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Wikipedia

Suicide

January 01, 1970

For information on prevention, see Suicide prevention. For other uses, see Suicide (disambiguation).

Suicide is the act of intentionally causing one's own death.[9] Mental disorders (including depression, bipolar disorder, schizophrenia, personality disorders, anxiety disorders, attention deficit hyperactivity disorder, cognitive disengagement syndrome), physical disorders (such as chronic fatigue syndrome), and substance abuse (including alcoholism and the use of and withdrawal from benzodiazepines) are risk factors.[2][3][5][10] Some suicides are impulsive acts due to stress (such as from financial or academic difficulties), relationship problems (such as breakups or divorces), or harassment and bullying.[2][11][12] Those who have previously attempted suicide are at a higher risk for future attempts.[2] Effective suicide prevention efforts include limiting access to methods of suicide such as firearms, drugs, and poisons; treating mental disorders and substance abuse; careful media reporting about suicide; improving economic conditions;[2][13] and dialectical behaviour therapy (DBT).[14] Although crisis hotlines are common resources, their effectiveness has not been well studied.[15][16]

Suicide
Le Suicidé by Édouard Manet
SpecialtyPsychiatry, clinical psychology, clinical social work
Usual onset15–30 and 70+ years old[1]
Risk factorsDepression, bipolar disorder, autism, schizophrenia, personality disorders, anxiety disorders, alcoholism, substance abuse[2][3][4][5]
PreventionLimiting access to methods of suicide, treating mental disorders and substance misuse, careful media reporting about suicide, improving social and economic conditions[2]
Frequency12 per 100,000 per year[6]
Deaths793,000 / 1.5% of deaths (2016)[7][8]
988 Suicide & Crisis Lifeline, a crisis line in the United States and Canada

The most commonly adopted method of suicide varies from country to country and is partly related to the availability of effective means.[17] Common methods of suicide include hanging, pesticide poisoning, and firearms.[2][18] Suicides resulted in 828,000 deaths globally in 2015, an increase from 712,000 deaths in 1990.[19][20][inconsistent] This makes suicide the 10th leading cause of death worldwide.[3][6]

Approximately 1.5% of all deaths worldwide are by suicide.[8] In a given year, this is roughly 12 per 100,000 people.[6] Rates of suicide are generally higher among men than women, ranging from 1.5 times higher in the developing world to 3.5 times higher in the developed world.[1] 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.[1] Europe had the highest rates of suicide by region in 2015.[21] There are an estimated 10 to 20 million non-fatal attempted suicides every year.[22] Non-fatal suicide attempts may lead to injury and long-term disabilities.[23] In the Western world, attempts are more common among young people and women.[23]

Views on suicide have been influenced by broad existential themes such as religion, honor, and the meaning of life.[24][25] The Abrahamic religions traditionally consider suicide as an offense towards God due to belief in the sanctity of life.[26] During the samurai era in Japan, a form of suicide known as seppuku (腹切り, harakiri) was respected as a means of making up for failure or as a form of protest.[27] Similarly, a ritual fast unto death, known as Vatakkiruttal (Tamil: வடக்கிருத்தல், Vaṭakkiruttal, 'fasting facing north'), was a Tamil ritual suicide in ancient India during the Sangam age.[28] Suicide and attempted suicide, while previously illegal, are no longer so in most Western countries.[29] It remains a criminal offense in some countries.[30] In the 20th and 21st centuries, suicide has been used on rare occasions as a form of protest; it may also be committed while or after murdering others, such as suicide attacks which have been used as both a military and terrorist tactic.[31] Suicide is often seen as a major catastrophe causing significant grief to the deceased's relatives, friends and community members, and it is viewed negatively almost everywhere around the world.[32][33][34]

Definitions

Main article: Suicide terminology

Suicide, derived from Latin suicidium, is "the act of taking one's own life".[9][35] Attempted suicide or non-fatal suicidal behavior amounts to self-injury with at least some desire to end one's life that does not result in death.[36][37] Assisted suicide occurs when one individual helps another bring about their own death indirectly via providing either advice or the means to the end.[38] This is in contrast to euthanasia, where another person takes a more active role in bringing about a person's death.[38]

Suicidal ideation is thoughts of ending one's life but not taking any active efforts to do so.[36] It may or may not involve exact planning or intent.[37] Suicidality is defined as "the risk of suicide, usually indicated by suicidal ideation or intent, especially as evident in the presence of a well-elaborated suicidal plan."[39]

In a murder–suicide (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.[40] Suicide in which the reason is that the person feels that they are not part of society is known as egoistic suicide.[41]

In 2011, in an article calling for changing the language used around suicide entitled "Suicide and language: Why we shouldn't use the 'C' word," the Centre for Suicide Prevention in Canada found that the normal verb in scholarly research and journalism for the act of suicide was commit, and argued for destigmatizing terminology related to suicide.[42][43] The American Psychological Association lists "committed suicide" as a term to avoid because it "frame[s] suicide as a crime".[44] Some advocacy groups recommend using the terms took his/her own life, died by suicide, or killed him/herself instead of committed suicide.[45][46][47] The Associated Press Stylebook recommends avoiding "committed suicide" except in direct quotes from authorities.[48] The Guardian and Observer style guides deprecate the use of "committed",[49] as does CNN.[50] Opponents of commit argue that it implies that suicide is criminal, sinful, or morally wrong.[51]

Risk factors

Precipitating circumstances in the US, 2017[52]
Categories Percentage
Diagnosed mental problem
 
 50%
Recent or upcoming crisis
 
 31%
Intimate partner problem
 
 27%
Physical health problem
 
 21%
Alcohol problem
 
 18%
Substance abuse (excluding alcohol)
 
 18%
Argument
 
 16%
Family problem
 
 10%
Job problem
 
 10%
Financial problem
 
 9%
Legal problem
 
 8%
Death of loved one
 
 7%
Suicide is multi-factorial. Multiple precipitating circumstances and risk factors can apply to the same person.

Factors that affect the risk of suicide include mental disorders, drug misuse, psychological states, cultural, family and social situations, genetics, experiences of trauma or loss, and nihilism.[53][54][16] Mental disorders and substance misuse frequently co-exist.[55] Other risk factors include having previously attempted suicide,[23] the ready availability of a means to take one's life, a family history of suicide, or the presence of traumatic brain injury.[56] For example, suicide rates have been found to be greater in households with firearms than those without them.[57]

Socio-economic problems such as unemployment, poverty, homelessness, and discrimination may trigger suicidal thoughts.[58][59] Suicide might be rarer in societies with high social cohesion and moral objections against suicide.[37] About 15–40% of people leave a suicide note.[60] War veterans have a higher risk of suicide due in part to higher rates of mental illness, such as post-traumatic stress disorder, and physical health problems related to war.[61] Genetics appears to account for between 38% and 55% of suicidal behaviors.[62] Suicides may also occur as a local cluster of cases.[63]

Most research does not distinguish between risk factors that lead to thinking about suicide and risk factors that lead to suicide attempts.[64][65] Risks for suicide attempt rather than just thoughts of suicide include a high pain tolerance and a reduced fear of death.[66]

Mental illness

Mental illness is present at the time of suicide 27% to more than 90% of the time.[67][23][68][69] Of those who have been hospitalized for suicidal behavior, the lifetime risk of suicide is 8.6%.[23][70] Comparatively, non-suicidal people hospitalized for affective disorders have a 4% lifetime risk of suicide.[70] Half of all people who die by suicide may have major depressive disorder; having this or one of the other mood disorders such as bipolar disorder increases the risk of suicide 20-fold.[71] Other conditions implicated include schizophrenia (14%), personality disorders (8%),[72][73] obsessive–compulsive disorder,[74] and post-traumatic stress disorder.[23] Those with autism also attempt and consider suicide more frequently.[75]

Others estimate that about half of people who die by suicide could be diagnosed with a personality disorder, with borderline personality disorder being the most common.[76] About 5% of people with schizophrenia die of suicide.[77] Eating disorders are another high risk condition.[78] Around 22% to 50% of people suffering with gender dysphoria have attempted suicide, however this greatly varies by region.[79][80][81][82][83]

Among approximately 80% of suicides, the individual has seen a physician within the year before their death,[84] including 45% within the prior month.[85] Approximately 25–40% of those who died by suicide had contact with mental health services in the prior year.[67][84] Antidepressants of the SSRI class appear to increase the frequency of suicide among children and young persons.[86] An unwillingness to get help for mental health problems also increases the risk.[63]

Substance misuse

 
"The Drunkard's Progress", 1846 demonstrating how alcoholism can lead to poverty, crime, and eventually suicide

Substance misuse is the second most common risk factor for suicide after major depression and bipolar disorder.[87] Both chronic substance misuse as well as acute intoxication are associated.[55][88] When combined with personal grief, such as bereavement, the risk is further increased.[88] Substance misuse is also associated with mental health disorders.[55]

Most people are under the influence of sedative-hypnotic drugs (such as alcohol or benzodiazepines) when they die by suicide,[89] with alcoholism present in between 15% and 61% of cases.[55] 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, or withdrawal symptoms.[10] Countries that have higher rates of alcohol use and a greater density of bars generally also have higher rates of suicide.[90] About 2.2–3.4% of those who have been treated for alcoholism at some point in their life die by suicide.[90] Alcoholics who attempt suicide are usually male, older, and have tried to take their own lives in the past.[55] Between 3 and 35% of deaths among those who use heroin are due to suicide (approximately fourteenfold greater than those who do not use).[91] In adolescents who misuse alcohol, neurological and psychological dysfunctions may contribute to the increased risk of suicide.[92]

The misuse of cocaine and methamphetamine has a high correlation with suicide.[55][93] In those who use cocaine, the risk is greatest during the withdrawal phase.[94] Those who used inhalants are also at significant risk with around 20% attempting suicide at some point and more than 65% considering it.[55] Smoking cigarettes is associated with risk of suicide.[95] 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.[95] Cannabis, however, does not appear to independently increase the risk.[55]

Previous attempts

A previous history of suicide attempts is the most accurate predictor of suicide.[23] Approximately 20% of suicides have had a previous attempt, and of those who have attempted suicide, 1% die by suicide within a year[23] and more than 5% die by suicide within 10 years.[78]

Self-harm

Non-suicidal self-harm is common with 18% of people engaging in self-harm over the course of their life.[96]: 1  Acts of self-harm are not usually suicide attempts and most who self-harm are not at high risk of suicide.[97] Some who self-harm, however, do still end their life by suicide, and risk for self-harm and suicide may overlap.[97] Individuals who have been identified as self-harming after being admitted to hospital are 68% (38–105%) more likely to die by suicide.[98]: 279 

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, and poor coping skills.[71][99][100] A poor ability to solve problems, the loss of abilities one used to have, and poor impulse control also play a role.[71][101] In older adults, the perception of being a burden to others is important.[102] Those who have never married are also at greater risk.[23] Recent life stresses, such as a loss of a family member or friend or the loss of a job, might be a contributing factor.[71][63]

Certain personality factors, especially high levels of neuroticism and introvertedness, have been associated with suicide. This might lead to people who are isolated and sensitive to distress to be more likely to attempt suicide.[99] On the other hand, optimism has been shown to have a protective effect.[99] Other psychological risk factors include having few reasons for living and feeling trapped in a stressful situation.[99] Changes to the stress response system in the brain might be altered during suicidal states.[37] Specifically, changes in the polyamine system[103] and hypothalamic–pituitary–adrenal axis.[104]

Social isolation and the lack of social support has been associated with an increased risk of suicide.[99] Poverty is also a factor,[105] with heightened relative poverty compared to those around a person increasing suicide risk.[106] Over 200,000 farmers in India have died by suicide since 1997, partly due to issues of debt.[107] 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.[108]

The time of year may also affect suicide rates. There appears to be a decrease around Christmas,[109] but an increase in rates during spring and summer, which might be related to exposure to sunshine.[37] Another study found that the risk may be greater for males on their birthday.[110]

Being religious may reduce one's risk of suicide while beliefs that suicide is noble may increase it.[111][63][112] This has been attributed to the negative stance many religions take against suicide and to the greater connectedness religion may give.[111] Muslims, among religious people, appear to have a lower rate of suicide; however, the data supporting this is not strong.[30] There does not appear to be a difference in rates of attempted suicide.[30] Young women in the Middle East may have higher rates.[113]

Medical conditions

There is an association between suicidality and physical health problems such as[78] chronic pain,[114] traumatic brain injury,[115] cancer,[116] chronic fatigue syndrome,[117] kidney failure (requiring hemodialysis), HIV, and systemic lupus erythematosus.[78] The diagnosis of cancer approximately doubles the subsequent frequency of suicide.[116] 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.[118]

Sleep disturbances, such as insomnia[119] and sleep apnea, are risk factors for depression and suicide. In some instances, the sleep disturbances may be a risk factor independent of depression.[120] A number of other medical conditions may present with symptoms similar to mood disorders, including hypothyroidism, Alzheimer's, brain tumors, systemic lupus erythematosus, and adverse effects from a number of medications (such as beta blockers and steroids).[23]

Occupational factors

See also: Suicide in the military

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,[121][122][123][124] and young veterans especially,[125][126][121] is markedly higher than that found in the general population.

Media

See also: Copycat suicide and Social media and suicide
 
In Goethe's The Sorrows of Young Werther, the title character kills himself due to a love triangle involving Charlotte (pictured at his grave). Some admirers of the story were triggered into copycat suicide, known as the "Werther effect".

The media, including the Internet, plays an important role.[53][99] Certain depictions of suicide may increase its occurrence, with high-volume, prominent, repetitive coverage glorifying or romanticizing suicide having the most impact.[127] When detailed descriptions of how to kill oneself by a specific means are portrayed, this method of suicide can be imitated in vulnerable people.[17] This phenomenon has been observed in several cases after press coverage.[128][129] 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.[127] Getting buy-in from the media industry, however, can be difficult, especially in the long term.[127]

This trigger of suicide contagion or copycat suicide is known as the "Werther effect", named after the protagonist in Goethe's The Sorrows of Young Werther who killed himself and then was emulated by many admirers of the book.[130] This risk is greater in adolescents who may romanticize death.[131] It appears that while news media has a significant effect, that of the entertainment media is equivocal.[132][133] It is unclear if searching for information about suicide on the Internet relates to the risk of suicide.[134] 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's opera The Magic Flute—fearing the loss of a loved one, he had planned to kill himself until his friends helped him out.[130] As a consequence, fictional portrayals of suicide, showing alternative consequences or negative consequences, might have a preventive effect,[135] for instance fiction might normalize mental health problems and encourage help-seeking.[136]

Other factors

Trauma is a risk factor for suicidality in both children[137] and adults.[99] Some may take their own lives to escape bullying or prejudice.[138] A history of childhood sexual abuse[139] and time spent in foster care are also risk factors.[140] Sexual abuse is believed to contribute to approximately 20% of the overall risk.[62] Significant adversity early in life has a negative effect on problem-solving skills and memory, both of which are implicated in suicidality.[37] According to a 2022 study, adverse childhood experiences maybe "associated with a two-fold higher odds" of anxiety disorders, depression and suicidality."[141]

Problem gambling is associated with increased suicidal ideation and attempts compared to the general population.[142] Between 12 and 24% of pathological gamblers attempt suicide.[143] The rate of suicide among their spouses is three times greater than that of the general population.[143] Other factors that increase the risk in problem gamblers include concomitant mental illness, alcohol, and drug misuse.[144]

Genetics might influence rates of suicide. A family history of suicide, especially in the mother, affects children more than adolescents or adults.[99] 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.[37] Once mental disorders are accounted for, the estimated heritability rate is 36% for suicidal ideation and 17% for suicide attempts.[37] An evolutionary explanation for suicide is that it may improve inclusive fitness. 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 to a very different ancestral environment may be maladaptive in the current one.[101][145]

Infection by the parasite Toxoplasma gondii, more commonly known as toxoplasmosis, has been linked with suicide risk. One explanation states that this is caused by altered neurotransmitter activity due to the immunological response.[37]

There appears to be a link between air pollution and depression and suicide. There may be an association between long-term PM2.5 exposure and depression, and a possible association between short-term PM10 exposure and suicide.[146]

Rational

 
Teenage recruits for Japanese Kamikaze suicide pilots in May 1945

Rational suicide is the reasoned taking of one's own life.[147] However, some consider suicide as never being rational.[147]

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.[148][149] They are supported by the legal arguments for a right to die.[149]

The act of taking one's life for the benefit of others is known as altruistic suicide.[150] 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.[150] Suicide in some Inuit cultures has been seen as an act of respect, courage, or wisdom.[151]

A suicide attack is a political or religious action where an attacker carries out violence against others which they understand will result in their own death.[152] Some suicide bombers are motivated by a desire to obtain martyrdoms or are religiously motivated.[61] Kamikaze missions were carried out as a duty to a higher cause or moral obligation.[151] Murder–suicide is an act of homicide followed within a week by suicide of the person who carried out the act.[153]

Mass suicides are often performed under social pressure where members give up autonomy to a leader (see Notable cases below).[154] Mass suicides can take place with as few as two people, often referred to as a suicide pact.[155] In extenuating situations where continuing to live would be intolerable, some people use suicide as a means of escape.[156][157] Some inmates in Nazi concentration camps are known to have killed themselves during the Holocaust by deliberately touching the electrified fences.[158]

Methods

 
Though substance overdose is the most common method of attempted suicide in the U.S., guns are the most lethal (most likely to result in death).[159]
 
Deaths by gun-related suicide versus non-gun-related suicide rates per 100,000 in high-income countries in 2010[160]
Main article: Suicide methods

The leading method of suicide varies among countries. The leading methods in different regions include hanging, pesticide poisoning, and firearms.[18] These differences are believed to be in part due to availability of the different methods.[17] A review of 56 countries found that hanging was the most common method in most of the countries,[18] accounting for 53% of male suicides and 39% of female suicides.[161]

Worldwide, 30% of suicides are estimated to occur from pesticide poisoning, most of which occur in the developing world.[2] The use of this method varies markedly from 4% in Europe to more than 50% in the Pacific region.[162] It is also common in Latin America due to the ease of access within the farming populations.[17] In many countries, drug overdoses account for approximately 60% of suicides among women and 30% among men.[163] Many are unplanned and occur during an acute period of ambivalence.[17] The death rate varies by method: firearms 80–90%, drowning 65–80%, hanging 60–85%, jumping 35–60%, charcoal burning 40–50%, pesticides 60–75%, and medication overdose 1.5–4.0%.[17] 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.[78]

In China, the consumption of pesticides is the most common method.[164] In Japan, self-disembowelment known as seppuku (harakiri) still occurs;[164] however, hanging and jumping are the most common.[165] Jumping to one's death is common in both Hong Kong and Singapore at 50% and 80% respectively.[17] In Switzerland, firearms are the most frequent suicide method in young males, although this method has decreased since guns have become less common.[166][167] 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%).[168] The next most common cause was hanging in males (28%) and self-poisoning in females (31%).[168] Together, hanging and poisoning constituted about 42% of U.S. suicides (as of 2017).[168]

Pathophysiology

There is no known unifying underlying pathophysiology for suicide;[23] it is believed to result from an interplay of behavioral, socio-economic and psychological factors.[17]

Low levels of brain-derived neurotrophic factor (BDNF) are both directly associated with suicide[169] and indirectly associated through its role in major depression, post-traumatic stress disorder, schizophrenia and obsessive–compulsive disorder.[170] Post-mortem studies have found reduced levels of BDNF in the hippocampus and prefrontal cortex, in those with and without psychiatric conditions.[171] Serotonin, a brain neurotransmitter, is believed to be low in those who die by suicide.[172] This is partly based on evidence of increased levels of 5-HT2A receptors found after death.[173] Other evidence includes reduced levels of a breakdown product of serotonin, 5-hydroxyindoleacetic acid, in the cerebral spinal fluid.[174] However, direct evidence is hard to obtain.[173] Epigenetics, the study of changes in genetic expression in response to environmental factors which do not alter the underlying DNA, is also believed to play a role in determining suicide risk.[175]

Prevention

Main article: Suicide prevention
 
 
As a suicide prevention initiative, these signs on the Golden Gate Bridge promote a special telephone that connects to a crisis hotline, as well as a 24/7 crisis text line.
 
A suicide prevention fence on a bridge

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.[54] About 60% of people with suicidal thoughts do not seek help.[176] Reasons for not doing so include low perceived need, and wanting to deal with the problem alone.[176] Despite these high rates, there are few established treatments available for suicidal behavior.[99]

Reducing access to certain methods, such as firearms or toxins such as opioids and pesticides, can reduce risk of suicide by that method.[17][177][16][37] Reducing access to easily-accessible methods of suicide may make impulsive attempts less likely to succeed.[178] Other measures include reducing access to charcoal (for burning) and adding barriers on bridges and subway platforms.[17][179][16] Treatment of drug and alcohol addiction, depression, and those who have attempted suicide in the past, may also be effective.[177][16] Some have proposed reducing access to alcohol as a preventive strategy (such as reducing the number of bars).[55]

In young adults who have recently thought about suicide, cognitive behavioral therapy appears to improve outcomes.[180][99] School-based programs that increase mental health literacy and train staff have shown mixed results on suicide rates.[16] Economic development through its ability to reduce poverty may be able to decrease suicide rates.[105] Efforts to increase social connection, especially in elderly males, may be effective.[181] In people who have attempted suicide, following up on them might prevent repeat attempts.[182] Although crisis hotlines are common, there is little evidence to support or refute their effectiveness.[15][16] Preventing childhood trauma provides an opportunity for suicide prevention.[137] The World Suicide Prevention Day is observed annually on 10 September with the support of the International Association for Suicide Prevention and the World Health Organization.[183]

Screening

IS PATH WARM [...] is an acronym [...] to assess [...] a potentially suicidal individual, (i.e., ideation, substance abuse, purposelessness, anger, feeling trapped, hopelessness, withdrawal, anxiety, recklessness, and mood).[184]

— American Association of Suicidology (2019)

There is little data on the effects of screening the general population on the ultimate rate of suicide.[185][186] 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 such as the Beck Depression Inventory or the Geriatric Depression Scale for older people are being used.[187] 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.[188] Assessing those at high risk, though, is recommended.[23] Asking about suicidality does not appear to increase the risk.[23]

Mental illness

See also: Antidepressants and suicide risk

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.[23] Possessions that may be used to harm oneself are typically removed.[78] Some clinicians get patients to sign suicide prevention contracts where they agree to not harm themselves if released.[23] However, evidence does not support a significant effect from this practice.[23] If a person is at low risk, outpatient mental health treatment may be arranged.[78] 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.[189][190]

There is tentative evidence that psychotherapy, specifically dialectical behaviour therapy, reduces suicidality in adolescents[191] as well as in those with borderline personality disorder.[192] It may also be useful in decreasing suicide attempts in adults at high risk.[193]

There is controversy around the benefit-versus-harm of antidepressants.[53] In young persons, some antidepressants, such as SSRIs, appear to increase the risk of suicidality from 25 per 1000 to 40 per 1000.[194] In older persons, however, they may decrease the risk.[23] Lithium 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.[195][196] Clozapine may decrease the thoughts of suicide in some people with schizophrenia.[197] Ketamine, which is a dissociative anaesthetic, seems to lower the rate of suicidal ideation.[198] In the United States, health professionals are legally required to take reasonable steps to try to prevent suicide.[199][200]

Epidemiology

Main articles: Epidemiology of suicide and List of countries by suicide rate
See also: Seasonal effects on suicide rates
 
The US has had the largest number of gun-related suicides in the world every year from 1990 through at least 2019.[201] With 4% of the world's population, the US had 44% of global gun suicides in 2019, and the highest rate per capita.[201]

Approximately 1.4% of people die by suicide, a mortality rate of 11.6 per 100,000 persons per year.[6][23] Suicide resulted in 842,000 deaths in 2013 up from 712,000 deaths in 1990.[20] Rates of suicide have increased by 60% from the 1960s to 2012, with these increases seen primarily in the developing world.[3] Globally, as of 2008/2009, suicide is the tenth leading cause of death.[3] For every suicide that results in death there are between 10 and 40 attempted suicides.[23]

Suicide rates differ significantly between countries and over time.[6] As a percentage of deaths in 2008 it was: Africa 0.5%, South-East Asia 1.9%, Americas 1.2% and Europe 1.4%.[6] 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.[202][203] It was ranked as the 10th leading cause of death in the United States in 2016 with about 45,000 cases that year.[204] Rates have increased in the United States in the last few years,[204] with about 49,500 people dying by suicide in 2022, the highest number ever recorded.[205] In the United States, about 650,000 people are seen in emergency departments yearly due to attempting suicide.[23] The United States rate among men in their 50s rose by nearly half in the decade 1999–2010.[206] Greenland, Lithuania, Japan, and Hungary have the highest rates of suicide.[6] Around 75% of suicides occur in the developing world.[2] 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.[6] In China, suicide is the 5th leading cause of death.[207]

  •  
    Death rate from suicide per 100,000 as of 2017[208]
  •  
    Share of deaths from suicide, 2017[209]

An unofficial report estimated 5,000 suicides in Iran in 2022.[210]

Sex and gender

Main article: Gender differences in suicide
 
 
Suicide rates per 100,000 males (left) and females (right).

Globally as of 2012, death by suicide occurs about 1.8 times more often in males than females.[6][211] In the Western world, males die three to four times more often by means of suicide than do females.[6] This difference is even more pronounced in those over the age of 65, with tenfold more males than females dying by suicide.[212] Suicide attempts and self-harm are between two and four times more frequent among females.[23][213][214] Researchers have attributed the difference between suicide and attempted suicide among the sexes to males using more lethal means to end their lives.[212][215][216] 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.[217]

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).[6][207] In the Eastern Mediterranean, suicide rates are nearly equivalent between males and females.[6] The highest rate of female suicide is found in South Korea at 22 per 100,000, with high rates in South-East Asia and the Western Pacific generally.[6]

A number of reviews have found an increased risk of suicide among lesbian, gay, bisexual, and transgender people.[218][219] Among transgender persons, rates of attempted suicide are about 40% compared to a general population rate of 5%.[220][221] This is believed to in part be due to social stigmatisation.[222]

Age

 
Suicide rates by age[223]

In many countries, the rate of suicide is highest in the middle-aged[224] or elderly.[17] 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.[6] Worldwide, the average age of suicide is between age 30 and 49 for both men and women.[225] This means that half of people who died by suicide were approximately age 40 or younger, and half were older.[225] Suicidality is rare in children, but increases during the transition to adolescence.[226]

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.[23] It is the second most common cause of death in adolescents[53] and in young males is second only to accidental death.[224] In young males in the developed world, it is the cause of nearly 30% of mortality.[224] 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.[224] 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.[6]

History

Main article: History of suicide
 
The Ludovisi Gaul killing himself and his wife, Roman copy after the Hellenistic original, Palazzo Massimo alle Terme

In ancient Athens, 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.[227] It was also common for the hand to be cut off the body and buried separately[228] - the hand (and the instrument used) being considered the perpetrator.[229] However, it was deemed to be an acceptable method to deal with military defeat.[230] In Ancient Rome, while suicide was initially permitted, it was later deemed a crime against the state due to its economic costs.[231] Aristotle condemned all forms of suicide while Plato was ambivalent.[232] In Rome, some reasons for suicide included volunteering death in a gladiator 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.[232]

 
The Death of Seneca (1684), painting by Luca Giordano, depicting the suicide of Seneca the Younger in Ancient Rome

Suicide came to be regarded as a sin in Christian Europe and was condemned at the Council of Arles (452) as the work of the Devil. In the Middle Ages, the Church had drawn-out discussions as to when the desire for martyrdom was suicidal, as in the case of martyrs of Córdoba. 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 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.[233][234]

Attitudes towards suicide slowly began to shift during the Renaissance. John Donne's work Biathanatos contained one of the first modern defences of suicide, bringing proof from the conduct of Biblical figures, such as Jesus, Samson and Saul, and presenting arguments on grounds of reason and nature to sanction suicide in certain circumstances.[235]

The secularization of society that began during the Enlightenment questioned traditional religious attitudes (such as Christian views on suicide) toward suicide and brought a more modern perspective to the issue. David Hume 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?"[235] 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.[236] A shift in public opinion at large can also be discerned; The Times in 1786 initiated a spirited debate on the motion "Is suicide an act of courage?".[237]

By the 19th century, the act of suicide had shifted from being viewed as caused by sin to being caused by insanity in Europe.[234] Although suicide remained illegal during this period, it increasingly became the target of satirical comments, such as the Gilbert and Sullivan comic opera The Mikado, 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.[238] In 1882, the deceased were permitted daylight burial in England[239] 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.[232]

Social and culture

Legislation

Main article: Suicide legislation
 
A tantō knife prepared for seppuku (abdomen-cutting)
 
Samurai about to perform seppuku

No country in Europe currently considers suicide or attempted suicide to be a crime.[240] It was, however, in most Western European countries from the Middle Ages until at least the 19th century.[238] 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.[241] 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.[242] Switzerland has taken steps to legalize assisted suicide for the chronically mentally ill. The high court in Lausanne, Switzerland, in a 2006 ruling, granted an anonymous individual with longstanding psychiatric difficulties the right to end his own life.[243] England and Wales decriminalized suicide via the Suicide Act 1961 and the Republic of Ireland in 1993.[240] The word "commit" was used in reference to its being illegal, but many organisations have stopped it because of the negative connotation.[244][245]

In the United States, suicide is not illegal, but may be associated with penalties for those who attempt it.[240] Physician-assisted suicide is legal in the state of Washington for people with terminal diseases.[246] In Oregon, people with terminal diseases may request medications to help end their life.[247] 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.[248][249]

In Australia, suicide is not a crime.[250] However, it is a crime to counsel, incite, or aid and abet 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.[251] The Northern Territory of Australia briefly had legal physician-assisted suicide from 1996 to 1997.[252]

In India, suicide was illegal until 2014, and surviving family members used to face legal difficulties.[253][254] It remains a criminal offense in most Muslim-majority nations.[30]

In Malaysia, suicide per se is not a crime; however, attempted suicide is. Under Section 309 of the Penal Code, a person convicted of attempting suicide can be punished with imprisonment of up to one year, fined, or both. There are ongoing efforts to decriminalise attempted suicide, although rights groups and non-governmental organisations such as the local chapter of Befrienders note that progress has been slow.[255][256] Proponents of decriminalisation argue that suicide legislation may deter people from seeking help, and may even strengthen the resolve of would-be suicides to end their lives to avoid prosecution.[257] The first reading of a bill to repeal Section 309 of the Penal Code was tabled in Parliament in April 2023, bringing Malaysia one step closer towards decriminalising attempted suicide.[258]

Suicide became a trending crisis in North Korea in 2023; a secret order criminalized suicide as treason against socialist state.[259]

Religious views

Main article: Religious views on suicide

Christianity

Main article: Christian views on suicide

Most forms of Christianity consider suicide sinful, based mainly on the writings of influential Christian thinkers of the Middle Ages, such as St. Augustine and St. Thomas Aquinas, but suicide was not considered a sin under the Byzantine Christian code of Justinian, for instance.[260][261] In Catholic and Orthodox doctrine, suicide is considered to be murder, violating the commandment "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.[262] 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.[263] However, it is believed that mental illness or grave fear of suffering diminishes the responsibility of the one completing suicide.[264]

Judaism

Main article: Jewish views on suicide

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, Masada, First French persecution of the Jews and York Castle 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). 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.[265]

Islam

Islamic religious views are against suicide.[30] The Quran forbids it by stating "do not kill or destroy yourself".[266][267] The hadiths also state individual suicide to be unlawful and a sin.[30] Stigma is often associated with suicide in Islamic countries.[267]

Hinduism and Jainism

 
A Hindu widow burning herself with her husband's corpse, 1820s

In Hinduism, suicide is generally disdained and is considered equally sinful as murdering another in contemporary Hindu society. Hindu Scriptures 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.[268] However, Hinduism accepts a man's right to end one's life through the non-violent practice of fasting to death, termed Prayopavesa;[269] but Prayopavesa is strictly restricted to people who have no desire or ambition left, and no responsibilities remaining in this life.[269]

Jainism has a similar practice named Santhara. Sati, or self-immolation by widows, is a rare and illegal practice in Hindu society.[270]

Ainu

Within the Ainu religion, someone who dies by suicide is believed to become a ghost (tukap) who would haunt the living,[271] to come to fulfillment from which they were excluded during life.[272] Also, someone who insults another so they kill themselves is regarded as co-responsible for their death.[273] 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.[273]

Philosophy

Main article: Philosophy of suicide

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.[274] 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, Thomas Aquinas,[274] Immanuel Kant[275] and, arguably, John Stuart Mill – 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.[276] 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.[277] 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 include Scottish empiricist David Hume,[274] who accepted suicide so long as it did not harm or violate a duty to God, other people, or the self,[236] and American bioethicist Jacob Appel.[243][278]

Advocacy

See also: Advocacy of suicide
 
In this painting by Alexandre-Gabriel Decamps, the palette, pistol, and note lying on the floor suggest that the event has just taken place; an artist has taken his own life.[279]

Advocacy of suicide has occurred in many cultures and subcultures. The Japanese military during World War II encouraged and glorified kamikaze attacks, which were suicide attacks by military aviators from the Empire of Japan against Allied naval vessels in the closing stages of the Pacific Theater of World War II. Japanese society as a whole has been described as "suicide-tolerant"[280] (see Suicide in Japan).

Internet searches for information on suicide return webpages that, in a 2008 study, about 50% of the time provide information on suicide methods. A similar study found that 11% of sites encouraged suicide attempts.[281] 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. The Internet, however, may also help prevent suicide by providing a social group for those who are isolated.[282]

Locations

See also: List of suicide sites and Suicides at the Golden Gate Bridge

Some landmarks have become known for high levels of suicide attempts.[283] These include China's Nanjing Yangtze River Bridge,[284] San Francisco's Golden Gate Bridge, Japan's Aokigahara Forest,[285] England's Beachy Head,[283] and Toronto's Bloor Street Viaduct.[286] As of 2010, the Golden Gate Bridge has had more than 1,300 suicides by jumping since its construction in 1937.[287] Many locations where suicide is common have constructed barriers to prevent it;[288] this includes the Luminous Veil in Toronto,[286] the Eiffel Tower in Paris, the West Gate Bridge in Melbourne, and Empire State Building in New York City.[288] They generally appear to be effective.[289]

Notable cases

 
Japanese general Hideki Tojo, receiving treatment immediately after attempted suicide, 1945
Main article: List of suicides

An example of mass suicide is the 1978 Jonestown mass murder/suicide in which 909 members of the Peoples Temple, an American new religious movement led by Jim Jones, ended their lives by drinking grape Flavor Aid laced with cyanide and various prescription drugs.[290][291][292]

Thousands of Japanese civilians took their own lives in the last days of the Battle of Saipan in 1944, some jumping from "Suicide Cliff" and "Banzai Cliff".[293] The 1981 Irish hunger strikes, led by Bobby Sands, 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.[294] During World War II, Erwin Rommel was found to have foreknowledge of the 20 July plot on Hitler's life; he was threatened with public trial, execution, and reprisals on his family unless he killed himself.[295]

Other species

Main article: Animal suicide

As suicide requires a willful attempt to die, some feel it therefore cannot be said to occur in non-human animals.[230] Suicidal behavior has been observed in Salmonella seeking to overcome competing bacteria by triggering an immune system response against them.[296] Suicidal defenses by workers are also noted in the Brazilian ant Forelius pusillus, where a small group of ants leaves the security of the nest after sealing the entrance from the outside each evening.[297]

Pea aphids, when threatened by a ladybug, can explode themselves, scattering and protecting their brethren and sometimes even killing the ladybug; this form of suicidal altruism is known as autothysis.[298] Some species of termites (for example Globitermes sulphureus)[299] have soldiers that explode, covering their enemies with sticky goo.[300][299]

There have been anecdotal reports of dogs, horses, and dolphins killing themselves,[301] but little scientific study of animal suicide.[302] 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.[303]

See also

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January 01, 1970
suicide, information, prevention, prevention, other, uses, disambiguation, intentionally, causing, death, mental, disorders, including, depression, bipolar, disorder, schizophrenia, personality, disorders, anxiety, disorders, attention, deficit, hyperactivity,. For information on prevention see Suicide prevention For other uses see Suicide disambiguation Suicide is the act of intentionally causing one s own death 9 Mental disorders including depression bipolar disorder schizophrenia personality disorders anxiety disorders attention deficit hyperactivity disorder cognitive disengagement syndrome physical disorders such as chronic fatigue syndrome and substance abuse including alcoholism and the use of and withdrawal from benzodiazepines are risk factors 2 3 5 10 Some suicides are impulsive acts due to stress such as from financial or academic difficulties relationship problems such as breakups or divorces or harassment and bullying 2 11 12 Those who have previously attempted suicide are at a higher risk for future attempts 2 Effective suicide prevention efforts include limiting access to methods of suicide such as firearms drugs and poisons treating mental disorders and substance abuse careful media reporting about suicide improving economic conditions 2 13 and dialectical behaviour therapy DBT 14 Although crisis hotlines are common resources their effectiveness has not been well studied 15 16 SuicideLe Suicide by Edouard ManetSpecialtyPsychiatry clinical psychology clinical social workUsual onset15 30 and 70 years old 1 Risk factorsDepression bipolar disorder autism schizophrenia personality disorders anxiety disorders alcoholism substance abuse 2 3 4 5 PreventionLimiting access to methods of suicide treating mental disorders and substance misuse careful media reporting about suicide improving social and economic conditions 2 Frequency12 per 100 000 per year 6 Deaths793 000 1 5 of deaths 2016 7 8 988 Suicide amp Crisis Lifeline a crisis line in the United States and Canada The most commonly adopted method of suicide varies from country to country and is partly related to the availability of effective means 17 Common methods of suicide include hanging pesticide poisoning and firearms 2 18 Suicides resulted in 828 000 deaths globally in 2015 an increase from 712 000 deaths in 1990 19 20 inconsistent This makes suicide the 10th leading cause of death worldwide 3 6 Approximately 1 5 of all deaths worldwide are by suicide 8 In a given year this is roughly 12 per 100 000 people 6 Rates of suicide are generally higher among men than women ranging from 1 5 times higher in the developing world to 3 5 times higher in the developed world 1 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 1 Europe had the highest rates of suicide by region in 2015 21 There are an estimated 10 to 20 million non fatal attempted suicides every year 22 Non fatal suicide attempts may lead to injury and long term disabilities 23 In the Western world attempts are more common among young people and women 23 Views on suicide have been influenced by broad existential themes such as religion honor and the meaning of life 24 25 The Abrahamic religions traditionally consider suicide as an offense towards God due to belief in the sanctity of life 26 During the samurai era in Japan a form of suicide known as seppuku 腹切り harakiri was respected as a means of making up for failure or as a form of protest 27 Similarly a ritual fast unto death known as Vatakkiruttal Tamil வடக க ர த தல Vaṭakkiruttal fasting facing north was a Tamil ritual suicide in ancient India during the Sangam age 28 Suicide and attempted suicide while previously illegal are no longer so in most Western countries 29 It remains a criminal offense in some countries 30 In the 20th and 21st centuries suicide has been used on rare occasions as a form of protest it may also be committed while or after murdering others such as suicide attacks which have been used as both a military and terrorist tactic 31 Suicide is often seen as a major catastrophe causing significant grief to the deceased s relatives friends and community members and it is viewed negatively almost everywhere around the world 32 33 34 Contents 1 Definitions 2 Risk factors 2 1 Mental illness 2 2 Substance misuse 2 3 Previous attempts 2 4 Self harm 2 5 Psychosocial factors 2 6 Medical conditions 2 7 Occupational factors 2 8 Media 2 9 Other factors 2 10 Rational 3 Methods 4 Pathophysiology 5 Prevention 5 1 Screening 5 2 Mental illness 6 Epidemiology 6 1 Sex and gender 6 2 Age 7 History 8 Social and culture 8 1 Legislation 8 2 Religious views 8 2 1 Christianity 8 2 2 Judaism 8 2 3 Islam 8 2 4 Hinduism and Jainism 8 2 5 Ainu 8 3 Philosophy 8 4 Advocacy 8 5 Locations 8 6 Notable cases 9 Other species 10 See also 11 References 12 Further reading 13 External linksDefinitionsMain article Suicide terminology Suicide derived from Latin suicidium is the act of taking one s own life 9 35 Attempted suicide or non fatal suicidal behavior amounts to self injury with at least some desire to end one s life that does not result in death 36 37 Assisted suicide occurs when one individual helps another bring about their own death indirectly via providing either advice or the means to the end 38 This is in contrast to euthanasia where another person takes a more active role in bringing about a person s death 38 Suicidal ideation is thoughts of ending one s life but not taking any active efforts to do so 36 It may or may not involve exact planning or intent 37 Suicidality is defined as the risk of suicide usually indicated by suicidal ideation or intent especially as evident in the presence of a well elaborated suicidal plan 39 In a murder suicide 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 40 Suicide in which the reason is that the person feels that they are not part of society is known as egoistic suicide 41 In 2011 in an article calling for changing the language used around suicide entitled Suicide and language Why we shouldn t use the C word the Centre for Suicide Prevention in Canada found that the normal verb in scholarly research and journalism for the act of suicide was commit and argued for destigmatizing terminology related to suicide 42 43 The American Psychological Association lists committed suicide as a term to avoid because it frame s suicide as a crime 44 Some advocacy groups recommend using the terms took his her own life died by suicide or killed him herself instead of committed suicide 45 46 47 The Associated Press Stylebook recommends avoiding committed suicide except in direct quotes from authorities 48 The Guardian and Observer style guides deprecate the use of committed 49 as does CNN 50 Opponents of commit argue that it implies that suicide is criminal sinful or morally wrong 51 Risk factorsPrecipitating circumstances in the US 2017 52 Categories Percentage Diagnosed mental problem 50 Recent or upcoming crisis 31 Intimate partner problem 27 Physical health problem 21 Alcohol problem 18 Substance abuse excluding alcohol 18 Argument 16 Family problem 10 Job problem 10 Financial problem 9 Legal problem 8 Death of loved one 7 Suicide is multi factorial Multiple precipitating circumstances and risk factors can apply to the same person Factors that affect the risk of suicide include mental disorders drug misuse psychological states cultural family and social situations genetics experiences of trauma or loss and nihilism 53 54 16 Mental disorders and substance misuse frequently co exist 55 Other risk factors include having previously attempted suicide 23 the ready availability of a means to take one s life a family history of suicide or the presence of traumatic brain injury 56 For example suicide rates have been found to be greater in households with firearms than those without them 57 Socio economic problems such as unemployment poverty homelessness and discrimination may trigger suicidal thoughts 58 59 Suicide might be rarer in societies with high social cohesion and moral objections against suicide 37 About 15 40 of people leave a suicide note 60 War veterans have a higher risk of suicide due in part to higher rates of mental illness such as post traumatic stress disorder and physical health problems related to war 61 Genetics appears to account for between 38 and 55 of suicidal behaviors 62 Suicides may also occur as a local cluster of cases 63 Most research does not distinguish between risk factors that lead to thinking about suicide and risk factors that lead to suicide attempts 64 65 Risks for suicide attempt rather than just thoughts of suicide include a high pain tolerance and a reduced fear of death 66 Mental illness Mental illness is present at the time of suicide 27 to more than 90 of the time 67 23 68 69 Of those who have been hospitalized for suicidal behavior the lifetime risk of suicide is 8 6 23 70 Comparatively non suicidal people hospitalized for affective disorders have a 4 lifetime risk of suicide 70 Half of all people who die by suicide may have major depressive disorder having this or one of the other mood disorders such as bipolar disorder increases the risk of suicide 20 fold 71 Other conditions implicated include schizophrenia 14 personality disorders 8 72 73 obsessive compulsive disorder 74 and post traumatic stress disorder 23 Those with autism also attempt and consider suicide more frequently 75 Others estimate that about half of people who die by suicide could be diagnosed with a personality disorder with borderline personality disorder being the most common 76 About 5 of people with schizophrenia die of suicide 77 Eating disorders are another high risk condition 78 Around 22 to 50 of people suffering with gender dysphoria have attempted suicide however this greatly varies by region 79 80 81 82 83 Among approximately 80 of suicides the individual has seen a physician within the year before their death 84 including 45 within the prior month 85 Approximately 25 40 of those who died by suicide had contact with mental health services in the prior year 67 84 Antidepressants of the SSRI class appear to increase the frequency of suicide among children and young persons 86 An unwillingness to get help for mental health problems also increases the risk 63 Substance misuse nbsp The Drunkard s Progress 1846 demonstrating how alcoholism can lead to poverty crime and eventually suicide Substance misuse is the second most common risk factor for suicide after major depression and bipolar disorder 87 Both chronic substance misuse as well as acute intoxication are associated 55 88 When combined with personal grief such as bereavement the risk is further increased 88 Substance misuse is also associated with mental health disorders 55 Most people are under the influence of sedative hypnotic drugs such as alcohol or benzodiazepines when they die by suicide 89 with alcoholism present in between 15 and 61 of cases 55 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 or withdrawal symptoms 10 Countries that have higher rates of alcohol use and a greater density of bars generally also have higher rates of suicide 90 About 2 2 3 4 of those who have been treated for alcoholism at some point in their life die by suicide 90 Alcoholics who attempt suicide are usually male older and have tried to take their own lives in the past 55 Between 3 and 35 of deaths among those who use heroin are due to suicide approximately fourteenfold greater than those who do not use 91 In adolescents who misuse alcohol neurological and psychological dysfunctions may contribute to the increased risk of suicide 92 The misuse of cocaine and methamphetamine has a high correlation with suicide 55 93 In those who use cocaine the risk is greatest during the withdrawal phase 94 Those who used inhalants are also at significant risk with around 20 attempting suicide at some point and more than 65 considering it 55 Smoking cigarettes is associated with risk of suicide 95 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 95 Cannabis however does not appear to independently increase the risk 55 Previous attempts A previous history of suicide attempts is the most accurate predictor of suicide 23 Approximately 20 of suicides have had a previous attempt and of those who have attempted suicide 1 die by suicide within a year 23 and more than 5 die by suicide within 10 years 78 Self harm Non suicidal self harm is common with 18 of people engaging in self harm over the course of their life 96 1 Acts of self harm are not usually suicide attempts and most who self harm are not at high risk of suicide 97 Some who self harm however do still end their life by suicide and risk for self harm and suicide may overlap 97 Individuals who have been identified as self harming after being admitted to hospital are 68 38 105 more likely to die by suicide 98 279 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 and poor coping skills 71 99 100 A poor ability to solve problems the loss of abilities one used to have and poor impulse control also play a role 71 101 In older adults the perception of being a burden to others is important 102 Those who have never married are also at greater risk 23 Recent life stresses such as a loss of a family member or friend or the loss of a job might be a contributing factor 71 63 Certain personality factors especially high levels of neuroticism and introvertedness have been associated with suicide This might lead to people who are isolated and sensitive to distress to be more likely to attempt suicide 99 On the other hand optimism has been shown to have a protective effect 99 Other psychological risk factors include having few reasons for living and feeling trapped in a stressful situation 99 Changes to the stress response system in the brain might be altered during suicidal states 37 Specifically changes in the polyamine system 103 and hypothalamic pituitary adrenal axis 104 Social isolation and the lack of social support has been associated with an increased risk of suicide 99 Poverty is also a factor 105 with heightened relative poverty compared to those around a person increasing suicide risk 106 Over 200 000 farmers in India have died by suicide since 1997 partly due to issues of debt 107 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 108 The time of year may also affect suicide rates There appears to be a decrease around Christmas 109 but an increase in rates during spring and summer which might be related to exposure to sunshine 37 Another study found that the risk may be greater for males on their birthday 110 Being religious may reduce one s risk of suicide while beliefs that suicide is noble may increase it 111 63 112 This has been attributed to the negative stance many religions take against suicide and to the greater connectedness religion may give 111 Muslims among religious people appear to have a lower rate of suicide however the data supporting this is not strong 30 There does not appear to be a difference in rates of attempted suicide 30 Young women in the Middle East may have higher rates 113 Medical conditions There is an association between suicidality and physical health problems such as 78 chronic pain 114 traumatic brain injury 115 cancer 116 chronic fatigue syndrome 117 kidney failure requiring hemodialysis HIV and systemic lupus erythematosus 78 The diagnosis of cancer approximately doubles the subsequent frequency of suicide 116 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 118 Sleep disturbances such as insomnia 119 and sleep apnea are risk factors for depression and suicide In some instances the sleep disturbances may be a risk factor independent of depression 120 A number of other medical conditions may present with symptoms similar to mood disorders including hypothyroidism Alzheimer s brain tumors systemic lupus erythematosus and adverse effects from a number of medications such as beta blockers and steroids 23 Occupational factors See also Suicide in the military 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 121 122 123 124 and young veterans especially 125 126 121 is markedly higher than that found in the general population Media See also Copycat suicide and Social media and suicide nbsp In Goethe s The Sorrows of Young Werther the title character kills himself due to a love triangle involving Charlotte pictured at his grave Some admirers of the story were triggered into copycat suicide known as the Werther effect The media including the Internet plays an important role 53 99 Certain depictions of suicide may increase its occurrence with high volume prominent repetitive coverage glorifying or romanticizing suicide having the most impact 127 When detailed descriptions of how to kill oneself by a specific means are portrayed this method of suicide can be imitated in vulnerable people 17 This phenomenon has been observed in several cases after press coverage 128 129 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 127 Getting buy in from the media industry however can be difficult especially in the long term 127 This trigger of suicide contagion or copycat suicide is known as the Werther effect named after the protagonist in Goethe s The Sorrows of Young Werther who killed himself and then was emulated by many admirers of the book 130 This risk is greater in adolescents who may romanticize death 131 It appears that while news media has a significant effect that of the entertainment media is equivocal 132 133 It is unclear if searching for information about suicide on the Internet relates to the risk of suicide 134 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 s opera The Magic Flute fearing the loss of a loved one he had planned to kill himself until his friends helped him out 130 As a consequence fictional portrayals of suicide showing alternative consequences or negative consequences might have a preventive effect 135 for instance fiction might normalize mental health problems and encourage help seeking 136 Other factors Trauma is a risk factor for suicidality in both children 137 and adults 99 Some may take their own lives to escape bullying or prejudice 138 A history of childhood sexual abuse 139 and time spent in foster care are also risk factors 140 Sexual abuse is believed to contribute to approximately 20 of the overall risk 62 Significant adversity early in life has a negative effect on problem solving skills and memory both of which are implicated in suicidality 37 According to a 2022 study adverse childhood experiences maybe associated with a two fold higher odds of anxiety disorders depression and suicidality 141 Problem gambling is associated with increased suicidal ideation and attempts compared to the general population 142 Between 12 and 24 of pathological gamblers attempt suicide 143 The rate of suicide among their spouses is three times greater than that of the general population 143 Other factors that increase the risk in problem gamblers include concomitant mental illness alcohol and drug misuse 144 Genetics might influence rates of suicide A family history of suicide especially in the mother affects children more than adolescents or adults 99 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 37 Once mental disorders are accounted for the estimated heritability rate is 36 for suicidal ideation and 17 for suicide attempts 37 An evolutionary explanation for suicide is that it may improve inclusive fitness 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 to a very different ancestral environment may be maladaptive in the current one 101 145 Infection by the parasite Toxoplasma gondii more commonly known as toxoplasmosis has been linked with suicide risk One explanation states that this is caused by altered neurotransmitter activity due to the immunological response 37 There appears to be a link between air pollution and depression and suicide There may be an association between long term PM2 5 exposure and depression and a possible association between short term PM10 exposure and suicide 146 Rational nbsp Teenage recruits for Japanese Kamikaze suicide pilots in May 1945 Rational suicide is the reasoned taking of one s own life 147 However some consider suicide as never being rational 147 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 148 149 They are supported by the legal arguments for a right to die 149 The act of taking one s life for the benefit of others is known as altruistic suicide 150 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 150 Suicide in some Inuit cultures has been seen as an act of respect courage or wisdom 151 A suicide attack is a political or religious action where an attacker carries out violence against others which they understand will result in their own death 152 Some suicide bombers are motivated by a desire to obtain martyrdoms or are religiously motivated 61 Kamikaze missions were carried out as a duty to a higher cause or moral obligation 151 Murder suicide is an act of homicide followed within a week by suicide of the person who carried out the act 153 Mass suicides are often performed under social pressure where members give up autonomy to a leader see Notable cases below 154 Mass suicides can take place with as few as two people often referred to as a suicide pact 155 In extenuating situations where continuing to live would be intolerable some people use suicide as a means of escape 156 157 Some inmates in Nazi concentration camps are known to have killed themselves during the Holocaust by deliberately touching the electrified fences 158 Methods nbsp Though substance overdose is the most common method of attempted suicide in the U S guns are the most lethal most likely to result in death 159 nbsp Deaths by gun related suicide versus non gun related suicide rates per 100 000 in high income countries in 2010 160 Main article Suicide methods The leading method of suicide varies among countries The leading methods in different regions include hanging pesticide poisoning and firearms 18 These differences are believed to be in part due to availability of the different methods 17 A review of 56 countries found that hanging was the most common method in most of the countries 18 accounting for 53 of male suicides and 39 of female suicides 161 Worldwide 30 of suicides are estimated to occur from pesticide poisoning most of which occur in the developing world 2 The use of this method varies markedly from 4 in Europe to more than 50 in the Pacific region 162 It is also common in Latin America due to the ease of access within the farming populations 17 In many countries drug overdoses account for approximately 60 of suicides among women and 30 among men 163 Many are unplanned and occur during an acute period of ambivalence 17 The death rate varies by method firearms 80 90 drowning 65 80 hanging 60 85 jumping 35 60 charcoal burning 40 50 pesticides 60 75 and medication overdose 1 5 4 0 17 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 78 In China the consumption of pesticides is the most common method 164 In Japan self disembowelment known as seppuku harakiri still occurs 164 however hanging and jumping are the most common 165 Jumping to one s death is common in both Hong Kong and Singapore at 50 and 80 respectively 17 In Switzerland firearms are the most frequent suicide method in young males although this method has decreased since guns have become less common 166 167 In the United States 50 of suicides involve the use of firearms with this method being somewhat more common in men 56 than women 31 168 The next most common cause was hanging in males 28 and self poisoning in females 31 168 Together hanging and poisoning constituted about 42 of U S suicides as of 2017 update 168 PathophysiologyThere is no known unifying underlying pathophysiology for suicide 23 it is believed to result from an interplay of behavioral socio economic and psychological factors 17 Low levels of brain derived neurotrophic factor BDNF are both directly associated with suicide 169 and indirectly associated through its role in major depression post traumatic stress disorder schizophrenia and obsessive compulsive disorder 170 Post mortem studies have found reduced levels of BDNF in the hippocampus and prefrontal cortex in those with and without psychiatric conditions 171 Serotonin a brain neurotransmitter is believed to be low in those who die by suicide 172 This is partly based on evidence of increased levels of 5 HT2A receptors found after death 173 Other evidence includes reduced levels of a breakdown product of serotonin 5 hydroxyindoleacetic acid in the cerebral spinal fluid 174 However direct evidence is hard to obtain 173 Epigenetics the study of changes in genetic expression in response to environmental factors which do not alter the underlying DNA is also believed to play a role in determining suicide risk 175 PreventionMain article Suicide prevention nbsp nbsp As a suicide prevention initiative these signs on the Golden Gate Bridge promote a special telephone that connects to a crisis hotline as well as a 24 7 crisis text line nbsp A suicide prevention fence on a bridge 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 54 About 60 of people with suicidal thoughts do not seek help 176 Reasons for not doing so include low perceived need and wanting to deal with the problem alone 176 Despite these high rates there are few established treatments available for suicidal behavior 99 Reducing access to certain methods such as firearms or toxins such as opioids and pesticides can reduce risk of suicide by that method 17 177 16 37 Reducing access to easily accessible methods of suicide may make impulsive attempts less likely to succeed 178 Other measures include reducing access to charcoal for burning and adding barriers on bridges and subway platforms 17 179 16 Treatment of drug and alcohol addiction depression and those who have attempted suicide in the past may also be effective 177 16 Some have proposed reducing access to alcohol as a preventive strategy such as reducing the number of bars 55 In young adults who have recently thought about suicide cognitive behavioral therapy appears to improve outcomes 180 99 School based programs that increase mental health literacy and train staff have shown mixed results on suicide rates 16 Economic development through its ability to reduce poverty may be able to decrease suicide rates 105 Efforts to increase social connection especially in elderly males may be effective 181 In people who have attempted suicide following up on them might prevent repeat attempts 182 Although crisis hotlines are common there is little evidence to support or refute their effectiveness 15 16 Preventing childhood trauma provides an opportunity for suicide prevention 137 The World Suicide Prevention Day is observed annually on 10 September with the support of the International Association for Suicide Prevention and the World Health Organization 183 Screening IS PATH WARM is an acronym to assess a potentially suicidal individual i e ideation substance abuse purposelessness anger feeling trapped hopelessness withdrawal anxiety recklessness and mood 184 American Association of Suicidology 2019 There is little data on the effects of screening the general population on the ultimate rate of suicide 185 186 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 such as the Beck Depression Inventory or the Geriatric Depression Scale for older people are being used 187 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 188 Assessing those at high risk though is recommended 23 Asking about suicidality does not appear to increase the risk 23 Mental illness See also Antidepressants and suicide risk 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 23 Possessions that may be used to harm oneself are typically removed 78 Some clinicians get patients to sign suicide prevention contracts where they agree to not harm themselves if released 23 However evidence does not support a significant effect from this practice 23 If a person is at low risk outpatient mental health treatment may be arranged 78 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 189 190 There is tentative evidence that psychotherapy specifically dialectical behaviour therapy reduces suicidality in adolescents 191 as well as in those with borderline personality disorder 192 It may also be useful in decreasing suicide attempts in adults at high risk 193 There is controversy around the benefit versus harm of antidepressants 53 In young persons some antidepressants such as SSRIs appear to increase the risk of suicidality from 25 per 1000 to 40 per 1000 194 In older persons however they may decrease the risk 23 Lithium 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 195 196 Clozapine may decrease the thoughts of suicide in some people with schizophrenia 197 Ketamine which is a dissociative anaesthetic seems to lower the rate of suicidal ideation 198 In the United States health professionals are legally required to take reasonable steps to try to prevent suicide 199 200 EpidemiologyMain articles Epidemiology of suicide and List of countries by suicide rate See also Seasonal effects on suicide rates nbsp The US has had the largest number of gun related suicides in the world every year from 1990 through at least 2019 201 With 4 of the world s population the US had 44 of global gun suicides in 2019 and the highest rate per capita 201 Approximately 1 4 of people die by suicide a mortality rate of 11 6 per 100 000 persons per year 6 23 Suicide resulted in 842 000 deaths in 2013 up from 712 000 deaths in 1990 20 Rates of suicide have increased by 60 from the 1960s to 2012 with these increases seen primarily in the developing world 3 Globally as of 2008 update 2009 suicide is the tenth leading cause of death 3 For every suicide that results in death there are between 10 and 40 attempted suicides 23 Suicide rates differ significantly between countries and over time 6 As a percentage of deaths in 2008 it was Africa 0 5 South East Asia 1 9 Americas 1 2 and Europe 1 4 6 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 9 202 203 It was ranked as the 10th leading cause of death in the United States in 2016 with about 45 000 cases that year 204 Rates have increased in the United States in the last few years 204 with about 49 500 people dying by suicide in 2022 the highest number ever recorded 205 In the United States about 650 000 people are seen in emergency departments yearly due to attempting suicide 23 The United States rate among men in their 50s rose by nearly half in the decade 1999 2010 206 Greenland Lithuania Japan and Hungary have the highest rates of suicide 6 Around 75 of suicides occur in the developing world 2 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 6 In China suicide is the 5th leading cause of death 207 nbsp Death rate from suicide per 100 000 as of 2017 208 nbsp Share of deaths from suicide 2017 209 An unofficial report estimated 5 000 suicides in Iran in 2022 210 Sex and gender Main article Gender differences in suicide nbsp nbsp Suicide rates per 100 000 males left and females right 0 5 5 10 10 15 15 25 25 35 Above 35 No data Globally as of 2012 update death by suicide occurs about 1 8 times more often in males than females 6 211 In the Western world males die three to four times more often by means of suicide than do females 6 This difference is even more pronounced in those over the age of 65 with tenfold more males than females dying by suicide 212 Suicide attempts and self harm are between two and four times more frequent among females 23 213 214 Researchers have attributed the difference between suicide and attempted suicide among the sexes to males using more lethal means to end their lives 212 215 216 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 217 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 6 207 In the Eastern Mediterranean suicide rates are nearly equivalent between males and females 6 The highest rate of female suicide is found in South Korea at 22 per 100 000 with high rates in South East Asia and the Western Pacific generally 6 A number of reviews have found an increased risk of suicide among lesbian gay bisexual and transgender people 218 219 Among transgender persons rates of attempted suicide are about 40 compared to a general population rate of 5 220 221 This is believed to in part be due to social stigmatisation 222 Age nbsp Suicide rates by age 223 In many countries the rate of suicide is highest in the middle aged 224 or elderly 17 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 6 Worldwide the average age of suicide is between age 30 and 49 for both men and women 225 This means that half of people who died by suicide were approximately age 40 or younger and half were older 225 Suicidality is rare in children but increases during the transition to adolescence 226 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 23 It is the second most common cause of death in adolescents 53 and in young males is second only to accidental death 224 In young males in the developed world it is the cause of nearly 30 of mortality 224 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 224 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 6 HistoryMain article History of suicide nbsp The Ludovisi Gaul killing himself and his wife Roman copy after the Hellenistic original Palazzo Massimo alle Terme In ancient Athens 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 227 It was also common for the hand to be cut off the body and buried separately 228 the hand and the instrument used being considered the perpetrator 229 However it was deemed to be an acceptable method to deal with military defeat 230 In Ancient Rome while suicide was initially permitted it was later deemed a crime against the state due to its economic costs 231 Aristotle condemned all forms of suicide while Plato was ambivalent 232 In Rome some reasons for suicide included volunteering death in a gladiator 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 232 nbsp The Death of Seneca 1684 painting by Luca Giordano depicting the suicide of Seneca the Younger in Ancient Rome Suicide came to be regarded as a sin in Christian Europe and was condemned at the Council of Arles 452 as the work of the Devil In the Middle Ages the Church had drawn out discussions as to when the desire for martyrdom was suicidal as in the case of martyrs of Cordoba 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 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 233 234 Attitudes towards suicide slowly began to shift during the Renaissance John Donne s work Biathanatos contained one of the first modern defences of suicide bringing proof from the conduct of Biblical figures such as Jesus Samson and Saul and presenting arguments on grounds of reason and nature to sanction suicide in certain circumstances 235 The secularization of society that began during the Enlightenment questioned traditional religious attitudes such as Christian views on suicide toward suicide and brought a more modern perspective to the issue David Hume 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 235 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 236 A shift in public opinion at large can also be discerned The Times in 1786 initiated a spirited debate on the motion Is suicide an act of courage 237 By the 19th century the act of suicide had shifted from being viewed as caused by sin to being caused by insanity in Europe 234 Although suicide remained illegal during this period it increasingly became the target of satirical comments such as the Gilbert and Sullivan comic opera The Mikado 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 238 In 1882 the deceased were permitted daylight burial in England 239 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 232 Social and cultureLegislation Main article Suicide legislation nbsp A tantō knife prepared for seppuku abdomen cutting nbsp Samurai about to perform seppuku No country in Europe currently considers suicide or attempted suicide to be a crime 240 It was however in most Western European countries from the Middle Ages until at least the 19th century 238 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 241 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 242 Switzerland has taken steps to legalize assisted suicide for the chronically mentally ill The high court in Lausanne Switzerland in a 2006 ruling granted an anonymous individual with longstanding psychiatric difficulties the right to end his own life 243 England and Wales decriminalized suicide via the Suicide Act 1961 and the Republic of Ireland in 1993 240 The word commit was used in reference to its being illegal but many organisations have stopped it because of the negative connotation 244 245 In the United States suicide is not illegal but may be associated with penalties for those who attempt it 240 Physician assisted suicide is legal in the state of Washington for people with terminal diseases 246 In Oregon people with terminal diseases may request medications to help end their life 247 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 248 249 In Australia suicide is not a crime 250 However it is a crime to counsel incite or aid and abet 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 251 The Northern Territory of Australia briefly had legal physician assisted suicide from 1996 to 1997 252 In India suicide was illegal until 2014 and surviving family members used to face legal difficulties 253 254 It remains a criminal offense in most Muslim majority nations 30 In Malaysia suicide per se is not a crime however attempted suicide is Under Section 309 of the Penal Code a person convicted of attempting suicide can be punished with imprisonment of up to one year fined or both There are ongoing efforts to decriminalise attempted suicide although rights groups and non governmental organisations such as the local chapter of Befrienders note that progress has been slow 255 256 Proponents of decriminalisation argue that suicide legislation may deter people from seeking help and may even strengthen the resolve of would be suicides to end their lives to avoid prosecution 257 The first reading of a bill to repeal Section 309 of the Penal Code was tabled in Parliament in April 2023 bringing Malaysia one step closer towards decriminalising attempted suicide 258 Suicide became a trending crisis in North Korea in 2023 a secret order criminalized suicide as treason against socialist state 259 Religious views Main article Religious views on suicide Christianity Main article Christian views on suicide Most forms of Christianity consider suicide sinful based mainly on the writings of influential Christian thinkers of the Middle Ages such as St Augustine and St Thomas Aquinas but suicide was not considered a sin under the Byzantine Christian code of Justinian for instance 260 261 In Catholic and Orthodox doctrine suicide is considered to be murder violating the commandment 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 262 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 263 However it is believed that mental illness or grave fear of suffering diminishes the responsibility of the one completing suicide 264 Judaism Main article Jewish views on suicide 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 Masada First French persecution of the Jews and York Castle 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 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 265 Islam Islamic religious views are against suicide 30 The Quran forbids it by stating do not kill or destroy yourself 266 267 The hadiths also state individual suicide to be unlawful and a sin 30 Stigma is often associated with suicide in Islamic countries 267 Hinduism and Jainism nbsp A Hindu widow burning herself with her husband s corpse 1820s In Hinduism suicide is generally disdained and is considered equally sinful as murdering another in contemporary Hindu society Hindu Scriptures 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 268 However Hinduism accepts a man s right to end one s life through the non violent practice of fasting to death termed Prayopavesa 269 but Prayopavesa is strictly restricted to people who have no desire or ambition left and no responsibilities remaining in this life 269 Jainism has a similar practice named Santhara Sati or self immolation by widows is a rare and illegal practice in Hindu society 270 Ainu Within the Ainu religion someone who dies by suicide is believed to become a ghost tukap who would haunt the living 271 to come to fulfillment from which they were excluded during life 272 Also someone who insults another so they kill themselves is regarded as co responsible for their death 273 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 273 Philosophy Main article Philosophy of suicide 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 274 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 Thomas Aquinas 274 Immanuel Kant 275 and arguably John Stuart Mill 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 276 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 277 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 include Scottish empiricist David Hume 274 who accepted suicide so long as it did not harm or violate a duty to God other people or the self 236 and American bioethicist Jacob Appel 243 278 Advocacy See also Advocacy of suicide nbsp In this painting by Alexandre Gabriel Decamps the palette pistol and note lying on the floor suggest that the event has just taken place an artist has taken his own life 279 Advocacy of suicide has occurred in many cultures and subcultures The Japanese military during World War II encouraged and glorified kamikaze attacks which were suicide attacks by military aviators from the Empire of Japan against Allied naval vessels in the closing stages of the Pacific Theater of World War II Japanese society as a whole has been described as suicide tolerant 280 see Suicide in Japan Internet searches for information on suicide return webpages that in a 2008 study about 50 of the time provide information on suicide methods A similar study found that 11 of sites encouraged suicide attempts 281 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 The Internet however may also help prevent suicide by providing a social group for those who are isolated 282 Locations See also List of suicide sites and Suicides at the Golden Gate Bridge Some landmarks have become known for high levels of suicide attempts 283 These include China s Nanjing Yangtze River Bridge 284 San Francisco s Golden Gate Bridge Japan s Aokigahara Forest 285 England s Beachy Head 283 and Toronto s Bloor Street Viaduct 286 As of 2010 update the Golden Gate Bridge has had more than 1 300 suicides by jumping since its construction in 1937 287 Many locations where suicide is common have constructed barriers to prevent it 288 this includes the Luminous Veil in Toronto 286 the Eiffel Tower in Paris the West Gate Bridge in Melbourne and Empire State Building in New York City 288 They generally appear to be effective 289 Notable cases nbsp Japanese general Hideki Tojo receiving treatment immediately after attempted suicide 1945 Main article List of suicides An example of mass suicide is the 1978 Jonestown mass murder suicide in which 909 members of the Peoples Temple an American new religious movement led by Jim Jones ended their lives by drinking grape Flavor Aid laced with cyanide and various prescription drugs 290 291 292 Thousands of Japanese civilians took their own lives in the last days of the Battle of Saipan in 1944 some jumping from Suicide Cliff and Banzai Cliff 293 The 1981 Irish hunger strikes led by Bobby Sands 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 294 During World War II Erwin Rommel was found to have foreknowledge of the 20 July plot on Hitler s life he was threatened with public trial execution and reprisals on his family unless he killed himself 295 Other speciesMain article Animal suicide As suicide requires a willful attempt to die some feel it therefore cannot be said to occur in non human animals 230 Suicidal behavior has been observed in Salmonella seeking to overcome competing bacteria by triggering an immune system response against them 296 Suicidal defenses by workers are also noted in the Brazilian ant Forelius pusillus where a small group of ants leaves the security of the nest after sealing the entrance from the outside each evening 297 Pea aphids when threatened by a ladybug can explode themselves scattering and protecting their brethren and sometimes even killing the ladybug this form of suicidal altruism is known as autothysis 298 Some species of termites for example Globitermes sulphureus 299 have soldiers that explode covering their enemies with sticky goo 300 299 There have been anecdotal reports of dogs horses and dolphins killing themselves 301 but little scientific study of animal suicide 302 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 303 See alsoCaring letters List of suicide crisis lines List of countries by suicide rate Prisoner suicide Substance induced psychosis Youth suicideReferences a b c Preventing suicide a global imperative WHO 2014 pp 7 20 40 ISBN 978 92 4 156477 9 a b c d e f g h i Suicide Fact sheet N 398 WHO April 2016 Archived from the original on 4 March 2016 Retrieved 3 March 2016 a b c d e Hawton K van Heeringen K April 2009 Suicide Lancet 373 9672 1372 81 doi 10 1016 S0140 6736 09 60372 X PMID 19376453 S2CID 208790312 De La Vega D Giner L Courtet P March 2018 Suicidality in Subjects With Anxiety or Obsessive Compulsive and Related Disorders Recent Advances Current Psychiatry Reports 20 4 26 doi 10 1007 s11920 018 0885 z PMID 29594718 S2CID 4549236 a b Richa S Fahed M Khoury E Mishara B 2014 Suicide in autism spectrum disorders Archives of Suicide Research 18 4 327 39 doi 10 1080 13811118 2013 824834 PMID 24713024 S2CID 25741716 a b c d e f g h i j k l m n o Varnik P March 2012 Suicide in the world International Journal of Environmental Research and Public Health 9 3 760 71 doi 10 3390 ijerph9030760 PMC 3367275 PMID 22690161 Suicide across the world 2016 World Health Organization 27 September 2019 Archived from the original on 1 July 2004 Retrieved 16 October 2019 a b Fazel S Runeson B January 2020 Suicide New England Journal of Medicine 382 3 266 74 doi 10 1056 NEJMra1902944 PMC 7116087 PMID 31940700 S2CID 210332277 a b Stedman s Medical Dictionary 28th ed Philadelphia Lippincott Williams amp Wilkins 2006 ISBN 978 0 7817 3390 8 a b Dodds TJ March 2017 Prescribed Benzodiazepines and Suicide Risk A Review of the Literature The Primary Care Companion for CNS Disorders 19 2 doi 10 4088 PCC 16r02037 PMID 28257172 Bottino SM Bottino CM Regina CG Correia AV Ribeiro WS March 2015 Cyberbullying and adolescent mental health systematic review Cadernos de Saude Publica 31 3 463 75 doi 10 1590 0102 311x00036114 PMID 25859714 Suicide rates rising across the U S CDC Online Newsroom 11 April 2019 Retrieved 19 September 2019 Relationship problems or loss substance misuse physical health problems and job money legal or housing stress often contributed to risk for suicide Preventing Suicide A Resource for Media Professionals PDF World Health Organization Department of Mental Health and Substance Abuse 2008 ISBN 978 92 4 159707 4 DeCou CR Comtois KA Landes SJ January 2019 Dialectical Behavior Therapy Is Effective for the Treatment of Suicidal Behavior A Meta Analysis Behav Ther 50 1 60 72 doi 10 1016 j beth 2018 03 009 PMID 30661567 S2CID 58666001 a b Sakinofsky I June 2007 The current evidence base for the clinical care of suicidal patients strengths and weaknesses Canadian Journal of Psychiatry 52 6 Suppl 1 7S 20S PMID 17824349 Other suicide prevention strategies that have been considered are crisis centres and hotlines method control and media education There is minimal research on these strategies Even though crisis centres and hotlines are used by suicidal youth information about their impact on 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