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Depression Depression
. Reviewed by the Faculty of Harvard Medical School

Suicide

Suicide is a rare event — most depressed people do NOT commit suicide. The rarity of suicide, however, makes it impossible to predict which people are most likely to follow through.

Even though suicide is rare, all depressed people are at some risk of suicide. Active treatment of depression makes suicide less likely. Thus, mental-health providers pay attention to thoughts of suicide, aiming to relieve suffering and reduce suicide risk.


Suicide rates in the United States are down slightly since 1995. The suicide rate was 11 per 100,000 people in 2002 down from nearly 12 per 100,000 in 1995. The reasons for this trend are unknown. Many factors, including better education about depression and more active treatment, are probably involved.

In the U.S. in 2002, there were more than 31,000 deaths from suicide. Of those, 80 percent were men. Suicide is the 11th leading cause of death, but it is the third leading cause (after accidents and homicide) among 15 to 24 year-olds. It's in second place (after accidents) among 25 to 34 year-olds. Rates of suicide also jump significantly after age 75, particularly among men. More than half of the suicides in the U.S. are committed using firearms.

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Having risk factors does not mean you will commit suicide. In fact, 99 percent of those who have risk factors for suicide do not kill themselves. A risk factor is a marker for increased risk, not a cause of suicide. The point of identifying risk factors, therefore, is to take action, when possible, to reduce risk. For example, if people are more likely to commit suicide when depressed, then treating depression will reduce that risk.

Certain characteristics are found more frequently among those who commit suicide:

  • Having made previous suicide attempts
  • Having a family member who has attempted suicide
  • Having a mood disorder, such as major depression or bipolar disorder
  • Having psychotic symptoms, such as false beliefs (delusions) or false perceptions (hallucinations)
  • Experiencing sudden or severe anxiety or hopelessness
  • Being male
  • Being single, especially widowed, divorced or separated
  • Being unemployed
  • Being socially isolated
  • Experiencing sudden loss (such as the death of a loved one) or a life crisis (such as bankruptcy)
  • Having a chronic medical illness or chronic pain
  • Being a victim of violence
  • Having a marked downturn in social or economic status
  • Having been in jail or prison
  • Having access to firearms

Identifying risk factors helps with making a plan to reduce suicide risk.

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The risk of suicide will never be completely eliminated, but it can be reduced. The first step is to make a list of risk factors, separating the factors you can do something about (for example, a mood disorder) from the ones you can't do anything about (for example, your age and gender). Work with your health-care provider to address those risk factors that can be treated or modified in a helpful way. For example, if you have depression, anxiety or distorted thinking, drug treatment or psychotherapy may have a very positive effect. Or if you have a problem with alcohol or drugs, counseling or a 12-step program may help you get it under control.

Here are other factors that can help lower the risk of suicide:

  • Treating mental, physical and substance-use problems
  • Improving family and/or community support
  • Getting help with problem solving
  • Getting re-engaged with a meaningful cultural or religious community
  • Removing access to deadly means of suicide, such as firearms

The success of treatment depends on many things. First, a suicidal person will make more progress if he or she is open to getting help. This issue is key, because it is easy for suicidal people to hide thoughts and feelings. Even though they contemplate suicide as a way out, most suicidal people hope to get help and are likely to be open to treatment.

Nonetheless, treatment can be demanding. For example, abstinence can be tough if you are an alcoholic. Psychiatric drug treatment is taxing if you dislike taking medication. Psychotherapy requires attention and work. Yet these efforts cannot only save your life, but may also make your life worth living.

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Visit the Web site of the Department of Health and Human Services to read about the National Strategy for Suicide Prevention, which outlines important principles for preventing suicide, such as the need to reduce stigma, increase opportunities for screening, improve access to mental health services, and reduce access to means of suicide.

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Last updated October 24, 2007


   
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