Suicidal Thoughts (cont.)
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This question is complex and difficult to answer -- our best information comes from people who have survived suicide attempts or by trying to understand what people who killed themselves may have in common. Alternately, some people leave a suicide note that may give some insight into their state of mind. Many people who attempted suicide indicate that they don't necessarily want to die but more often want to end their pain -- emotional or physical.
Most, but not all, people who commit suicide have a mental illness. This includes depression, bipolar disorder, anxiety, or schizophrenia. Additionally, mental illness also includes substance-abuse disorders. Substance-abuse disorders include alcoholism (alcohol dependence), alcohol abuse (including binge drinking), as well as dependence on or abuse of any other drug such as heroin, cocaine ("coke", "crack"), methamphetamine ("meth"), opiates/opioids (oxycodone, hydrocodone, morphine, methadone), or others. When people are using alcohol or drugs (they are drunk, high, or stoned), they can be more impulsive -- more likely to act without thinking about what might happen. Unfortunately, this is often when suicide attempts occur.
Specific symptoms of mental illness are related to suicide attempts and completed suicide. A feeling of hopelessness -- being unable to imagine that things could get better -- is common in depression and related to suicide attempts. People may also describe this as feeling trapped or out of control -- this may or may not be related to a mental illness. Sometimes these feelings can be due to being bullied, abused, raped, or put through other trauma. Helplessness, a sense that nothing can be done to change things or to solve their problems, is also commonly described. Neuroscience researchers have tried to understand what biological factors are linked to suicide. Research on suicide is closely tied to research on depression, bipolar disorder, schizophrenia, and other mental-health disorders with increased risk of suicide. The strongest evidence is linked to the serotonin system in the brain. Serotonin is a brain chemical (neurotransmitter) that is involved in mood, anxiety, and impulsivity. Serotonin levels have been found to be lower in the cerebrospinal fluid (CSF, or "spinal fluid") and brain of suicide victims. Neurotransmitters send their signals in the brain by binding to receptors, which are proteins on a nerve cell surface. Some types of serotonin receptors are also decreased.
Stress levels are also connected to suicide rates. The body's response to stress is regulated by the hypothalamic-pituitary-adrenal (HPA) system, a system that links part of the brain (hypothalamus) and parts of the endocrine (hormone) system (pituitary and adrenal glands). People who committed suicide have been found to have abnormally high activity of this stress activation system. Other brain chemicals, structures, and activity have also shown possible links to suicide, but the evidence is not as strong. There is still more that we don't understand about brain changes and suicide, but these findings point us in a direction to hopefully better treat disorders with increased risk of suicide and to possibly identify people at risk for suicide early enough to prevent attempts.
People who feel isolated or different may turn to suicide attempts as an escape. People who have experienced sexual abuse or other types of trauma are more likely to attempt suicide. Similarly, veterans of the military, especially those who have served in combat or wartime, are at increased risk of suicide.
Loss is also a reason people consider suicide. Loss could include the death of a friend, family member, or loved one. Other triggers may include a breakup, loss of a romantic relationship, a move to another place, loss of housing, a loss of privilege or status, or a loss of freedom. It could be financial losses such as losing a job, a house, or business. During times of economic problems (such as the Great Depression or the recent Great Recession), more people attempt suicide.
If someone close to you commits suicide, you may be more likely to consider or attempt suicide yourself. Groups of suicides like this, especially in teenagers or young people, are often referred to as suicide clusters or copycat suicides.
Certain religious beliefs may influence people to commit suicide. Some religions may leave people feeling guilty for things they have done and may lead them to believe they can't be forgiven. Some individuals may believe that sacrificing their lives (committing suicide for their beliefs) will earn them a reward (like going to heaven) or will be best for the religion. Some people will take their own lives for their religion (martyr themselves). Suicide bombers, often from extreme Muslim groups, are an example of this.
In some cultures, such as traditional Japan, shame or dishonor might be a reason to end your life. This type of suicide, known as hara-kiri or seppuku, traditionally involves a specific ceremony and ritual knife.
Medically Reviewed by a Doctor on 11/18/2014
Michael J. Peterson, MD, PhD
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