Having a loved one commit suicide is one of the most emotionally devastating things that a person can experience; for this reason I would recommend paying attention to the textbook section entitled Effects of Suicide on Friends and Family.
This lesson is unique in that it involves statistics to a greater degree than any other lesson in the course; a purpose of this narrative is to help you navigate this sea of information by emphasizing the key findings and points from both the textbook and elsewhere.
Lesson Objectives
After completing this lesson you should be able to:
- Clear up myths and misconceptions about suicide.
- Be familiar with facts and statistics about suicide.
- Understand about the etiology, course, and treatment of suicide.
- Be familiar with the impact of geography on suicide rates.
- Understand about suicide in the military.
Lesson Readings and Activities
By the end of this lesson, make sure you have completed the readings and activities found in the Lesson 11 Course Schedule.
Defining Suicide
Fact or Myth?
The holiday season (December) is when suicides are most likely to occur.
Answer: MYTH!
Most suicides occur in the spring (Woo, Okusaga, & Postolache, 2012).
One potential explanation for this is that people don’t have much energy in the winter, but when the weather starts getting nicer they have more energy to act on suicidal thoughts. Can you think of any other possible explanations?
Suicide= The intentional, direct, and conscious taking of one’s own life.
In other words, a suicide is a conscious decision and thus not an accident (although suicides can be impulsive in some cases). Suicide has many different causes, and people kill themselves for many different reasons. It is a complex situation with many underlying factors, and we will go over some of those factors later on. For now, let’s examine some of the facts surrounding suicide.
Facts about Suicide
Suicide is currently the 10th leading cause of death in the United States (Murphy, Xu, & Kochanek, 2013, as cited in Sue et al., 2016).
According to the Centers for Disease Control and Prevention (CDC, 2015) there were 41,149 recorded suicides in the United States during the year 2013, which amounts to 113 suicides per day and a suicide every 13 minutes.
Suicide Risk Factors
The demographic most likely to commit suicide is elderly men (CDC WISQARS, 2013). What are some reasons why elderly men would be more likely to commit suicide than other demographics?
Even though elderly men are more likely to commit suicide, suicide is now the 2nd leading cause of death for young people aged 15-24 (CDC, 2015).
Fact or Myth?
Young people are the most at risk for committing suicide.
Answer: MYTH!
According to the Centers for Disease Control (2015), men are approximately 4 times more likely than women to commit suicide, despite the fact that women are more likely to have suicidal thoughts. Table 11.1 breaks down sex differences in suicide:
| Table 11.1. Sex Differences in Suicide | |
| Males | Females |
| Approximately 78% of suicides in the U.S. | Approximately 22% of suicides in the U.S. |
| 7th leading cause of death | 14th leading cause of death |
| Most common method = firearms (56.9%) | Most common method = poison (34.8%) |
These subsequent risk factors are from the textbook (Sue et al., 2010; Sue et al., 2016) and I would recommend carefully reading about them:
Divorce, Separation, or Death of a Spouse
Alcohol Consumption
Media Coverage of Suicide
Regarding media coverage or “copycat” suicides, recall the information on “media contagion” from the information about school shooters in Lesson 2. “Suicide contagion” is the official term for suicide sparked by media coverage. As an example of this, there was a 12% increase in suicides the year after Marilyn Monroe’s supposed suicide (Bailey, 2003, as cited in Sue et al., 2010).
One counterintuitive finding about suicide is that socioeconomic status by itself is actually not a risk factor for suicide. However, change in financial status (such as job loss or losing money in a stock market crash) is a potent risk factor for suicide.
A history of suicide attempts is another major risk factor (remember that the best predictor of future behavior is past behavior). Approximately 20% of people who attempt suicide attempt again within one year (Sue et al., 2010).
Finally, a sense of hopelessness may be the most powerful risk factor for suicide (Jobes, 2006).
If someone does not see any hope for the future then they are more likely to take their own life, which is why it’s important for clinicians to assess for future plans when working with a suicidal client; if a client does not have any plans for the future, or if they are doing something like giving away possessions or making a will, then it’s important to help them to develop a positive view of the future while also instilling a sense of meaning and purpose for them. We’ll discuss using meaning and purpose as antidotes for suicide in an activity later on.
The next page regards another suicide risk factor: certain occupations.
Brainstorm Ideas
Think about this question as you generate thoughts and ideas in preparation for the Lesson 11 Discussion Forum questions found at the end of the lesson.
- What are some potential reasons why men are so much more likely to commit suicide?
Occupation and Suicide
According to research (Soreff, 2013, as cited in Sue et al., 2016; Stallones, Doenges, Dik, & Valley, 2013) the following occupations are at increased risk for suicide:
- Psychiatrists
- Dentists
- Physicians
- Lawyers
- Law Enforcement
- Farmers
- Fishermen
- Foresters
On the next page we will consider another risk factor for suicide: geography.
Brainstorm Ideas
Think about this question as you generate thoughts and ideas in preparation for the Lesson 11 Discussion Forum questions found at the end of the lesson.
- What are some possible reasons why these occupations are at increased risk for suicide?
Geography and Suicide
Trivia Question: Which state in the United States has the highest suicide rate?
Wyoming, with Alaska and Montana in a close 2nd and 3rd (CDC WISQARS, 2013).
Let’s now turn our attention globally – Table 11.2 is a list of the countries with the highest suicide rates, according to the World Health Organization (WHO, 2012):
| Table 11.2. Country Suicide Rates | ||
| Rank | Country | Suicide Rate per 100,000 people |
| 1 | Guyana | 46.45 |
| 2 | Ukraine | 35.6 |
| 3 | South Korea | 29.85 |
| 4 | Lithuania | 29.7 |
| 5 | Kazakhstan/Tanzania (tie) | 24.95 |
| 6 | Russia | 20.65 |
| 7 | Hungary | 19.9 |
| 8 | Uganda | 19.6 |
| 9 | Belarus | 19.55 |
| 10 | Japan | 18.5 |
| FYI | United States | 12.3 |
A few notes about this list:
- Guyana is a small country in South America that is north of Brazil and east of Venezuela.
- South Korea has by far the world’s highest suicide rate for females; it is the only country in which the suicide rate for females is almost equal to that of males. The suicide rate for males far exceeds that of females in every other country.
- Overall the U.S. is in the “middle of the pack” globally when it comes to suicide rates.
We’ve established that suicide is a huge problem and is sadly quite common worldwide. On subsequent pages we will discuss things that can be done to alleviate the problem, starting with a way to potentially provide closure and healing for loved ones: a psychological autopsy.
Brainstorm Ideas
Think about these questions as you generate thoughts and ideas in preparation for the Lesson 11
Discussion Forum questions found at the end of the lesson.
- What are some explanations as to why Wyoming, Alaska, and Montana have the highest suicide rates in the USA?
- Consider the list of countries:
- What are some themes that stand out from this list?
- What are some potential reasons why these particular countries have high suicide rates?
Answer:
Various explanations and theories could work to explain why Wyoming, Alaska, and Montana have the highest rate of suicides in the United States. My view, again, tends to be humanistic, and to that degree, I tend to view human life and the uniqueness of the human experience as a cornerstone feature of the causal contributors to suicide in these states. It tends to be how those who suffer view the world around them and their position in it. To that end, the humanist perspective would view the life of one who has committed suicide, perhaps during a psychological autopsy, to determine the degree to which they evolved to feel hopeless and saw their lives without meaning.
I believe that many factors contribute to the lack of meaning in life that evolves to a particular degree of suicide. The environment enriches these features. Variations in light cycles lead to imbalances in sleep and wakefulness, which have well-documented biobehavioral effects. These determinants, combined with lesser access to mental health resources due to sparse populations, yield environments that are rich in depression and anxiety, to the degree that one abandon’s the will to live and terminates their life. To this end, I believe that access to mental health resources, alongside more biobehavioral dispositions resulting from environmental factors, are among the theories that advance an explanation of this phenomenon.
When considering the worldwide prevalence of suicide, the Table 11.2 offers a glimpse into the trend in SES or socioeconomic status, which works as a predictor of suicide. The table highlights nation-states that rank highest in prevalence as those with lower socioeconomic status (SES). Features of low SES environments typically include poor access to healthcare, low wages, and poverty. Guyana, which tops the list, would fit squarely into that mold.
Psychological Autopsy
Psychological Autopsy = The systematic examination of existing information for the purpose of understanding and explaining a person’s behavior before his or her death.
A major purpose of a psychological autopsy is to give some answers and hopefully provide some closure for grieving loved ones. Conducting such an investigation involves compiling and analyzing the following:
- Case histories of victims
- Recollections and records of therapists
- Interviews with relatives and friends
- Information obtained from crisis calls
- Messages left in suicide notes
Perhaps the most serious challenge when conducting a psychological autopsy is…
Sources are not always available or reliable. Many things from the above list are difficult or impossible to obtain, and if the information is obtained, then it may be biased.
For example, only 12 to 34% of those who commit suicide leave notes (Black, 1993; Leenaars, 1992).
So that particular source of information is not available in a large majority of cases. Moreover, many individuals who commit suicide have never been to psychotherapy (men with undiagnosed depression, for example) and thus have no records or case histories. Finally, the intense feelings of loved ones may lead to bias in their construal of the events; it’s difficult to be objective when one has experienced such a profound sense of loss and pain.
Antidotes for Suicide
The following are protective factors that can reduce the likelihood someone will attempt or complete suicide (Sue et al., 2010):
- Access to resources (health insurance, etc.)
- Restricted access to lethal means (e.g., not having a gun in the home)
- Social support
- Spirituality
- Problem solving and conflict resolution skills
- Hope
And finally… a sense of meaning and purpose, which is what the next page is about.
Life Purpose Questionnaire
Look at the Life Purpose Questionnaire from The Anxiety & Phobia Workbook by Edmund Bourne (2000), which is a book that I highly recommend by the way. This is an activity that can be helpful to clients who can benefit from generating a sense of meaning; finding and cultivating meaning can be a valuable way to combat the dangers of hopelessness.
How do you cultivate meaning and purpose in your life? Thinking about what your core values are can be a good starting point. Take a look at the list of values below and think about which ones are the most meaningful to you.
- Happy family life
- Material success
- Intimacy
- Career achievement
- Friendship
- Personal growth
- Good health
- Spiritual awareness
- Peace of mind
- Dedication to a social cause
- Serving others
Brainstorm Ideas
Think about this question as you generate thoughts and ideas in preparation for the Lesson 11 Discussion Forum questions found at the end of the lesson.
- Choose three values from the list: Why did you choose them (value them)?
- How do you derive meaning in life from them?
Suicide and the Military
Fact or Myth?
American soldiers are more likely to die from suicide than from combat.
Answer: FACT (Chappel, 2013, as cited in Sue et al., 2016)
Information on this page is about military personnel who are currently serving, including both “active duty” personnel and part time personnel in the Reserves and National Guard.
According to a report from the Department of Defense (2014), 438 service members took their lives during the 2014 fiscal year, which was slightly lower overall than the previous year (479) but higher than 2012 (when 349 service members committed suicide). One trend over the past few years is that Reservists have a higher, and increasing, suicide rate compared with active duty personnel.
The Army was the branch of the military with the highest per capita suicide rate (23.8 per 100,000 soldiers) while the Navy had the lowest (16.3 per 100,000).
Despite these numbers, however, the suicide rate among those currently serving in the military is below that of the average population. I served as a psychologist (73 Bravo) in the U.S. Army Medical Service Corps and can attest to how the military screens extensively for current mental health problems during the application process, which may at least partially account for the lower suicide rate among currently serving military personnel.
Guns were the most common method of suicide (over 60% of cases); most were privately owned rather than military issued. Finally, the military demographic most at risk for suicide is…
Answer: White, enlisted (lower ranking) males under age 25.
Rank is intimately related to mental health issues in the military, with higher rank and/or officer status serving as somewhat of a protective buffer against mental health problems.
Regarding veterans, according to the Department of Veterans Affairs (2012) a veteran commits suicide approximately once every 70 minutes. Such a statistic shows how dire the situation is for veterans in the United States.
Note: Service members and their families in crisis should seek help immediately by contacting the Military and Veteran Crisis Line at 800-273-8255, (press 1 for military) for 24/7 crisis support. The crisis line also provides an online chat and text service (838255). The Military and Veteran Crisis Line provides 24/7 confidential support to all service members and their families.
Lesson Summary
Suicide is a diverse, complex, and pervasive mental health-related phenomenon. In this lesson we saw how serious the situation is with suicide given the statistics, but we also learned about ways to prevent or minimize suicide. Possessing a greater awareness of the risk factors involved in suicide can help to avoid or alleviate them to some degree.
In the next lesson we will get back to learning about DSM-5 diagnoses when we cover the schizophrenia spectrum (note that the next lesson contains so much information that it is broken up into two parts).
References
- Bailey, D.S. (2003). Help the media prevent copycat suicides, Monitor, 34, 14.
- Black, S.T. (1993). Comparing genuine and simulated suicide notes: A new perspective. Journal of Consulting and Clinical Psychology, 67, 699.702.
- Bourne, E.J. (2000). The anxiety & phobia workbook (3rd ed.). Oakland, CA: New Harbinger.
- Centers for Disease Control and Prevention (2015). Suicide facts at a glance. Retrieved May 14th, 2016.
- Centers for Disease Control and Prevention Web-based Injury Statistics Query and Reporting System (2013), Leading causes of death reports. Retrieved May 14th, 2016.
- Chappel, P. (2013, January 14). U.S. military’ suicide rate surpassed combat deaths in 2012.
- Department of Defense (2014). Suicide event report. Retrieved May 15th, 2016.
- Jobes, D. A. (2006). Managing suicidal risk: A collaborative approach. New York: The Guilford Press.
- Leenaars, A.A. (1992). Suicide notes, communication, and ideation. In R.W. Maris, A.L. Berman, J.T. Maltsberger, & R.I. Yufit (Eds.), Assessment and prevention of suicide. New York: Guilford Press.
- Murphy, S.L., Xu, J., & Kochanek, K.D. (2013). Deaths: Final data for 2010. National Vital Statistics Reports, 61, 1-118.
- Soreff, S. (2013). Suicide.
- Stallones, L., Doenges, T., Dik, B.J., & Valley, M.A. (2013). Occupation and suicide: Colorado, 2004-2006. American Journal of Industrial Medicine, 56, 1290-1295.
- Sue, D., Sue, D.W., & Sue, S. (2010). Understanding abnormal behavior (9th ed.). Boston: Wadsworth/Cengage.
- Sue, D., Sue, D.W., Sue, D., & Sue, S. (2016).Understanding abnormal behavior (11th ed.). Stamford, CT: Cengage.
- World Health Organization (2012). Age-standardized suicide rates (per 100,00 population). Retrieved May 14th, 2016.
- Woo, J.M., Okusaga, O., & Postolache, T.T. (2012). Seasonality of suicidal behavior. International Journal of Environmental Research and Public Health, 9(2), 531-547.
