At one point in my life, I seriously considered pursuing a career in therapy, psychiatric medicine, or psychology. But for most of my life, up to this very day, I’ve remained very interested in these topics, as well as human behavior in general.
I befriended or otherwise became exposed to many people with a range of traumatic experience, mental illnesses, and social problems. Though I could scarcely relate with the bulk of them, my bouts of anxiety and depression, coupled with my own sense of social exclusion, gave me a certain sense of affinity towards these individuals.
I guess I was just interested in what the outcastes of society had to say, and where they were coming from, given how taboo these issues are (cruelly, society’s inability to discuss them openly and normally only makes the problem worse).
The issue of suicide is one that particularly interests me. Part of it has to do with my fascination with death, but most of it stems from trying to understand how and why a person would come to do something that, for all intents and purposes, seems the most counterintuitive imaginable.
To that end, I’m compiled an amateur “study” of suicide based on what I’ve read across a range of sources, from Wikipedia to government health agencies. Note that I’m not presenting anything here as rock solid, as I frankly haven’t had the time to glean through the reliability of this data.
Furthermore, suicide – like most sociological and psychological topics – is still poorly understood and very hard to measure. I’m only sharing this to give people a rough idea of some of the clearer things we know, and to raise attention to this growing and underestimated problem.
Studying suicide can be very difficult, and not just because it’s a taboo subject (like everything related to death). The actual incidence of suicide will probably never be known, given that so many cases go unreported as a result of religious and social pressures. Even so, there are a few definitive trends that can still be gleaned from what we have been able to confirm.
A 2006 report by the World Health Organisation (WHO) states that nearly a million people take their own lives every year, and another 10 to 20 million make the attempt. This would mean that at least one person somewhere in the world takes their own life every 40 seconds. This would me that more people kill themselves than are killed in military conflicts – in fact, in many countries, the rate of suicide is higher than that of homicide. Suicide is anywhere from the 10th to 13th leading cause of death worldwide.
Suicide Rates Around the World
The rates of suicide by region and country vary wildly based on the data. Overall, it appears that the Baltic states, the former Soviet Union (especially the Slavic parts), andEast Asia have the highest rate of suicide. In some cases, the Pacific Islands, South Asia, and Sub-Saharan Africa also seem to top the list.
Western Europe, North America, and Oceania (namely Australia and New Zealand) are somewhere in the middle, while Latin America, the Caribbean, North Africa, Central Asia, and Muslim-majority countries have among the lowest. Overall, however, suicide rates have grown across the world, including in developing countries.
In terms of individual countries, Lithuania, Belarus, Ukraine, Russia, Japan, and South Korea generally top the charts as far as suicide rates. Other countries currently at the top of the list (again, depending on the source) include Guyana, Sri Lanka, Kazakhstan, Hungary, Slovenia, and China.
Contrary to popular belief, the Scandinavian nations do not have a particularly high rate of suicide, with the possible exception ofFinland(more on that later).
According to the National Institute of Mental Health, suicide contagion is a serious problem, especially for young people. A phenomenon known as the Werther Effect describes the tendency for copy-cat suicides to emerge following a well-publicized case of suicide on the media. The exact psychological and social mechanics of this are still unknown.
In the United States, males are four times more likely to die by suicide than females, although women are four times more likely to attempt it. The most recent data found that in the US, suicide was the 8th leading cause of death for males, and the 19th leading cause of death for females (in general, it may be the 6th leading cause of death for Americans).
This isn’t unique to the US however: male suicide rates are higher than females in all age groups, and among nearly all countries. The former Soviet Union sees a particularly high imbalance: the overwhelming majority of suicide victims are male (as high as 90% inBelarus, and close to it in Russia, Ukraine, and Lithuania).China is the only country in which the rate between men and women is more or less the same.
The reasons for this imbalance may have a lot to do with methodology, as males tend to use far more violent means to end their lives (such as firearms) then females (who generally prefer overdoses, which have a comparative lower chance of mortality than a gun).
It may also have to do with the social pressures that are placed upon men, who have higher expectations of being emotionally strong or financial independent: males generally take unemployment, infirmity, and other “signs of weakness” far worse then women, leading to more psychological distress and, subsequently, a higher rate of suicide.
Finally, there may be a biological aspect involved: testosterone generally leads to greater impulsivity and risk-taking (though not aggression, as is popularly believed). This tendency may lead men to reach the final tipping point in ending their lives.
Race, Ethnicity and Suicide
As of 2003, American whites were nearly 2.5 times more likely to kill themselves than were blacks or Hispanics. It’s unknown why suicide, and mental illness issues in general for that matter, seem to be more of an “Anglo” problem (similar racial discrepancies have been observed in other Anglophone countries such as the UK, Canada, and Australia).
Suicide rates are higher – and steadily increasing – among many East Asian Pacific-Island countries, despite the fact that Americans from these regions don’t have particularly high rates, thereby suggesting that domestic and social dynamics within those nations play a larger role.
I’ve read elsewhere that Native Americans, Multiracial Americans, and Filipino Americans have the highest risk of suicide, though I can’t confirm the veracity of this claim. It is certainly true that indigenous people in Anglo countries have higher rates of social and mental problems, which would put them at greater risk of suicide and other self-destructive behavior.
The Finno-Ugrian suicide hypothesis suggests that there may be some sort of genetic element that determines suicide risk. The Mari and Udmurts ethnic group have been found to have three times the suicide rate of closely related Finns and Hungarians, who also have relatively high rates. The genetic ties originating among Finno-Ugric these groups suggest that perhaps there is some sort of allele that predisposes people towards suicidal behavior.
Sexual Orientation and Suicide
LGBT people have a higher chance of suicide than heterosexuals and non-transgendered people. Additionally, lesbians are more likely to attempt than gay or bisexual males.
There’s also a dynamic regarding race and age: male whites have higher incidences up until the age of 25, after which their risk is down to less than half of what it was; black gays, on the other hand, will see their risk continue steadily past that point. Throughout a lifetime the risks are 5.7 times higher than heterosexuals for whites, and 12.8 for black gay and bisexual males.
With regards to lesbian and bisexual females, the opposite is true: there are less attempts in their youth compared to young heterosexual females. Throughout their lifetime the likelihood to attempt are nearly triple the youth ratio for Caucasian females, though for black females the rate is affected very little, as heterosexual black females have a slightly higher risk throughout most of the age-based study.
Gay and lesbian youth who attempt suicide are disproportionately subject to anti-gay attitudes, lack the skills for coping with subsequent discrimination, isolation, and loneliness, and were more likely to experience family rejection than those who do not attempt suicide. Another study found that gay and bisexual youth who attempted suicide had more feminine gender roles, adopted an LGB identity at a young age, and were more likely than peers to report sexual abuse, drug abuse, and arrests for misconduct.
In other words, being homosexual in itself doesn’t raise the risk, but the way your loved ones – and society as a whole – regard it. Homosexuals who feel accepted are obviously going to suffer less abuse, and thus psychological trauma, than those who don’t.
On the other hand, one study among Norwegians found that homosexual behavior, but not homosexual attraction or homosexual identity, was the determining factor for suicide among adolescents. InDenmark, the suicide risk for men in registered domestic partnerships was nearly eight times greater than for men with in healthy heterosexual marriage, and nearly twice as high for men who had never married. Given the biological origins of homosexuality, it’s possible that certain psychological factors are congenital with those that influence sexuality.
Risk Factors of Suicide
Clinical studies have shown that underlying mental disorders are present in 87% to 98% of suicides; however, there are numerous factors that correlation with (though may not necessarily cause) suicide risk, including drug addiction, availability of means, family history of suicide, or even brain injury.
Suicide rates rise during times of economic uncertainty, and although poverty is not a direct cause, it can contribute to the risk of suicide given that depression rates are high among the poor. Most studies show a relationship between suicide or suicidal behavior, and socio-economic distress, which includes low educational achievement, homelessness, unemployment, economic dependency (whether on loved ones or the state), and brush ups with the law. A history of childhood physical or sexual abuse, and time spent in foster care, are also factors.
One study among prison inmates found that suicide rates were higher among those who had committed a violent crime. It’s possible that the trauma of violence, or the preexisting mental problems that lead to violent behavior, influence “self-violence” as well, in the form of suicide and other destructive behavior.
Despair, a belief that there is no prospect of improvement in one’s situation, is a strong indicator of suicide, with the results of one study showing that 91% of those who scored a 10 or higher on the Beck Hopelessness Scale would eventually commit suicide.
A feeling that one’s existence is a burden to others, namely caregivers and loved ones, is often coupled with despair. In fact, several studies have found this sentiment to be a very prominent risk factor: it is believed that the lethality of a suicide is higher when it is done out of “altruism” – e.g. removing the burden on others – then when driven by other factors. In a similar vein, non-lethal self-injuries, be they self-injury or para-suicide, are characterized by feelings of anger or self-punishment. It’s sad to imagine that our capacity for caring about one another is strong enough to be the greatest incentive for taking our own lives.
Loneliness is a major factor in suicide, whether it is emotional (feeling isolated) or real (living alone or lacking friends and a social network). After despair and burdensomeness, a feeling of not belonging is strongly present in those expressing suicidal ideation.
Intelligence may also be a factor, as a relationship between high IQ and suicide has been found in a number of studies. This fits with the wider pattern of intelligent people having higher rates of depression and psychological distress. A classical argument is that it takes a certain amount of intelligence to commit suicide – existential contemplations, or an intimate understanding of the negative aspects of reality (war, poverty, etc), may drive someone into experiencing the feelings that precipitate suicide, such as despair. However, intelligence in itself is not an accurate predictor of suicide, as near as we can tell.
According to the American Psychiatric Association, “religiously unaffiliated subjects had significantly more lifetime suicide attempts and more first-degree relatives who committed suicide than subjects who endorsed a religious affiliation.” Moreover, individuals with no religious affiliation were found to have fewer moral objections to suicide than believers – unsurprising, given that nearly every religion treats suicide as a taboo (especially the Abrahamic ones).
However, it should be noted that the largely irreligious societies of countries such as Australia or Sweden do not have particularly high rates of suicide. It may be that, like homosexuals, the nonreligious experience higher rates of distress in environments where their identity is marginalized or isolated (such as in highly-religiousAmerica).
A significant link has been found between suicidal ideation and certain medical conditions such as chronic pain, physical disabilities, infirmity, and brain injury. Even after adjusting for other factors, such as depression, patients with these conditions still had a high risk of suicide. The risk is particularly greater when there are multiple conditions.
The most common medical conditions associated with psychiatric problems in general include, by order of frequency: infectious, pulmonary, thyroid, diabetic, hematopoietic, hepatic, and neurological diseases. At a minimum, around 10% of all psychological symptoms may be attributed to undiagnosed medical problems, and one study suggested that about 50% of individuals with a serious mental illness also suffer from an untreated that may contribute to or cause psychiatric problems. This has lead to the suggestion that general medical settings should also consider signs of suicidal ideation.
A lack of sleep, especially when resulting from chronic conditions such as insomnia and sleep apnea, have been cited in various studies as risk indicators for depression and suicide; in fact, sleep disturbances alone can increase the risk of suicide, a consequence of the mind’s impaired judgment and cognition resulting from a lack of rest.
Certain mental disorders are present in those that attempt or commit suicide – it is estimated that 87% to 98% of suicides are committed by people with some type of mental disorder. The most common are mood disorders like depression (accounting for 30% of cases), substance abuse (18%), schizophrenia (14%), and personality disorders (13%).
Unsurprisingly, depression (whether clinical or as part of bipolar disorder) is the most common factor in suicide attempts, and the risk is particularly high for those in the earlier stages of the condition. Depression along is among the most commonly diagnosed psychiatric disorder, affecting 17.6 million Americans (roughly 1 in 6 people) and millions more worldwide. If current trends persist, than within the next two decades, clinical depression may become the leading cause of disability in developed nations and the second leading cause of disability worldwide.
Though no longer classified as suicide attempts, incidences of self-harm have been correlated to increased suicide risk, though this may have less to do with causality and more to two with both suicide and self-injury being symptoms of broader depression. Deliberate self-harm and is most common in younger people, but recently begun rising among all age groups.
The majority of people who attempt suicide fail at their first try; but a history of suicide attempts leads to an increased likelihood that the individual will eventually succeed.
Some of the aforementioned mental disorders that increase suicide risk often have an underlying biological cause. The hormone serotonin is a vital neurotransmitter for facilitating brain function; those who have attempted suicide have been found to have below-normal serotonin levels, while those who succeeded had even less. An alteration in the serotonin activity in the ventromedial prefrontal cortex has been found to be a risk factor for suicide, regardless of other factors, including depression.
There is also a neurobiological basis for suicide risk that is independent of the genetic factors that cause high-risk mental disorders. A level of heritability has been found among suicidal individuals, so that a family history of suicide – especially if a parent has committed the act – raises the likelihood. This may also be related to epigenetics, in which environmental factors alter gene expression (but not genes themselves), leading to a change in one’s biology that increases suicide risk.
One explanation is that suicide may be informed by an evolutionary drive to benefit one’s kin. Similar to the burdensomeness factor, people who perceive their existence to be detrimental to their family may take their own lives to preserve their loved ones’ own wellbeing. However, many healthy or otherwise productive people commit suicide as well, so this explanation may insufficient, at least as far as addressing all causes of suicide.
Generally, higher levels of social and national cohesion reduce suicide rates. Suicide levels are highest among the retired, unemployed, impoverished, divorced, the childless, urbanites, empty nesters, and other people who live alone. However, it should be noted that even communitarian societies, such as those of East Asia, have high suicide rates, so social cohesion alone is not a sufficient predictor of risk.
Social attitudes towards death or suicide may also play a role: broadly speaking, Japan and Korea have a less taboo view of suicide than many Western nations do. Countries with high rates of death, such as much of the formerSoviet Union, may have a social milieu that places less value on life.
Believe it or not, war is traditionally believed to be associated with a fall in suicide rates, though this has been questioned in recent studies that show a more mixed influence. It’s certainly true that among those who are actually participating in war, suicide rates are higher, due to mounting psychological trauma and a military culture that is not conducive to expressions of “weakness.”
Substance Abuse and Suicide
In the United States 16.5% of suicides are related to alcohol, and alcoholics are 5 to 20 times more likely to kill themselves. In fact, about 15% of alcoholics commit suicide, and about 33% of suicide by people under 35 is tied or alcohol or substance abuse – over 50% of all suicides in general are related to alcohol or drug dependence. This correlation is particularly pronounced among adolescents, as alcohol or drug misuse plays a role in up to 70% of their suicides. The misuse of any drug increases the risk 10 to 20 times among all groups.
Time and Season
The idea that suicide is more common during the winter holidays, particularly Christmas, is actually a myth, generally reinforced by a confirmation bias among the media: suicides during this period are given disproportionate attention, most likely because the act is more sensationalized and tragic given the pervasive holiday spirit.
On the contrary, the National Center for Health Statistics found that suicides drop during the winter months, and peak during spring and early summer. Considering that there is a correlation between the winter season and rates of depression, there are theories that this might be accounted for by capability to commit suicide and relative cheerfulness – people commit suicide after the long period of depression from the proceeding winter.
The variation in suicides by day of week is actually greater than any seasonal variation. In the United States, more people die by suicide on Monday than any other day, while Saturday is the day with the least number of suicides.
Certain time trends can be related to the type of death. In the United Kingdom, for example, the steady rise in suicides from 1945 to 1963 was thereafter reduced to some extent by the removal of carbon monoxide from domestic gas supplies, which occurred with the change from coal gas to natural gas during the 1960s.
Cultural Variations in Methodology
Methods vary across cultures, depending on the access to certain lethal substances and means. In the United States for example, self-inflicted death by firearm is the most common method, due to the wide availability of guns. In many developing countries, the use of pesticides is more popular, due to the abundance of agricultural activity.
Weight and Body Type
Apparently, suicide rates are markedly lower among obese people, and the risk of suicide seems to decline as one’s weight increase. It’s unknown why this is the case, but it’s been hypothesized that a larger body weight leads to a higher circulation of hormones such as tryptophan, serotonin, and leptin, all of which reduce impulsive behavior.
It is estimated that global annual suicide fatalities could rise to 1.5 million by 2020. As it stands, globally-speaking, suicide ranks among the three leading causes of death among those aged 15–44 years. As I noted earlier, it’s already the 10th to 13th leading cause of death in general.
Furthermore, suicide attempts are up to 20 times more frequent than completed suicide, suggesting the suicidal tendencies in general are rising. Once again, keep in mind that these are just the reported cases: many suicides could be deliberately or accidentally recorded as a result of unintentional injury.