mental health disorders
Suicidal Behavior
Causes of Suicidal Behavior
Research has shown that many people who completed suicide were experiencingmultiplerisk factors at the time of death. About 85 to 95% of people who die by suicide have a diagnosable mental health condition at the time of their death. The most common health condition that contributes to suicidal behavior is Depression . including the depression that is part of Bipolar Disorder is involved in over 50% of attempted suicides and an even higher percentage of completed suicides. Depression can occur out of the blue, be triggered by a recent loss or other distressing event, or result from a combination of factors. In people with depression, marital problems, recent arrest or trouble with the law, unhappy or ended love affairs, disputes with parents or bullying (among adolescents), or the recent loss of a loved one (particularly among older people) may trigger a suicide attempt. The risk of suicide is higher if people with depression also have significant Traumatic childhood experiences,particularly including physical and sexual abuse, increase the risk of attempted suicide. Isolationincreases the risk of suicidal behavior. People who have been separated, divorced, or widowed are more likely to complete suicide. Suicide is less common among people who are in a secure relationship than among single people. Use ofalcoholmay intensify depression, which, in turn, makes suicidal behavior more likely. Alcohol also reduces self-control and increases impulsivity. About 30% of people who attempt suicide drink alcohol before the attempt, and about half of them are intoxicated at the time. Because alcohol use, particularly binge drinking, often causes deep feelings of remorse during dry periods, people who engage in unhealthy alcohol use are at higher risk of suicide. Almost all othermental health conditionsalso put people at higher risk of suicide. People with Schizophrenia or other psychotic disorders may have delusions (fixed false beliefs) that they find impossible to cope with, or they may hear voices (auditory hallucinations) commanding them to kill themselves. Also, people with schizophrenia are prone to depression. As a result, they die by suicide at a much higher rate (10%) than the general population. People with Borderline Personality Disorder (BPD) or , especially those that are painful and chronic, contribute to about 20% of suicides in older adults. Recently diagnosed medical disorders, such as Diabetes Mellitus (DM) , About 1 in 6 people who kill themselves leave a suicide note, which sometimes provides clues about why they did it. Reasons given include mental illness, feelings of hopelessness, feeling like a burden to others, and inability to cope with various life stresses. Preoccupation with, well-defined plans for, family history of, and/or previous attempts at suicide Depression (especially when accompanied by anxiety, as part of major depression or bipolar disorder, or associated with recent hospitalization) and other mental disorders Substance or alcohol use disorders Being the victim of bullying (for example, cyberbullying, social rejection, discrimination, humiliation, disgrace) Aggressive or impulsive behavior Traumatic childhood experiences, including physical or sexual abuse Medical illness, particularly one that is painful or disabling, or affects the brain Bereavement or loss Feelings of sadness or hopelessness (when persistent) Living alone Relationship conflict Work disruption (for example, unemployment) and periods of transition (for example, going from active duty to veteran status, retiring) Financial stress from economic downturns, debt, or underemployment Legal problems The risk of suicide attempts is greatest in the month before starting antidepressant treatment, and the risk of death by suicide is no higher after antidepressants are started. However, antidepressants sometimes slightly increase the frequency of suicidal thoughts and attempts (but not of completed suicide) in children, adolescents, and young adults. So parents of children and adolescents should be warned about this risk, and children and adolescents should be carefully monitored for the following side effects, especially during the first few weeks after they start taking the medication: Increased anxiety Agitation Restlessness Irritability Anger A shift into Hypomania (when people feel full of energy and cheerful but are often easily irritated, distracted, and agitated) is also an important side effect to watch out for. Mental health professionals, patients, and families should bear in mind that suicidality (thoughts and ideas about and preoccupation with death, particularly by suicide) is a core feature of depression. Treatments that alleviate depression reduce the risk of suicide. Because of public health warnings about the possible association between taking antidepressants and an increased risk of suicide, doctors began diagnosing depression less and started prescribing antidepressants more than 30% less often for children and young people. However, during this same time, suicide rates among young people temporarily increased by 14%. Thus, it is possible that by discouraging the use of medications for the treatment of depression, these warnings resulted in more, not fewer, deaths by suicide. When people with depression are given antidepressants, doctors take certain precautions to reduce the risk of suicidal behavior by: Giving people antidepressants in amounts that would not cause death Scheduling more frequent visits when treatment is first started Clearly warning people and their family members and significant others to be alert for worsening symptoms, agitation, insomnia, or suicidal ideation Instructing people and their family members and significant others to immediately call the doctor who prescribed the antidepressant or to seek care elsewhere if symptoms worsen or suicidal thoughts occur Taking antidepressants has been linked with an increased risk of suicidal thoughts and attempts in people under age 24, but not treating depression appropriately (which can include medications and/or psychotherapy) may increase the risk of suicide much more. Making the home environment safe is one important way to effectively reduce the risk of suicide. Removing lethal means by securing firearms, medications, illicit drugs, and toxic substances can be life-saving. In the 1990s, Suicidal Behavior in Children and Adolescents decreased after having climbed steadily for more than a decade, only to start climbing again in the early 2000s. This upward trend included an increase in deaths by firearms. Many influences contribute to this increase, including the following: Unaddressed mental health conditions (including Depression and Mood Dysregulation Disorder in Children and Adolescents , Health conditions such as Overview of Head Injuries or Adverse childhood events (including Overview of Child Neglect and Abuse ) Experiences of trauma or loss (including unstable home environment; growing up with a parent with mental illness; exposure to peer suicide and/or relative who died by suicide; or experience of bullying or discrimination based on race, gender, or sexual orientation) Suicide contagion refers to a phenomenon in which one suicide seems to lead to others in a community, school, or workplace. Highly publicized suicides may have a very wide effect. Children, adolescents, and young adults are especially vulnerable to contagion effects. They may be exposed directly because they know someone who attempts or dies by suicide. They may also be indirectly exposed by round-the-clock, sensationalized, graphic media coverage of a celebrity's death by suicide. Conversely, media coverage with positive messaging about a suicide death can decrease the risk of suicide contagion for vulnerable youth. Positive messaging typically communicates clearly about the tragic loss of a community member and goes on to express support for the grieving community. Messaging should describe mental health struggles as part of life and point out there is no stigma related to seeking help and treatment. Such portrayal of mental health issues and suicide can have a positive public health impact, rather than endanger vulnerable viewers. Suicide contagion may be a factor in an estimated 1 to 5% of all adolescent suicides. School administrators, mental health professionals, and other community leaders can learn to use the media and social platforms to stop the spread of suicide contagion. Sensitive reporting and the enforcement of postvention (an intervention conductedaftera suicide) guidelines in schools and workplaces are 2 strategies for preventing additional suicides. 