Thought Provoking Question #12

How Much Do You Know About Suicide? 

"I am just going outside and may be some time." So said Lawrence Oates (1880–1912), English soldier and explorer on Scott’s last expedition. It was his diary entry of March 16-17, 1912. These were Oates’ last words, before walking out into an Antarctic blizzard on Captain Scott’s ill-fated expedition to the South Pole. Scott recorded, "We knew it was the act of a brave man and an English gentleman."  

Overview - I was only 22 when I experienced my first suicide. I was working at a resort in Lake Tahoe for the summer before joining the United States Peace Corps the following fall. There was a whole bunch of us who worked this brassy bright-lit casino. Mark was the joyous one of our group. But he changed. By mid-summer he seemed different. After several weeks of being severely depressed, Mark suddenly became bubbly and filled with a newfound zest for life. We, his friends, all thought he was finally coming out of it. Less than a week later, Mark died of a self-inflicted gunshot to his head. He was only 21. None of it made any sense to us, his friends. None of us knew the signs of suicide or how to help someone like this. Things might have been different had we known more about suicide. We were all sad the day Mark died. He was a good guy, a nice kid to know. It was a human tragedy. We all mourned his loss and were listless for some time. Suicide takes a very heavy toll on survivors, and to observe this struggle, each year November 18th is designated as "National Survivors of Suicide Day."  

At this point stop and complete the "Suicide Knowledge Questionnaire" that follows at the end of this article. When finished, return and resume reviewing this article  

Some Facts - 105 Americans commit suicide each day in the United States --- one every 12.9 minutes. Depressed people commit suicide at a rate 25 times higher than non-depressed people. The Centers for Disease Control reported 40,600 "official" suicides for 2012, the last year for which official statistics are available. Most experts believe the figure is well in excess of 100,000 a year. The official figures just don’t capture those who crash themselves to death driving on the roads or who drink or drug themselves to death. There are thousands of suspicious deaths each year that are nothing more than disguised forms of suicide but are not labeled as such. Some cultures have particularly high suicide rates. Native American youth have suicide rates five times greater than suicide rates among youth of the general population. Gay and lesbian youth have higher rates as well. Social stigma hides many suicides. I remember reading in the newspaper some time ago of a retired policeman who shot himself. His wife lied and said an intruder had entered the premises and shot her husband. Investigators and fellow police officers that knew him all helped to cover up the real cause, so as to save embarrassment and allow her husband to have a Christian burial. It wasn’t until many years later that the truth came out. Suicide is the tenth leading cause of death for all ages in 2010. Suicide is the third leading cause of death among 15- to 24-year-olds. Five million living Americans have attempted to kill themselves. For every completed suicide there are 8 to 20 suicide attempts. A suicide usually affects at least 6 other people, putting the number of people’s lives touched by U. S. suicides, between 1970 and 1992, at about 3.5 million. One of the more alarming social problems is the rise of youth suicide. Every nine minutes a teenager attempts suicide, and every 90 minutes a teenager succeeds. In any one week, 1000 teenagers will try suicide and 125 will succeed in killing themselves.  

Age Group Differences 

Using 2012 data, the highest suicide rate was among people 45 to 59 years old. Suicide was the third leading cause of death among 15-24 year olds; the second among 25-34 year olds; the fourth among 35-54 year olds; and eighth among 55-64 year olds. Among 15-24 year olds, suicide accounts for one in five deaths annually. Suicide rates for females are highest among those aged 45-54. Suicide rates for males are highest among the 75 and older group. Thr rate of suicide for adults aged 75 and older (2010 data) was 16.3 per 100,000. (All data from CDC @ http://www.cdc.gov/ violenceprevention/pdf/Suicide_DataSheet-a.pdf).  

Social isolation seems to be a major factor, with firearms the primary method. In the general suicide population, the most common suicide method is firearms followed by poison, hanging, or strangulation.  

Some Reasons - Risk factors for suicide varies as much as do those who commit suicide. Some themes appear again and again during psychological autopsies. A psychological autopsy is an investigative process performed by forensic mental health specialists. It is a tedious process by which the past is recreated and examined in an effort to determine what was going on in the mind of a person, so as to create the climate or milieu that led to their suicide. Some of these risk factors include: (1) family break-up and separation, (2) financial hardship, (3) dysfunctional family situations, (4) increasing social isolation and lack of peer relationships, (5) sex roles issues, (6) parental expectations for success and achievement, (7) peer pressure, (8) media attention given to suicide and self-destructive themes in pop culture, (9) issues surrounding lack of personal control, self-esteem, and self-image, (10) emotional and other psychological issues, and (11) substance abuse.  

Risk factors for the elderly include (1) loneliness and isolation, (2) chronic illnesses, (3) growing acceptance of suicide so as to not be a "burden" and die with "dignity," (4) depression and other mental illnesses, (5) lack of purpose, meaning, usefulness, and boredom, (6) multiple bereavements, (7) financial difficulties, and (8) substance abuse. 

Warning Signs - There appears to be a fairly reliable cluster of warning signs for those considering suicide. This cluster includes the following signs:  

1. Getting Affairs in Order - making amends, attempting to heal troubled relationships  

2. Giving Away Possessions - especially treasured and loved possessions  

3. Verbal Cues - saying good-bye, discussing suicide, wishing oneself dead  

4. Emotional Displays - feelings of sadness, despondency, crying, "not caring anymore"  

5. Stamina Loss - extreme fatigue, loss of energy, boredom, change of exercise routines 

6. Withdrawal - pulling away from friends, less and less socializing, "stay-in" behavior  

7. Mood Swings - quick to "snap" or yell, irritable, moody, apathetic, or energy bursts  

8. Concentration - loss of concentration, easily distracted, memory problems, forgetting  

9. Work or School Problems - absenteeism, poor grades, discipline, and daily declines in effort  

10. Personal Appearance - unshaven, disheveled, poorly groomed, unclean, neglectful & uncaring  

11. Sleep Disturbance - loss of sleep, excessive sleep, disruptive sleep, nightmares  

12. Appetite Change - loss of appetite, eating more, "junk food" binges, substance abuse  

13. Physical Complaints - stomachaches, backaches, headaches, and other ailments  

Helpful Tips - Suicide is a scary subject. Mystery and myth surround it. It may be a frightening ordeal to someone thinking about it, and a total devastation to the survivors. Remember the discussion of my friend Mark in the opening paragraph of this exercise? Why was it the week before he killed himself he seemed to have regained his old self? Now I know better. He had made the decision to commit suicide and was relieved by that decision. That upbeat energy burst in his remaining days was used to get his affairs in order and give prized possessions away. He also needed time to find a gun and plan his own death. In light of living a nightmarish life, death may seem preferable to one who is distraught and filled with despair. There is no simple and foolproof way to prevent someone from suicide. One expert makes the point that "perhaps nobody really knows exactly what to do when dealing with an imminent suicide." However, there are some general rules and advice that may prove helpful if you ever find yourself needed in such a dire situation. The following seven pointers may save a life someday. Take time to review them carefully. We, at times, are each other’s keeper.  

1. Take suicidal talk seriously. It is not idle talk or a veiled threat. Ask them directly if they are considering suicide. A suicidal person is often glad to have someone to talk to. It may be the first time they have discussed suicide with anyone else. Such discussion may diffuse the desire to die.  

2. Provide empathy and social support. Be genuine and show concern. Try and link the suicidal person with professional help or other helpful networks. Know the resources in your community.  

3. Offer help. Suicide is a last-ditch cry for help. Don’t walk away. Don’t leave the person alone. Your help is better than no help at all. Simply being there and talking with them is very helpful.  

4. Identify and clarify the crucial problem. A suicidal person is often confused and in a sea of frustration and problems. Their thinking is cloudy. If problems can be identified and broken down they become more manageable and will seem less insurmountable.  

5. Suggest alternatives. The suicidal person often sees suicide as the only way out. Mediate options.  

6. Capitalize on any doubts. For most it is not easy to give up. The suicidal person is often racked by doubts in the wisdom of their decision to end their lives. Zero in on these doubts. They may be the best argument for life over death.  

7. Encourage professional help. Don’t leave the person alone. Call for help. Use suicide prevention hotline. Make a difference. The time you spend may be enough to pull suicidal people out of their peak desire to kill themselves, and get the help they need and deserve.  


Debriefing - (1) Review your answers to the "Suicide Knowledge Questionnaire" (The correct answers follow the questionnaire). Have you known anyone who committed suicide? (2) What were or might have been the reasons for the suicide? (3) What was your bereavement experience like? (4) What strategies might be used to help someone who is suicidal and has telephoned you? (5) Locate and keep handy some suicide prevention materials from a community organization near you. (7) Role-play a situation involving someone considering suicide. How might you assist the person?  

An excellent Website for learning more about suicide is the "American Foundation for Suicide Prevention" at http://www.afsp.org/.  



Suicide Knowledge Questionnaire 

Directions - Read the following statements and choose true or false. Choose the answer for each statement that actually represents your belief. Do not leave any blanks. When you are finished, return to the section you were asked to return to at the beginning of this exercise.  

T F 1. People who talk about suicide don’t actually commit suicide or give a warning.  

T F 2. All people who commit suicide have definitely decided they want to die.  

T F 3. Improvement in a suicidal person means the danger has passed.  

T F 4. Once a suicide risk, always a suicide risk.  

T F 5. Suicide is an inherited trait in a person.  

T F 6. Suicide occurs more often among people who are wealthy.  

T F 7. Suicidal behavior occurs when the person becomes insane.  

T F 8. Suicidal people are always depressed beforehand.  

T F 9. The motive for a particular suicide is evident.  

T F 10. Men attempt suicide more often than women.  

T F 11. Women commit suicide more often than men.  

T F 12. Poisoning, by either drugs or gas, is the most common form of suicide.  

T F 13. Minorities have the highest suicide rates.  

T F 14. The suicide rate for gay and lesbian youth is lower than for non-gay youth.  

T F 15. After about 60 years of age, suicide rates begin to decline continuously.  

T F 16. Suicide rates for college students reached an all-time peak in the 1960s and have declined somewhat since then.  

T F 17. Suicide rates are higher for terminally ill people than for people who have chronic illnesses with no end in sight.  

T F 18. There are 50,000 suicide attempts in the United States each year. Roughly one in eight of these attempts succeeds.  

T F 19. Most people who commit suicide are under the age of 45.  

T F 20. Though a serious problem, suicide is not among the top 10 leading causes of death in the United States.  



Suicide Knowledge Questionnaire - Correct Responses 

The answers are all false! The responses represent the most recent knowledge and consensus regarding such statements about suicide. A brief discussion now follows.  

(1) Eight out of ten of the people who commit suicide have given some warning beforehand that they were about to do so. Often they have given multiple warnings.  

(2) Those who commit suicide are not certain that they really want to die. They often take a gamble that someone will save them. The person who overdoses on drugs often calls someone first, in hopes they will be saved.  

(3) In fact, most suicides occur while an individual is still depressed but after the individual shows some recovery. Often, people who are severely depressed are unable even to gather the energy to put together the means to commit suicide.  

(4) Most suicides occur during an acute crisis. Once the person gets through the crisis, the desire to commit suicide fades. One researcher tracked down 515 people who had attempted suicide by jumping off the Golden Gate Bridge many years earlier. Fewer than 5 percent had actually committed suicide in the subsequent decades. (Seiden, 1978)  

(5) Though there appears to be a genetic link for some forms of depression no major evidence exists for a genetic connection for suicide. There are some family and generational suicidal clusters, but the reasoning is not yet understood. It may have more to do with family value systems as to why various family members commit suicide.  

(6) Suicide is about equally prevalent at all levels of the socioeconomic spectrum, though higher rates are at both extremes of the spectrum--the very poor and unemployed and the very successful and high-pressured, such as attorneys and executives.  

(7) Although suicide is linked to depression, relatively few people who commit suicide are truly out of touch with reality.  

(8) Although depressed people commit suicide at a rate 25 times higher than nondepressed people, many suicides are by those who are chronically ill or elderly. Peace of mind or not becoming a burden are often factors rather than depression.  

(9) There is no "suicidal type." The reasoning and motive for a suicide are often as varied as those who commit suicide. There are some cluster factors. They include depression, isolation, loneliness, substance abuse, and romantic and financial factors.  

(10) Men do not attempt suicide as often as women do. However, men succeed more often in actually committing suicide because they use more lethal means, such as guns. Women attempt suicide more often but fail, as they use drugs, such as pills. (rather than guns) thus contributing to the likelihood they will be hospitalized rather than die. Despite fewer attempts, adolescent boys are over four times more likely to succeed at suicide than are adolescent girls.  

(11) Women are more prone to depression thus more prone to attempting suicide more often than men. They succeed far less often than men, however.  

(12) The methods most often used in suicide are firearms (60%), poison (18%), hanging or strangulation (15%), and other (7%).  

(13) Although suicide rates are generally lower for nonwhites than for whites, there is one startling exception: among Native American youth, suicide is five times greater than among youth of the general population.  

(14) Gay and lesbian youth are several times over the national average for suicide attempts and completed suicides. These higher suicide rates undoubtedly reflect the relative lack of social support for a homosexual orientation.  

(15) After declining for nearly four decades, the suicide rate among elderly Americans climbed nearly 9% between 1980 and 1992. The rates seemed to be increasing in 1993 and 1994. The reasons may include acceptance of suicide and chronic illness.  

(16) Unfortunately, suicide rates have tripled among adolescents and young adults in the last several decades. College students are at higher risk than their noncollege peers. Suicide is the third leading cause of death for young people between the ages of 15 and 24.  

(17) Someone with a chronic disease or illness is more prone to commit suicide than someone with a terminal illness.  

(18) The figure is 250,000 attempts each year. Otherwise the statement is correct.  

(19) Most people who commit suicide are over the age of 45. However, youthful suicide has grown between 200% and 300% between 1960 and 1988.  

(20) According to the Centers for Disease Control (2012), suicide is the tenth leading cause of death. More people die from suicide than in car accidents or from homocides.  



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The following sources were used for the Suicide Knowledge Questionnaire. Wade, C., & Tavris, C. (1996). Psychology. (4th Ed.). New York: HarperCollins; Weiten, W. (1995). Psychology: Themes and variations. (3rd Ed.). Pacific Grove, CA: Brooks/Cole; Despelder, L. A., & Strickland, A. L. (1996). The last dance. (4th Ed.). Mountain View, CA: Mayfield; Berk, L. E. (1996). Infants, children, and adolescents. (2nd Ed.). Boston: Allyn & Bacon; Zimbardo, P. G., & Gerrig, R. J. (1996). Psychology and life. (14th Ed.). New York: HarperCollins; Sternberg, R. J. (1994). In search of the human mind. New York: Harcourt Brace; and Seiden, R. (1978). Where are they now? A follow-up study of suicide attempters from the Golden Gate Bridge. Suicide and Life-Threatening Behavior, 8:203-216.  

[This article is by J. Davis Mannino and originally appeared in the community newspaper We The People or elsewhere. All Rights Reserved by the author.]