate.
Notes: "…"=Category not applicable."—" = Data not available. Starting with, 2003, rates for 1991–99 were revised using intercensal population estimates based on census 2000. Rates for 2000 were revised based on census 2000 counts. Rates for 2001 and 2002 were computed using 2000-based postcensal estimates. 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 February 27, 2006)
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 * * * * 7.4
25-44 years 10.7 * 7.2 6.1 5.6
45-64 years * * * * *
65 years and over * * * * *
Asian or Pacific Islander femalec
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 * 3.9 2.7 3.6
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 * 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 2.2 1.5 1.5 1.6
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 * * * 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

kinds of violent deaths along with details regarding those deaths. Six states joined the NVDRS in 2003.

Figure 6.1 shows that suicide rates in the United States declined from 1993 to 1999, and then rose slightly between 2000 and 2002, falling again in 2003. (The 2003 data are not shown on Table 6.1.) The rate for the six NVDRS states is lower than the national rate, but rose from 2002 to 2003 when suicide rates were declining across the U.S.

Gopal K. Singh and Mohammad Siahpush compared the suicide rates in rural and urban populations in the United States. In "Increasing Rural-Urban Gradients in U.S. Suicide Mortality, 1970–1997" (American Journal of Public Health, vol. 92, no. 7, July 2002), Singh and Siahpush reported that the rate of suicide in rural populations of males increased between 1970 and 1997, while the rate of suicide in urban populations of males decreased over the same period. Although the rates are lower for females and the changes not as dramatic, a decrease was also noted in the suicide rate for urban females, while the suicide rate among rural females remained relatively stable.

In explaining these differences, Singh and Siahpush suggest that both rural and urban areas have experienced profound social and demographic changes during the past three decades. They contend, however, that change has affected life in rural areas more than in urban areas. Figure 6.1 Age-adjusted suicide rates, 1993–2003 Adapted from T.L. Serpi, et al., "Figure. Age-Adjusted Homicide and Suicide Rates, by Year—United States and Six NVDRS States, 2000–2003," in "Homicide and Suicide Rates—National Violent Death Reporting System, Six States, 2003," Morbidity and Mortality Weekly Report, vol. 54, no. 15, April 22, 2005, http://www.cdc.gov/mmwr/PDF/wk/mm5415.pdf (accessed December 7, 2005)They note that high levels of social isolation, as often occurs in rural areas, are correlated with high suicide rates.

Suicide among Young People

According to the American Association of Suicidology, the rate of suicide among young people increased 200% between the 1950s and 1990s. During the 1990s death rates for suicide declined, but in some age groups the rate of suicide attempts actually rose. In 2003 suicide was the third-leading cause of death among people ages fifteen to twenty-four. (See Table 4.2 in Chapter 4.) While females are more likely to attempt suicide, males are more likely to die from their attempts ("Youth Risk Behavior Surveillance—United States, 2003," Morbidity and Mortality Weekly Report, vol. 53, No. SS-2, May 21, 2004).

While the overall suicide rate among African-American youths has been relatively low in comparison with that of white males, the rate rose among African-American males between 1950 and 1990. (See Table 6.1.) By 1990 the death rate for suicide among African-American males ages twenty-five to forty-four years had risen to a high of 19.6 suicides per one hundred thousand. After 1990 the suicide rate for young African-American males steadily declined, and by 2000 it dropped to 14.3 per one hundred thousand. The rate rose slightly in 2001 to 14.4, and then rose more dramatically in 2002, to 15.1 per one hundred thousand.

Death rates for suicide rose for white males ages twenty-five to forty-four from 1950 through 1990. By 2000 the death rate had declined to 22.9, but it rose again to 24 in 2001 and 2002. (See Table 6.1.)

In 1990 the highest suicide death rate among youth ages fifteen to twenty-four was 49.1 suicides per one hundred thousand people among male American Indian or Alaska Natives. (See Table 6.1.) By 2001 this rate fell to 24.7 per one hundred thousand but rose again in 2002 to 27.9.

While death rates from suicide declined among young adults ages fifteen to nineteen between 1990 and 2002 (see Table 6.1), the percentage of high school students who attempted suicide increased from 7.3% in 1991 to 8.5% in 2003, peaking in 2001 at 8.8%. (See Table 6.2.) The percentage of students injured during a suicide attempt also rose from 1.7% in 1991 to 2.9% in 2003.

Table 6.3 shows that the percentage of high school students who attempted suicide was highest among ninth graders and decreased as grade level increased. The percentage of suicide attempts requiring medical attention followed the same pattern: a higher percentage of the suicide attempts of ninth graders required medical attention than did those of older students, and this percentage decreased as grade level increased. Hispanic students were the most likely to attempt suicide and white students the least likely. In addition, suicide attempts were highest among high school students living in Ohio, Texas, Michigan, and Kentucky. (See Table 6.4.)

The CDC also collects data on the percentage of high school students who feel sad or hopeless, who seriously consider attempting suicide, and who make a suicide plan. In 2003 nearly 30% of high school students in all grades felt sad or hopeless. Approximately 17% seriously considered attempting suicide, and 16% to 17% made a suicide plan. (See Table 6.5.) In 2003 the states in which more than 30% of high school students felt sad or hopeless were Arizona, Florida, Kentucky, Ohio, Texas, West Virginia, and Wyoming. (See Table 6.6.)

Figures 6.2 and 6.3 show the annual suicide rates among young people by method. The use of firearms was the method most frequently used by ten- to fourteen-year-olds from 1992 to 1996. In 1997 and from 1999 to 2001 suffocation (e.g. hanging) overtook firearms as the most frequently used method of suicide in this age group. Poisoning is the third most widely used method of suicide, although its use decreased from 1992 to 1996 and then somewhat stabilized by 2001. Other methods (for TABLE 6.2 Suicide ideation, attempts, and injuries among students in grades 9-12, by sex, grade level, race, and Hispanic origin, selected years 1991–2003example, jumping from high places such as bridges) were used infrequently from 1992 to 2001.

TABLE 6.2
Suicide ideation, attempts, and injuries among students in grades 9-12, by sex, grade level, race, and Hispanic origin, selected years 1991–2003
[Data are based on a national sample of high school students, grades 9-12]
Sex, grade level, race, and Hispanic origin 1991 1993 1995 1997 1999 2001 2003
Percent of students who seriously considered suicidea
    Total 29.0 24.1 24.1 20.5 19.3 19.0 16.9
Male
    Total 20.8 18.8 18.3 15.1 13.7 14.2 12.8
9th grade 17.6 17.7 18.2 16.1 11.9 14.7 11.9
10th grade 19.5 18.0 16.7 14.5 13.7 13.8 13.2
11th grade 25.3 20.6 21.7 16.6 13.7 14.1 12.9
12th grade 20.7 18.3 16.3 13.5 15.6 13.7 13.2
Not Hispanic or Latino:
    White 21.7 19.1 19.1 14.4 12.5 14.9 12.0
    Black or African American 13.3 15.4 16.7 10.6 11.7 9.2 10.3
Hispanic or Latino 18.0 17.9 15.7 17.1 13.6 12.2 12.9
Female
    Total 37.2 29.6 30.4 27.1 24.9 23.6 21.3
9th grade 40.3 30.9 34.4 28.9 24.4 26.2 22.2
10th grade 39.7 31.6 32.8 30.0 30.1 24.1 23.8
11th grade 38.4 28.9 31.1 26.2 23.0 23.6 20.0
12th grade 30.7 27.3 23.9 23.6 21.2 18.9 18.0
Not Hispanic or Latino:
    White 38.6 29.7 31.6 26.1 23.2 24.2 21.2
    Black or African American 29.4 24.5 22.2 22.0 18.8 17.2 14.7
Hispanic or Latino 34.6 34.1 34.1 30.3 26.1 26.5 23.4
Percent of students who attempted suicidea
    Total 7.3 8.6 8.7 7.7 8.3 8.8 8.5
Male
    Total 3.9 5.0 5.6 4.5 5.7 6.2 5.4
9th grade 4.5 5.8 6.8 6.3 6.1 8.2 5.8
10th grade 3.3 5.9 5.4 3.8 6.2 6.7 5.5
11th grade 4.1 3.4 5.8 4.4 4.8 4.9 4.6
12th grade 3.8 4.5 4.7 3.7 5.4 4.4 5.2
Not Hispanic or Latino:
    White 3.3 4.4 5.2 3.2 4.5 5.3 3.7
    Black or African American 3.3 5.4 7.0 5.6 7.1 7.5 7.7
Hispanic or Latino 3.7 7.4 5.8 7.2 6.6 8.0 6.1
Female
    Total 10.7 12.5 11.9 11.6 10.9 11.2 11.5
9th grade 13.8 14.4 14.9 15.1 14.0 13.2 14.7
10th grade 12.2 13.1 15.1 14.3 14.8 12.2 12.7
11th grade 8.7 13.6 11.4 11.3 7.5 11.5 10.0
12th grade 7.8 9.1 6.6 6.2 5.8 6.5 6.9
Not Hispanic or Latino:
    White 10.4 11.3 10.4 10.3 9.0 10.3 10.3
    Black or African American 9.4 11.2 10.8 9.0 7.5 9.8 9.0
Hispanic or Latino 11.6 19.7 21.0 14.9 18.9 15.9 15.0

Although the use of firearms to commit suicide dropped considerably in the fifteen- to nineteen-year-old age group, it was still the most frequently used method in 2001. (See Figure 6.3.) The use of suffocation to commit suicide increased slightly from 1992 to 2001. Poisoning and other methods of suicide ranked low in this age group during those years, as in the ten- to fourteen-year-old group. Poisoning declined in use from 1992 to 1997, and then stabilized. As a comparison, in the general population in 2002, 54% (17,108) of those who took their own lives used a firearm, 20% (6,462) used suffocation, and 17% (5,486) used poison. Other methods were used much less frequently. (See Table 6.7.)

The statistics in this section underscore the urgent need for prevention, education, and support programs to help teens and young adults at risk. The National Center for Injury Prevention and Control (NCIPC) sponsors initiatives to raise public awareness of suicide and institutes strategies to reduce suicide deaths. Along with supporting research about risk factors for suicide in the general population, NCIPC develops programs for high-risk populations.

SUICIDE AMONG GAY AND LESBIAN ADOLESCENTS

The suicide rate for gay and lesbian adolescents is dramatically higher than for the general adolescent

TABLE 6.2 Suicide ideation, attempts, and injuries among students in grades 9-12, by sex, grade level, race, and Hispanic origin, selected years 1991–2003 [CONTINUED] "Table 62. Suicidal Ideation, Suicide Attempts, and Injurious Suicide Attempts among Students in Grades 9-12, by Sex, Grade Level, Race, and Hispanic Origin: United States, Selected Years 1991–2003," 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 February 27, 2006)

TABLE 6.2
Suicide ideation, attempts, and injuries among students in grades 9-12, by sex, grade level, race, and Hispanic origin, selected years 1991–2003 [CONTINUED]
[Data are based on a national sample of high school students, grades 9-12]
Sex, grade level, race, and Hispanic origin 1991 1993 1995 1997 1999 2001 2003
aResponse is for the 12 months preceding the survey.
bA suicide attempt that required medical attention.
Notes: Only youths attending school participated in the survey. Persons of Hispanic origin may be of any race.
SOURCE: "Table 62. Suicidal Ideation, Suicide Attempts, and Injurious Suicide Attempts among Students in Grades 9-12, by Sex, Grade Level, Race, and Hispanic Origin: United States, Selected Years 1991–2003," 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 February 27, 2006)
Percent of students with an injurious suicide attempta,b
    Total 1.7 2.7 2.8 2.6 2.6 2.6 2.9
Male
    Total 1.0 1.6 2.2 2.0 2.1 2.1 2.4
9th grade 1.0 2.1 2.3 3.2 2.6 2.6 3.1
10th grade 0.5 1.3 2.4 1.4 1.8 2.5 2.1
11th grade 1.5 1.1 2.0 2.6 2.1 1.6 2.0
12th grade 0.9 1.5 2.2 1.0 1.7 1.5 1.8
Not Hispanic or Latino:
    White 1.0 1.4 2.1 1.5 1.6 1.7 1.1
    Black or African American 0.4 2.0 2.8 1.8 3.4 3.6 5.2
Hispanic or Latino 0.5 2.0 2.9 2.1 1.4 2.5 4.2
Female
    Total 2.5 3.8 3.4 3.3 3.1 3.1 3.2
9th grade 2.8 3.5 6.3 5.0 3.8 3.8 3.9
10th grade 2.6 5.1 3.8 3.7 4.0 3.6 3.2
11th grade 2.1 3.9 2.9 2.8 2.8 2.8 2.9
12th grade 2.4 2.9 1.3 2.0 1.3 1.7 2.2
Not Hispanic or Latino:
    White 2.3 3.6 2.9 2.6 2.3 2.9 2.4
    Black or African American 2.9 4.0 3.6 3.0 2.4 3.1 2.2
Hispanic or Latino 2.7 5.5 6.6 3.8 4.6 4.2 5.7

TABLE 6.3 Percentage of high school students who actually attempted suicide and whose suicide attempt required medical attention, by sex and race/ethnicity, and grade, 2003 Jo Anne Grunbaum, et al., "Table 18. Percentage of High School Students Who Actually Attempted Suicide and Whose Suicide Attempt Required Medical Attention, by Sex, Race/Ethnicity, and Grade—United States, Youth Risk Behavior Survey, 2003," in "Youth Risk Behavior Surveillance—United States, 2003," Morbidity and Mortality Weekly Report, vol. 53, no. SS-2, May 21, 2004, http://www.cdc.gov/mmwr/PDF/SS/SS5302.pdf (accessed November 9, 2005)

TABLE 6.3
Percentage of high school students who actually attempted suicide and whose suicide attempt required medical attention, by sex and race/ethnicity, and grade, 2003
Category Attempted Suicidea,b Suicide attempt required medical attentiona
Female Male Total Female Male Total
Percent Percent Percent Percent Percent Percent
aDuring the 12 months preceding the survey.
bOne or more times.
cNon-Hispanic.
SOURCE: Jo Anne Grunbaum, et al., "Table 18. Percentage of High School Students Who Actually Attempted Suicide and Whose Suicide Attempt Required Medical Attention, by Sex, Race/Ethnicity, and Grade—United States, Youth Risk Behavior Survey, 2003," in "Youth Risk Behavior Surveillance—United States, 2003," Morbidity and Mortality Weekly Report, vol. 53, no. SS-2, May 21, 2004, http://www.cdc.gov/mmwr/PDF/SS/SS5302.pdf (accessed November 9, 2005)
Race/ethnicity
Whitec 10.3 3.7 6.9 2.4 1.1 1.7
Blackc 9.0 7.7 8.4 2.2 5.2 3.7
Hispanic 15.0 6.1 10.6 5.7 4.2 5.0
Grade
 9 14.7 5.8 10.1 3.9 3.1 3.5
10 12.7 5.5 9.1 3.2 2.1 2.6
11 10.0 4.6 7.3 2.9 2.0 2.4
12 6.9 5.2 6.1 2.2 1.8 2.1
    Total 11.5 5.4 8.5 3.2 2.4 2.9

TABLE 6.4 Percentage of high school students who actually attempted suicide and whose suicide attempt required medical attention, by sex and selected U.S. sites, 2003

TABLE 6.4
Percentage of high school students who actually attempted suicide and whose suicide attempt required medical attention, by sex and selected U.S. sites, 2003
Site Attempted suicidea,b Suicide attempt required medical attentiona
Female Male Total Female Male Total
Percent Percent Percent Percent Percent Percent
State surveys
Alabama 10.7 3.8 7.3 3.9 1.4 2.6
Alaska 10.0 6.1 8.1 1.5 2.6 2.1
Arizona 11.2 4.2 7.8 3.6 1.2 2.5
Delaware 11.5 5.5 8.6 3.5 2.0 2.7
Florida 11.8 6.2 9.0 3.9 2.9 3.4
Georgia 8.7 8.2 8.5 3.0 3.0 3.0
Idaho 11.3 5.8 8.6 3.3 1.9 2.7
Indiana 8.1 5.1 6.6 2.2 1.1 1.6
Kentucky 10.3 9.8 10.3 3.6 3.4 3.7
Maine 12.1 5.3 9.0 3.7 2.0 2.9
Massachusetts 9.4 7.3 8.4 2.7 2.8 2.8
Michigan 12.9 7.8 10.5 3.9 2.4 3.2
Mississippi 8.5 4.1 6.6 2.8 2.1 2.5
Missouri 9.8 4.8 7.3 2.7 1.4 2.0
Montana 12.3 6.8 9.7 3.8 2.3 3.0
Nebraska 11.3 6.4 8.8 3.7 3.2 3.4
Nevada 11.9 5.9 8.8 3.7 2.2 2.9
New Hampshire 11.4 3.9 7.7 4.0 0.9 2.5
New York 9.7 3.7 6.8 2.7 1.5 2.1
North Carolina c c c c c c
North Dakota 8.9 5.2 7.2 2.8 2.6 2.8
Ohio 12.8 10.8 11.9 5.7 4.2 5.0
Oklahoma 8.3 5.8 7.0 3.3 1.4 2.4
Rhode Island 9.5 6.9 8.3 2.5 3.1 2.9
South Dakota 12.4 6.3 9.3 3.1 2.4 2.7
Tennessee 11.5 6.4 8.9 3.8 2.5 3.1
Texasd 13.5 7.5 10.6 3.7 2.8 3.3
Utah 8.8 6.2 7.5 1.5 2.5 2.0
Vermont 9.9 4.6 7.2 2.8 1.7 2.3
West Virginia 12.8 6.0 9.3 2.6 2.5 2.5
Wisconsin 11.8 4.7 8.2 3.8 1.1 2.5
Wyoming 12.9 5.5 9.1 4.1 2.7 3.4
   Median 11.3 5.9 8.5 3.5 2.4 2.7
   Range 8.1-13.5 3.7-10.8 6.6-11.9 1.5-5.7 0.9-4.2 1.6-5.0
Local surveyse
Boston PS, MA 9.1 8.6 8.9 2.9 2.4 2.6
Broward County PS, FL 10.7 6.0 8.5 3.3 2.3 2.9
Chicago PS, IL 13.4 10.4 12.1 3.7 5.4 4.7
Dallas ISD, TX 13.0 5.3 9.5 2.0 1.3 1.7
DeKalb County PS, GA 8.5 6.1 7.4 2.5 2.8 2.6
Detroit PS, MI 14.1 9.2 12.0 4.5 2.8 3.7
District of Columbia PS 12.2 12.0 12.1 2.2 4.8 3.5
Los Angeles USD, CA 17.5 5.0 11.4 4.5 1.4 3.0
Memphis PS, TN 11.2 7.1 9.3 3.8 2.7 3.3
Miami-Dade County PS, FL 12.5 5.9 9.3 3.7 1.8 2.8
Milwaukee PS, WI 11.4 10.3 10.9 3.8 3.0 3.4
New Orleans PS, LA 10.9 10.0 10.4 3.6 4.2 3.9
New York City PS, NY 11.3 5.1 8.4 2.2 1.5 1.9

population (S. McAndrew and R. Warne, "Ignoring the Evidence Dictating the Practice: Sexual Orientation, Suicidality and the Dichotomy of the Mental Health Nurse," Journal of Psychiatric and Mental Health Nursing, vol. 11, no. 4, 2004). Adolescence (the transition to adulthood) is often a difficult period. For gay and lesbian adolescents, this transition is compounded by having to come to terms with their sexuality in a society generally unaccepting of homosexuality.

At this period in their lives, when the need to confide in and gain acceptance from friends and family may be crucial, gay and lesbian adolescents are often torn between choices that do not necessarily meet either of these needs. Those who are open about their sexual orientation risk disappointing or even alienating their families and facing the hostility of their peers. Teens who choose not to disclose their homosexuality may suffer emotional distress because they have nowhere to turn for emotional support. In either scenario, despair, isolation, anger, guilt, and overwhelming depression may promote suicidal thoughts or actual suicide attempts.

TABLE 6.4 Percentage of high school students who actually attempted suicide and whose suicide attempt required medical attention, by sex and selected U.S. sites, 2003 [CONTINUED] Jo Anne Grunbaum, et al., "Table 19. Percentage of High School Students Who Actually Attempted Suicide and Whose Suicide Attempt Required Medical Attention, by Sex—Selected U.S. Sites, Youth Risk Behavior Survey, 2003," in "Youth Risk Behavior Surveillance—United States, 2003," Morbidity and Mortality Weekly Report, vol. 53, no. SS-2, May 21, 2004, http://www.cdc.gov/mmwr/PDF/SS/SS5302.pdf (accessed November 9, 2005)

TABLE 6.4
Percentage of high school students who actually attempted suicide and whose suicide attempt required medical attention, by sex and selected U.S. sites, 2003 [CONTINUED]
Site Attempted suicidea,b Suicide attempt required medical attentiona
Female Male Total Female Male Total
Percent Percent Percent Percent Percent Percent
aDuring the 12 months preceding the survey.
bOne or more times.
cNot available.
dSurvey did not include students from one of the state's large school districts.
ePS=public school, SD=school district, ISD independent school district, USD=unified school district.
SOURCE: Jo Anne Grunbaum, et al., "Table 19. Percentage of High School Students Who Actually Attempted Suicide and Whose Suicide Attempt Required Medical Attention, by Sex—Selected U.S. Sites, Youth Risk Behavior Survey, 2003," in "Youth Risk Behavior Surveillance—United States, 2003," Morbidity and Mortality Weekly Report, vol. 53, no. SS-2, May 21, 2004, http://www.cdc.gov/mmwr/PDF/SS/SS5302.pdf (accessed November 9, 2005)
Orange County PS, FL 12.1 6.4 9.3 4.1 2.8 3.5
Palm Beach County SD, FL 10.3 8.1 9.4 3.1 4.2 3.8
Philadelphia SD, PA 14.2 9.9 12.3 3.4 2.6 3.1
San Bernardino USD, CA 13.2 9.5 11.5 5.3 3.9 4.8
San Diego USD, CA 13.1 8.9 10.9 2.9 3.6 3.3
   Median 12.1 8.3 9.9 3.5 2.8 3.3
   Range 8.5-17.5 5.0-12.0 7.4-12.3 2.0-5.3 1.3-5.4 1.7-4.8

TABLE 6.5 Percentage of high school students who felt sad or hopeless, who seriously considered attempting suicide, and who made a suicide plan, by sex, race/ethnicity, and grade, 2003 Anne Grunbaum, et al., "Table 16. Percentage of High School Students Who Felt Sad or Hopeless, Who Seriously Considered Attempting Suicide, and Who Made a Suicide Plan, by Sex, Race/Ethnicity, and Grade—Youth Risk Behavior Survey, 2003," in "Youth Risk Behavior Surveillance—United States, 2003," Morbidity and Mortality Weekly Report, vol. 53, no. SS-2, May 21, 2004, http://www.cdc.gov/mmwr/PDF/SS/SS5302.pdf (accessed November 9, 2005)

TABLE 6.5
Percentage of high school students who felt sad or hopeless, who seriously considered attempting suicide, and who made a suicide plan, by sex, race/ethnicity, and grade, 2003
Category Felt sad or hopelessa,b Seriously considered attempting suicideb Made a suicide planb
Female Male Total Female Male Total Female Male Total
Percent Percent Percent Percent Percent Percent Percent Percent Percent
aFelt so sad or hopeless almost every day for ≥2 weeks in a row that they stopped doing some usual activities.
bDuring the 12 months preceding the survey.
cNon-Hispanic.
SOURCE: Anne Grunbaum, et al., "Table 16. Percentage of High School Students Who Felt Sad or Hopeless, Who Seriously Considered Attempting Suicide, and Who Made a Suicide Plan, by Sex, Race/Ethnicity, and Grade—Youth Risk Behavior Survey, 2003," in "Youth Risk Behavior Surveillance—United States, 2003," Morbidity and Mortality Weekly Report, vol. 53, no. SS-2, May 21, 2004, http://www.cdc.gov/mmwr/PDF/SS/SS5302.pdf (accessed November 9, 2005)
Race/ethnicity
Whitec 33.3 19.6 26.2 21.2 12.0 16.5 18.6 13.9 16.2
Blackc 30.8 21.7 26.3 14.7 10.3 12.5 12.4 8.4 10.4
Hispanic 44.9 25.9 35.4 23.4 12.9 18.1 20.7 14.6 17.6
Grade
 9 35.7 21.0 28.0 22.2 11.9 16.9 20.9 14.8 17.7
10 36.9 22.7 29.7 23.8 13.2 18.3 19.5 13.1 16.3
11 35.9 22.1 28.9 20.0 12.9 16.4 17.9 14.4 16.2
12 32.6 22.0 27.4 18.0 13.2 15.5 16.2 13.7 14.9
    Total 35.5 21.9 28.6 21.3 12.8 16.9 18.9 14.1 16.5

Exact data are not available for suicide rates of gay, lesbian, and bisexual teenagers because the sexual orientation of suicide victims often is unknown. But according to a 2006 study by the McCreary Center Society in British Columbia, Canada, lesbian teenagers are at particularly high risk of suicide ("Lesbian Teens Face Higher Risk of Suicide: Study," Toronto Star, June 2, 2006). In fact, the study found that suicide attempts among lesbian girls increased from one in five in 1992, to one in four in 1998, to one in three in 2003. In all, 38% of lesbian teenagers surveyed reported that they had attempted suicide in the past year, versus just 8.2% of heterosexual girls surveyed. Only 8.8% of gay male teenagers, and 3.3% of straight males, reported having attempted suicide in the past year, according to the survey.

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