In 2001, suicide resulted in the loss of 30,000 lives in the United States.1,2 It was the 11th-leading cause of death that year. Of the deaths, firearms were the leading cause at 55%.1,2 Of the more than 30,000 deaths, firearm involvement claimed more than 17,000 lives, suffocation claimed more than 6,000 lives and poisoning/ingestion resulted in more than 5,000 deaths.2 In 2002, suicide attempts resulted in more than 130,000 hospitalizations, and more than 100,000 suicidal individuals were evaluated in emergency departments and subsequently released.2,3 In 2002, there were more than 500,000 emergency department visits for self-inflicted wounds. In general, suicides are more likely to occur in the spring and are less frequent during the winter.1,2
Following is a discussion of uncompleted suicide attempts, with a review of gender comparison, methods and potential complications of suicide attempts. By being provided an overview of suicide techniques, including the effects of failed attempts, providers may be more prepared to manage such cases, which may lead to a reduction in patient morbidity and mortality.
Suicide attempt rates and successes differ by gender. For males, suicide is the eighth-leading cause of death.1,4 Men are four times more likely to die from suicide than women.1,2,4 Of the completed male suicides reported in 2001, more than half involved a firearm.1,4 Although females attempt suicide three times more often than males, female attempts are less likely to be completed.1,2,5 This is partially due to the nature of the attempt. For example, a female may pursue ingestion, whereas a male may use a firearm.1,2,5
Youth and Young Adults
Suicide attempts and completions vary by age. Suicide is the third-leading cause of death for individuals between ages 15 and 24 and ranks second for those aged 25 to 34.1,5 In 2001, for the 15-24 age group, more than 75% of completed suicides involved males and over half involved a firearm.1,5 In general, the rate of completed suicides among the youth has increased since 1950.1,2,3,5 In 1950, the completion rate was 2.7 per 100,000; in 1994, the rate was 11.0 per 100,000. For individuals between ages 10-14, the rate of completed suicides has increased more than 120% since 1950.1,5,6,7
Suicide rates increase with age.1 In 2001, more than 5,300 individuals over age 65 committed suicide.1,5,6 Of this group, 85% were male; 15% were female. Firearms were involved in more than 70% of these cases.1,5,6 Numerous contributing factors may be present including depression, divorce, living alone, bipolar disorder and dysthymic disorder (daily depressed mood lasting for more than two years, but not as acute as severe depression).4,8 Elderly suicide victims are also frequently observed to be mildly or moderately depressed a few weeks prior to attempting suicide (see Table I on page 74).1,8
Suicide Risk Factors
Several factors have been identified that place an individual at risk for suicide.1 For example, widowed and divorced individuals have a higher rate, with nearly 30 per 100,000 individuals attempting suicide.1 Married individuals have the lowest rate. Family history, lack of access to mental health resources and substance abuse have also been identified as risk factors.1,9-13 Table II provides additional examples.
The presence of alcohol and/or substance abuse, especially in combination with a depressive disorder, has been associated with an increased likelihood that suicide may be considered.15 One study reviewed nontraffic-related fatalities that were associated with alcohol intoxication. More than 20% were attributed to suicide.1,6 Providers are encouraged to thoroughly assess any patient who appears to be under the influence of an intoxicating substance (e.g., alcohol or illegal drugs) for potential suicidal thoughts or intent.14,15,16