Suicidal Thoughts (cont.)
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Suicide Risk Factors
Even though suicide is a relatively common cause of deaths, it is extremely difficult to predict. People who attempt or commit suicide come from every race, country, age group, and other demographic. There are many factors that are common among people who died by suicide, but most other people with these same factors still do not attempt suicide. For example, even though most people who commit suicide have some mental disorder, such as depression, most people who have depression do not commit suicide. Even so, we can still learn about suicide, and hopefully do better at preventing suicides, by understanding risk factors.
Globally, societal and cultural factors also affect suicide risks. Communities with limited access to health care or that discourage help-seeking behavior place people at higher risk. Countries involved in war or other violent conflicts, as well as natural disasters, also tend to have higher suicide rates. Ethnic groups who are facing significant discrimination, particularly with displacement or immigration, are also at risk.
Certain demographic factors are associated with an increased suicide risk, and since they can't be changed, they are sometimes called non-modifiable risk factors. These include male gender, Caucasian ethnicity, age (under 25 or over 65), and relationship status (divorced, widowed, and single). Certain professions, such as physicians and dentists, may be more at risk for suicide. It is not clear if this is due to job stresses, knowledge of and access to lethal means, or other factors. Unemployment or recent job loss may also increase the risk of suicide attempts. Importantly, individuals with limited social supports are a higher risk of attempting suicide. Individuals with a family history of completed suicide are at higher risk of suicide themselves. This may be related to hereditary (genetic) factors but may also be due to the trauma and distress of losing a family member in this way. Lastly, one of the strongest predictors of future suicide attempts is past suicide attempts.
Social factors, including current or past discrimination, abuse, or trauma also predispose people to suicidal acts. People who have been subject to bullying are more likely to consider or attempt suicide. This is true both for young people currently being bullied, as well as adults who were bullied when younger. It is likely that more recent tactics, such as cyberbullying, would have the same impact. A similar pattern is seen for those who have been sexually abused or assaulted, both women and men. For adults sexually abused as children, suicide attempts were two to four times more likely in women and four to 11 times more likely in men, compared to those not abused. People who identify as lesbian, gay, bisexual, or transgender (LGBT) also seem to have higher rates of suicide. People exposed to combat, either civilians or military personnel, have an increased risk of suicide as well. Although these stressors are very different, they likely have a similar impact on people; people can feel isolated and helpless in controlling or escaping these situations, and they may also feel more socially isolated and unable to reach out for help.
A mental-health diagnosis is one of the most significant risk factors for suicidal thoughts or actions. Psychological autopsy studies identified one or more mental-health diagnoses in 90% people who completed suicide. The most common diagnoses are depression (including bipolar depression), schizophrenia, or alcohol or drug dependence. The lifetime risk of suicide for individuals with these diagnoses is higher than in the general population, although reports vary from about two to 20 times the risk for the general population. Individuals diagnosed with certain personality disorders, such as antisocial, borderline, or narcissistic personality disorder, also have higher risk of suicidal thoughts or behaviors. Alcohol dependence increases the risk of suicide by 50%-70% compared to those without alcoholism. In addition, at least one-third of suicides had alcohol in their system, 20.8% had opiates (including heroin, morphine or prescription pain killers), and 23% had antidepressants. These statistics may support how common depression, alcohol abuse, and drug abuse are in those who commit suicide, however part of this may be people using these substances as part of their attempt to end their lives. Although the association between a mental-illness diagnosis and suicide risk is strong, it is important to remember that most people with mental illness do not attempt or complete suicide.
In addition to formal mental-illness diagnoses, specific symptoms -- even without a full diagnosis -- increase the risk of suicidal actions. Certain symptoms of depression, particularly hopelessness and anhedonia, are more closely tied to increased suicidal thoughts than a depression diagnosis. Hopelessness describes a feeling that things cannot change or be better than they are now. Anhedonia means an inability to enjoy anything, or to feel interested in things that would usually give pleasure. Feelings of anxiety (often also described as worry, nervousness, or fear) are also linked to suicidal thoughts. Some studies suggest that feelings of anxiety or agitation may increase how likely someone is to act on thoughts of suicide. A study of people who committed suicide after discharge from a psychiatric hospital showed that 79% expressed "extreme" or "severe" anxiety, but only 22% had suicidal thoughts.
Problems with sleep, such as insomnia, are an acute risk for suicide, whether or not they are part of a depressive episode. It is important to note that sleep problems increased the suicide risk, even after controlling for other variables such as gender, mood, and alcohol problems. Fortunately, recent studies suggest that managing sleep disorders can reduce suicide risk.
Nonpsychiatric diagnoses may also increase the risk of suicidal thoughts and actions. A wide range of medical conditions, particularly those associated with long-term (chronic) pain, a terminal (life-ending) diagnosis, or limited treatment options, have a higher risk. Some of the diagnoses shown to have a higher risk include cancer, kidney failure, rheumatoid arthritis, epilepsy (seizure disorder), AIDS, and Huntington's disease. Appropriate treatment of these conditions, and any concurrent depression, can help improve quality of life and reduce suicide risk.
Medically Reviewed by a Doctor on 5/12/2016
Michael J. Peterson, MD, PhD
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