Suicide

Gustavo Turecki

McGill Group for Suicide Studies, McGill University, Montreal, QC, Canada

Synonyms

Self-destructive completion behavior; Self-immolation; Suicide

Definition

Suicide is an act of taking one's own life voluntarily, usually intentionally. Suicidal behavior is a general term used to refer to suicide and suicide attempts. under the latter, we refer to the actions taken to end one's life, irrespective ofthe degree of intentionality, which does not result in death. While suicidal ideation is not a behavior, it is often considered under the category of suicidal behaviors. It refers to the wish to die, including thoughts of actively ending one's life.

Current Concepts and State of Knowledge

Suicide is one of the leading causes of death worldwide, among the top ten causes of death in most of the world and one of the three leading causes of death for people between the ages of 15-34 (WHO 2000). As such, it has been referred to as the 'leading cause of unnecessary and premature death.' Over the last 45 years, suicide rates have been increasing dramatically, by as much as 60% in some countries. In the uSA, this rate is approximately 11 per 100,000, while much of Asia sees a rate exceeding 13 per 100,000. With the notable exception of rural China, suicide is significantly more common among males than females. Western countries, and particularly those from Northern Europe and the ex-Soviet Union, present larger gender effects on suicide rates, while Asian countries tend to have sex ratios closer to one. Age is another important demographic factor that seems to have a large impact on suicide risk. Accordingly, the distribution of suicide risk through the lifespan displays marked age effects, with peaks among youth and elderly age groups.

Suicide methods vary considerably among different countries and world regions and relate to the availability of means to suicide, as well as popular concepts and imagery associated with suicide. As such, in North America, suicide by firearms and hanging are the most common methods, whereas in Asia, suicide by pesticides is the most prevalent. Suicidal behavior has been classified as violent and nonviolent, depending exclusively on the method used. In general, the term nonviolent refers to suicidal behavior by substance intoxication (typically medication overdose) or superficial cuts, which are generally associated with low suicide intent and are frequently of low lethality. All other methods are considered violent.

Suicide is strongly associated with psychopathology (Arsenault-Lapierre et al. 2004). While there is significant regional variability in the percentages found, all studies have consistently shown that most individuals who have died by suicide were affected by mental disorders in the last months of their life. Meta-analyses of studies investigating rates of mental disorders among individuals who died by suicide suggest that up to 90% of suicides had a history of mental illness. Table 1 lists the most common mental disorders found among suicide completers, according to different world regions. Mood disorders, and ► major depressive disorder, in particular, are the most common diagnoses among individuals who died by suicide.

Predictors of Suicide

Suicide is a complex behavior, likely the result of several interacting factors. Figure 1 conceptualizes the relationships among key factors believed to play an important role in suicide. While, as mentioned earlier, psychopathol-ogy is strongly associated with suicide risk, it is neither sufficient nor specific, as only a fraction of people affected by mental illness will die by suicide.

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