By Chris Woolston
CONSUMER HEALTH INTERACTIVE

If the entire United States were condensed into a small, close-knit town of 10,000 people, every year would be marked by the tragedy of at least one suicide. Often, the victim would be a white male -- perhaps a teen struggling in school, or an elderly man with health problems -- who killed himself with a gun. In some years, the victim would be a woman who took an overdose of pills. No matter what the circumstances, each victim forces the community to face agonizing questions: Why would anyone take his or her own life, and could it have been prevented?

The elderly, particularly older white men, are more likely than anyone else to commit suicide. Younger men between the ages of 15 and 24 are also a high-risk group. Still, there's really no such thing as a "typical person" who commits suicide. Victims can be young or old, male or female, rich or poor. Some people commit suicide after years of personal turmoil and multiple attempts, but others seemingly go without warning. Spotting people at risk can be difficult enough for trained professionals. For friends and family of potential victims, preventing it may sometimes be impossible.

The path to suicide usually starts with depression. According to the National Institute of Mental Health, about 60 percent of suicide victims suffered some form of mood disorder, such as major depression or bipolar disorder. They're also at high risk if they've tried to kill themselves before, if someone in their family has committed suicide, or if they've recently been released from the hospital with a mental illness like bipolar disorder or depression. Several other things can drive people to suicide. Young people who kill themselves often abuse drugs or alcohol in addition to being depressed. Others may have a history of being abused as a child. Being young and gay or bisexual may unfortunately also be a risk; several studies suggest these youth have higher rates of suicidal thoughts. People who are naturally impulsive may kill themselves on a whim, especially if they have easy access to a firearm. All of these factors are even more dangerous when combined with depression.

About 60 percent of all male suicide victims used a gun. Other common methods include poisoning or intentional drug overdoses (especially among women) and hanging (especially among men).

Women are more likely than men to suffer from depression, so it stands to reason that they're also more likely to attempt suicide. In fact, women report trying to kill themselves about three times more often than men, according to the Centers for Disease and Control and Prevention (CDC).

Men, however, are much better at completing the job. According to the CDC, men are four times more likely than women to actually die from a suicide attempt. Men aren't necessarily more serious about dying -- for whatever reason, they just pick more effective methods. Men are more likely than women to use a gun in a suicide attempt, while women around the world are more likely than men to take poison or a drug overdose. In parts of the world that don't have good medical care for poisoning victims, suicide rates are higher for women than for men.

Christmas is often a time when people feel more isolated and lonely, but contrary to conventional wisdom, there's no surge in suicides around the holidays. In fact, fewer people in the United States commit suicide in the winter than any other time of year. Spring is the most popular season.

If someone you know talks about suicide or seems severely depressed or in despair, take the comments seriously and try to get that person professional help as soon as possible. Try to be understanding and compassionate instead of judgmental. If possible, you should make sure the person doesn't have easy access to anything that could be used in a suicide attempt. Above all, remove guns and other firearms from the house.

In many cases, you may need to stay with someone until help arrive, according to the National Institute of Mental Health: "If someone is in imminent danger of harming himself or herself, do not leave the person alone," the agency warns. "You may need to take emergency steps to get help, such as calling 911." Even if the person doesn't seem to be in immediate danger, encourage her to get help quickly.

Recent studies prove that professional treatment can dramatically reduce the risk of suicide. For example, a 2005 study of 120 patients who had previously tried to kill themselves found that cognitive or "talk" therapy cut the risk of another attempt in half. Antidepressant medications may also lower the risk of suicide in adults -- but children need to exercise caution. The FDA has warned that certain antidepressants increase suicidal tendencies in young people. In fact, the agency issued a black box warning label on antidepressants for children, the most serious warning in prescription medication. Only a professional can determine the safest, most effective treatment for any particular person.

Suicide among young people has increased significantly in recent years. Parents should watch out for verbal "hints" from teens who may try to kill themselves, such as "I won't be around much longer," "Nothing matters," "It's no use," and "I won't see you again," according to the American Academy of Child & Adolescent Psychiatry. Other warning signs include:

•Withdrawal from friends and family

•Violent actions or running away

•A marked personality change or unusual neglect of personal appearance

•Drug and alcohol use

•Persistent boredom, difficulty concentrating, and recurring complaints about physical symptoms often linked to emotions, such as headaches, stomachaches, and so on

•Intolerance of praise or rewards

•Loss of interest in activities he or she normally loves

•Complaints about being a bad or worthless person

•Becoming suddenly lighthearted after a period of depression

•Giving away beloved possessions, throwing away important belongings, and cleaning up a typically messy room

•Showing signs of psychosis, such as hallucinations

Seniors are another especially vulnerable group, according to the American Association for Geriatric Psychiatry, especially when they feel isolated or suffer sleep problems. If you know an older person who seems depressed, be vigilant about whether he or she consumes more than normal amounts of alcohol, pain medications, or sleeping pills, acts confused, can't concentrate, seems lost in the midst of family affairs, or can't seem to stop crying.

•Talking about dying or shooting himself, or other types of self harm

•A recent loss. This can include death, divorce, lost relationship, firing or layoff

•A change in personality. Being sad, withdrawn, irritable, anxious, tired, indecisive, apathetic

•A change in behavior. The person complains he can't concentrate on school, work, or routine tasks

•A change in sleep patterns. Chronic insomnia, often with early waking or oversleeping, nightmares

•Loss of appetite and weight, or its opposite -- overeating

•Loss of interest in sex

•Fear of losing control, going crazy, harming self or others

•Low self esteem. The person may say things like, "My family would be better off without me."

•Hopelessness

•You should also watch out for impulsive behavior and talk, including giving away favorite pets, substance abuse, making out wills, overspending, hyperactivity, restlessness or lethargy.

Keep in mind that people don't always come right out and say, "I'm thinking about suicide." Don't be afraid to ask, "Have you ever considered committing suicide?" and if the person says yes, take it seriously. If you're concerned about someone, trust your instincts, and assist them in getting help.

-- Chris Woolston, M.S., a health and medical writer with a master's degree in biology, is a contributing editor at Consumer Health Interactive. He was a staff writer at Hippocrates, a magazine for physicians, and has also covered science issues for Time Inc. Health, WebMD, and the Chronicle of Higher Education.

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First published December 19, 2005
Last updated February 19, 2008
Copyright © 2005 Consumer Health Interactive

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