Are There Groups That Have Particularly High Or Low Suicide Rates?

Yes. Native Americans have the highest "racial" rate (16.2/100,000 (1991-3, age-adjusted) while the White rate was 11.1/100,000 [1992, age-adjusted]).

Among Native Americans, the pattern of suicide resembles that of Black Americans: a male peak in early twenties, and decreasing thereafter. This pattern differs from that of White Americans, where elderly White males have the highest rates.

Black Americans have reported suicide rates substantially lower than those of Whites, except among males 24-35 years old, whose rates are similar. The overall rate for Blacks (6.2/100,000 in 1980; 7.0/100,000 in 1994) is roughly half that of Whites, a ratio which has been consistent over many years. There is, however, some evidence that a small part of the difference is due to more under-reporting of Black suicide than White.

The best single socio-economic predictor appears to be religious affiliation. Suicide is infrequent in Moslem populations, typically reported as less than 1 per 100,000 per year. It also is uncommon in many Catholic countries, with rates of 2 to 8 per 100,000 per year.

On the other hand, Catholic Austria and Hungary have rates of 23 and 39 per 100,000 per year, respectively. Protestant, Hindu, and Buddhist regions have, with a few exceptions, higher reported suicide rates than Moslem or Catholic ones.

However, there is substantial skepticism about the accuracy of suicide statistics, particularly from societies in which suicide is most condemned. Psychiatrist Erwin Stengel observes, "In Roman Catholic and Moslem countries a verdict of suicide is such a disgrace for the deceased and his family that it is to be avoided wherever possible."

The suicide rate is not reliably correlated with such factors as income, education, and health care availability. The effect of unemployment is in dispute. For example, while some studies have found an association between unemployment and suicide, in England there was a 35 percent decrease in the suicide rate between 1963 and 1975, the same period that showed a 50 percent increase in unemployment.

While there is no good correlation with wealth or poverty and suicide, certain professions have especially high rates: psychiatrists, physicians, lawyers, and retired military officers.

However, (to combine some risk factors for suicide) the highest suicide likelihood would probably be found in a depressed, ill, elderly white Protestant male immigrant, widowed, divorced or unmarried, who sleeps more than 9 hours a day, has more than three drinks a day, smokes, and keeps a gun in the house.

Youth Suicide

Teenagers attempt suicide roughly 10 times more frequently than adults, although their fatality rate of 11.1 per 100,000 people is about the same as adults'. This is the third leading cause of death among 15-19 year-olds. For this age group, there were 5,174 motor-vehicle deaths in 1994, compared to 1,948 suicides.

According to U.S. national data released in September 1991, about one million teens (out of about 25 million) attempt suicide each year, of which an estimated 276,000 sustained injuries serious enough to require medical treatment.

Some other estimates (these are total, not per-year) are considerably higher: 3% of elementary-school, 11% of high-school, and 17% of college students. However, "Most were low-lethality attempts for which medical or other attention was not sought. Accordingly, the vast majority of [these] suicide attempts will not be uncovered by investigations dealing solely with clinical or medically identified populations." Thus, estimates or calculations of teenage suicide-attempt rates are particularly unreliable.

About four times more girls than boys make suicide attempts, but boys are much more likely to die: about 11% of (reported) males' attempts were fatal, compared to 0.1% of females', a ratio of more than 100:1. This also gives a ballpark average of about 50 attempts for every fatality in this age group.

This low fatality rate might be taken to mean that most of these adolescents don't want to kill themselves (true) and that there is generally one or more "warning" attempts before a lethal one (not true). In a study from Finland, only 30 percent of male, and 68 percent of female suicides 13 to 22 years old had made a previous (known) suicide bid. This suggests that many of these lethal first-time-attempters intended to die.

Compared to those of older people, adolescents' suicide-attempt statistics show two significant differences. First the fatality rate for boys is a hundred times that of girls, a much greater gender difference than with any other age group. The immediate reason is clear enough: most teenage girls use relatively low-lethality methods like drugs and wrist cuts, while a substantial number of boys use guns and hanging. The reasons behind these choices are not known.

Second, the fatality rate among adolescents, less than 2%, is much lower than that among the elderly, variously reported to be between 25% and 50%. This may be because the young, however miserable, usually have more reason for optimism about the future than do the old, who are too often without friends, family, job, and health.

Nevertheless, their suicide rate is increasing, and approaching the national average.

This corresponds to about 2000 suicides among 15-19 year-olds per year. While it's true that the suicide rate is substantially higher among old people, suicide is a relatively more frequent cause of death in the young, who have few deaths from illness. That's why it's the third leading cause of death among 15-24 year-olds, but ranks ninth or tenth for those 55-74.

These numbers show that overall U.S. suicide rates have been essentially unchanged between 1980-94, while 15-19 year-old rates have risen significantly and elderly rates held steady.

Among children between the ages of 10 and 14, the suicide rate increased 110 percent (from 0.8 per 100,000 to 1.7 per 100,000) between 1980 and 1994.

There are also claims of an epidemic of youth suicide, with increases on the order of 300% between the early 1950s and late 1980s. In 1950 the official rate for adolescent suicides was 2.7 per 100,000; by 1980 it had increased to 8.5 per 100,000. However, there is dispute about the magnitude of this "epidemic" in part because (1) the base rate chosen was the lowest in this century; (2) there is a greater willingness to admit to teen suicides now than in the 1950s.

The reasons for this rise are also in dispute. Besides the usual social rationales (e.g. higher divorce rates), "Some statistics indicate that suicide attempts among younger persons have not increased, but the methods and means they are using are more lethal, making the attempts more successful," says CDC's [centers for Disease Control] Dr. Alexander E. Crosby.

According to Crosby, in 1992 firearm-related deaths accounted for 64.9 percent of suicides among people under 25. Among those aged 15 through 19, firearm-related suicides accounted for 81 percent of the increase in the overall rate from 1980 to 1992.

International Data

Data from around the world shows no consistent suicide pattern. 20 of 27 national rates rose between 1970 and 1980; so did 22 of 27 youth rates. The male youth-suicide rate generally increased more than the female rate. In most countries, the youth suicide rate is around one half of the adult rate, but in Chile, Venezuela, and Thailand, the youth rate is somewhat higher than the overall adult rates. The reasons are uncertain; and youth suicide rates show fewer correlations with social variables, such as income or national birth rate, than do adult rates.

In terms of methods, a 16-country survey found suicide rates from 1960 to 1980 increased for motor vehicle exhaust (carbon monoxide), guns, and hanging; decreased for domestic gas; were stable for solid and liquid poisons, drowning, and cuts/stabs.

Suicidal adolescents are so caught up in their own misery, that they can't see they have choices. Most have had little experience dealing with problems. They often can't or won't talk with their parents and may have no other trusted adults in their lives. Frequently they have withdrawn from their friends. This isolation further decreases their contact with other ideas and views.

Death may seem like the only solution to teenagers grieving over a major loss in their lives. In the bleak words of one fourteen-year-old girl, "If I died, I wouldn't hurt as much as I do now."

`But if you could say to them, "Don't commit suicide because I can get you away from the pain without dying," says psychiatrist Michael Peck, they'd likely be ready to do it.'

One counselor's description of a session with a suicidal college student follows: the student was highly religious, single, and pregnant. Overcome by guilt, she wanted to kill herself. The counselor tried to show her that there were other possible solutions:

"I did several things. For one, I took out a single sheet of paper and began to "widen her blinders."

Our conversation went something on these general lines: "Now, let's see: You could have an abortion here locally." ("I couldn't do that.") ...."You could go away and have an abortion." ("I couldn't do that.") "You could bring the baby to term and keep the baby." ("I couldn't do that.") "You could have the baby and adopt it out." ("I couldn't do that.") "

We could get in touch with the young man involved." ("I couldn't do that.") "We could involve the help of your parents." ("I couldn't do that.") "You can always commit suicide, but there is obviously no need to do that today." (No response.) "Now, let's look at this list and rank them in order of your preference, keeping in mind that none of them is perfect."

"The very making of this list, my non-hortatory and non-judgmental approach, had already had a calming influence on her. Within a few minutes her lethality had begun to de-escalate. She actually ranked the list, commenting negatively on each item. What was of critical importance was that suicide was now no longer first or second. We were then simply "haggling" about life, a perfectly viable solution."

Sometimes the triggering event is astonishingly trivial: George Colt mentions, "...the fourteen-year-old boy who, according to his parents, shot himself because he was upset about getting braces for his teeth that afternoon; the girl who killed herself moments after her father refused to let her watch "Camelot" on television....Such incidents are often misinterpreted as the "reason" for a suicide, but they are usually the culmination of a long series of difficulties..."

Even so, there may be qualitative differences between suicidal adolescents and older people. "When young people are suicidal, they're not necessarily thinking about death being preferable, they're thinking about life being intolerable," says Sally Casper, former director of a suicide prevention agency in Lawrence, Massachusetts. "They're not thinking of where they're going, they're thinking of what they're escaping from.

Recently, a fifteen-year-old girl came in here. In one pocket she had a bottle of sleeping pills, and in the other pocket she had a bottle of ipecac, a liquid that makes you vomit. She said, `I want to kill myself, but I don't want to be dead. I mean, I want to be dead, but I don't want to be dead forever, I only want to be dead until my eighteenth birthday.' "

The fact that more than 95% of adolescents who live through their suicide attempt do not go on to kill themselves suggests that their problems are not as permanent or serious as their attempted solution. Feeling miserable and hopeless, these adolescents choose an irrevocable solution to temporary problems and, "...reject not just a last few bitter moments, but life, all of it and at once, with all its myriad possibilities...'"

This is what make youth suicide especially heartbreaking.

Statistics, though informative, diminish the impact and reality of death. While this book is filled with figures and abstractions, behind each of the numbers is a real person, with a history, personality, and pain that is both particular to each and common to us all. They are not just numbers; these are our friends, and neighbors, and families, and selves. I include some of their words to give a sense of the quality of their lives, and the thinking that led to their choice of suicide.

Karen, sixteen:

I was really upset and depressed. My life just seemed to be in total chaos. My boyfriend just dumped me flat, and he said he loved the other girl and didn't love me at all. My parents and I also just got into another fight again about some really dumb things, so I just went into my room and closed the door. There was this bottle of sleeping pills my mother was using, and I had them with me.

I sat and stared at it for a long time, weighing out the good and the bad things in my life. The bad things came out ahead. I poured some of the pills in my hand, and figured ten or fifteen ought to be enough to do it. Those pills, they all looked so innocent and peaceful, like they couldn't do much to hurt anyone. Well, I put them in my mouth and held them there for a long time, wondering if I should or shouldn't.

I took a glass of water and swallowed. At first nothing happened, and then they all hit me at once. The room started to blur and spin, small sounds were going on in my head. The last thing I remembered was trying to move and not being able to. I woke up in the hospital. They were pumping out my stomach, one of the worst things you can have done to you. My mother came into the room, and she apologized for the fight we had.

I place suicide attempters in one of four groups: (1) Rational people facing an insoluble problem, generally a fatal or debilitating illness; (2) Impulsive people, frequently young, truly but temporarily miserable, sometimes drunk, who wouldn't even consider suicide six months later; (3) Irrational people, often alcoholic, schizophrenic, or depressed; (4) People trying to make a safe gesture as a "cry for help" or to get someone's attention.

The first group, and most of us will eventually be in it, has, in my view, the right to decide the time, place, and manner of their death. It is clear that a competent person who really wants to kill himself can usually do so. However, seriously ill or physically impaired people often have both the greatest interest in, and least ability to carry out, suicide. They ought to have medical help to die peacefully and without pain, but this, while sometimes surreptitiously done, cannot at present be relied on.

Many of us have known people who have suffered long, agonizing deaths because they became too ill to kill themselves and their physicians were unwilling to act on their request. I will not mince words by calling it "euthanasia" or "self-deliverance": if you're terminally ill, I hope to provide you with information that will help you determine the best way to kill yourself, if that's your well-considered decision.

What about the young and impulsive, particularly teenagers? At the moment, they seem to have the worst of all worlds, where: lethal and not-so-lethal suicide methods are readily available; neither they, their parents, nor their teachers are likely to know how dangerous particular methods are; personal ("Are you thinking about...?) or practical ("How would you go about...?) discussion of suicide is largely taboo.

While many schools now teach about AIDS and its transmission, more teenagers will attempt or commit suicide next year than will become HIV-infected. The ignorance, stigma, and fear about suicide would decrease if that topic were added to the curriculum and treated honestly.

A case will be made that people shouldn't commit suicide and that, therefore, a manual telling them how to go about it is pernicious.(6f) This is like one of the arguments against sex education: "If they know how, they'll do it." Well, they do it anyway. Thirty thousand suicide deaths a year in the U.S. should make this clear.

In the absence of knowledge about suicide methods, and the consequences of failed attempts, people will continue to act in desperation and ignorance, as they have throughout recorded history, with gun, rope, blade, poison, and anything else available.

That is the reality. And the methods people use all too often leave them neither dead nor fully recovered, but maimed and permanently injured: paralyzed from jumps, brain-damaged from gunshots, comatose from drugs.

But for anyone considering suicide (or even "safe" suicidal gestures; nothing is 100 percent reliable), I urge you to try every alternative first, and then try them again. These include a variety of anti-depressant drug therapies, various flavors of psychotherapy, electroshock, and "reality therapy", helping people worse off than you. Each of these will work for some; no single solution will work for everyone. That's why it's vital not to give up if one or two or three don't do much to decrease your pain. How do you know that suicide is the best solution if you haven't tried everything else first? You can always kill yourself later.

I've known several people who have killed themselves, and others who intended to, but waited too long. Three have been significant influences:

One man had a series of small strokes and specified that if he had a major one he did not want so-called "heroic" measures used. Soon afterwards, he did suffer a massive stroke and was reduced to a vegetative state, kept alive contrary to his written instructions. His son, a physician himself, was appalled by the contravention of his father's instructions in a medically hopeless situation. Nevertheless it took weeks of argument and delay before the hospital agreed to act in accordance with their wishes.

Another man, 80 years old, entered a hospital intending to kill himself (he said) if he didn't get better. After four months and a series of operations, he became too weak and disoriented to act on his intention. He "lived" another four months in the hospital, progressively deteriorating both physically and mentally.

One young woman took a drug overdose, expecting that her housemates would return soon. They were delayed. I would like to believe that, had she known about less lethal methods, she would be alive today.

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from suicide and attempted suicide by geo stone.