Suicide

{{Short description|Intentional act causing one's own death}} {{For-multi|information on prevention|Suicide prevention|other uses|Suicide (disambiguation)}} {{protection padlock|small=yes}}  {{cs1 config|name-list-style=vanc}} {{Use dmy dates|date=October 2022}} {{Infobox medical condition | name = Suicide | field = Psychiatry, clinical psychology, clinical social work | symptoms = | complications = | onset = 15–30 and 70+ years old<ref name=WHO2014Pre/> | duration = | causes =  | risks = Depression, previous attempts, bipolar disorder, autism, bereavement, breakups, divorce, loneliness, schizophrenia, personality disorders, anxiety disorders, alcoholism, chronic fatigue, chronic pain, crises, financial problems, mental disorders, physical disorders, substance abuse<ref name=WHO2016/><ref name=Hawton2009/><ref>{{cite journal |vauthors=De La Vega D, Giner L, Courtet P |title=Suicidality in Subjects With Anxiety or Obsessive-Compulsive and Related Disorders: Recent Advances |journal=Current Psychiatry Reports |volume=20 |issue=4 |article-number=26 |date=March 2018 |pmid=29594718 |doi=10.1007/s11920-018-0885-z }}</ref><ref name=Autism2014/> | diagnosis = | differential = | prevention = Limiting access to methods of suicide, treating mental disorders and substance misuse, careful media reporting about suicide, improving social and economic conditions, improving behavior of others<ref name=WHO2016/> | treatment = | medication = | prognosis = | frequency = 12 per 100,000 per year<ref name=Var2012/> | deaths = 793,000 / 1.5% of deaths (2016)<ref name=WHO2019Epi>{{cite web |title=Suicide across the world (2016) |website=World Health Organization |date=27 September 2019 |url=https://www.who.int/mental_health/prevention/suicide/suicideprevent/en/ |archive-url=http://webarchive.loc.gov/all/20040701084208/http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/ |archive-date=1 July 2004 |access-date=16 October 2019}}</ref><ref name=NEJM2020/> | image = Édouard Manet - Le Suicidé (ca. 1877).jpg | alt = | caption = ''Le Suicidé'' by Édouard Manet, {{circa|1877}} | image_size = 275px }} {{Suicide sidebar}}

'''Suicide''' is the act of intentionally causing one's own death.<ref name=Sted2006>{{cite book |title=Stedman's Medical Dictionary |url=https://archive.org/details/stedmansmedicald00sted_3 |url-access=registration |year=2006 |publisher=Lippincott Williams & Wilkins |location=Philadelphia |isbn=978-0-7817-3390-8 |edition=28th}}</ref> Risk factors for suicide include mental disorders, neurodevelopmental disorders, physical disorders, and substance abuse.<ref name="WHO2016" /><ref name="Hawton2009">{{cite journal |vauthors=Hawton K, van Heeringen K |title=Suicide |journal=The Lancet |volume=373 |issue=9672 |pages=1372–1381 |date=April 2009 |pmid=19376453 |doi=10.1016/S0140-6736(09)60372-X |bibcode=2009Lanc..373.1372H }}</ref><ref name="Autism2014">{{cite journal | vauthors = Richa S, Fahed M, Khoury E, Mishara B | title = Suicide in autism spectrum disorders | journal = Archives of Suicide Research | volume = 18 | issue = 4 | pages = 327–39 | date = 2014 | pmid = 24713024 | doi = 10.1080/13811118.2013.824834 }}</ref><ref name="Dod2017">{{cite journal |vauthors=Dodds TJ |title=Prescribed Benzodiazepines and Suicide Risk: A Review of the Literature |journal=The Primary Care Companion for CNS Disorders |volume=19 |issue=2 |date=March 2017 |pmid=28257172 |doi=10.4088/PCC.16r02037 |doi-access=free}}</ref> Some suicides are impulsive acts driven by stress (such as from financial or academic difficulties), relationship problems (such as breakups or divorces), or harassment and bullying.<ref name="WHO2016" /><ref>{{cite journal |vauthors=Bottino SM, Bottino CM, Regina CG, Correia AV, Ribeiro WS |title=Cyberbullying and adolescent mental health: systematic review |journal=Cadernos de Saude Publica |volume=31 |issue=3 |pages=463–475 |date=March 2015 |pmid=25859714 |doi=10.1590/0102-311x00036114 |doi-access=free}}</ref><ref>{{cite web |title=Suicide rates rising across the U.S. |url=https://www.cdc.gov/media/releases/2018/p0607-suicide-prevention.html |website=CDC Online Newsroom |access-date=19 September 2019 |language=en-us |date=11 April 2019 |quote=Relationship problems or loss, substance misuse; physical health problems; and job, money, legal or housing stress often contributed to risk for suicide. |archive-date=9 May 2021 |archive-url=https://web.archive.org/web/20210509013348/https://www.cdc.gov/media/releases/2018/p0607-suicide-prevention.html |url-status=live }}</ref> Those who have previously attempted suicide are at a higher risk for future attempts.<ref name="WHO2016" /> Effective suicide prevention efforts include limiting access to methods of suicide such as firearms, drugs, and poisons; treating mental disorders and substance abuse; careful media reporting about suicide; improving economic conditions;<ref name="WHO2016">{{cite web |title=Suicide Fact sheet N°398 |url=https://www.who.int/mediacentre/factsheets/fs398/en/ |website=WHO |access-date=3 March 2016 |date=April 2016 |url-status=live |archive-url=https://web.archive.org/web/20160304192347/http://www.who.int/mediacentre/factsheets/fs398/en/ |archive-date=4 March 2016}}</ref><ref>{{cite book |url=https://www.who.int/mental_health/prevention/suicide/resource_media.pdf |title=Preventing Suicide A Resource for Media Professionals |year=2008 |publisher=World Health Organization. Department of Mental Health and Substance Abuse |isbn=978-92-4-159707-4 |archive-date=29 August 2021 |access-date=18 December 2018 |archive-url=https://web.archive.org/web/20210829073711/https://www.who.int/mental_health/prevention/suicide/resource_media.pdf |url-status=live }}</ref> and psychotherapy, primarily dialectical behaviour therapy (DBT) and cognitive behavioural therapy (CBT).<ref name=":5">{{cite journal |last1=Méndez-Bustos |first1=Pablo |last2=Calati |first2=Raffaella |last3=Rubio-Ramírez |first3=Francisca |last4=Olié |first4=Emilie |last5=Courtet |first5=Philippe |last6=Lopez-Castroman |first6=Jorge |title=Effectiveness of Psychotherapy on Suicidal Risk: A Systematic Review of Observational Studies |journal=Frontiers in Psychology |date=19 February 2019 |volume=10 |doi=10.3389/fpsyg.2019.00277 |doi-access=free|pmid=30837920 |pmc=6389707 }}</ref><ref name="pmid30661567">{{cite journal |vauthors=DeCou CR, Comtois KA, Landes SJ |title=Dialectical Behavior Therapy Is Effective for the Treatment of Suicidal Behavior: A Meta-Analysis |journal=Behav Ther |volume=50 |issue=1 |pages=60–72 |date=January 2019 |pmid=30661567 |doi=10.1016/j.beth.2018.03.009 }}</ref> Although crisis hotlines, like 988 in North America and 13 11 14 in Australia, are common resources, their effectiveness has not been well studied.<ref name=":6">{{cite journal |last1=Hoffberg |first1=Adam S. |last2=Stearns-Yoder |first2=Kelly A. |last3=Brenner |first3=Lisa A. |title=The Effectiveness of Crisis Line Services: A Systematic Review |journal=Frontiers in Public Health |date=17 January 2020 |volume=7 |doi=10.3389/fpubh.2019.00399 |doi-access=free|pmid=32010655 |pmc=6978712 |quote=High quality evidence demonstrating crisis line effectiveness is lacking. Moreover, most approaches to demonstrating impact only measured proximal outcomes. }}</ref><ref name="Zal2016">{{cite journal |vauthors = Zalsman G, Hawton K, Wasserman D, van Heeringen K, Arensman E, Sarchiapone M, Carli V, Höschl C, Barzilay R, Balazs J, Purebl G, Kahn JP, Sáiz PA, Lipsicas CB, Bobes J, Cozman D, Hegerl U, Zohar J |display-authors=6 |title=Suicide prevention strategies revisited: 10-year systematic review |journal=The Lancet. Psychiatry |volume=3 |issue=7 |pages=646–659 |date=July 2016 |pmid=27289303 |doi=10.1016/S2215-0366(16)30030-X |quote=Other approaches that need further investigation include gatekeeper training, education of physicians, and internet and helpline support. |hdl=1854/LU-8509936 |hdl-access=free}}</ref>

Suicide is the 10th-leading cause of death worldwide,<ref name="Hawton2009" /><ref name="Var2012">{{cite journal |vauthors=Värnik P |title=Suicide in the world |journal=International Journal of Environmental Research and Public Health |volume=9 |issue=3 |pages=760–771 |date=March 2012 |pmid=22690161 |pmc=3367275 |doi=10.3390/ijerph9030760 |doi-access=free}}</ref> accounting for about 1.5% of deaths.<ref name="NEJM2020">{{cite journal |vauthors=Fazel S, Runeson B |title=Suicide |journal=New England Journal of Medicine |date=January 2020 |volume=382 |issue=3 |pages=266–74 |doi=10.1056/NEJMra1902944 |pmid=31940700 |pmc=7116087}}</ref> In a given year, this is roughly 12 per 100,000 people.<ref name="Var2012" /> Though suicides resulted in 828,000 deaths globally in 2015, up from 712,000 deaths in 1990, the age-standardized death rate decreased by 23.3%.<ref name="GBD2015De">{{cite journal |vauthors=Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, etal |date=October 2016 |title=Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015 |journal=The Lancet |volume=388 |issue=10053 |pages=1459–1544 |doi=10.1016/S0140-6736(16)31012-1 |pmc=5388903 |pmid=27733281 |collaboration=GBD 2015 Mortality and Causes of Death Collaborators}}. For the number 828,000, see Table 5, line "Self-harm", second column (year 2015)</ref><ref name="GDB2013">{{cite journal |vauthors=Naghavi M, Wang H, Lozano R, Davis A, Liang X, Zhou M, etal |date=January 2015 |title=Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013 |journal=The Lancet |volume=385 |issue=9963 |pages=117–171 |doi=10.1016/S0140-6736(14)61682-2 |pmc=4340604 |pmid=25530442 |collaboration=GBD 2013 Mortality and Causes of Death Collaborators}}. For the number 712,000, see Table 2, line "Self-harm", first column (year 1990)</ref> By gender, suicide rates are generally higher among men than women, ranging from 1.5 times higher in the developing world to 3.5 times higher in the developed world; in the Western world, non-fatal suicide attempts are more common among young people and women.<ref name="EB2011">{{cite journal |vauthors=Chang B, Gitlin D, Patel R |title=The depressed patient and suicidal patient in the emergency department: evidence-based management and treatment strategies |journal=Emergency Medicine Practice |volume=13 |issue=9 |pages=1–23; quiz 23–4 |date=September 2011 |pmid=22164363}}</ref> Suicide is generally most common among those over the age of 70; however, in certain countries, those aged between 15 and 30 are at the highest risk.<ref name="WHO2014Pre">{{cite book |title=Preventing suicide: a global imperative |date=2014 |publisher=WHO |isbn=978-92-4-156477-9 |pages=7, 20, 40}}</ref> Europe had the highest rates of suicide by region in 2015.<ref>{{cite web |url=https://www.who.int/gho/mental_health/suicide_rates_crude/en/ |title=Suicide rates per (100 000 population) |website=World Health Organization |access-date=28 March 2020 |archive-date=19 September 2018 |archive-url=https://web.archive.org/web/20180919174425/http://www.who.int/gho/mental_health/suicide_rates_crude/en/ |url-status=live }}</ref>

There are an estimated 10 to 20 million non-fatal attempted suicides every year.<ref>{{cite journal |vauthors=Bertolote JM, Fleischmann A |date=October 2002 |title=Suicide and psychiatric diagnosis: a worldwide perspective |journal=World Psychiatry |volume=1 |issue=3 |pages=181–5 |pmc=1489848 |pmid=16946849}}</ref> Non-fatal suicide attempts may lead to injury and long-term disabilities.<ref name=EB2011/> The most commonly adopted method of suicide varies from country to country and is partly related to the availability of effective means.<ref name=Yip2012>{{cite journal |vauthors=Yip PS, Caine E, Yousuf S, Chang SS, Wu KC, Chen YY |title=Means restriction for suicide prevention |journal=The Lancet |volume=379 |issue=9834 |pages=2393–2399 |date=June 2012 |pmid=22726520 |pmc=6191653 |doi=10.1016/S0140-6736(12)60521-2}}</ref> Assisted suicide, sometimes done when a person is in severe pain or facing an imminent death, is legal in many countries and increasing in numbers.<ref name="auto4">{{Cite news |url=https://www.thetimes.com/world/us-world/article/canada-assisted-dying-law-wm7zfnpqv |title='It's social murder' — is Canada's assisted dying a model or a warning? |first=Josie Ensor |last=Montreal |date=16 October 2024 |work=The Times }}</ref><ref>{{Cite news |url=https://www.thetimes.com/world/us-world/article/assisted-dying-law-countries-hv6cjcrgz|title=Where is assisted dying legal? How the rules worldwide compare |first1=Bruno |last1=Waterfield |first2=Josie |last2=Ensor |first3=Bernard Lagan |last3=Sydney |date=16 October 2024 |work=The Times }}</ref>

Views on suicide have been influenced by broad existential themes such as religion, honor, and the meaning of life.<ref>{{cite book |vauthors=Tomer A |title=Existential and Spiritual Issues in Death Attitudes |date=2013 |publisher=Psychology Press |isbn=978-1-136-67690-1 |page=282 |url=https://books.google.com/books?id=hJTruwsicuoC&pg=PA282}}</ref><ref>{{cite book |veditors=Ritzer G, Stepnisky J |title=The Wiley-Blackwell companion to major social theorists |date=2011 |publisher=Wiley-Blackwell |location=Malden, MA |isbn=978-1-4443-9660-7 |page=65 |url=https://books.google.com/books?id=MDwdmVUMIh8C&pg=PA65}}</ref> Most religions disapprove of suicide.<ref>{{cite book|title=God, Religion, Science, Nature, Culture, and Morality|date=2014|publisher=Archway Publishing|isbn=978-1-4808-1124-9|page=254|url=https://books.google.com/books?id=xGGVBQAAQBAJ&pg=PA254 }}</ref> During the samurai era in Japan, a form of suicide known as seppuku ({{Lang|ja|腹切り}}, {{Lang|ja-Latn|harakiri}}) was respected as a means of making up for failure or as a form of protest.<ref>{{cite book |vauthors=Colt GH |title=The enigma of suicide |date=1992 |publisher=Simon & Schuster |location=New York |isbn=978-0-671-76071-7 |page=139 |edition=1st Touchstone |url=https://books.google.com/books?id=DOz3hStePfYC&pg=PA139}}</ref> Suicide and attempted suicide, while previously illegal, are no longer so in most Western countries.<ref name=White2010>{{cite book |vauthors=White T |title=Working with suicidal individuals: a guide to providing understanding, assessment and support |year=2010|publisher=Jessica Kingsley Publishers |location=London |isbn=978-1-84905-115-6 |page=12 |url=https://books.google.com/books?id=p_ZvK-DBYfIC&pg=PT12}}</ref> It remains a criminal offense in some countries.<ref name=Islam2006>{{cite journal |vauthors=Lester D |title=Suicide and islam |journal=Archives of Suicide Research |volume=10 |issue=1 |pages=77–97 |year=2006 |pmid=16287698 |doi=10.1080/13811110500318489}}</ref> In the 20th and 21st centuries, suicide has been used on rare occasions as a form of protest; it has also been committed while or after murdering others, a tactic that has been used both militarily and by terrorists.<ref>{{cite journal | vauthors = Aggarwal N | title = Rethinking suicide bombing | journal = Crisis | volume = 30 | issue = 2 | pages = 94–7 | year = 2009 | pmid = 19525169 | doi = 10.1027/0227-5910.30.2.94 }}</ref> Suicide is often seen as a major catastrophe, causing significant grief to the deceased's relatives, friends and community members, and it is viewed negatively almost everywhere around the world.<ref>{{cite news |vauthors=Vaughan M |title=The 'discovery' of suicide in Africa |url=https://www.bbc.co.uk/programmes/articles/5PPwm7sf3xy78q7lz4tdpWC/the-discovery-of-suicide-in-africa |work=BBC |access-date=16 June 2020 |language=en-GB |archive-date=22 May 2022 |archive-url=https://web.archive.org/web/20220522075628/https://www.bbc.co.uk/programmes/articles/5PPwm7sf3xy78q7lz4tdpWC/the-discovery-of-suicide-in-africa |url-status=live }}</ref><ref>{{cite web |title=Suicide |url=https://www.who.int/news-room/fact-sheets/detail/suicide |work=World Health Organization |access-date=16 June 2020 |language=en |archive-date=17 May 2019 |archive-url=https://web.archive.org/web/20190517230601/https://www.who.int/news-room/fact-sheets/detail/suicide |url-status=live }}</ref>{{TOC limit}}

== Definitions == {{main|Suicide terminology}} {{redirect|Extended–suicide|the full basis and background|Murder–suicide}} Suicide, derived from Latin {{Lang|la|suicidium}}, is "the act of taking one's own life".<ref name=Sted2006/><ref>{{cite book|title=Issues in Law & Medicine, Volume 3|date=1987|publisher=National Legal Center for the Medically Dependent & Disabled, Incorporated, and the Horatio R. Storer Foundation, Incorporated |page=39 |url=https://books.google.com/books?id=g1cqAAAAMAAJ&q=Latin+suicidium%27+%22to+kill+oneself%22.}}</ref> Attempted suicide, or non-fatal suicidal behavior, amounts to self-injury with at least some desire to end one's life that does not result in death.<ref name=Krug2002>{{cite book |vauthors=Krug E |title=World Report on Violence and Health |volume=1 |year=2002 |publisher=World Health Organization |location=Genève |isbn=978-92-4-154561-7 |page=[https://archive.org/details/worldreportonvio2002unse/page/185 185] |url=https://archive.org/details/worldreportonvio2002unse/page/185}}</ref><ref name="Tur2016">{{cite journal |vauthors=Turecki G, Brent DA |date=March 2016 |title=Suicide and suicidal behaviour |journal=The Lancet |volume=387 |issue=10024 |pages=1227–39 |doi=10.1016/S0140-6736(15)00234-2 |pmc=5319859 |pmid=26385066}}</ref> Assisted suicide occurs when one individual helps another bring about their own death indirectly by providing either advice or the means to the end.<ref name=Gullota2002>{{cite book |vauthors=Gullota TP, Bloom M |title=Encyclopedia of Primary Prevention and Health Promotion |year=2002 |publisher=Kluwer Academic/Plenum |location=New York |isbn=978-0-306-47296-1 |page=1112 |url=https://books.google.com/books?id=Elx37xzO0bsC&pg=PA1112}}</ref> Euthanasia, more specifically voluntary euthanasia, is where another person takes a more active role in bringing about a person's death.<ref name=Gullota2002/>

Suicidal ideation is thoughts of ending one's life but not taking any active efforts to do so.<ref name=Krug2002/> It may or may not involve exact planning or intent.<ref name=Tur2016 /> '''Suicidality''' is defined as "the risk of suicide, usually indicated by suicidal ideation or intent, especially as evident in the presence of a well-elaborated suicidal plan."<ref>{{cite APA Dictionary |title=suicidality |shortlink=suicidality |access-date=2023-08-03 }}</ref>

In a murder–suicide (or homicide–suicide), the individual aims at taking the lives of others at the same time. A special case of this is extended suicide, where the murder is motivated by seeing the murdered persons as an extension of their self.<ref>{{cite book |vauthors=Lester D |veditors=Wasserman D, Wasserman C |title=Oxford textbook of suicidology |pages=134–136 |date=2009 |publisher=Oxford University Press |location=Oxford |isbn=978-0-19-857005-9 |chapter=Extended suicide |doi=10.1093/med/9780198570059.003.0022}}</ref> Suicide in which the reason is that the person feels that they are not part of society is known as egoistic suicide.<ref>{{cite book |url=https://books.google.com/books?id=6PGzHFuS1xkC&pg=PA144 |title=Seminars in general adult psychiatry |vauthors=Stein G, Wilkinson G |date=2007 |publisher=Gaskell |isbn=978-1-904671-44-2 |edition=2nd |location=London |page=144}}</ref>

The Centre for Suicide Prevention in Canada found that the normal verb in scholarly research and journalism for the act of suicide was ''commit'', and argued for destigmatizing terminology related to suicide; in 2011, they published an article calling for changing the language used around suicide entitled "Suicide and language: Why we shouldn't use the 'C' word".<ref name="Olsen 2011">{{cite journal |vauthors=Olson R |title=Suicide and Language |journal=Centre for Suicide Prevention |year=2011 |series=InfoExchange |issue=3 |page=4 |url=http://suicideinfo.ca/LinkClick.aspx?fileticket=sNKET0k90VY%3d&tabid=554 |access-date=15 May 2013 |url-status=live |archive-url=https://web.archive.org/web/20120506202903/http://suicideinfo.ca/LinkClick.aspx?fileticket=sNKET0k90VY%3D&tabid=554 |archive-date=6 May 2012}}</ref><ref name="Beaton 2013">{{cite journal |vauthors=Beaton S, Forster P, Maple M |title=Suicide and Language: Why we Shouldn't Use the 'C' Word |journal=In Psych |date=February 2013 |volume=35 |issue=1 |pages=30–31 |url=http://www.psychology.org.au/Content.aspx?ID=5048 |url-status=live |archive-url=https://web.archive.org/web/20140815173633/http://www.psychology.org.au/Content.aspx?ID=5048 |archive-date=15 August 2014}}</ref> The American Psychological Association lists "committed suicide" as a term to avoid because it "frame[s] suicide as a crime."<ref>{{cite book |url=https://www.apa.org/about/apa/equity-diversity-inclusion/language-guidelines.pdf |access-date=13 February 2022 |title=Inclusive Language Guidelines |publisher=American Psychological Association |location=Washington, D.C. |page=19 |archive-date=13 February 2022 |archive-url=https://web.archive.org/web/20220213231554/https://www.apa.org/about/apa/equity-diversity-inclusion/language-guidelines.pdf |url-status=live }}</ref> Some advocacy groups recommend using the terms ''took his/her own life'', ''died by suicide'', or ''killed him/herself'' instead of ''committed suicide''.<ref name="Beck 1974">{{cite book |veditors=Beck AT, Resnik HL, Lettieri DJ |title=The prediction of suicide |location=Bowie, MD |publisher=Charles Press |year=1974 |page=41 |chapter=Development of suicidal intent scales |isbn=978-0-913486-13-9 }}</ref><ref name="NIMH 2001">{{cite web|title=Recommendations for Reporting on Suicide |url=http://www.nimh.nih.gov/health/topics/suicide-prevention/save_310_guide_v6.pdf |publisher=National Institute of Mental Health |access-date=15 May 2013 |year=2001 |archive-url=https://web.archive.org/web/20130427114237/http://www.nimh.nih.gov/health/topics/suicide-prevention/save_310_guide_v6.pdf |archive-date=27 April 2013}}</ref><ref name="Time To Change 2008">{{cite web |title=Reporting Suicide and Self Harm |url=http://www.time-to-change.org.uk/node/75408 |publisher=Time To Change |access-date=2 January 2016 |year=2008 |url-status=live |archive-url=https://web.archive.org/web/20160114191733/http://www.time-to-change.org.uk/node/75408 |archive-date=14 January 2016}}</ref> The Associated Press Stylebook recommends avoiding "committed suicide" except in direct quotes from authorities.<ref>{{cite tweet |user=apstylebook |number=865283308476928002 |date=18 May 2017 |title=Avoid "committed suicide" except in direct quotes from authorities. Alternatives: "killed himself," "took her own life," "died by suicide." }}</ref> The ''Guardian'' and ''Observer'' style guides deprecate the use of "committed",<ref>{{cite news |title=Guardian and Observer style guide: S |url=https://www.theguardian.com/guardian-observer-style-guide-s |work=The Guardian |date=4 May 2021 |language=en |archive-date=25 January 2009 |access-date=10 November 2021 |archive-url=https://web.archive.org/web/20090125031436/http://www.guardian.co.uk/styleguide/s |url-status=live }}</ref> as does CNN.<ref>{{cite news |vauthors=Ravitz J |title=The words to say -- and not to say -- about suicide |url=https://edition.cnn.com/2018/06/09/health/suicide-language-words-matter/index.html |work=CNN |date=11 June 2018 |archive-date=10 November 2021 |access-date=10 November 2021 |archive-url=https://web.archive.org/web/20211110160806/https://edition.cnn.com/2018/06/09/health/suicide-language-words-matter/index.html |url-status=live }}</ref> Opponents of ''commit'' argue that it implies that suicide is criminal, sinful, or morally wrong.<ref name="Ball 2005">{{cite web |vauthors=Ball PB |title=The Power of words |url=http://www.suicideprevention.ca/about-suicide/the-power-of-words/ |publisher=Canadian Association of Suicide Prevention |access-date=16 May 2013 |year=2005 |archive-url=https://web.archive.org/web/20130513011216/http://www.suicideprevention.ca/about-suicide/the-power-of-words/ |archive-date=13 May 2013}}</ref>

Suicide may involve more than one method or result in unintended secondary trauma, such as in the case of complex and complicated suicides. Complex suicides involve the use of more than one method either simultaneously or successively; a rare type that may be further decomposed into secondary (i.e., a succeeding method spontaneously used after the principal is perceived to have failed to prevent pain or suffering) or primary (i.e., a succeeding method initiated after the principal is perceived to have failed) types. Complicated suicide describes a poorly understood process that results in secondary unintentional trauma as a result of using a single method.<ref>{{cite journal |last1=Törő |first1=Klára |last2=Pollak |first2=Stefan |title=Complex suicide versus complicated suicide |journal=Forensic Science International |date=January 2009 |volume=184 |issue=1-3 |pages=6–9 |doi=10.1016/j.forsciint.2008.10.020 }}</ref>

== Pathophysiology == thumb|upright|BDNF - Brain-derived neurotrophic factor (violet) and NT-4 heterodimer (blue) There is no known unifying underlying pathophysiology for suicide;<ref name=EB2011/> it is believed to result from an interplay of behavioral, socio-economic and psychological factors.<ref name=Yip2012/>

Low levels of brain-derived neurotrophic factor (BDNF) are directly associated with suicide<ref>{{cite journal | vauthors = Pjevac M, Pregelj P |title=Neurobiology of suicidal behaviour | journal = Psychiatria Danubina | volume = 24 | issue = Suppl 3 |pages=S336-41 |date=October 2012 |pmid=23114813}}</ref> and indirectly associated through its role in major depression, post-traumatic stress disorder, schizophrenia and obsessive–compulsive disorder.<ref>{{cite journal | vauthors = Sher L |title=The role of brain-derived neurotrophic factor in the pathophysiology of adolescent suicidal behavior |journal=International Journal of Adolescent Medicine and Health |volume=23 |issue=3 |pages=181–185 | year = 2011 |pmid=22191181 |doi=10.1515/ijamh.2011.041}}</ref> Post-mortem studies have found reduced levels of BDNF in the hippocampus and prefrontal cortex, in those with and without psychiatric conditions.<ref>{{cite journal |vauthors=Sher L |title=Brain-derived neurotrophic factor and suicidal behavior |journal=QJM |volume=104 |issue=5 |pages=455–458 |date=May 2011 |pmid=21051476 |doi=10.1093/qjmed/hcq207 |doi-access=free}}</ref> Serotonin, a brain neurotransmitter, is believed to be low in those who die by suicide.<ref>{{cite book |vauthors=Yanowitch R, Coccaro EF |title=Aggression |chapter=The neurochemistry of human aggression |series=Advances in Genetics |volume=75 |pages=151–169 |date=2011 |pmid=22078480 |doi=10.1016/b978-0-12-380858-5.00005-8 |publisher=Elsevier |isbn=978-0-12-380858-5}}</ref> This is partly based on evidence of increased levels of 5-HT2A receptors found after death.<ref name=Dwi2012>{{cite book |vauthors=Dwivedi Y |title=The neurobiological basis of suicide |year=2012 |publisher=Taylor & Francis/CRC Press |location=Boca Raton, FL |isbn=978-1-4398-3881-5 |page=166 |url=https://books.google.com/books?id=5hcOf_SM-U0C&pg=PA166 |archive-date=1 October 2024 |access-date=27 June 2015 |archive-url=https://web.archive.org/web/20241001061442/https://books.google.com/books?id=5hcOf_SM-U0C&pg=PA166#v=onepage&q&f=false |url-status=live }}</ref> Other evidence includes reduced levels of a breakdown product of serotonin, 5-hydroxyindoleacetic acid, in the cerebral spinal fluid.<ref>{{cite book |vauthors=Stein G, Wilkinson G |title=Seminars in general adult psychiatry |year=2007 |publisher=Gaskell |location=London |isbn=978-1-904671-44-2 |page=145 |url=https://books.google.com/books?id=6PGzHFuS1xkC&pg=PA145 |edition=2nd}}</ref> However, direct evidence is hard to obtain.<ref name=Dwi2012/> Epigenetics, the study of changes in genetic expression in response to environmental factors which do not alter the underlying DNA, is also believed to play a role in determining suicide risk.<ref>{{cite journal |vauthors=Autry AE, Monteggia LM |title=Epigenetics in suicide and depression |journal=Biological Psychiatry |volume=66 |issue=9 |pages=812–813 |date=November 2009 |pmid=19833253 |pmc=2770810 |doi=10.1016/j.biopsych.2009.08.033}}</ref>

== Risk factors == {{Bar box|title=Precipitating circumstances in the US, 2017<ref>{{cite journal |vauthors=Petrosky E, Ertl A, Sheats KJ, Wilson R, Betz CJ, Blair JM |title=Surveillance for Violent Deaths - National Violent Death Reporting System, 34 States, Four California Counties, the District of Columbia, and Puerto Rico, 2017 |journal=MMWR. Surveillance Summaries |volume=69 | issue = 8 | pages = 1–37 |date=December 2020 | pmid = 33270620 |pmc=7713989 |doi=10.15585/mmwr.ss6908a1}}</ref>|titlebar=#DDD|left1=Categories|right2=Percentage|width=500px|bars={{bar percent|Diagnosed mental problem|green|50}}

{{bar percent|Death of loved one|black|7}} |caption=Suicide is multi-factorial. Multiple precipitating circumstances and risk factors can apply to the same person.|barwidth=180px|float=right}}

Factors that affect the risk of suicide include mental disorders, drug misuse, psychological states, cultural, family and social situations, genetics, experiences of trauma or loss, and nihilism.<ref name=Hawton2012/><ref name="cdc.gov">{{cite web |title=Suicide Risk and Protective Factors{{!}}Suicide{{!}}Violence Prevention{{!}}Injury Center{{!}}CDC |url=https://www.cdc.gov/violenceprevention/suicide/riskprotectivefactors.html |website=www.cdc.gov |access-date=29 July 2019 |language=en-us |date=25 April 2019 |archive-date=6 July 2019 |archive-url=https://web.archive.org/web/20190706042247/https://www.cdc.gov/violenceprevention/suicide/riskprotectivefactors.html |url-status=live }}</ref><ref name=Zal2016/> Mental disorders and substance misuse frequently co-exist.<ref name=Drug2011/> Other risk factors include having previously attempted suicide,<ref name=EB2011/> the ready availability of a means to take one's life, a family history of suicide, or the presence of traumatic brain injury.<ref>{{cite journal | vauthors = Simpson G, Tate R | title = Suicidality in people surviving a traumatic brain injury: prevalence, risk factors and implications for clinical management | journal = Brain Injury | volume = 21 | issue = 13–14 | pages = 1335–51 | date = December 2007 | pmid = 18066936 | doi = 10.1080/02699050701785542 }}</ref> For example, suicide rates have been found to be greater in households with firearms than those without them.<ref name="Miller 393–408">{{cite journal | vauthors = Miller M, Azrael D, Barber C | title = Suicide mortality in the United States: the importance of attending to method in understanding population-level disparities in the burden of suicide | journal = Annual Review of Public Health | volume = 33 | pages = 393–408 | date = April 2012 | pmid = 22224886 | doi = 10.1146/annurev-publhealth-031811-124636 |doi-access=free}}</ref> Research examining 3,018 US counties found that "the distribution of suicide rates across US states corresponded to variations in [social determinants of health] cluster distribution in each state."<ref>{{cite journal |last1=Xiao |first1=Yunyu |last2=Meng |first2=Yuan |last3=Brown |first3=Timothy T. |last4=Tsai |first4=Alexander C. |last5=Snowden |first5=Lonnie R. |last6=Chow |first6=Julian Chun-Chung |last7=Pathak |first7=Jyotishman |last8=Mann |first8=J. John |title=Machine learning to investigate policy-relevant social determinants of health and suicide rates in the United States |journal=Nature Mental Health |date=12 May 2025 |volume=3 |issue=6 |pages=675–684 |doi=10.1038/s44220-025-00424-4 }}</ref>

Socio-economic problems such as unemployment, poverty, homelessness, and discrimination may trigger suicidal thoughts.<ref>{{cite journal |vauthors=Qin P, Agerbo E, Mortensen PB |title=Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial factors: a national register-based study of all suicides in Denmark, 1981–1997 |journal=The American Journal of Psychiatry |volume=160 |issue=4 |pages=765–772 |date=April 2003 |pmid=12668367 |doi=10.1176/appi.ajp.160.4.765 |hdl=10818/17040 |hdl-access=free }}</ref><ref>{{cite journal | title = Suicide among adults aged 35-64 years--United States, 1999-2010 |journal=MMWR. Morbidity and Mortality Weekly Report |volume=62 |issue=17 |pages=321–325 |date=May 2013 |pmid=23636024 |pmc=4604925 |author1=Centers for Disease Control Prevention (CDC) |author1-link=Centers for Disease Control Prevention}}</ref> Suicide might be rarer in societies with high social cohesion and moral objections against suicide.<ref name=Tur2016 /> Genetics appears to account for between 38% and 55% of suicidal behaviors.<ref name=Brent2008>{{cite journal | vauthors = Brent DA, Melhem N | title = Familial transmission of suicidal behavior | journal = The Psychiatric Clinics of North America | volume = 31 | issue = 2 | pages = 157–77 | date = June 2008 | pmid = 18439442 | pmc = 2440417 | doi = 10.1016/j.psc.2008.02.001 }}</ref> Suicides may also occur as a local cluster of cases.<ref name="CDC2018Risk">{{cite web |url=https://www.cdc.gov/violenceprevention/suicide/riskprotectivefactors.html |title=Suicide Risk and Protective Factors{{!}}Suicide{{!}}Violence Prevention{{!}}Injury Center{{!}}CDC |date=25 April 2019 |website=Centers for Disease Control Prevention |access-date=17 June 2019 |archive-date=6 July 2019 |archive-url=https://web.archive.org/web/20190706042247/https://www.cdc.gov/violenceprevention/suicide/riskprotectivefactors.html |url-status=live }}</ref>

Most research does not distinguish between risk factors that lead to thinking about suicide and risk factors that lead to suicide attempts.<ref>{{cite journal| vauthors = May AM, Klonsky ED |date=2016|title=What Distinguishes Suicide Attempters From Suicide Ideators? A Meta-Analysis of Potential Factors|journal=Clinical Psychology: Science and Practice|volume=23|issue=1|pages=5–20|doi=10.1111/cpsp.12136 }}</ref><ref>{{cite journal | vauthors = Klonsky ED, May AM | title = Differentiating suicide attempters from suicide ideators: a critical frontier for suicidology research | journal = Suicide & Life-Threatening Behavior | volume = 44 | issue = 1 | pages = 1–5 | date = February 2014 | pmid = 24313594 | doi = 10.1111/sltb.12068 }}</ref> Risks for suicide attempt, rather than just thoughts of suicide, include a high pain tolerance and a reduced fear of death.<ref>{{cite journal | vauthors = Klonsky ED, Qiu T, Saffer BY | title = Recent advances in differentiating suicide attempters from suicide ideators | journal = Current Opinion in Psychiatry | volume = 30 | issue = 1 | pages = 15–20 | date = January 2017 | pmid = 27798483 | doi = 10.1097/YCO.0000000000000294 }}</ref>

=== Autism === {{Main|Suicide among autistic individuals}}

Autistic individuals, on average, face more mental health and social challenges than non-autistic individuals, including higher rates of anxiety, depression, and social isolation.<ref>{{cite journal |last1=Lai |first1=Meng-Chuan |last2=Kassee |first2=Caroline |last3=Besney |first3=Richard |last4=Bonato |first4=Sarah |last5=Hull |first5=Laura |last6=Mandy |first6=William |last7=Szatmari |first7=Peter |last8=Ameis |first8=Stephanie H |title=Prevalence of co-occurring mental health diagnoses in the autism population: a systematic review and meta-analysis |journal=The Lancet Psychiatry |date=October 2019 |volume=6 |issue=10 |pages=819–829 |doi=10.1016/S2215-0366(19)30289-5 |pmid=31447415 }}</ref><ref>{{cite web | title=Social difficulties in autism spectrum disorder | website=KU SOE | date=2023-05-22 | url=https://educationonline.ku.edu/community/social-difficulties-in-autism-spectrum-disorder | access-date=2025-05-08 | archive-date=16 May 2025 | archive-url=https://web.archive.org/web/20250516004402/https://educationonline.ku.edu/community/social-difficulties-in-autism-spectrum-disorder | url-status=live }}</ref> They attempt and consider suicide more frequently than the general population.<ref>{{cite journal |last1=Zahid |first1=Sofia |last2=Upthegrove |first2=Rachel |title=Suicidality in Autistic Spectrum Disorders: A Systematic Review |journal=Crisis |date=July 2017 |volume=38 |issue=4 |pages=237–246 |doi=10.1027/0227-5910/a000458 |pmid=28468556 }}</ref> Autistic people are about three times as likely as non-autistic people to attempt suicide.<ref name="Risk2">{{Cite journal |last1=Blanchard |first1=Ashley |last2=Chihuri |first2=Stanford |last3=DiGuiseppi |first3=Carolyn G. |last4=Li |first4=Guohua |date=2021-10-01 |title=Risk of Self-harm in Children and Adults With Autism Spectrum Disorder: A Systematic Review and Meta-analysis |journal=JAMA Network Open |volume=4 |issue=10 |pages=e2130272 |doi=10.1001/jamanetworkopen.2021.30272 |pmc=8527356 |pmid=34665237 }}</ref><ref name="burden">{{Cite journal |last1=Santomauro |first1=Damian F. |last2=Hedley |first2=Darren |last3=Sahin |first3=Ensu |last4=Brugha |first4=Traolach S. |last5=Naghavi |first5=Mohsen |last6=Vos |first6=Theo |last7=Whiteford |first7=Harvey A. |last8=Ferrari |first8=Alize J. |last9=Stokes |first9=Mark A. |date=November 2024 |title=The global burden of suicide mortality among people on the autism spectrum: A systematic review, meta-analysis, and extension of estimates from the Global Burden of Disease Study 2021 |journal=Psychiatry Research |volume=341 |article-number=116150 |pmid=39197224 |doi=10.1016/j.psychres.2024.116150 |doi-access=free }}</ref> Suicide is a leading cause of early death for autistic people without co-occurring learning disabilities.<ref>{{cite journal |last1=Newell |first1=Victoria |last2=Phillips |first2=Lucy |last3=Jones |first3=Chris |last4=Townsend |first4=Ellen |last5=Richards |first5=Caroline |last6=Cassidy |first6=Sarah |title=A systematic review and meta-analysis of suicidality in autistic and possibly autistic people without co-occurring intellectual disability |journal=Molecular Autism |date=15 March 2023 |volume=14 |issue=1 |article-number=12 |doi=10.1186/s13229-023-00544-7 |doi-access=free |pmid=36922899 }}</ref>

=== Environmental exposures === {{See also|Brain health and pollution}} Some environmental exposures, including air pollution, intense sunlight, sunlight duration, hot weather, and high altitude, are associated with suicide.<ref name=":0">{{Cite journal |last1=Cornelius |first1=Sarah L. |last2=Berry |first2=Tara |last3=Goodrich |first3=Amanda J. |last4=Shiner |first4=Brian |last5=Riblet |first5=Natalie B. |date=2021-07-23 |title=The Effect of Meteorological, Pollution, and Geographic Exposures on Death by Suicide: A Scoping Review |journal=International Journal of Environmental Research and Public Health |volume=18 |issue=15 |page=7809 |doi=10.3390/ijerph18157809 |doi-access=free |pmc=8345465 |pmid=34360101}}</ref> There is a possible association between short-term PM<sub>10</sub> exposure and suicide.<ref name="pm2024">{{cite journal | last1=Go | first1=Tae-Hwa | last2=Kim | first2=Min-Hyuk | last3=Choi | first3=Yoon-Young | last4=Han | first4=Jaehyun | last5=Kim | first5=Changsoo | last6=Kang | first6=Dae Ryong | title=The short-term effect of ambient particulate matter on suicide death | journal=Environmental Health | publisher=Springer Science and Business Media LLC | volume=23 | issue=1 | date=3 Jan 2024 | page=3 | doi=10.1186/s12940-023-01042-2 | doi-access=free | pmid=38169380 | type=meta-analysis| pmc=10763266 | bibcode=2024EnvHe..23....3G }}</ref><ref name="pmid31850801">{{cite journal |vauthors=Braithwaite I, Zhang S, Kirkbride JB, Osborn DP, Hayes JF |date=December 2019 |title=Air Pollution (Particulate Matter) Exposure and Associations with Depression, Anxiety, Bipolar, Psychosis and Suicide Risk: A Systematic Review and Meta-Analysis |journal=Environmental Health Perspectives |volume=127 |issue=12 |article-number=126002 |doi=10.1289/EHP4595 |pmc=6957283 |pmid=31850801|bibcode=2019EnvHP.127l6002B }}</ref> These factors might affect certain high-risk individuals more than others.<ref name=":0" />

The time of year may also affect suicide rates. There appears to be a decrease around Christmas,<ref>{{cite journal |vauthors=Carley S, Hamilton M |date=November 2004 |title=Best evidence topic report. Suicide at christmas |journal=Emergency Medicine Journal |volume=21 |issue=6 |pages=716–7 |doi=10.1136/emj.2004.019703 |pmc=1726490 |pmid=15496706}}</ref> but an increase in rates during spring and summer, which might be related to exposure to sunshine.<ref name="Tur2016" /> Another study found that the risk may be greater for males on their birthday.<ref>{{cite journal |display-authors=6 |vauthors=Williams A, While D, Windfuhr K, Bickley H, Hunt IM, Shaw J, Appleby L, Kapur N |date=2011 |title=Birthday blues: examining the association between birthday and suicide in a national sample |journal=Crisis |volume=32 |issue=3 |pages=134–42 |doi=10.1027/0227-5910/a000067 |pmid=21616762}}</ref>

Genetics might influence rates of suicide. A family history of suicide, especially in the mother, affects children more than adolescents or adults.<ref name="Ocon2014" /> Adoption studies have shown that this is the case for biological relatives, but not adopted relatives. This makes familial risk factors unlikely to be due to imitation.<ref name="Tur2016" /> Once mental disorders are accounted for, the estimated heritability rate is 36% for suicidal ideation and 17% for suicide attempts.<ref name="Tur2016" /> An evolutionary explanation for suicide is that it may improve inclusive fitness. This may occur if the person dying by suicide cannot have more children and takes resources away from relatives by staying alive. An objection to this explanation is that deaths by healthy adolescents likely do not increase inclusive fitness. Adaptation to a very different ancestral environment may be maladaptive in the current one.<ref name="Joiner2005" /><ref>{{cite journal |vauthors=Confer JC, Easton JA, Fleischman DS, Goetz CD, Lewis DM, Perilloux C, Buss DM |date=1 January 2010 |title=Evolutionary psychology. Controversies, questions, prospects, and limitations |journal=The American Psychologist |volume=65 |issue=2 |pages=110–26 |citeseerx=10.1.1.601.8691 |doi=10.1037/a0018413 |pmid=20141266}}</ref>

=== Media === {{See also|Copycat suicide|Social media and suicide}}[[File:Lotte_an_Werthers_Grabmal.jpg|thumb|upright=1.35|In Goethe's ''The Sorrows of Young Werther'', the title character kills himself due to a love triangle involving Charlotte (pictured at his grave). Some admirers of the story were triggered into copycat suicide, known as the "Werther effect".]] The media, including the Internet, plays an important role.<ref name=Hawton2012/><ref name="Ocon2014" /> Certain depictions of suicide may increase its occurrence, with high-volume, prominent, repetitive coverage glorifying or romanticizing suicide having the most impact.<ref name=Boh2012>{{cite journal | vauthors = Bohanna I, Wang X | title = Media guidelines for the responsible reporting of suicide: a review of effectiveness | journal = Crisis | volume = 33 | issue = 4 | pages = 190–8 | year = 2012 | pmid = 22713977 | doi = 10.1027/0227-5910/a000137 }}</ref> For example, about 15–40% of people leave a suicide note,<ref>{{cite book |url=https://books.google.com/books?id=E2sKf-sexZwC&pg=PA215 |title=Crisis intervention strategies |vauthors=Gilliland B, James R |date=8 May 2012 |publisher=Brooks/Cole |isbn=978-1-111-18677-7 |edition=7th |location=Belmont, CA |page=215 |archive-url=https://web.archive.org/web/20151003151518/https://books.google.com/books?id=E2sKf-sexZwC&pg=PA215 |archive-date=3 October 2015 |url-status=live}}</ref> and media are discouraged from reporting the contents of that message. When detailed descriptions of how to kill oneself by a specific means are portrayed, this method of suicide can be imitated in vulnerable people.<ref name=Yip2012/> This phenomenon has been observed in several cases after press coverage.<ref>{{cite journal | vauthors = Exeter DJ, Boyle PJ | title = Does young adult suicide cluster geographically in Scotland? | journal = Journal of Epidemiology and Community Health | volume = 61 | issue = 8 | pages = 731–6 | date = August 2007 | pmid = 17630375 | pmc = 2653005 | doi = 10.1136/jech.2006.052365 }}</ref><ref>{{cite journal | vauthors = Gould MS, Wallenstein S, Davidson L | title = Suicide clusters: a critical review | journal = Suicide & Life-Threatening Behavior | volume = 19 | issue = 1 | pages = 17–29 | date = 1989 | pmid = 2652386 | doi = 10.1111/j.1943-278X.1989.tb00363.x }}</ref> In a bid to reduce the adverse effect of media portrayals concerning suicide report, one of the effective methods is to educate journalists on how to report suicide news in a manner that might reduce that possibility of imitation and encourage those at risk to seek for help. When journalists follow certain reporting guidelines the risk of suicides can be decreased.<ref name="Boh2012" /> Getting buy-in from the media industry can be difficult, especially in the long term.<ref name="Boh2012" />

This trigger of suicide contagion or copycat suicide is known as the "Werther effect", named after the protagonist in Goethe's ''The Sorrows of Young Werther'' who killed himself and then was emulated by many admirers of the book.<ref name=Sia2012/> This risk is greater in adolescents who may romanticize death.<ref>{{cite journal | vauthors = Stack S | title = Suicide in the media: a quantitative review of studies based on non-fictional stories | journal = Suicide and Life-Threatening Behavior | volume = 35 | issue = 2 | pages = 121–33 | date = April 2005 | pmid = 15843330 | doi = 10.1521/suli.35.2.121.62877 }}</ref> It appears that while news media has a significant effect, that of the entertainment media is equivocal.<ref>{{cite journal |author=Pirkis J |title=Suicide and the media|journal=Psychiatry |volume=8 |issue=7 |pages=269–71 |date=July 2009 |doi=10.1016/j.mppsy.2009.04.009}}</ref><ref>{{cite book | vauthors = Shrivastava A, Kimbrell M, Lester D |title=Suicide from a global perspective: psychosocial approaches|date=2012|publisher=Nova Science Publishers|location=New York|isbn=978-1-61470-965-7|pages=115–18}}</ref> It is unclear if searching for information about suicide on the Internet relates to the risk of suicide.<ref>{{cite journal | vauthors = Mok K, Jorm AF, Pirkis J | title = Suicide-related Internet use: A review | journal = The Australian and New Zealand Journal of Psychiatry | volume = 49 | issue = 8 | pages = 697–705 | date = August 2015 | pmid = 25698810 | doi = 10.1177/0004867415569797 | hdl = 11343/58519 | hdl-access = free }}</ref> The opposite of the Werther effect is the proposed "Papageno effect", in which coverage of effective coping mechanisms may have a protective effect. The term is based upon a character in Mozart's opera ''The Magic Flute''—fearing the loss of a loved one, he had planned to kill himself until his friends helped him out.<ref name=Sia2012>{{cite journal | vauthors = Sisask M, Värnik A | title = Media roles in suicide prevention: a systematic review | journal = International Journal of Environmental Research and Public Health | volume = 9 | issue = 1 | pages = 123–38 | date = January 2012 | pmid = 22470283 | pmc = 3315075 | doi = 10.3390/ijerph9010123 | doi-access = free }}</ref> As a consequence, fictional portrayals of suicide, showing alternative consequences or negative consequences, might have a preventive effect,<ref>{{cite journal | vauthors = Scalvini M, Rigamonti F | title = Why we must defend suicide in fiction | journal = BMJ | volume = 359 | article-number = j4743 | date = October 2017 | pmid = 29046321 | doi = 10.1136/bmj.j4743 }}</ref> for instance fiction might normalize mental health problems and encourage help-seeking.<ref>{{cite journal| vauthors = Scalvini M |date=18 June 2020|title=13 Reasons Why: can a TV show about suicide be 'dangerous'? What are the moral obligations of a producer?|journal=Media, Culture & Society|volume=42|issue=7–8|pages=1564–1574|doi=10.1177/0163443720932502 |doi-access=free|hdl=1765/128013|hdl-access=free}}</ref>

=== Medical conditions === There is an association between suicidality and physical health problems such as<ref name="Tint2010" /> chronic pain,<ref>{{cite journal | vauthors = Manthorpe J, Iliffe S | title = Suicide in later life: public health and practitioner perspectives | journal = International Journal of Geriatric Psychiatry | volume = 25 | issue = 12 | pages = 1230–1238 | date = December 2010 | pmid = 20104515 | doi = 10.1002/gps.2473 }}</ref> traumatic brain injury,<ref>{{cite journal |last1=Simpson |first1=Grahame K |last2=Tate |first2=Robyn L |title=Preventing suicide after traumatic brain injury: implications for general practice |journal=Medical Journal of Australia |date=August 2007 |volume=187 |issue=4 |pages=229–232 |doi=10.5694/j.1326-5377.2007.tb01206.x |pmid=17708726 }}</ref> cancer,<ref name="Ang2012">{{cite journal | vauthors = Anguiano L, Mayer DK, Piven ML, Rosenstein D | title = A literature review of suicide in cancer patients | journal = Cancer Nursing | volume = 35 | issue = 4 | pages = E14–E26 | date = Jul–Aug 2012 | pmid = 21946906 | doi = 10.1097/NCC.0b013e31822fc76c | doi-access = free }}</ref> chronic fatigue syndrome,<ref>{{cite journal | vauthors = Chu L, Elliott M, Stein E, Jason LA | title = Identifying and Managing Suicidality in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome | journal = Healthcare | volume = 9 | issue = 6 | date = May 2021 | page = 629 | pmid = 34070367 | pmc = 8227525 | doi = 10.3390/healthcare9060629 | doi-access = free }}</ref> kidney failure (requiring hemodialysis), HIV, and systemic lupus erythematosus.<ref name="Tint2010" /> The diagnosis of cancer approximately doubles the subsequent frequency of suicide.<ref name="Ang2012" /> The prevalence of increased suicidality persisted after adjusting for depressive illness and alcohol abuse. Among people with more than one medical condition the frequency was particularly high. In Japan, health problems are listed as the primary justification for suicide.<ref>{{cite book|url=https://books.google.com/books?id=HuHQbtlyM40C&pg=PA11|title=Suicide in Asia: causes and prevention|vauthors=Yip PS|publisher=Hong Kong University Press|year=2008|isbn=978-962-209-943-2|location=Hong Kong|page=11|archive-date=1 October 2024|access-date=27 June 2015|archive-url=https://web.archive.org/web/20241001061427/https://books.google.com/books?id=HuHQbtlyM40C&pg=PA11|url-status=live}}</ref>

Sleep disturbances, such as insomnia<ref>{{cite journal | vauthors = Ribeiro JD, Pease JL, Gutierrez PM, Silva C, Bernert RA, Rudd MD, Joiner TE | title = Sleep problems outperform depression and hopelessness as cross-sectional and longitudinal predictors of suicidal ideation and behavior in young adults in the military | journal = Journal of Affective Disorders | volume = 136 | issue = 3 | pages = 743–50 | date = February 2012 | pmid = 22032872 | doi = 10.1016/j.jad.2011.09.049 }}</ref> and sleep apnea, are risk factors for depression and suicide. In some instances, the sleep disturbances may be a risk factor independent of depression.<ref>{{cite journal | vauthors = Bernert RA, Joiner TE, Cukrowicz KC, Schmidt NB, Krakow B | title = Suicidality and sleep disturbances | journal = Sleep | volume = 28 | issue = 9 | pages = 1135–41 | date = September 2005 | pmid = 16268383 | doi = 10.1093/sleep/28.9.1135 | doi-access = free }}</ref> A number of other medical conditions may present with symptoms similar to mood disorders, including hypothyroidism, Alzheimer's, brain tumors, systemic lupus erythematosus, and adverse effects from a number of medications (such as beta blockers and steroids).<ref name="EB2011" />

=== Mental illness === Mental illness is present at the time of suicide 27% to more than 90% of the time.<ref name="University of Manchester Centre for Mental Health and Risk">{{cite web|last=University of Manchester Centre for Mental Health and Risk|title=The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness|url=http://www.medicine.manchester.ac.uk/cmhr/centreforsuicideprevention/nci/reports/annual_report_2012.pdf|archive-url=https://web.archive.org/web/20120714134607/http://www.medicine.manchester.ac.uk/cmhr/centreforsuicideprevention/nci/reports/annual_report_2012.pdf|archive-date=14 July 2012|access-date=25 July 2012}}</ref><ref name=EB2011/><ref>{{cite journal | vauthors = Stone DM, Simon TR, Fowler KA, Kegler SR, Yuan K, Holland KM, Ivey-Stephenson AZ, Crosby AE | display-authors = 6 | title = Vital Signs: Trends in State Suicide Rates – United States, 1999–2016 and Circumstances Contributing to Suicide – 27 States, 2015 | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 67 | issue = 22 | pages = 617–624 | date = June 2018 | pmid = 29879094 | pmc = 5991813 | doi = 10.15585/mmwr.mm6722a1 }}</ref><ref>{{cite journal | vauthors = Arsenault-Lapierre G, Kim C, Turecki G | title = Psychiatric diagnoses in 3275 suicides: a meta-analysis | journal = BMC Psychiatry | volume = 4 | issue = 1 | article-number = 37 | date = November 2004 | pmid = 15527502 | pmc = 534107 | doi = 10.1186/1471-244X-4-37 | doi-access = free }}</ref> Of those who have been hospitalized for suicidal behavior, the lifetime risk of suicide is 8.6%.<ref name=EB2011/><ref name=Bos2000>{{cite journal | vauthors = Bostwick JM, Pankratz VS | title = Affective disorders and suicide risk: a reexamination | journal = The American Journal of Psychiatry | volume = 157 | issue = 12 | pages = 1925–32 | date = December 2000 | pmid = 11097952 | doi = 10.1176/appi.ajp.157.12.1925 }}</ref> Comparatively, non-suicidal people hospitalized for affective disorders have a 4% lifetime risk of suicide.<ref name=Bos2000/> Half of all people who die by suicide may have major depressive disorder; having this or one of the other mood disorders such as bipolar disorder increases the risk of suicide 20-fold.<ref name=Che2012>{{cite book | vauthors = Kutcher S, Chehil S |title=Suicide Risk Management A Manual for Health Professionals.|publisher=John Wiley & Sons|location=Chicester|isbn=978-1-119-95311-1|pages=30–33|year=2012|url=https://books.google.com/books?id=fV8_1u0c7l0C&pg=PA31|edition=2nd }}</ref> Other conditions implicated include schizophrenia (14%), personality disorders (8%),<ref>{{cite journal | vauthors = Pompili M, Girardi P, Ruberto A, Tatarelli R | title = Suicide in borderline personality disorder: a meta-analysis | journal = Nordic Journal of Psychiatry | volume = 59 | issue = 5 | pages = 319–24 | date = 2005 | pmid = 16757458 | doi = 10.1080/08039480500320025 }}</ref><ref>{{cite journal | vauthors = Bertolote JM, Fleischmann A, De Leo D, Wasserman D | title = Psychiatric diagnoses and suicide: revisiting the evidence | journal = Crisis | volume = 25 | issue = 4 | pages = 147–55 | year = 2004 | pmid = 15580849 | doi = 10.1027/0227-5910.25.4.147 }}</ref> obsessive–compulsive disorder,<ref>{{cite journal | vauthors = Angelakis I, Gooding P, Tarrier N, Panagioti M | title = Suicidality in obsessive compulsive disorder (OCD): a systematic review and meta-analysis | journal = Clinical Psychology Review | volume = 39 | pages = 1–15 | date = July 2015 | pmid = 25875222 | doi = 10.1016/j.cpr.2015.03.002 }}</ref> and post-traumatic stress disorder.<ref name=EB2011/>

Others estimate that about half of people who die by suicide could be diagnosed with a personality disorder, with borderline personality disorder being the most common.<ref>{{cite journal | vauthors = Lieb K, Zanarini MC, Schmahl C, Linehan MM, Bohus M | title = Borderline personality disorder | journal = Lancet | volume = 364 | issue = 9432 | pages = 453–461 | year = 2004 | pmid = 15288745 | doi = 10.1016/S0140-6736(04)16770-6 | quote = Between 40% and 65% of individuals who commit suicide meet criteria for a personality disorder, with borderline personality disorder being the most commonly associated. }}</ref> About 5% of people with schizophrenia die of suicide.<ref name=Lancet09>{{cite journal |last1=van Os |first1=Jim |last2=Kapur |first2=Shitij |title=Schizophrenia |journal=The Lancet |date=August 2009 |volume=374 |issue=9690 |pages=635–645 |doi=10.1016/S0140-6736(09)60995-8 |pmid=19700006 |bibcode=2009Lanc..374..635V |author-link1=Jim van Os }}</ref> Eating disorders are another high risk condition.<ref name=Tint2010/> Around 22% to 50% of people with gender dysphoria have attempted suicide, although this varies greatly by region.<ref>{{cite web |vauthors=Cheung A, Zwickl S |date=23 March 2021 |title=Why have nearly half of transgender Australians attempted suicide? |url=https://pursuit.unimelb.edu.au/articles/why-have-nearly-half-of-transgender-australians-attempted-suicide |access-date=26 August 2022 |website=Pursuit |language=en |location=Melbourne, Australia |publisher=University of Melbourne |archive-date=26 August 2022 |archive-url=https://web.archive.org/web/20220826080242/https://pursuit.unimelb.edu.au/articles/why-have-nearly-half-of-transgender-australians-attempted-suicide |url-status=live }}</ref><ref>{{cite news |title=Transgender people and suicide |url=https://www.suicideinfo.ca/resource/transgender-people-suicide/ |access-date=26 August 2022 |website=Centre for Suicide Prevention |language=en-CA |archive-date=26 August 2022 |archive-url=https://web.archive.org/web/20220826080242/https://www.suicideinfo.ca/resource/transgender-people-suicide/ |url-status=live }}</ref><ref>{{cite journal | vauthors = Biggs M | title = Suicide by Clinic-Referred Transgender Adolescents in the United Kingdom | journal = Archives of Sexual Behavior | volume = 51 | issue = 2 | pages = 685–690 | date = February 2022 | pmid = 35043256 | pmc = 8888486 | doi = 10.1007/s10508-022-02287-7 }}</ref><ref>{{cite web |date=13 July 2021 |title=Suicide risk in transgender and gender diverse people |url=https://www.nationalelfservice.net/mental-health/suicide/suicide-risk-transgender-people/ |access-date=26 August 2022 |website=National Elf Service |language=en-GB}}</ref><ref>{{cite web |title=Study Shows Shocking Rates of Attempted Suicide Among Trans Teens |url=https://www.hrc.org/news/new-study-reveals-shocking-rates-of-attempted-suicide-among-trans-adolescen |access-date=26 August 2022 |website=Human Rights Campaign |date=12 September 2018 |language=en-US |archive-date=26 August 2022 |archive-url=https://web.archive.org/web/20220826080242/https://www.hrc.org/news/new-study-reveals-shocking-rates-of-attempted-suicide-among-trans-adolescen |url-status=live }}</ref>

Among approximately 80% of suicides, the individual has seen a physician within the year before their death,<ref name=Pir1998/> including 45% within the prior month.<ref>{{cite journal | vauthors = Luoma JB, Martin CE, Pearson JL | title = Contact with mental health and primary care providers before suicide: a review of the evidence | journal = The American Journal of Psychiatry | volume = 159 | issue = 6 | pages = 909–16 | date = June 2002 | pmid = 12042175 | pmc = 5072576 | doi = 10.1176/appi.ajp.159.6.909 }}</ref> Approximately 25–40% of those who died by suicide had contact with mental health services in the prior year.<ref name="University of Manchester Centre for Mental Health and Risk"/><ref name=Pir1998>{{cite journal | vauthors = Pirkis J, Burgess P | title = Suicide and recency of health care contacts. A systematic review | journal = The British Journal of Psychiatry | volume = 173 | issue = 6 | pages = 462–74 | date = December 1998 | pmid = 9926074 | doi = 10.1192/bjp.173.6.462 }}</ref> Antidepressants of the SSRI class appear to increase the frequency of suicide among children and young persons.<ref>{{cite journal | vauthors = Sharma T, Guski LS, Freund N, Gøtzsche PC | title = Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports | journal = BMJ | volume = 352 | page = i65 | date = January 2016 | pmid = 26819231 | pmc = 4729837 | doi = 10.1136/bmj.i65 }}</ref> Lithium significantly reduces the risk of suicide in people with mood disorders.<ref name=":1" /><ref name=":3" /><ref name=":4" /> Untreated mental health conditions significantly increase the risk of suicide.<ref>{{cite journal |last1=McClellan |first1=Chandler |last2=Ali |first2=Mir M. |last3=Mutter |first3=Ryan |title=Impact of Mental Health Treatment on Suicide Attempts |journal=The Journal of Behavioral Health Services & Research |date=January 2021 |volume=48 |issue=1 |pages=4–14 |doi=10.1007/s11414-020-09714-4 |pmid=32514809 }}</ref>

=== Occupational factors === {{See also|Suicide in the military}} Certain occupations carry an elevated risk of self-harm and suicide, such as military careers. Research in several countries has found that the rate of suicide among former armed forces personnel in particular,<ref name="AIHW-2021">{{cite web |last=Australian Institute of Health and Welfare |date=29 September 2021 |title=Serving and ex-serving Australian Defence Force members who have served since 1985: suicide monitoring 2001 to 2019 |url=https://www.aihw.gov.au/getmedia/c0338ed6-a0da-4f5a-b503-41abde024230/aihw-phe-290.pdf.aspx |url-status=live |access-date=26 August 2022 |website=aihw.gov.au |archive-date=26 August 2022 |archive-url=https://web.archive.org/web/20220826112322/https://www.aihw.gov.au/getmedia/c0338ed6-a0da-4f5a-b503-41abde024230/aihw-phe-290.pdf.aspx }}</ref><ref name="DND-2022">{{cite web |last=Department of National Defence |date=11 May 2022 |title=2021 Report on Suicide Mortality in the Canadian Armed Forces (1995 to 2020) |url=https://www.canada.ca/en/department-national-defence/corporate/reports-publications/health/2021-report-on-suicide-mortality-in-the-caf-1995-to-2020.html |url-status=live |access-date=30 August 2022 |website=www.canada.ca |archive-date=30 August 2022 |archive-url=https://web.archive.org/web/20220830091042/https://www.canada.ca/en/department-national-defence/corporate/reports-publications/health/2021-report-on-suicide-mortality-in-the-caf-1995-to-2020.html }}</ref><ref name="Simkus-2020">{{cite web | vauthors = Simkus K, Hall A, Heber A, VanTil L |date=18 June 2020 | title = Veteran Suicide Mortality Study: Follow-up period from 1976 to 2014 |url=https://www.veterans.gc.ca/eng/about-vac/research/research-directorate/publications/reports/veteran-suicide-mortality-study-2019 |url-status=live |access-date=30 August 2022 | location = Ottawa, ON | publisher = Veterans Affairs Canada |archive-date=30 August 2022 |archive-url=https://web.archive.org/web/20220830104419/https://www.veterans.gc.ca/eng/about-vac/research/research-directorate/publications/reports/veteran-suicide-mortality-study-2019 }}</ref><ref name="US Department of Veterans USDVA-2021">{{cite web |last=US Department of Veterans Affairs (Office of Mental Health and Suicide Prevention) |date=September 2021 |title=2001-2019 National Suicide Data Appendix |url=https://www.mentalhealth.va.gov/docs/data-sheets/2019/2001-2019-National-Data-Appendix_508.xlsx |access-date=30 August 2022 |website=va.gov |archive-date=14 August 2023 |archive-url=https://web.archive.org/web/20230814134854/https://www.mentalhealth.va.gov/docs/data-sheets/2019/2001-2019-National-Data-Appendix_508.xlsx |url-status=live }}</ref> and young veterans especially,<ref name="Kapur-2009">{{cite journal | vauthors = Kapur N, While D, Blatchley N, Bray I, Harrison K | title = Suicide after leaving the UK armed forces--a cohort study | journal = PLOS Medicine | volume = 6 | issue = 3 | article-number = e26 | date = March 2009 | pmid = 19260757 | pmc = 2650723 | doi = 10.1371/journal.pmed.1000026 | veditors = Hotopf M | doi-access = free }}</ref><ref>{{cite journal |last1=Jones |first1=Margaret |last2=Jones |first2=N |last3=Burdett |first3=H |last4=Bergman |first4=B P |last5=Fear |first5=N T |last6=Wessely |first6=S |last7=Rona |first7=R J |title=Do Junior Entrants to the UK Armed Forces have worse outcomes than Standard Entrants? |journal=BMJ Military Health |date=June 2023 |volume=169 |issue=3 |pages=218–224 |doi=10.1136/bmjmilitary-2021-001787 |pmid=33879526 |url=https://eprints.gla.ac.uk/239172/2/239172.pdf |archive-date=14 July 2024 |access-date=8 February 2026 |archive-url=https://web.archive.org/web/20240714101333/https://eprints.gla.ac.uk/239172/2/239172.pdf |url-status=live }}</ref><ref name="AIHW-2021" /> is markedly higher than that found in the general population. War veterans have a higher risk of suicide due in part to higher rates of mental illness, such as post-traumatic stress disorder, and physical health problems related to war.<ref name="Martyr2009">{{cite journal |vauthors=Rozanov V, Carli V |date=July 2012 |title=Suicide among war veterans |journal=International Journal of Environmental Research and Public Health |volume=9 |issue=7 |pages=2504–19 |doi=10.3390/ijerph9072504 |pmc=3407917 |pmid=22851956 |doi-access=free}}</ref>

=== Previous attempts === A 2002 review of about 90 suicide related studies concluded that the risk of suicide following a previous attempt or self-harm is hundreds of times larger than in the general population.<ref name=":sar3">{{cite journal |last1=Owens |first1=David |last2=Horrocks |first2=Judith |last3=House |first3=Allan |title=Fatal and non-fatal repetition of self-harm: Systematic review |journal=British Journal of Psychiatry |date=September 2002 |volume=181 |issue=3 |pages=193–199 |doi=10.1192/bjp.181.3.193 |pmid=12204922 }}</ref> Later, a 2017 study estimated that individuals with a history of suicide attempts are approximately 25 times more likely to die by suicide compared to the general population.<ref name=":sar0">{{Cite journal |last1=Parra-Uribe |first1=Isabel |last2=Blasco-Fontecilla |first2=Hilario |last3=Garcia-Parés |first3=Gemma |last4=Martínez-Naval |first4=Luis |last5=Valero-Coppin |first5=Oliver |last6=Cebrià-Meca |first6=Annabel |last7=Oquendo |first7=Maria A. |last8=Palao-Vidal |first8=Diego |title=Risk of re-attempts and suicide death after a suicide attempt: A survival analysis |journal=BMC Psychiatry |language=en |volume=17 |issue=1 |date=2017|page=163 |doi=10.1186/s12888-017-1317-z |doi-access=free |pmc=5415954 |pmid=28472923}}</ref> These findings makes a suicide attempt one of the strongest predictors of eventual suicide.<ref name="EB2011" />

Among the population that died by suicide, it is estimated that between 25% (up to a year prior)<ref name=":sar3" /> to 40%<ref name=":sar2">{{Cite journal |last1=Bostwick |first1=J. Michael |last2=Pabbati |first2=Chaitanya |last3=Geske |first3=Jennifer R. |last4=McKean |first4=Alastair J. |date=2016-11-01 |title=Suicide Attempt as a Risk Factor for Completed Suicide: Even More Lethal Than We Knew |journal=American Journal of Psychiatry |volume=173 |issue=11 |pages=1094–1100 |doi=10.1176/appi.ajp.2016.15070854 |pmc=5510596 |pmid=27523496}}</ref> attempted suicide before. The likelihood of dying by suicide after the subsequent attempt depends on the means used, the age of the person and their gender.<ref name=":sar2" /> Other risk factors such as substance use and mental health<ref name=":sar0" /> impact likelihood of suicide after an attempt. High suicidal intent during previous attempts is another strong predictor.<ref>{{Cite journal |last1=Suominen |first1=Kirsi |last2=Isometsä |first2=Erkki |last3=Ostamo |first3=Aini |last4=Lönnqvist |first4=Jouko |date=2004-04-20 |title=Level of suicidal intent predicts overall mortality and suicide after attempted suicide: a 12-year follow-up study |journal=BMC Psychiatry |volume=4 |issue=1 |page=11 |doi=10.1186/1471-244X-4-11 |doi-access=free |pmc=415554 |pmid=15099401}}</ref>

Time passed since the last attempt also plays a critical role. The first and the second year have the highest risk of suicide.<ref name=":sar3" /><ref name=":sar0" /> It is estimated that 1% die by suicide within a year of the first attempt,<ref name="EB2011" /> and that about 90% of suicide survivors will not die of suicide.<ref name=":sar1">{{Cite web |date=2012-09-11 |title=Attempters' Longterm Survival |url=https://www.hsph.harvard.edu/means-matter/means-matter/survival/ |access-date=2024-11-01 |website=Means Matter |language=en-us |archive-date=2 November 2024 |archive-url=https://web.archive.org/web/20241102202908/https://www.hsph.harvard.edu/means-matter/means-matter/survival/ |url-status=live }}</ref><ref name="Tint2010" />

=== Psychosocial factors ===  A number of psychological factors increase the risk of suicide including: hopelessness, loss of pleasure in life, depression, anxiousness, agitation, rigid thinking, rumination, thought suppression, and poor coping skills.<ref name=Che2012/><ref name=Ocon2014>{{cite journal | vauthors = O'Connor RC, Nock MK | title = The psychology of suicidal behaviour | journal = The Lancet. Psychiatry | volume = 1 | issue = 1 | pages = 73–85 | date = June 2014 | pmid = 26360404 | doi = 10.1016/S2215-0366(14)70222-6 }}</ref><ref>{{cite journal | vauthors = Bostwick JM, Rackley SJ | title = Completed suicide in medical/surgical patients: who is at risk? | journal = Current Psychiatry Reports | volume = 9 | issue = 3 | pages = 242–6 | date = June 2007 | pmid = 17521522 | doi = 10.1007/s11920-007-0026-6 }}</ref> A poor ability to solve problems, the loss of abilities one used to have, and poor impulse control also play a role.<ref name=Che2012/><ref name=Joiner2005>{{cite journal | vauthors = Joiner TE, Brown JS, Wingate LR | title = The psychology and neurobiology of suicidal behavior | journal = Annual Review of Psychology | volume = 56 | pages = 287–314 | year = 2005 | pmid = 15709937 | doi = 10.1146/annurev.psych.56.091103.070320 }}</ref> In older adults, the perception of being a burden to others is important.<ref name=Van2011>{{cite journal | vauthors = Van Orden K, Conwell Y | title = Suicides in late life | journal = Current Psychiatry Reports | volume = 13 | issue = 3 | pages = 234–41 | date = June 2011 | pmid = 21369952 | pmc = 3085020 | doi = 10.1007/s11920-011-0193-3 }}</ref> Those who have never married are also at greater risk.<ref name=EB2011/> Recent life stresses, such as a loss of a family member or friend or the loss of a job, might be a contributing factor.<ref name=Che2012/><ref name=CDC2018Risk/>

Certain personality factors, especially high levels of neuroticism and introvertedness, have been associated with suicide. This might lead to people who are isolated and sensitive to distress to be more likely to attempt suicide.<ref name="Ocon2014" /> On the other hand, optimism has been shown to have a protective effect.<ref name="Ocon2014" /> Other psychological risk factors include having few reasons for living and feeling trapped in a stressful situation.<ref name="Ocon2014" /> Changes to the stress response system in the brain might be altered during suicidal states.<ref name="Tur2016" /> Specifically, changes in the polyamine system<ref>{{cite journal | vauthors = Turecki G | title = Polyamines and suicide risk | journal = Molecular Psychiatry | volume = 18 | issue = 12 | pages = 1242–3 | date = December 2013 | pmid = 24166408 | pmc = 5293538 | doi = 10.1038/mp.2013.153 }}</ref> and hypothalamic–pituitary–adrenal axis.<ref>{{cite journal | vauthors = Nemeroff CB, Owens MJ, Bissette G, Andorn AC, Stanley M | title = Reduced corticotropin releasing factor binding sites in the frontal cortex of suicide victims | journal = Archives of General Psychiatry | volume = 45 | issue = 6 | pages = 577–9 | date = June 1988 | pmid = 2837159 | doi = 10.1001/archpsyc.1988.01800300075009 }}</ref>

Social isolation and the lack of social support has been associated with an increased risk of suicide.<ref name="Ocon2014" /> Poverty is also a factor,<ref name="Stark2011">{{cite journal|vauthors=Stark CR, Riordan V, O'Connor R|year=2011|title=A conceptual model of suicide in rural areas|url=http://www.rrh.org.au/articles/subviewnew.asp?ArticleID=1622|journal=Rural and Remote Health|volume=11|issue=2|page=1622|pmid=21702640|archive-date=4 March 2016|access-date=15 October 2019|archive-url=https://web.archive.org/web/20160304090502/http://www.rrh.org.au/articles/subviewnew.asp?ArticleID=1622|url-status=live}}</ref> with heightened relative poverty compared to those around a person increasing suicide risk.<ref>{{cite journal |last1=Daly |first1=Mary C. |last2=Wilson |first2=Daniel J. |last3=Johnson |first3=Norman J. |title=Relative Status and Well-Being: Evidence from U.S. Suicide Deaths |journal=Federal Reserve Bank of San Francisco, Working Paper Series |date=September 2012 |pages=01–52 |doi=10.24148/wp2012-16 }}</ref> Over 200,000 farmers in India have died by suicide since 1997, partly due to issues of debt.<ref>{{cite news|url=http://articles.cnn.com/2010-01-05/world/india.farmer.suicides_1_farmer-suicides-andhra-pradesh-vandana-shiva|title=Activist: Farmer suicides in India linked to debt, globalization| vauthors = Lerner G |date=5 January 2010|newspaper=CNN World|access-date=13 February 2013|archive-url=https://web.archive.org/web/20130116020225/http://articles.cnn.com/2010-01-05/world/india.farmer.suicides_1_farmer-suicides-andhra-pradesh-vandana-shiva?_s=PM%3AWORLD|archive-date=16 January 2013}}</ref> In China, suicide is three times as likely in rural regions as urban ones, partly, it is believed, due to financial difficulties in this area of the country.<ref>{{cite journal | vauthors = Law S, Liu P | title = Suicide in China: unique demographic patterns and relationship to depressive disorder | journal = Current Psychiatry Reports | volume = 10 | issue = 1 | pages = 80–6 | date = February 2008 | pmid = 18269899 | doi = 10.1007/s11920-008-0014-5 }}</ref>

Being religious may reduce one's risk of suicide while beliefs that suicide is noble may increase it.<ref name="Religion2009">{{cite journal |last1=Koenig |first1=Harold G |title=Research on Religion, Spirituality, and Mental Health: A Review |journal=The Canadian Journal of Psychiatry |date=May 2009 |volume=54 |issue=5 |pages=283–291 |doi=10.1177/070674370905400502 |pmid=19497160 |doi-access=free }}</ref><ref name="CDC2018Risk" /><ref>{{cite book | vauthors = Zuckerman P | veditors = Martin M |title=The Cambridge Companion to Atheism|date=2007|publisher=Cambridge Univ. Press|isbn=978-0-521-60367-6|pages=58–59|quote=Concerning suicide rates, religious nations fare better than secular nations. According to the 2003 World Health Organization's report on international male suicides rates, of the top ten nations with the highest male suicide rates, all but one (Sri Lanka) are strongly irreligious nations with high levels of atheism. Of the top remaining nine nations leading the world in male suicide rates, all are former Soviet/Communist nations, such as Belarus, Ukraine, and Latvia. Of the bottom ten nations with the lowest male suicide rates, all are highly religious nations with statistically insignificant levels of organic atheism.}}</ref> This has been attributed to the negative stance many religions take against suicide and to the greater connectedness religion may give.<ref name="Religion2009" /> Muslims, among religious people, appear to have a lower rate of suicide; however, the data supporting this is not strong.<ref name="Islam2006" /> There does not appear to be a difference in rates of attempted suicide.<ref name="Islam2006" /> Young women in the Middle East may have higher rates.<ref>{{cite journal | vauthors = Rezaeian M | title = Suicide among young Middle Eastern Muslim females | journal = Crisis | volume = 31 | issue = 1 | pages = 36–42 | date = 2010 | pmid = 20197256 | doi = 10.1027/0227-5910/a000005 }}</ref>

=== Rational <span class="anchor" id="Rational suicide"></span>=== [[File:72nd Shinbu 1945 Kamikaze.jpg|thumb|180px|Teenage recruits for Japanese Kamikaze suicide pilots in May 1945]] Rational suicide is the reasoned taking of one's own life.<ref name=Loue2008>{{cite book| vauthors = Loue S |title=Encyclopedia of aging and public health: with 19 tables|year=2008|publisher=Springer|location=New York|isbn=978-0-387-33753-1|page=696}}</ref> However, some consider suicide as never being rational.<ref name=Loue2008/>

Euthanasia and assisted suicide are accepted practices in a number of countries among those who have a poor quality of life without the possibility of getting better.<ref>{{cite journal | vauthors = Conejero I, Olié E, Courtet P, Calati R | title = Suicide in older adults: current perspectives | journal = Clinical Interventions in Aging | volume = 13 | pages = 691–699 | date = 2018 | pmid = 29719381 | pmc = 5916258 | doi = 10.2147/CIA.S130670 | doi-access = free }}</ref><ref name=Cal2016>{{cite journal | vauthors = Calabrò RS, Naro A, De Luca R, Russo M, Caccamo L, Manuli A, Bramanti A, Bramanti P | display-authors = 6 | title = The Right to Die in Chronic Disorders of Consciousness: Can We Avoid the Slippery Slope Argument? | journal = Innovations in Clinical Neuroscience | volume = 13 | issue = 11–12 | pages = 12–24 | date = 2016 | pmid = 28210521 | pmc = 5300707 }}</ref> They are supported by the legal arguments for a right to die.<ref name=Cal2016/>

The act of taking one's life for the benefit of others is known as altruistic suicide.<ref name="Moody2010">{{cite book| vauthors = Moody HR | title = Aging: concepts and controversies|year=2010|publisher=Pine Forge Press|location=Los Angeles|isbn=978-1-4129-6966-6 |page=158 |url=https://books.google.com/books?id=qj8GS77QAgwC&pg=PA158|edition=6th}}</ref> An example of this is an elder ending their life to leave greater amounts of food for the younger people in the community.<ref name="Moody2010" /> Suicide in some Inuit cultures has been seen as an act of respect, courage, or wisdom.<ref name="Hales2012" />

A suicide attack is a political or religious action where an attacker carries out violence against others which they understand will result in their own death.<ref>{{cite book | vauthors = Sobh T |title=Innovations and advances in computer sciences and engineering|year=2010|publisher=Springer Verlag|location=Dordrecht|isbn=978-90-481-3658-2|page=503|url=https://books.google.com/books?id=B-Zf1sQZapMC&pg=PA503|edition=Online-Ausg. }}</ref> Some suicide bombers are motivated by a desire to obtain martyrdoms or are religiously motivated.<ref name="Martyr2009" /> Kamikaze missions in the latter stages of World War II were carried out as a duty to a higher cause or moral obligation.<ref name="Hales2012">{{cite book|vauthors=Hales RE, Simon RI|title=The American Psychiatric Publishing textbook of suicide assessment and management|publisher=American Psychiatric Pub.|location=Washington, DC|isbn=978-1-58562-414-0|page=714|url=https://books.google.com/books?id=H8tigTjBCRkC&pg=PA714|edition=2nd|year=2012|archive-date=1 October 2024|access-date=27 June 2015|archive-url=https://web.archive.org/web/20241001061441/https://books.google.com/books?id=H8tigTjBCRkC&pg=PA714#v=onepage&q&f=false|url-status=live}}</ref> Murder–suicide is an act of homicide followed within a week by suicide of the person who carried out the act.<ref>{{cite journal | vauthors = Eliason S | title = Murder-suicide: a review of the recent literature | journal = The Journal of the American Academy of Psychiatry and the Law | volume = 37 | issue = 3 | pages = 371–6 | year = 2009 | pmid = 19767502 }}</ref>

Mass suicides are often performed under social pressure where members give up autonomy to a leader (see Notable cases below).<ref>{{cite book|vauthors=Kornblum W, Smith CD|title=Sociology in a changing world|publisher=Wadsworth Cengage Learning|location=Belmont, CA|isbn=978-1-111-30157-6|page=27|url=https://books.google.com/books?id=DtKcG6qoY5AC&pg=PT51|edition=9th|date=31 January 2011|archive-date=1 October 2024|access-date=27 June 2015|archive-url=https://web.archive.org/web/20241001061441/https://books.google.com/books?id=DtKcG6qoY5AC&pg=PT51|url-status=live}}</ref> Mass suicides can take place with as few as two people, often referred to as a suicide pact.<ref>{{cite book| vauthors = Campbell RJ |title=Campbell's psychiatric dictionary|year=2004|publisher=Oxford University Press|location=Oxford|isbn=978-0-19-515221-0|page=636|url=https://books.google.com/books?id=Vrlsos_O13UC&pg=PA636|edition=8th }}</ref> In extenuating situations where continuing to live would be intolerable, some people use suicide as a means of escape.<ref>{{cite book | vauthors = Veatch RM |title=Medical ethics|year=1997|publisher=Jones and Bartlett|location=Sudbury, MA|isbn=978-0-86720-974-7|page=292|url=https://books.google.com/books?id=UCOT4sj-DwUC&pg=PA292|edition=2nd }}</ref><ref>{{cite book| vauthors = Warburton N |year=2004 |page=21|title=The Basics - Philosophy|edition=4th|publisher=Routledge|place=New York|isbn=978-0-415-32773-2}}</ref> Some inmates in Nazi concentration camps are known to have killed themselves during the Holocaust by deliberately touching the electrified fences.<ref>{{cite book| vauthors = Gutman Y, Berenbaum M |title=Anatomy of the Auschwitz death camp|year=1998|publisher=Publ. in association with the United States Holocaust Memorial Museum, Washington, D.C. by Indiana University Press|location=Bloomington|isbn=978-0-253-20884-2|page=400|edition=1st }}</ref>

=== Self-harm === Non-suicidal self-harm is common with 18% of people engaging in self-harm over the course of their life.<ref>{{cite journal | vauthors = Plener PL, Schumacher TS, Munz LM, Groschwitz RC | title = The longitudinal course of non-suicidal self-injury and deliberate self-harm: a systematic review of the literature | journal = Borderline Personality Disorder and Emotion Dysregulation | volume = 2 | issue = 1 | page = 2 | date = 2015 | pmid = 26401305 | pmc = 4579518 | doi = 10.1186/s40479-014-0024-3 | doi-access = free }}</ref>{{Rp|page=1}} Acts of self-harm are not usually suicide attempts and most who self-harm are not at high risk of suicide.<ref name="Grey2009">{{cite journal | vauthors = Greydanus DE, Shek D | title = Deliberate self-harm and suicide in adolescents | journal = The Keio Journal of Medicine | volume = 58 | issue = 3 | pages = 144–151 | date = September 2009 | pmid = 19826208 | doi = 10.2302/kjm.58.144 | doi-access = free | hdl = 10397/4495 | hdl-access = free }}</ref> Some who self-harm, however, do still end their life by suicide, and risk for self-harm and suicide may overlap.<ref name="Grey2009" /> Individuals who have been identified as self-harming after being admitted to hospital are {{Estimate|68|38|105|unit=%|mini=yes}} more likely to die by suicide.<ref>{{cite journal | vauthors = Chan MK, Bhatti H, Meader N, Stockton S, Evans J, O'Connor RC, Kapur N, Kendall T | display-authors = 6 | title = Predicting suicide following self-harm: systematic review of risk factors and risk scales | journal = The British Journal of Psychiatry | volume = 209 | issue = 4 | pages = 277–283 | date = October 2016 | pmid = 27340111 | doi = 10.1192/bjp.bp.115.170050 | doi-access = free }}</ref>{{Rp|page=279}}

=== Sexual and gender variance === {{Main|Suicide among LGBTQ people}} LGBTQ individuals face significantly higher risk of suicide and self-harm than straight and cisgender individuals.<ref>{{cite journal |last1=Marchi |first1=Mattia |last2=Arcolin |first2=Elisa |last3=Fiore |first3=Gianluca |last4=Travascio |first4=Antonio |last5=Uberti |first5=Daniele |last6=Amaddeo |first6=Francesco |last7=Converti |first7=Manlio |last8=Fiorillo |first8=Andrea |last9=Mirandola |first9=Massimo |last10=Pinna |first10=Federica |last11=Ventriglio |first11=Antonio |last12=Galeazzi |first12=Gian Maria |title=Self-harm and suicidality among LGBTIQ people: a systematic review and meta-analysis |journal=International Review of Psychiatry |date=19 May 2022 |volume=34 |issue=3–4 |pages=240–256 |doi=10.1080/09540261.2022.2053070 |pmid=36151841 }}</ref> Internalized queerphobia, family rejection, anti-LGBTQ legislation, as well as minority stressors in the form of discrimination, abuse, bullying, and violence are among the main risk factors for suicide in LGBTQ individuals.<ref name=":02">{{cite journal |last1=Wallace |first1=Emma Rebecca |last2=O'Neill |first2=Siobhan |last3=Lagdon |first3=Susan |title=Risk and protective factors for suicidality among lesbian, gay, bisexual, transgender, and queer (LGBTQ+) young people, from countries with a high global acceptance index (GAI), within the context of the socio-ecological model: A scoping review |journal=Journal of Adolescence |date=July 2024 |volume=96 |issue=5 |pages=897–924 |doi=10.1002/jad.12308 |pmid=38372179 }}</ref><ref>{{cite journal |last1=Virupaksha |first1=H. G. |last2=Muralidhar |first2=Daliboyina |last3=Ramakrishna |first3=Jayashree |title=Suicide and Suicidal Behavior among Transgender Persons |journal=Indian Journal of Psychological Medicine |date=November 2016 |volume=38 |issue=6 |pages=505–509 |doi=10.4103/0253-7176.194908 |doi-access=free |pmid=28031583 |pmc=5178031 }}</ref><ref>{{Cite web |last=Aldrin |first=Puneet Narang, Steven Lippmann, Simrat Kaur Sarai, Stephanie |date=2018-06-21 |title=Suicide Among Transgender and Gender-Nonconforming People |url=https://www.psychiatrist.com/pcc/suicide-among-transgender-and-gender-nonconforming-people/ |access-date=2026-02-03 |website=Psychiatrist.com |language=en-US |archive-date=1 February 2026 |archive-url=https://web.archive.org/web/20260201122138/https://www.psychiatrist.com/pcc/suicide-among-transgender-and-gender-nonconforming-people/ |url-status=live }}</ref> Supportive environments, inclusive legislation, boosted self-esteem, and access to gender-affirming healthcare for trans individuals are among the main protective factors.<ref name=":02" />

=== Substance misuse === [[File:The Drunkard's Progress 1846.jpg|thumb|upright=1.35|"The Drunkard's Progress", 1846, demonstrating how alcoholism can lead to poverty, crime, and eventually suicide]] Substance misuse is the second most common risk factor for suicide after major depression and bipolar disorder.<ref>{{cite book|vauthors=Levin JD, Culkin J, Perrotto RS|title=Introduction to chemical dependency counseling|year=2001|publisher=Jason Aronson|location=Northvale, NJ|isbn=978-0-7657-0289-0|pages=150–52|url=https://books.google.com/books?id=felzn3Ntd-cC&pg=RA1-PA151|archive-date=1 October 2024|access-date=27 May 2020|archive-url=https://web.archive.org/web/20241001061428/https://books.google.com/books?id=felzn3Ntd-cC&pg=RA1-PA151#v=onepage&q&f=false|url-status=live}}</ref> Both chronic substance misuse as well as acute intoxication are associated.<ref name="Drug2011" /><ref name="Fadem2004">{{cite book|title=Behavioral science in medicine| vauthors = Fadem B |publisher=Lippincott Williams & Wilkins|year=2004|isbn=978-0-7817-3669-5|location=Philadelphia|page=[https://archive.org/details/behavioralscienc00fade_0/page/217 217]|url=https://archive.org/details/behavioralscienc00fade_0/page/217}}</ref> When combined with personal grief, such as bereavement, the risk is further increased.<ref name="Fadem2004" /> Substance misuse is also associated with mental health disorders.<ref name="Drug2011" />

Most people are under the influence of sedative-hypnotic drugs (such as alcohol or benzodiazepines) when they die by suicide,<ref name="Youssef2008">{{cite journal | vauthors = Youssef NA, Rich CL | title = Does acute treatment with sedatives/hypnotics for anxiety in depressed patients affect suicide risk? A literature review | journal = Annals of Clinical Psychiatry | volume = 20 | issue = 3 | pages = 157–69 | year = 2008 | pmid = 18633742 | doi = 10.1080/10401230802177698 }}</ref> with alcoholism present in between 15% and 61% of cases.<ref name="Drug2011" /> Use of prescribed benzodiazepines is associated with an increased rate of suicide and attempted suicide. The pro-suicidal effects of benzodiazepines are suspected to be due to a psychiatric disturbance caused by side effects, such as disinhibition, or withdrawal symptoms.<ref name="Dod2017" /> Countries that have higher rates of alcohol use and a greater density of bars generally also have higher rates of suicide.<ref name="ETOH2006">{{cite journal | vauthors = Sher L | title = Alcohol consumption and suicide | journal = QJM | volume = 99 | issue = 1 | pages = 57–61 | date = January 2006 | pmid = 16287907 | doi = 10.1093/qjmed/hci146 | doi-access = free }}</ref> About 2.2–3.4% of those who have been treated for alcoholism at some point in their life die by suicide.<ref name="ETOH2006" /> Alcoholics who attempt suicide are usually male, older, and have tried to take their own lives in the past.<ref name="Drug2011" /> Between 3 and 35% of deaths among those who use heroin are due to suicide (approximately fourteenfold greater than those who do not use).<ref>{{cite journal | vauthors = Darke S, Ross J | title = Suicide among heroin users: rates, risk factors and methods | journal = Addiction | volume = 97 | issue = 11 | pages = 1383–94 | date = November 2002 | pmid = 12410779 | doi = 10.1046/j.1360-0443.2002.00214.x | doi-access = free }}</ref> In adolescents who misuse alcohol, neurological and psychological dysfunctions may contribute to the increased risk of suicide.<ref name="pmid17458319">{{cite journal | vauthors = Sher L | title = Functional magnetic resonance imaging in studies of the neurobiology of suicidal behavior in adolescents with alcohol use disorders | journal = International Journal of Adolescent Medicine and Health | volume = 19 | issue = 1 | pages = 11–8 | year = 2007 | pmid = 17458319 | doi = 10.1515/ijamh.2007.19.1.11 }}</ref>

The misuse of cocaine and methamphetamine has a high correlation with suicide.<ref name="Drug2011" /><ref>{{cite journal | vauthors = Darke S, Kaye S, McKetin R, Duflou J | title = Major physical and psychological harms of methamphetamine use | journal = Drug and Alcohol Review | volume = 27 | issue = 3 | pages = 253–62 | date = May 2008 | pmid = 18368606 | doi = 10.1080/09595230801923702 }}</ref><ref>{{cite journal |last1=Moçambique |first1=M |last2=Hoffmann |first2=A |last3=Roglio |first3=VS |last4=Kessler |first4=FHP |last5=Dalbosco |first5=C |last6=Schuch |first6=JB |last7=Pechansky |first7=F |title= Prevalence of suicide in cocaine users accessing health services: A systematic review and meta-analysis|journal= Brazilian Journal of Psychiatry|date=24 June 2022 |volume=44 |issue=4 |pages=441–8 |doi=10.47626/1516-4446-2021-2207 |pmid=35751594 |pmc=9375660}}</ref> In those who use cocaine, the risk is greatest during the withdrawal phase.<ref>{{cite book|url=https://books.google.com/books?id=ea_QVG2BFy8C&q=256|title=Lexicon of psychiatry, neurology, and the neurosciences | vauthors = Ayd FJ |publisher=Lippincott Williams & Wilkins|year=2000|isbn=978-0-7817-2468-5|edition=2nd|location=Philadelphia [u.a.]|page=256 }}</ref> Those who used inhalants are also at significant risk with around 20% attempting suicide at some point and more than 65% considering it.<ref name="Drug2011" /> Smoking cigarettes is associated with risk of suicide.<ref name="Hughes2008">{{cite journal | vauthors = Hughes JR | title = Smoking and suicide: a brief overview | journal = Drug and Alcohol Dependence | volume = 98 | issue = 3 | pages = 169–78 | date = December 2008 | pmid = 18676099 | pmc = 2585177 | doi = 10.1016/j.drugalcdep.2008.06.003 }}</ref> There is little evidence as to why this association exists; however, it has been hypothesized that those who are predisposed to smoking are also predisposed to suicide, that smoking causes health problems which subsequently make people want to end their life, and that smoking affects brain chemistry causing a propensity for suicide.<ref name="Hughes2008" /> Cannabis, however, does not appear to independently increase the risk.<ref name="Drug2011" />

=== Other factors === Trauma is a risk factor for suicidality in both children<ref name="Port2017">{{cite journal | vauthors = Ports KA, Merrick MT, Stone DM, Wilkins NJ, Reed J, Ebin J, Ford DC | title = Adverse Childhood Experiences and Suicide Risk: Toward Comprehensive Prevention | journal = American Journal of Preventive Medicine | volume = 53 | issue = 3 | pages = 400–403 | date = September 2017 | pmid = 28483301 | pmc = 5603224 | doi = 10.1016/j.amepre.2017.03.015 }}</ref> and adults.<ref name="Ocon2014" /> Some may take their own lives to escape bullying or prejudice.<ref name="Cox2012">{{cite journal | vauthors = Cox WT, Abramson LY, Devine PG, Hollon SD | title = Stereotypes, Prejudice, and Depression: The Integrated Perspective | journal = Perspectives on Psychological Science | volume = 7 | issue = 5 | pages = 427–49 | date = September 2012 | pmid = 26168502 | doi = 10.1177/1745691612455204 }}</ref> A history of childhood sexual abuse<ref>{{cite journal | vauthors = Wegman HL, Stetler C | title = A meta-analytic review of the effects of childhood abuse on medical outcomes in adulthood | journal = Psychosomatic Medicine | volume = 71 | issue = 8 | pages = 805–12 | date = October 2009 | pmid = 19779142 | doi = 10.1097/PSY.0b013e3181bb2b46 }}</ref> and time spent in foster care are also risk factors.<ref>{{cite journal | vauthors = Oswald SH, Heil K, Goldbeck L | title = History of maltreatment and mental health problems in foster children: a review of the literature | journal = Journal of Pediatric Psychology | volume = 35 | issue = 5 | pages = 462–72 | date = June 2010 | pmid = 20007747 | doi = 10.1093/jpepsy/jsp114 | doi-access = free }}</ref> Sexual abuse is believed to contribute to approximately 20% of the overall risk.<ref name="Brent2008" /> Significant adversity early in life has a negative effect on problem-solving skills and memory, both of which are implicated in suicidality.<ref name=Tur2016 /> According to a 2022 study, adverse childhood experiences maybe "associated with a two-fold higher odds" of anxiety disorders, depression and suicidality."<ref name="Sahel">{{cite journal |vauthors=Sahle BW, Reavley NJ, Li W, Morgan AJ, Yap MB, Reupert A, Jorm AF |title=The association between adverse childhood experiences and common mental disorders and suicidality: an umbrella review of systematic reviews and meta-analyses |journal=Eur Child Adolesc Psychiatry |volume=31 |issue=10 |pages=1489–1499 |date=October 2022 |pmid=33638709 |doi=10.1007/s00787-021-01745-2 }}</ref>

Problem gambling is associated with increased suicidal ideation and attempts compared to the general population.<ref>{{cite book |vauthors=Pallanti S, Rossi NB, Hollander E |chapter=11. Pathological Gambling |veditors=Hollander E, Stein DJ |title=Clinical manual of impulse-control disorders |chapter-url=https://books.google.com/books?id=u2wVP8KJJtcC&pg=PA253 |year=2006 |publisher=American Psychiatric Pub |isbn=978-1-58562-136-1 |page=253 |archive-date=1 October 2024 |access-date=27 June 2015 |archive-url=https://web.archive.org/web/20241001061431/https://books.google.com/books?id=u2wVP8KJJtcC&pg=PA253#v=onepage&q&f=false |url-status=live }}</ref> Between 12 and 24% of pathological gamblers attempt suicide.<ref name="Oliv2008" /> The rate of suicide among their spouses is three times greater than that of the general population.<ref name="Oliv2008">{{cite journal | vauthors = Oliveira MP, Silveira DX, Silva MT | title = [Pathological gambling and its consequences for public health] | journal = Revista de Saude Publica | volume = 42 | issue = 3 | pages = 542–9 | date = June 2008 | pmid = 18461253 | doi = 10.1590/S0034-89102008005000026 | doi-access = free }}</ref> Other factors that increase the risk in problem gamblers include concomitant mental illness, alcohol, and drug misuse.<ref>{{cite journal | vauthors = Hansen M, Rossow I | title = [Gambling and suicidal behaviour] | journal = Tidsskrift for den Norske Laegeforening | volume = 128 | issue = 2 | pages = 174–6 | date = January 2008 | pmid = 18202728 }}</ref>

Infection by the parasite ''Toxoplasma gondii'', more commonly known as toxoplasmosis, has been linked with suicide risk. One explanation states that this is caused by altered neurotransmitter activity due to the immunological response.<ref name=Tur2016 />

Community-level factors can also play a role. For example, a 2025 study found that a one-unit increase in local homicide rates was followed by a 3.6% rise in suicide rates the next year, suggesting that community-level violence may contribute to suicide risk.<ref>{{cite journal |last1=Semenza |first1=Daniel C. |title=Local homicides increase suicide in US counties |journal=Social Science & Medicine |date=29 July 2025 |volume=382 |article-number=118406 |doi=10.1016/j.socscimed.2025.118406 |pmid=40935491 }}</ref>

Dutch research by Lin Zhang focuses on the role of P2RX7 and the apoptosis of microglia in suicidal ideation.{{refn|<ref name="f846">{{cite news |last1=Takken |first1=Wilfred |title=Twee tv-programma's tonen wat er gebeurt als de dood uit de lucht komt vallen |trans-title=Two TV programs show what happens when death falls from the sky |url=https://www.nrc.nl/nieuws/2025/09/10/twee-programmas-tonen-wat-als-de-dood-uit-de-lucht-komt-vallen-a4905632 |work=NRC |date=10 September 2025 |language=nl |archive-date=11 September 2025 |access-date=10 September 2025 |archive-url=https://web.archive.org/web/20250911040312/https://www.nrc.nl/nieuws/2025/09/10/twee-programmas-tonen-wat-als-de-dood-uit-de-lucht-komt-vallen-a4905632 |url-status=live }}</ref><ref>''Focus'', NPO2, 9 September 2025, 21:00 CEST.</ref><ref name="v601">{{cite journal | last1=Zhang | first1=Lin | last2=Lucassen | first2=Paul J. | last3=Salta | first3=Evgenia | last4=Verhaert | first4=Peter D. E. M. | last5=Swaab | first5=Dick F. | title=Hippocampal neuropathology in suicide: Gaps in our knowledge and opportunities for a breakthrough | journal=Neuroscience and Biobehavioral Reviews | volume=132 | date=2022 | pmid=34906612 | doi=10.1016/j.neubiorev.2021.12.023 | doi-access=free | pages=542–552}}</ref><ref name="b822">{{Cite thesis |last=Zhang |first=Lin |title=Molecular pathology of suicide: A postmortem study |date=2023 |hdl=11245.1/da6f5dee-5a73-4602-ac84-a3789e966fed |hdl-access=free }}{{page needed|date=February 2026}}</ref>}}

== Prevention == {{Main|Suicide prevention}}

{{multiple image | align = right | direction = horizontal | header = | header_align = left/right/center | header_background = | footer = As a suicide prevention initiative, these signs on the Golden Gate Bridge promote a special telephone that connects to a crisis hotline, as well as a 24/7 crisis text line. | footer_align = left/right/center | footer_background = | total_width = 444 | image1 = Suicide prevention sign on the Golden Gate Bridge 2.jpg | alt1 = | caption1 = | image2 = Crisis Counseling at Golden Gate Bridge.jpg | alt2 = | caption2 = }}

Suicide prevention is a term used for the collective efforts to reduce the incidence of suicide through preventive measures. Protective factors for suicide include support, and access to therapy.<ref name="cdc.gov"/> About 60% of people with suicidal thoughts do not seek help.<ref name="Bruffaerts-2011">{{cite journal | vauthors = Bruffaerts R, Demyttenaere K, Hwang I, Chiu WT, Sampson N, Kessler RC, Alonso J, Borges G, de Girolamo G, de Graaf R, Florescu S, Gureje O, Hu C, Karam EG, Kawakami N, Kostyuchenko S, Kovess-Masfety V, Lee S, Levinson D, Matschinger H, Posada-Villa J, Sagar R, Scott KM, Stein DJ, Tomov T, Viana MC, Nock MK | display-authors = 6 | title = Treatment of suicidal people around the world | journal = The British Journal of Psychiatry | volume = 199 | issue = 1 | pages = 64–70 | date = July 2011 | pmid = 21263012 | pmc = 3167419 | doi = 10.1192/bjp.bp.110.084129 }}</ref> Reasons for not doing so include low perceived need, and wanting to deal with the problem alone.<ref name="Bruffaerts-2011" /> Despite these high rates, there are few established treatments available for suicidal behavior.<ref name="Ocon2014" />

Reducing access to certain methods, such as access to firearms or toxins such as opioids and pesticides, can reduce risk of suicide by that method.<ref name=Yip2012/><ref name=WHO2012>{{cite web |title=Suicide prevention |publisher=World Health Organization |date=31 August 2012 |work=WHO Sites: Mental Health |url=https://www.who.int/mental_health/prevention/suicide/suicideprevent/en/ |archive-url=http://webarchive.loc.gov/all/20040701084208/http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/ |archive-date=1 July 2004 |access-date=13 January 2013}}</ref><ref name=Zal2016/><ref name=Tur2016/> Reducing access to easily-accessible methods of suicide may make impulsive attempts less likely to succeed.<ref>{{cite journal |vauthors=Miller M, Hemenway D | title = Guns and suicide in the United States |journal=The New England Journal of Medicine |volume=359 | issue = 10 | pages = 989–991 | date = September 2008 | pmid = 18768940 |doi=10.1056/NEJMp0805923 |doi-access=free}}</ref> Other measures include reducing access to charcoal (for burning) and adding barriers on bridges and subway platforms.<ref name="Yip2012"/><ref>{{cite journal | vauthors = Cox GR, Owens C, Robinson J, Nicholas A, Lockley A, Williamson M, Cheung YT, Pirkis J | display-authors = 6 | title = Interventions to reduce suicides at suicide hotspots: a systematic review |journal=BMC Public Health | volume = 13 | article-number = 214 | date = March 2013 | pmid = 23496989 | pmc = 3606606 |doi=10.1186/1471-2458-13-214 | doi-access = free }}</ref><ref name="Zal2016" /> Treatment of drug and alcohol addiction, depression, and those who have attempted suicide in the past, may also be effective.<ref name="WHO2012" /><ref name="Zal2016"/> Some have proposed reducing access to alcohol as a preventive strategy (such as reducing the number of bars).<ref name="Drug2011">{{cite journal | vauthors = Vijayakumar L, Kumar MS, Vijayakumar V | title = Substance use and suicide | journal = Current Opinion in Psychiatry | volume = 24 | issue = 3 | pages = 197–202 | date = May 2011 | pmid = 21430536 | doi = 10.1097/YCO.0b013e3283459242 }}</ref> thumb|A suicide prevention fence on a bridge

In young adults who have recently thought about suicide, cognitive behavioral therapy appears to improve outcomes.<ref>{{cite journal | vauthors = Robinson J, Hetrick SE, Martin C | title = Preventing suicide in young people: systematic review | journal = The Australian and New Zealand Journal of Psychiatry | volume = 45 | issue = 1 | pages = 3–26 | date = January 2011 | pmid = 21174502 | doi = 10.3109/00048674.2010.511147 }}</ref><ref name="Ocon2014"/> School-based programs that increase mental health literacy and train staff have shown mixed results on suicide rates.<ref name="Zal2016" /> Economic development through its ability to reduce poverty may be able to decrease suicide rates.<ref name="Stark2011" /> Efforts to increase social connection, especially in elderly males, may be effective.<ref>{{cite journal | vauthors = Fässberg MM, van Orden KA, Duberstein P, Erlangsen A, Lapierre S, Bodner E, Canetto SS, De Leo D, Szanto K, Waern M | display-authors = 6 | title = A systematic review of social factors and suicidal behavior in older adulthood | journal = International Journal of Environmental Research and Public Health | volume = 9 | issue = 3 | pages = 722–45 | date = March 2012 | pmid = 22690159 | pmc = 3367273 | doi = 10.3390/ijerph9030722 | doi-access = free }}</ref> In people who have attempted suicide, following up on them might prevent repeat attempts.<ref>{{cite journal | vauthors = Luxton DD, June JD, Comtois KA | title = Can postdischarge follow-up contacts prevent suicide and suicidal behavior? A review of the evidence | journal = Crisis | volume = 34 | issue = 1 | pages = 32–41 | date = January 2013 | pmid = 22846445 | doi = 10.1027/0227-5910/a000158 }}</ref> Although crisis hotlines are common, there is little evidence to support or refute their effectiveness.<ref name=":6" /><ref name="Zal2016" /> Preventing childhood trauma provides an opportunity for suicide prevention.<ref name="Port2017" /> The World Suicide Prevention Day is observed annually on 10 September with the support of the International Association for Suicide Prevention and the World Health Organization.<ref>{{cite web| url =http://www.iasp.info/wspd/| title =World Suicide Prevention Day −10 September, 2013| work =IASP| access-date =29 October 2013| url-status=live| archive-url =https://web.archive.org/web/20131104145146/http://www.iasp.info/wspd/| archive-date =4 November 2013}}</ref>

=== Diet ===

{{cleanup | reason=Contains material about diet and depression that does not directly address suicide; consider moving to Depression or a diet article.|date=June 2026}}

{{refimprove|section|reason=No sources are cited that directly link diet to suicidal behavior or risk; please add reliable sources or reframe.|date=June 2026}}

About 50% of people who die of suicide have a mood disorder such as major depression.<ref name="Barlow Durand 2005 p.">{{cite book | last1=Barlow | first1=David H. | last2=Durand | first2=Vincent Mark | title=Abnormal Psychology | publisher=Wadsworth Publishing Company | date=2005 | pages=248–249 | isbn=978-0-534-63356-1 }}</ref><ref>{{cite journal |vauthors=Bachmann S |title=Epidemiology of Suicide and the Psychiatric Perspective |journal=International Journal of Environmental Research and Public Health |date=6 July 2018 |volume=15 |issue=7 |page=1425 |doi=10.3390/ijerph15071425 |pmid=29986446|pmc=6068947 |quote=Half of all completed suicides are related to depressive and other mood disorders|doi-access=free }}</ref> Sleep and diet may play a role in depression (major depressive disorder), and interventions in these areas may be an effective add-on to conventional methods.<ref>{{cite journal |last1=Lopresti |first1=Adrian L. |last2=Hood |first2=Sean D. |last3=Drummond |first3=Peter D. |title=A review of lifestyle factors that contribute to important pathways associated with major depression: Diet, sleep and exercise |journal=Journal of Affective Disorders |date=May 2013 |volume=148 |issue=1 |pages=12–27 |doi=10.1016/j.jad.2013.01.014 |pmid=23415826 }}</ref> Vitamin B<sub>2</sub>, B<sub>6</sub> and B<sub>12</sub> deficiency may cause depression in females.<ref>{{cite journal |vauthors= Wu Y, Zhang L, Li S, Zhang D | title=Associations of dietary vitamin B1, vitamin B2, vitamin B6, and vitamin B12 with the risk of depression: a systematic review and meta-analysis | journal=Nutrition Reviews | publisher=Oxford University Press (OUP) | date=29 April 2021 | volume=80 | issue=3 | pages=351–366 | doi=10.1093/nutrit/nuab014 | pmid=33912967 }}</ref>

Risk of depression may be reduced with a healthy diet "high in fruits, vegetables, nuts, and legumes; moderate amounts of poultry, eggs, and dairy products; and only occasional red meat".<ref name="healthdirect j246">{{cite web | title=Food, drink and mental health | website=healthdirect | url=https://www.healthdirect.gov.au/food-drink-and-mental-health | access-date=25 Aug 2023 | archive-date=25 August 2023 | archive-url=https://web.archive.org/web/20230825190834/https://www.healthdirect.gov.au/food-drink-and-mental-health | url-status=live }}</ref><ref>{{cite web | title=How to Boost Mental Health Through Better Nutrition | website=Psychiatry.org | date=18 Apr 2023 | url=https://www.psychiatry.org/News-room/APA-Blogs/Mental-Health-Through-Better-Nutrition | access-date=25 May 2024 | archive-date=25 May 2024 | archive-url=https://web.archive.org/web/20240525214405/https://www.psychiatry.org/News-room/APA-Blogs/Mental-Health-Through-Better-Nutrition | url-status=live }}</ref> A balanced diet and the consumption of lots of water is essential for mental health. Consuming oily fish may also help as they contain omega-3 fats. Consuming too much refined carbohydrates (e.g., snack foods) may increase the risk of depression symptoms. The mechanism on how diet improves or worsens mental health is still not fully understood. Blood glucose levels alterations, inflammation, or effects on the gut microbiome have been suggested.<ref name="healthdirect j246" />

{{multiple image | align = right | direction = horizontal | header = | header_align = left/right/center | header_background = | footer = Examples of balanced diets, proven essential for maintaining mental health<ref name="healthdirect j246" /> | footer_align = left/right/center | footer_background = | total_width = 444 | image1 = Richmond Hotel Premier Asakusa International breakfast buffet 20160503-001.jpg | alt1 = | caption1 = | image2 = Richmond Hotel Premier Tokyo Oshiage 5F Sizzler breakfast buffet 20160221-001.jpg | alt2 = | caption2 = }}

=== Screening ===

{{Blockquote |text=IS PATH WARM [...] is an acronym [...] to assess [...] a potentially suicidal individual, (i.e., ideation, substance abuse, purposelessness, anger, feeling trapped, hopelessness, withdrawal, anxiety, recklessness, and mood).<ref>{{cite book |last=Young |first=Mark |date=2020 |chapter=Assessment and Goal Setting |title=Learning the Art of Helping: Building Blocks and Techniques |publisher=Pearson |page=195 |quote=[And] was developed by the American Association of Suicidology (2019) to gauge suicidal risk (see also Juhnke, Granello, & Lebrón-Striker, 2007)}}{{isbn?}}</ref> |author=American Association of Suicidology (2019)}}

There is little data on the effects of screening the general population on the ultimate rate of suicide.<ref>{{cite journal |vauthors=Williams SB, O'Connor EA, Eder M, Whitlock EP |title=Screening for child and adolescent depression in primary care settings: a systematic evidence review for the US Preventive Services Task Force |journal=Pediatrics |volume=123 |issue=4 |pages=e716-35 |date=April 2009 |pmid=19336361 |doi=10.1542/peds.2008-2415}}</ref><ref>{{cite journal | vauthors = LeFevre ML | title = Screening for suicide risk in adolescents, adults, and older adults in primary care: U.S. Preventive Services Task Force recommendation statement |journal=Annals of Internal Medicine |volume=160 | issue = 10 | pages = 719–726 | date = May 2014 | pmid = 24842417 | doi = 10.7326/M14-0589 |doi-access=free}}</ref> Screening those who come to the emergency departments with injuries from self-harm have been shown to help identify suicide ideation and suicide intention. Psychometric tests such as the Beck Depression Inventory or the Geriatric Depression Scale for older people are being used.<ref name="Meier 2008 169">{{cite book |vauthors=Clinard MB, Meier RF |author1-link=Marshall B. Clinard |title=Sociology of deviant behavior |year=2008 |publisher=Wadsworth Cengage Learning |location=Belmont, CA |isbn=978-0-495-81167-1 |page=169 |url=https://books.google.com/books?id=VB3OezIoI44C&pg=PA169 |edition=14th |archive-date=1 October 2024 |access-date=27 June 2015 |archive-url=https://web.archive.org/web/20241001061930/https://books.google.com/books?id=VB3OezIoI44C&pg=PA169 |url-status=live }}</ref> As there is a high rate of people who test positive via these tools that are not at risk of suicide, there are concerns that screening may significantly increase mental health care resource utilization.<ref>{{cite journal | vauthors = Horowitz LM, Ballard ED, Pao M | title = Suicide screening in schools, primary care and emergency departments | journal = Current Opinion in Pediatrics | volume = 21 | issue = 5 | pages = 620–7 | date = October 2009 | pmid = 19617829 | pmc = 2879582 | doi = 10.1097/MOP.0b013e3283307a89 }}</ref> Assessing those at high risk, though, is recommended for.<ref name=EB2011/> Asking about suicidality does not appear to increase the risk.<ref name=EB2011/>

=== Treatment of mental illness === In those with mental health problems, a number of treatments may reduce the risk of suicide.

==== Hospitalization ==== Those who are actively suicidal may be admitted to psychiatric care either voluntarily or involuntarily.<ref name="EB2011" /> Possessions that may be used to harm oneself are typically removed.<ref name="Tint2010">{{cite book |author=Tintinalli, Judith E. |title=Emergency Medicine: A Comprehensive Study Guide (Emergency Medicine (Tintinalli)) |publisher=McGraw-Hill Companies |location=New York |year=2010 |pages=1940–46|isbn=978-0-07-148480-0 }}</ref> Some clinicians get patients to sign suicide prevention contracts where they agree to not harm themselves if released.<ref name="EB2011" /> However, evidence does not support a significant effect from this practice.<ref name="EB2011" /> If a person is at low risk, outpatient mental health treatment may be arranged.<ref name="Tint2010" /> Short-term hospitalization has not been found to be more effective than community care for improving outcomes in those with borderline personality disorder who are chronically suicidal.<ref>{{cite journal | vauthors = Paris J | title = Is hospitalization useful for suicidal patients with borderline personality disorder? | journal = Journal of Personality Disorders | volume = 18 | issue = 3 | pages = 240–7 | date = June 2004 | pmid = 15237044 | doi = 10.1521/pedi.18.3.240.35443 }}</ref><ref>{{cite journal | vauthors = Goodman M, Roiff T, Oakes AH, Paris J | title = Suicidal risk and management in borderline personality disorder | journal = Current Psychiatry Reports | volume = 14 | issue = 1 | pages = 79–85 | date = February 2012 | pmid = 22113831 | doi = 10.1007/s11920-011-0249-4 }}</ref>

==== Psychotherapy ==== {{See also|Group psychotherapy}} There is tentative evidence that certain types of psychotherapy, particularly dialectical behaviour therapy and cognitive behavioural therapy, reduce suicidality, though there currently exists no expert consensus on how these interventions should be applied to maximize positive outcomes (in large part due to the heterogeneity of suicide patients).<ref name=":5" />

==== Antidepressants ==== {{See also|Antidepressants and suicide risk}} There is controversy around the benefit-versus-harm of antidepressants.<ref name=Hawton2012/> In young persons, some antidepressants, such as SSRIs, appear to increase the risk of suicidality from 25 per 1000 to 40 per 1000.<ref>{{cite journal | vauthors = Hetrick SE, McKenzie JE, Cox GR, Simmons MB, Merry SN | title = Newer generation antidepressants for depressive disorders in children and adolescents | journal = The Cochrane Database of Systematic Reviews | volume = 11 | article-number = CD004851 | date = November 2012 | issue = 9 | pmid = 23152227 | doi = 10.1002/14651858.CD004851.pub3 | pmc = 8786271 | veditors = Hetrick SE | hdl = 11343/59246 | hdl-access = free }}</ref> In older persons, however, they may decrease the risk.<ref name=EB2011/>

==== Lithium ==== {{See also|Lithium#Medicine}}

Lithium is proven to significantly reduce the risk of suicide in mood disorders by 87% in randomized controlled trials.<ref name=":1" /><ref>{{cite journal |last1=Barroilhet |first1=S. A. |last2=Ghaemi |first2=S. N. |title=When and how to use lithium |journal=Acta Psychiatrica Scandinavica |date=September 2020 |volume=142 |issue=3 |pages=161–172 |doi=10.1111/acps.13202 }}</ref><ref name=":2">{{Cite book |last=Ghaemi |first=S. Nassir |title=Clinical Psychopharmacology: Principles and Practice |date=2019 |publisher=Oxford University Press |isbn=9780199995486 |edition=1st |location=New York, NY |pages=324–330}}</ref> It is effective at lowering the risk of suicide in those with bipolar disorder and major depression to nearly the same levels as that of the general population.<ref name=":3">{{cite journal | vauthors = Baldessarini RJ, Tondo L, Hennen J | title = Lithium treatment and suicide risk in major affective disorders: update and new findings | journal = The Journal of Clinical Psychiatry | volume = 64 | issue = Suppl 5 | pages = 44–52 | year = 2003 | pmid = 12720484 }}</ref><ref name=":1">{{cite journal | vauthors = Cipriani A, Hawton K, Stockton S, Geddes JR | title = Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis | journal = BMJ | volume = 346 | issue = jun27 4 | article-number = f3646 | date = June 2013 | pmid = 23814104 | doi = 10.1136/bmj.f3646 | doi-access = free }}</ref> It is thought to exert this effect by treating the underlying mood disorder and through a reduction in impulsivity and aggressiveness.<ref name=":4">{{cite journal |last1=Benard |first1=V. |last2=Vaiva |first2=G. |last3=Masson |first3=M. |last4=Geoffroy |first4=P.A. |title=Lithium and suicide prevention in bipolar disorder |journal=L'Encéphale |date=June 2016 |volume=42 |issue=3 |pages=234–241 |doi=10.1016/j.encep.2016.02.006 |pmid=27000268 }}</ref><ref name=":1" /> In addition to its effects on suicide, lithium use lowers the risk of death from all causes in people with mood disorders.<ref>{{cite journal |last1=Cipriani |first1=Andrea |last2=Pretty |first2=Heather |last3=Hawton |first3=Keith |last4=Geddes |first4=John R. |title=Lithium in the Prevention of Suicidal Behavior and All-Cause Mortality in Patients With Mood Disorders: A Systematic Review of Randomized Trials |journal=American Journal of Psychiatry |date=October 2005 |volume=162 |issue=10 |pages=1805–1819 |doi=10.1176/appi.ajp.162.10.1805 }}</ref>

Lithium in the water supply is correlated with lower overall suicide rates, especially among men. In addition to lower rates of suicide, areas with high concentrations of lithium in the water supply have lower rates of homicide, rape, drug arrests, and other crimes.<ref>{{cite journal |last1=Schrauzer |first1=Gerhard N. |title=Lithium: Occurrence, Dietary Intakes, Nutritional Essentiality |journal=Journal of the American College of Nutrition |date=February 2002 |volume=21 |issue=1 |pages=14–21 |doi=10.1080/07315724.2002.10719188 |pmid=11838882 }}</ref><ref>{{cite journal |last1=Barjasteh-Askari |first1=Fateme |last2=Davoudi |first2=Mojtaba |last3=Amini |first3=Homayoun |last4=Ghorbani |first4=Mohammad |last5=Yaseri |first5=Mehdi |last6=Yunesian |first6=Masoud |last7=Mahvi |first7=Amir Hossein |last8=Lester |first8=David |title=Relationship between suicide mortality and lithium in drinking water: A systematic review and meta-analysis |journal=Journal of Affective Disorders |date=March 2020 |volume=264 |pages=234–241 |doi=10.1016/j.jad.2019.12.027 |pmid=32056756 }}</ref><ref>{{cite journal |last1=Memon |first1=Anjum |last2=Rogers |first2=Imogen |last3=Fitzsimmons |first3=Sophie M. D. D. |last4=Carter |first4=Ben |last5=Strawbridge |first5=Rebecca |last6=Hidalgo-Mazzei |first6=Diego |last7=Young |first7=Allan H. |title=Association between naturally occurring lithium in drinking water and suicide rates: systematic review and meta-analysis of ecological studies |journal=The British Journal of Psychiatry |date=December 2020 |volume=217 |issue=6 |pages=667–678 |doi=10.1192/bjp.2020.128 |pmid=32716281 }}</ref>

==== Other ==== Clozapine may decrease the thoughts of suicide in some people with schizophrenia.<ref>{{cite journal | vauthors = Wagstaff A, Perry C | title = Clozapine: in prevention of suicide in patients with schizophrenia or schizoaffective disorder | journal = CNS Drugs | volume = 17 | issue = 4 | pages = 273–80; discussion 281–3 | date = 2003 | pmid = 12665398 | doi = 10.2165/00023210-200317040-00004 }}</ref> Most systematic reviews suggest that ketamine shows short-term efficacy in reducing suicidality with generally mild side effects, but the evidence is largely low quality and its long-term efficacy remains unclear.<ref>{{Cite journal |last=Shamabadi|first=Ahmad|last2=Ahmadzade|first2=Ali|last3=Hasanzadeh|first3=Alireza|date=2022|title=Ketamine for suicidality: An umbrella review|url=https://pubmed.ncbi.nlm.nih.gov/35451097|journal=British Journal of Clinical Pharmacology|volume=88|issue=9|pages=3990–4018|doi=10.1111/bcp.15360|issn=1365-2125|pmid=35451097}}</ref> In the United States, health professionals are legally required to take reasonable steps to try to prevent suicide.<ref>{{cite news| vauthors = Caldwell BE |title=Whose Conscience Matters?|url=https://www.aamft.org/imis15/Documents/SO13FTMSinglePage.pdf|access-date=22 January 2018|work=Family Therapy Magazine (page 22)|publisher=American Association for Marriage and Family Therapy (AAMFT)|date=September–October 2013|archive-date=22 January 2018|archive-url=https://web.archive.org/web/20180122235109/https://www.aamft.org/imis15/Documents/SO13FTMSinglePage.pdf}}</ref><ref>{{cite case|title=Bellah v. Greenson|url=https://caselaw.findlaw.com/ca-court-of-appeal/1836783.html|court=California First District Court of Appeals|via=Findlaw|access-date=22 January 2018|date=6 June 1978}}</ref>

===Caring letters=== {{main|Caring letters}}

[[File:Caringletter.jpg|thumb|upright=1.35|A caring letter sent by Jerome Motto to his patient]] The "Caring Letters" model of suicide prevention<ref name = "Luxton 2014">{{cite journal |last1=Luxton |first1=David D. |last2=Thomas |first2=Elissa K. |last3=Chipps |first3=Joan |last4=Relova |first4=Rona M. |last5=Brown |first5=Daphne |last6=McLay |first6=Robert |last7=Lee |first7=Tina T. |last8=Nakama |first8=Helenna |last9=Smolenski |first9=Derek J. |title=Caring letters for suicide prevention: Implementation of a multi-site randomized clinical trial in the U.S. military and veteran affairs healthcare systems |journal=Contemporary Clinical Trials |date=March 2014 |volume=37 |issue=2 |pages=252–260 |doi=10.1016/j.cct.2014.01.007 |pmid=24473106 }}</ref><ref name = "Nock 2014">{{Cite book|url=https://books.google.com/books?id=IYNSAwAAQBAJ&pg=PA375|title=The Oxford Handbook of Suicide and Self-Injury|last=Nock|first=Matthew K.|date=2014-05-08|publisher=Oxford University Press|isbn=978-0-19-020914-8|pages=375|language=en}}</ref> involved mailing short letters that expressed the researchers' interest in the recipients without pressuring them to take any action. The intervention reduced deaths by suicide, as proven through a randomized controlled trial.<ref name="Cherkis 2018">{{Cite news |last=Cherkis |first=Jason |date=15 November 2018 |title=The Best Way To Save People From Suicide |url=https://highline.huffingtonpost.com/articles/en/how-to-help-someone-who-is-suicidal/ |access-date=19 November 2018 |work=The Huffington Post |archive-date=25 November 2018 |archive-url=https://web.archive.org/web/20181125170855/https://highline.huffingtonpost.com/articles/en/how-to-help-someone-who-is-suicidal/ |url-status=live }}</ref> The technique involves letters sent from a researcher who had spoken at length with the recipient during a suicidal crisis.<ref name = "Nock 2014" /> The typewritten form letters were brief – sometimes as short as two sentences – personally signed by the researcher, and expressed interest in the recipient without making any demands.<ref name = "Nock 2014" /> They were initially sent monthly, eventually decreasing in frequency to quarterly letters; if the recipient wrote back, then an additional personal letter was mailed.<ref name = "Nock 2014" />

Caring letters are inexpensive and either the only,<ref name = "Nock 2014" /> or one of very few,<ref name = "Luxton 2014" /> approaches to suicide prevention that has been scientifically proven to work during the first years after a suicide attempt that resulted in hospitalization.

== Methods == thumb|upright=1.25|Deaths by gun-related suicide versus non-gun-related suicide rates per 100,000 in high-income countries in 2010<ref name=AJM201603>{{cite journal |last1=Grinshteyn |first1=Erin |last2=Hemenway |first2=David |title=Violent Death Rates: The US Compared with Other High-income OECD Countries, 2010 |journal=The American Journal of Medicine |date=March 2016 |volume=129 |issue=3 |pages=266–273 |doi=10.1016/j.amjmed.2015.10.025 |pmid=26551975 |doi-access=free }}</ref> {{Main|Suicide methods}}

The leading method of suicide varies among countries. The leading methods in different regions include hanging, pesticide poisoning, and firearms.<ref name=Aj2008>{{cite journal | vauthors = Ajdacic-Gross V, Weiss MG, Ring M, Hepp U, Bopp M, Gutzwiller F, Rössler W | title = Methods of suicide: international suicide patterns derived from the WHO mortality database | journal = Bulletin of the World Health Organization | volume = 86 | issue = 9 | pages = 726–32 | date = September 2008 | pmid = 18797649 | pmc = 2649482 | doi = 10.2471/BLT.07.043489 }}</ref> These differences are believed to be in part due to availability of the different methods.<ref name=Yip2012/> A review of 56 countries found that hanging was the most common method in most of the countries,<ref name="Aj2008"/> accounting for 53% of male suicides and 39% of female suicides.<ref>{{cite book | veditors = O'Connor RC, Platt S, Gordon J |title=International Handbook of Suicide Prevention: Research, Policy and Practice |url=https://books.google.com/books?id=3fDGLWQtwFkC&pg=PA34 |date=1 June 2011 |publisher=John Wiley and Sons |isbn=978-1-119-99856-3 |page=34 }}</ref>

Worldwide, 30% of suicides are estimated to occur from pesticide poisoning, most of which occur in the developing world.<ref name=WHO2016/> The use of this method varies markedly from 4% in Europe to more than 50% in the Pacific region.<ref>{{cite journal | vauthors = Gunnell D, Eddleston M, Phillips MR, Konradsen F | title = The global distribution of fatal pesticide self-poisoning: systematic review | journal = BMC Public Health | volume = 7 | article-number = 357 | date = December 2007 | pmid = 18154668 | pmc = 2262093 | doi = 10.1186/1471-2458-7-357 | doi-access = free }}</ref> It is also common in Latin America due to the ease of access within the farming populations.<ref name=Yip2012/> In many countries, drug overdoses account for approximately 60% of suicides among women and 30% among men.<ref>{{cite book|vauthors=Geddes J, Price J, McKnight R, Gelder M, Mayou R|title=Psychiatry|publisher=Oxford University Press|location=Oxford|isbn=978-0-19-923396-0|page=62|url=https://books.google.com/books?id=F4THKWvbAPEC&pg=PA62|edition=4th|date=5 January 2012|archive-date=1 October 2024|access-date=27 June 2015|archive-url=https://web.archive.org/web/20241001061431/https://books.google.com/books?id=F4THKWvbAPEC&pg=PA62#v=onepage&q&f=false|url-status=live}}</ref> Many are unplanned and occur during an acute period of ambivalence.<ref name=Yip2012/> The death rate varies by method: firearms 80–90%, drowning 65–80%, hanging 60–85%, jumping 35–60%, charcoal burning 40–50%, pesticides 60–75%, and medication overdose 1.5–4.0%.<ref name=Yip2012/> The most common attempted methods of suicide differ from the most common methods of completion; up to 85% of attempts are via drug overdose in the developed world.<ref name=Tint2010/>

In China, the consumption of pesticides is the most common method.<ref name=WRVp196>{{cite book| vauthors = Krug E |title=World Report on Violence and Health | volume = 1 |year=2002|publisher=World Health Organization|location=Genève|isbn=978-92-4-154561-7|page=[https://archive.org/details/worldreportonvio2002unse/page/196 196]|url=https://archive.org/details/worldreportonvio2002unse/page/196}}</ref> In Japan, self-disembowelment known as seppuku (''harakiri'') still occurs;<ref name=WRVp196/> however, hanging and jumping are the most common.<ref>{{cite journal | vauthors = Yoshioka E, Hanley SJ, Kawanishi Y, Saijo Y | title = Time trends in method-specific suicide rates in Japan, 1990–2011 | journal = Epidemiology and Psychiatric Sciences | volume = 25 | issue = 1 | pages = 58–68 | date = February 2016 | pmid = 25373686 | doi = 10.1017/S2045796014000675 | pmc = 6998669 }}</ref> Jumping to one's death is common in both Hong Kong and Singapore at 50% and 80% respectively.<ref name=Yip2012/> In Switzerland, firearms are the most frequent suicide method in young males, although this method has decreased since guns have become less common.<ref>{{cite journal | vauthors = Reisch T, Steffen T, Habenstein A, Tschacher W |author4-link=Wolfgang Tschacher | title = Change in suicide rates in Switzerland before and after firearm restriction resulting from the 2003 'Army XXI' reform | journal = The American Journal of Psychiatry | volume = 170 | issue = 9 | pages = 977–84 | date = September 2013 | pmid = 23897090 | doi = 10.1176/appi.ajp.2013.12091256 }}</ref><ref>{{cite book| vauthors = Eshun S, Gurung RA |title=Culture and mental health sociocultural influences, theory, and practice|year=2009|publisher=Wiley-Blackwell|location=Chichester|isbn=978-1-4443-0581-4|page=301|url=https://books.google.com/books?id=Y6uUDBBGqF4C&pg=PA301|url-status=live|archive-url=https://web.archive.org/web/20151003161655/https://books.google.com/books?id=Y6uUDBBGqF4C&pg=PA301|archive-date=3 October 2015}}</ref> In the United States, 50% of suicides involve the use of firearms, with this method being more common in men (56%) than women (31%).<ref name="NIMH-2019">{{cite web|url=https://www.nimh.nih.gov/health/statistics/suicide|title=Suicide – Mental Health Statistics|date=April 2019|website=National Institute of Mental Health|access-date=15 October 2019|archive-date=17 January 2018|archive-url=https://web.archive.org/web/20180117064001/https://www.nimh.nih.gov/health/statistics/suicide.shtml|url-status=live}}</ref> The next most common cause was hanging in males (28%) and self-poisoning in females (31%).<ref name="NIMH-2019" /> Together, hanging and poisoning constituted about 42% of U.S. suicides ({{as of|2017|lc=y|}}).<ref name="NIMH-2019" />

thumb|upright=1.35|The US has had the largest number of gun-related suicides in the world every year from 1990 through at least 2019.<ref name=CNN_20211126/> With 4% of the world's population, the US had 44% of global gun suicides in 2019, and the highest rate ''per capita''.<ref name=CNN_20211126>{{cite news |last1=Fox |first1=Kara |last2=Shveda |first2=Krystina |last3=Croker |first3=Natalie |last4=Chacon |first4=Marco |title=How US gun culture stacks up with the world |url=https://www.cnn.com/2021/11/26/world/us-gun-culture-world-comparison-intl-cmd/index.html |publisher=CNN |date=26 November 2021 |archive-url=https://web.archive.org/web/20231221215124/https://www.cnn.com/2021/11/26/world/us-gun-culture-world-comparison-intl-cmd/index.html/ |archive-date=21 December 2023 |url-status=live }} Article updated October 26, 2023. CNN cites data source: Institute for Health Metrics and Evaluation (Global Burden of Disease 2019), UN Population Division.</ref>

== Epidemiology == {{Main|Epidemiology of suicide|List of countries by suicide rate}} {{See also|Seasonal effects on suicide rates}} Approximately 1.4% of people die by suicide, a mortality rate of 11.6 per 100,000 persons per year.<ref name=Var2012/><ref name=EB2011/> Suicide resulted in 842,000 deaths in 2013 up from 712,000 deaths in 1990.<ref name=GDB2013/> Rates of suicide have increased by 60% from the 1960s to 2012, with these increases seen primarily in the developing world.<ref name=Hawton2009/> Globally, {{As of|2008|lc=y}}/2009, suicide is the tenth leading cause of death.<ref name=Hawton2009/> For every suicide that results in death there are between 10 and 40 attempted suicides.<ref name=EB2011/>

Suicide rates differ significantly between countries and over time.<ref name=Var2012/> As a percentage of deaths in 2008 it was: Africa 0.5%, South-East Asia 1.9%, Americas 1.2% and Europe 1.4%.<ref name=Var2012/> Rates per 100,000 were: Australia 8.6, Canada 11.1, China 12.7, India 23.2, United Kingdom 7.6, United States 11.4 and South Korea 28.9.<ref>{{cite web|title=Deaths estimates for 2008 by cause for WHO Member States|url=https://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html|publisher=World Health Organization|access-date=10 February 2013|url-status=live|archive-url=https://web.archive.org/web/20091111101009/http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html|archive-date=11 November 2009}}</ref><ref>{{cite web|title=Suicide rates Data by country|url=http://apps.who.int/gho/data/node.main.MHSUICIDE?lang=en.|website=who.int|access-date=23 November 2014|url-status=live|archive-url=https://web.archive.org/web/20151015120314/http://apps.who.int/gho/data/node.main.MHSUICIDE?lang=en.|archive-date=15 October 2015}}</ref> It was ranked as the 10th leading cause of death in the United States in 2016 with about 45,000 cases that year.<ref name=CDC2018Epi>{{cite news |author= |date=7 June 2018 |title=Suicide rates rising across the U.S. |url=https://www.cdc.gov/media/releases/2018/p0607-suicide-prevention.html |work=CDC Newsroom |access-date=11 October 2018 |archive-date=9 May 2021 |archive-url=https://web.archive.org/web/20210509013348/https://www.cdc.gov/media/releases/2018/p0607-suicide-prevention.html |url-status=live }}</ref> Rates have increased in the United States in the last few years,<ref name=CDC2018Epi/> with about 49,500 people dying by suicide in 2022, the highest number ever recorded.<ref>{{cite news |author= |date=August 10, 2023 |title=Suicides in the U.S. reached all-time high in 2022, CDC data shows |url=https://www.nbcnews.com/health/mental-health/cdc-data-finds-suicides-reached-time-high-2022-rcna99327 |work=NBC News |location= |access-date=August 11, 2023 |archive-date=15 August 2023 |archive-url=https://web.archive.org/web/20230815043036/https://www.nbcnews.com/health/mental-health/cdc-data-finds-suicides-reached-time-high-2022-rcna99327 |url-status=live }}</ref> In the United States, about 650,000 people are seen in emergency departments yearly due to attempting suicide.<ref name="EB2011"/> The United States rate among men in their 50s rose by nearly half in the decade 1999–2010.<ref>{{cite web|title=CDC finds suicide rates among middle-aged adults increased from 1999 to 2010|url=https://www.cdc.gov/media/releases/2013/p0502-suicide-rates.html|publisher=Centers for Disease Control and Prevention|access-date=15 July 2013|date=2 May 2013|url-status=live|archive-url=https://web.archive.org/web/20130621045612/http://www.cdc.gov/media/releases/2013/p0502-suicide-rates.html|archive-date=21 June 2013}}</ref> Greenland, Lithuania, Japan, and Hungary have the highest rates of suicide.<ref name=Var2012/> Around 75% of suicides occur in the developing world.<ref name=WHO2016/> The countries with the greatest absolute numbers of suicides are China and India, partly due to their large population size, accounting for over half the total.<ref name=Var2012/> In China, suicide is the 5th leading cause of death.<ref name=China2009/>

An unofficial report estimated 5,000 suicides in Iran in 2022.<ref>{{cite web |url=https://www.etemadonline.com/%D8%A8%D8%AE%D8%B4-%D8%A7%D8%AC%D8%AA%D9%85%D8%A7%D8%B9%DB%8C-23/628479-%D8%AE%D9%88%D8%AF%DA%A9%D8%B4%DB%8C-%D8%A7%DB%8C%D8%B1%D8%A7%D9%86-%D9%85%D8%AF%D8%AF%DA%A9%D8%A7%D8%B1%DB%8C-%D9%85%D8%B1%DA%AF |title=میزان خودکشی در ایران طی یک دهه گذشته، بیش از ۴۰درصد رشد کرده |website=etemadonline.com |language=Persian |access-date=28 December 2023 |archive-date=9 November 2023 |archive-url=https://web.archive.org/web/20231109013131/https://www.etemadonline.com/%D8%A8%D8%AE%D8%B4-%D8%A7%D8%AC%D8%AA%D9%85%D8%A7%D8%B9%DB%8C-23/628479-%D8%AE%D9%88%D8%AF%DA%A9%D8%B4%DB%8C-%D8%A7%DB%8C%D8%B1%D8%A7%D9%86-%D9%85%D8%AF%D8%AF%DA%A9%D8%A7%D8%B1%DB%8C-%D9%85%D8%B1%DA%AF |url-status=live }}</ref>

<div style="display:inline-table; vertical-align:top;"> {{owidslider |start = 2023 |list = Template:OWID/Suicide rate for 15 to 49 year olds#gallery |location = commons |caption = |title = |language = |file = link=|thumb|upright=1.6|right|Suicide rate for 15 to 49 year olds |startingView = World }} </div> <div style="display:inline-table; vertical-align:top;"> {{owidslider |start = 2023 |list = Template:OWID/suicide rate who mdb#gallery |location = commons |caption = |title = |language = |file = link=|thumb|upright=1.6|right|suicide rate who mdb |startingView = World }} </div> <div style="display:inline-table; vertical-align:top;"> {{owidslider |start = 2021 |list = Template:OWID/death rate from suicides#gallery |location = commons |caption = |title = |language = |file = link=|thumb|upright=1.6|right|death rate from suicides |startingView = World }} </div> <div style="display:inline-table; vertical-align:top;"> {{owidslider |start = 2021 |list = Template:OWID/number suicide deaths#gallery |location = commons |caption = |title = |language = |file = link=|thumb|upright=1.6|right|number suicide deaths |startingView = World }} </div> <div style="display:inline-table; vertical-align:top;"> {{owidslider |start = 2021 |list = Template:OWID/suicide death rates#gallery |location = commons |caption = |title = |language = |file = link=|thumb|upright=1.6|right|suicide death rates |startingView = World }} </div> <div style="display:inline-table; vertical-align:top;"> {{owidslider |start = 2023 |list = Template:OWID/Share deaths suicide#gallery |location = commons |caption = |title = |language = |file = link=|thumb|upright=1.6|right|Share deaths suicide |startingView = World }} </div>

=== Sex and gender === {{Main|Gender differences in suicide}} {{owidslider |start = 2021 |list = Template:OWID/Male female ratio suicides rates#gallery |location = commons |caption = |title = |language = |file = link=|thumb|upright=1.6|right|Male female ratio suicides rates |startingView = World }} Globally {{As of|2012|lc=y}}, death by suicide occurs about 1.8 times more often in males than females.<ref name=Var2012/><ref>{{cite web|title=Estimates for 2000–2012|url=https://www.who.int/entity/healthinfo/global_burden_disease/GHE_DthGlobal_2000_2012.xls?ua=1|website=WHO|access-date=24 August 2016|archive-date=23 August 2024|archive-url=https://web.archive.org/web/20240823221348/https://www.who.int/entity/healthinfo/global_burden_disease/GHE_DthGlobal_2000_2012.xls?ua=1|url-status=live}}</ref> In the Western world, males die three to four times more often by means of suicide than do females.<ref name=Var2012/> This difference is even more pronounced in those over the age of 65, with tenfold more males than females dying by suicide.<ref name=Sue2012/> Suicide attempts and self-harm are between two and four times more frequent among females.<ref name=EB2011/><ref>{{cite book| vauthors = Stern TA, Fava M, Wilens TE, Rosenbaum JF |title=Massachusetts General Hospital Comprehensive Clinical Psychiatry|date=2015|publisher=Elsevier Health Sciences|isbn=978-0-323-32899-9|page=589|edition=2|url=https://books.google.com/books?id=y5nTBgAAQBAJ&pg=PA589|url-status=live|archive-url=https://web.archive.org/web/20160914014509/https://books.google.com/books?id=y5nTBgAAQBAJ&pg=PA589|archive-date=14 September 2016}}</ref><ref>{{cite book| vauthors = Krug EG |title=World Report on Violence and Health|date=2002|publisher=World Health Organization|isbn=978-92-4-154561-7|page=191|url=https://books.google.com/books?id=db9OHpk-TksC&pg=PA191|url-status=live|archive-url=https://web.archive.org/web/20160914020823/https://books.google.com/books?id=db9OHpk-TksC&pg=PA191|archive-date=14 September 2016}}</ref> Researchers have attributed the difference between suicide and attempted suicide among the sexes to males using more lethal means to end their lives.<ref name=Sue2012>{{cite book | vauthors = Sue D, Sue DW, Sue S, Sue D |title=Understanding abnormal behavior|publisher=Wadsworth/Cengage Learning|location=Belmont, CA|isbn=978-1-111-83459-3|page=255|url=https://books.google.com/books?id=mTs--Kt-9a0C&pg=PA255|edition=Tenth [student] |date=1 January 2012|url-status=live|archive-url=https://web.archive.org/web/20151030225833/https://books.google.com/books?id=mTs--Kt-9a0C&pg=PA255|archive-date=30 October 2015|author2-link=Derald Wing Sue }}</ref><ref name="Kumar">{{cite book | vauthors = Osváth P, Voros V, Fekete SA | chapter = Gender Issues in Suicide Risk Assessment | veditors = Kumar U, Mandal MK |title=Suicidal Behaviour: Assessment of People-At-Risk|isbn=978-81-321-0499-5|publisher=SAGE Publications India|year=2010|page=139|access-date=4 March 2017| chapter-url=https://books.google.com/books?id=W5WHAwAAQBAJ&pg=PA139 }}</ref><ref name="Ellis">{{cite book | vauthors = Ellis L, Hershberger S, Pellis S, Field E, Wersinger S, Pellis S, Geary D, Palmer C, Hoyenga K, Hetsroni A, Karadi K |title=Sex Differences: Summarizing More than a Century of Scientific Research|isbn=978-1-136-87493-2|publisher=Psychology Press|year=2013|page=387|access-date=4 March 2017|url=https://books.google.com/books?id=Skw2mezpvO4C&pg=PA387|url-status=live|archive-url=https://web.archive.org/web/20170305152038/https://books.google.com/books?id=Skw2mezpvO4C&pg=PA387|archive-date=5 March 2017}}</ref> However, separating intentional suicide attempts from non-suicidal self-harm is not currently done in places like the United States when gathering statistics at the national level.<ref>{{cite web|title=Suicide Statistics|url=https://afsp.org/about-suicide/suicide-statistics/|website=American Foundation for Suicide Prevention (AFSP)|access-date=3 September 2016|url-status=live|archive-url=https://web.archive.org/web/20160902201450/https://afsp.org/about-suicide/suicide-statistics/|archive-date=2 September 2016|date=16 February 2016}}</ref>

China has one of the highest female suicide rates in the world and is the only country where it is higher than that of men (ratio of 0.9).<ref name=Var2012/><ref name=China2009>{{cite journal | vauthors = Weiyuan C | title = Women and suicide in rural China | journal = Bulletin of the World Health Organization | volume = 87 | issue = 12 | pages = 888–9 | date = December 2009 | pmid = 20454475 | pmc = 2789367 | doi = 10.2471/BLT.09.011209 }}</ref> In the Eastern Mediterranean, suicide rates are nearly equivalent between males and females.<ref name=Var2012/> The highest rate of female suicide is found in South Korea at 22 per 100,000, with high rates in South-East Asia and the Western Pacific generally.<ref name=Var2012/>

A number of reviews have found an increased risk of suicide among lesbian, gay, bisexual, and transgender people.<ref>{{cite journal | vauthors = Haas AP, Eliason M, Mays VM, Mathy RM, Cochran SD, D'Augelli AR, Silverman MM, Fisher PW, Hughes T, Rosario M, Russell ST, Malley E, Reed J, Litts DA, Haller E, Sell RL, Remafedi G, Bradford J, Beautrais AL, Brown GK, Diamond GM, Friedman MS, Garofalo R, Turner MS, Hollibaugh A, Clayton PJ | display-authors = 6 | title = Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: review and recommendations | journal = Journal of Homosexuality | volume = 58 | issue = 1 | pages = 10–51 | date = 2011 | pmid = 21213174 | pmc = 3662085 | doi = 10.1080/00918369.2011.534038 }}</ref><ref>{{cite web|title=Suicide Attempts among Transgender and Gender Non-Conforming Adults|url=https://williamsinstitute.law.ucla.edu/wp-content/uploads/AFSP-Williams-Suicide-Report-Final.pdf|access-date=28 April 2018|date=Jan 2014|archive-date=8 October 2017|archive-url=https://web.archive.org/web/20171008072751/https://williamsinstitute.law.ucla.edu/wp-content/uploads/AFSP-Williams-Suicide-Report-Final.pdf|url-status=live}}</ref> Among transgender persons, rates of attempted suicide are about 40% compared to a general population rate of 5%.<ref>{{cite journal| vauthors = Williams A |title=Risk factors for suicide in the transgender community|journal=European Psychiatry|date=April 2017|volume=41|page=S894|doi=10.1016/j.eurpsy.2017.01.1820 }}</ref><ref>{{cite journal | vauthors = Virupaksha HG, Muralidhar D, Ramakrishna J | title = Suicide and Suicidal Behavior among Transgender Persons | journal = Indian Journal of Psychological Medicine | volume = 38 | issue = 6 | pages = 505–509 | date = 2016 | pmid = 28031583 | pmc = 5178031 | doi = 10.4103/0253-7176.194908 | doi-access = free }}</ref> This is believed to in part be due to social stigmatisation.<ref>{{cite web|url=http://www.thetaskforce.org/downloads/reports/reports/ntds_full.pdf|title=Reports|access-date=25 July 2016|date=2011|archive-url=https://web.archive.org/web/20140908030754/http://www.thetaskforce.org/downloads/reports/reports/ntds_full.pdf|archive-date=8 September 2014}}</ref>

=== Age === thumb|upright=1.6|Suicide rates by age<ref>{{cite web |title=Suicide rates by age |url=https://ourworldindata.org/grapher/suicide-rates-by-age-detailed |website=Our World in Data |access-date=4 March 2020 |archive-date=21 March 2020 |archive-url=https://web.archive.org/web/20200321230506/https://ourworldindata.org/grapher/suicide-rates-by-age-detailed |url-status=live }}</ref>

In many countries, the rate of suicide is highest in the middle-aged<ref name=Pit2012>{{cite journal | vauthors = Pitman A, Krysinska K, Osborn D, King M | title = Suicide in young men | journal = Lancet | volume = 379 | issue = 9834 | pages = 2383–92 | date = June 2012 | pmid = 22726519 | doi = 10.1016/S0140-6736(12)60731-4 }}</ref> or elderly.<ref name=Yip2012/> The absolute number of suicides, however, is greatest in those between 15 and 29 years old, due to the number of people in this age group.<ref name=Var2012/> Worldwide, the average age of suicide is between age 30 and 49 for both men and women.<ref name=WHO2018Age>{{cite web |title=Summary tables of mortality estimates by cause, age and sex, globally and by region, 2000–2016 |url=https://www.who.int/healthinfo/global_burden_disease/GHE2016_Deaths_Global_2000_2016.xls |website=World Health Organization |access-date=21 December 2018 |date=2018 |archive-date=21 April 2019 |archive-url=https://web.archive.org/web/20190421222040/https://www.who.int/healthinfo/global_burden_disease/GHE2016_Deaths_Global_2000_2016.xls |url-status=dead }}</ref> Suicidality is rare in children, but increases during the transition to adolescence.<ref>{{cite journal | vauthors = Glenn CR, Kleiman EM, Kellerman J, Pollak O, Cha CB, Esposito EC, Porter AC, Wyman PA, Boatman AE | display-authors = 6 | title = Annual Research Review: A meta-analytic review of worldwide suicide rates in adolescents | journal = Journal of Child Psychology and Psychiatry, and Allied Disciplines | volume = 61 | issue = 3 | pages = 294–308 | date = March 2020 | pmid = 31373003 | doi = 10.1111/jcpp.13106 }}</ref>

In the United States, the suicide death rate is greatest in Caucasian men older than 80 years, even though younger people more frequently attempt suicide.<ref name="EB2011" /> It is the second most common cause of death in adolescents<ref name="Hawton2012">{{cite journal | vauthors = Hawton K, Saunders KE, O'Connor RC | title = Self-harm and suicide in adolescents | journal = Lancet | volume = 379 | issue = 9834 | pages = 2373–82 | date = June 2012 | pmid = 22726518 | doi = 10.1016/S0140-6736(12)60322-5 }}</ref> and in young males is second only to accidental death.<ref name="Pit2012" /> In young males in the developed world, it is the cause of nearly 30% of mortality.<ref name="Pit2012" /> In the developing world rates are similar, but it makes up a smaller proportion of overall deaths due to higher rates of death from other types of trauma.<ref name="Pit2012" /> In South-East Asia, in contrast to other areas of the world, deaths from suicide occur at a greater rate in young females than elderly females.<ref name="Var2012" />

== History == {{Main|History of suicide}}

[[File:10 2023 - Palazzo Altemps, Roma, Lazio, 00186, Italia - Galata suicida (Ludovisi Gaul) - Arte Ellenistica Greca - Copia Romana - Photo Paolo Villa FO232046 ombre gimp bis.jpg|thumb|upright|The Ludovisi Gaul killing himself and his wife, Roman copy after the Hellenistic original, Palazzo Massimo alle Terme]]

In ancient Athens, a person who died by suicide without the approval of the state was denied the honors of a normal burial. The person would be buried alone, on the outskirts of the city, without a headstone or marker.<ref>{{cite book|url=https://archive.org/details/fatalfreedomethi00szas|url-access=registration|title=Fatal freedom: the ethics and politics of suicide| vauthors = Szasz T |publisher=Praeger|year=1999|isbn=978-0-275-96646-1|location=Westport, CT|page=[https://archive.org/details/fatalfreedomethi00szas/page/11 11]}}</ref> It was also common for the hand to be cut off the body and buried separately<ref>{{Cite book |last=Battin |first=M. Pabst |title=The ethics of suicide: historical sources |date=2015 |publisher=Oxford University Press |isbn=978-0-19-938580-5 |location=Oxford; New York |page=2}}</ref> - the hand (and the instrument used) being considered the perpetrator.<ref>{{cite journal |last1=Naiden |first1=F.S. |title=The Sword Did It: A Greek Explanation for Suicide |journal=The Classical Quarterly |date=May 2015 |volume=65 |issue=1 |pages=85–95 |doi=10.1017/S0009838814000858 }}</ref> However, it was deemed to be an acceptable method to deal with military defeat.<ref name=Maris2000/> In Ancient Rome, while suicide was initially permitted, it was later deemed a crime against the state due to its economic costs.<ref>{{cite book| vauthors = Dickinson MR, Leming GE |title=Understanding dying, death, and bereavement|publisher=Wadsworth Cengage Learning|location=Belmont, CA|isbn=978-0-495-81018-6|page=290|url=https://books.google.com/books?id=L8ETDRsB8ZYC&pg=PA290|edition=7th|date=2 September 2010 }}</ref> Aristotle condemned all forms of suicide while Plato was ambivalent.<ref name="Minois Hist Suic" /> In Rome, some reasons for suicide included volunteering death in a gladiator combat, guilt over murdering someone, to save the life of another, as a result of mourning, from shame from being raped, and as an escape from intolerable situations like physical suffering, military defeat, or criminal pursuit.<ref name="Minois Hist Suic" />

In the medieval Baltics, especially in pagan Lithuania prior to its Christianization in 1387, suicide was sometimes regarded as an honorable, ritualized, or altruistic act. Historical sources describe self-sacrifice as a culturally accepted response to defeat, grief, or severe illness.<ref>{{cite journal |last1=Gailienė |first1=Danutė |last2=Ružytė |first2=Indrė |title=Ancient attitudes towards suicide in Lithuania |journal=Nordic Journal of Psychiatry |date=January 1997 |volume=51 |issue=1 |pages=29–35 |doi=10.3109/08039489709109081 }}</ref> Suicide was not limited to men: a Livonian priest named Johann recorded that in 1205, fifty Lithuanian women hanged themselves after learning that their husbands, who had joined a raid led by Duke Žvelgaitis, had been killed, believing they would reunite with them in the afterlife. Archaeological evidence, such as double graves among the Balts and other Indo-European peoples, may reflect similar beliefs, possibly including ritual widow suicide.<ref>{{Cite web |date=2020-10-04 |title=Suicides in the Pagan Lithuania - Orbis Lituaniae |url=https://www.ldkistorija.lt/suicides-in-the-pagan-lithuania/ |access-date=2026-02-02 |language=en-GB}}</ref> Defeated warriors also often chose death over captivity or enslavement, most famously in 1336 at Pilėnai Castle, where defenders reportedly killed their families and themselves rather than surrender to the Teutonic Knights.<ref>{{Cite web |date=2020-10-02 |title=Pilėnai and Margiris - Orbis Lituaniae |url=https://www.ldkistorija.lt/pilenai-and-margiris/ |access-date=2026-02-02 |language=en-GB |archive-date=17 February 2025 |archive-url=https://web.archive.org/web/20250217145312/https://www.ldkistorija.lt/pilenai-and-margiris/ |url-status=live }}</ref>

[[File:La mort de seneque.jpg|thumb|upright=1.35|''The Death of Seneca'' (1684), painting by Luca Giordano, depicting the suicide of Seneca the Younger in Ancient Rome]]

Suicide came to be regarded as a sin in Christian Europe and was condemned at the Council of Arles (452) as the work of the Devil. In the Middle Ages, the Church had drawn-out discussions as to when the desire for martyrdom was suicidal, as in the case of martyrs of Córdoba. Despite these disputes and occasional official rulings, Catholic doctrine was not entirely settled on the subject of suicide until the later 17th century. A criminal ordinance issued by Louis XIV of France in 1670 was extremely severe, even for the times: the dead person's body was drawn through the streets, face down, and then hung or thrown on a garbage heap. Additionally, all of the person's property was confiscated.<ref>{{cite book| vauthors = Pickering WS, Walford G |title= Durkheim's Suicide: a century of research and debate|year=2000|publisher=Routledge|location=London|isbn=978-0-415-20582-5|page=69|url=https://books.google.com/books?id=9KQO6dGY1cwC&pg=PA69|edition=1. publ.|url-status=live|archive-url=https://web.archive.org/web/20160402063717/https://books.google.com/books?id=9KQO6dGY1cwC&pg=PA69|archive-date=2 April 2016}}</ref><ref name=Maris540>{{cite book| vauthors = Maris R |title=Comprehensive textbook of suicidology|year=2000|publisher=Guilford Press|location=New York|isbn=978-1-57230-541-0|page=540|url=https://books.google.com/books?id=Zi-xoFAPnPMC&pg=PA540 }}</ref>

Attitudes towards suicide slowly began to shift during the Renaissance. John Donne's work ''Biathanatos'' contained one of the first modern defences of suicide, bringing proof from the conduct of Biblical figures, such as Jesus, Samson and Saul, and presenting arguments on grounds of reason and nature to sanction suicide in certain circumstances.<ref name="Stanf">{{cite book | url = http://plato.stanford.edu/entries/suicide/ | title = Suicide | publisher = Stanford Encyclopedia of Philosophy | year = 2017 | archive-date = 7 October 2008 | access-date = 27 February 2007 | archive-url = https://web.archive.org/web/20081007202319/http://plato.stanford.edu/entries/suicide | url-status = live }}</ref>

The secularization of society that began during the Enlightenment questioned traditional religious attitudes (such as Christian views on suicide) toward suicide and brought a more modern perspective to the issue. David Hume denied that suicide was a crime as it affected no one and was potentially to the advantage of the individual. In his 1777 ''Essays on Suicide and the Immortality of the Soul'' he rhetorically asked, "Why should I prolong a miserable existence, because of some frivolous advantage which the public may perhaps receive from me?"<ref name="Stanf"/> Hume's analysis was criticized by philosopher Philip Reed as being "uncharacteristically (for him) bad", since Hume took an unusually narrow conception of duty and his conclusion depended upon the suicide producing no harm to others – including causing no grief, feelings of guilt, or emotional pain to any surviving friends and family – which is almost never the case.<ref name="Reed-2020">{{cite book| vauthors = Reed P |url=https://books.google.com/books?id=BOcJEAAAQBAJ|title=Exploring the Philosophy of Death and Dying: Classical and Contemporary Perspectives|date=30 December 2020|publisher=Routledge|isbn=978-1-000-21674-5| veditors = Timmerman T, Cholbi M |language=en|chapter=Suicide and its Discontents}}</ref> A shift in public opinion at large can also be discerned; ''The Times'' in 1786 initiated a spirited debate on the motion "Is suicide an act of courage?".<ref>{{cite book |url=https://books.google.com/books?id=bWTcejAzQ8kC|title=A Companion to the Eighteenth-Century English Novel and Culture| vauthors = Backscheider PR, Ingrassia C |year=2008 |publisher=John Wiley & Sons |page=530|isbn=978-1-4051-5450-5}}</ref>

By the 19th century, the act of suicide had shifted from being viewed as caused by sin to being caused by insanity in Europe.<ref name=Maris540/> Although suicide remained illegal during this period, it increasingly became the target of satirical comments, such as the Gilbert and Sullivan comic opera ''The Mikado'', which satirized the idea of executing someone who had already killed himself.

By 1879, English law began to distinguish between suicide and homicide, although suicide still resulted in forfeiture of estate.<ref name="Dost">{{cite book| vauthors = Paperno I |title=Suicide as a cultural institution in Dostoevsky's Russia|year=1997|publisher=Cornell university press|location=Ithaca|isbn=978-0-8014-8425-4|page=60|url=https://books.google.com/books?id=m3pqf8f-6bMC&pg=PA60|url-status=live|archive-url=https://web.archive.org/web/20150928063739/https://books.google.com/books?id=m3pqf8f-6bMC&pg=PA60|archive-date=28 September 2015}}</ref> In 1882, the deceased were permitted daylight burial in England<ref>{{cite book|url=https://books.google.com/books?id=S60656aS4PAC|title=Life, Death and the Law: Law and Christian Morals in England and the United States| vauthors = St John-Stevas N |year=2002|publisher=Beard Books|page=233|isbn=978-1-58798-113-5}}</ref> and by the middle of the 20th century, suicide had become legal in much of the Western world. The term ''suicide'' first emerged shortly before 1700 to replace expressions on self-death which were often characterized as a form of self-murder in the West.<ref name="Minois Hist Suic">{{cite book| vauthors = Minois G |title=History of Suicide: Voluntary Death in Western Culture|date=2001|publisher=Johns Hopkins University Press|location=Baltimore|isbn=978-0-8018-6647-0|edition=Johns Hopkins University}}</ref>

== Society and culture ==

=== Legislation === {{Main|Suicide legislation}}

[[File:Wakisashi-sepukku-p1000699.jpg|thumb|A ''tantō'' knife prepared for ''seppuku'' (abdomen-cutting)]] [[File:Seppuku-2.jpg|thumb|Samurai about to perform seppuku]]

Suicide is a crime in some parts of the world.<ref>{{Cite book |last1=Smith |first1=John C. |title=Smith & Hogan's criminal law |last2=Hogan |first2=Brian |last3=Ormerod |first3=David C. |last4=Ormerod |first4=David |publisher=Oxford Univ. Press |year=2011 |isbn=978-0-19-958649-3 |edition=13th |location=Oxford |page=583}}</ref> No country in Europe currently considers suicide or attempted suicide to be a crime.<ref name="McL2007">{{cite book|url=https://books.google.com/books?id=I2FJRbekdC8C&pg=PA24|title=Suicide-related behaviour understanding, caring and therapeutic responses| vauthors = McLaughlin C |publisher=John Wiley & Sons|year=2007|isbn=978-0-470-51241-8|location=Chichester|page=24}}</ref> However, it was in most Western European countries from the Middle Ages until at least the 19th century.<ref name="Dost"/> The Netherlands was the first country to legalize both physician-assisted suicide and euthanasia, which took effect in 2002, although only doctors are allowed to assist in either of them, and have to follow a protocol prescribed by Dutch law.<ref>{{cite news|url=http://news.bbc.co.uk/2/hi/europe/1269682.stm|title=Dutch 'mercy killing law' passed|date=11 April 2001|access-date=27 February 2019|archive-date=25 February 2019|archive-url=https://web.archive.org/web/20190225063457/http://news.bbc.co.uk/2/hi/europe/1269682.stm|url-status=live}}</ref> If such protocol is not followed, it is an offence punishable by law. In Germany, active euthanasia is illegal and anyone present during suicide may be prosecuted for failure to render aid in an emergency.<ref>{{cite news|url=http://www.timesonline.co.uk/tol/news/world/europe/article4251894.ece|title=German politician Roger Kusch helped elderly woman to die|date=2 July 2008|newspaper=Times Online|archive-url=https://web.archive.org/web/20100601051855/http://www.timesonline.co.uk/tol/news/world/europe/article4251894.ece|archive-date=1 June 2010}}</ref> Switzerland has taken steps to legalize assisted suicide for the chronically mentally ill. The high court in Lausanne, Switzerland, in a 2006 ruling, granted an anonymous individual with longstanding psychiatric difficulties the right to end his own life.<ref name="pmid17649899">{{cite journal | vauthors = Appel JM | title = A suicide right for the mentally ill? A Swiss case opens a new debate | journal = The Hastings Center Report | volume = 37 | issue = 3 | pages = 21–3 | date = May 2007 | pmid = 17649899 | doi = 10.1353/hcr.2007.0035 }}</ref> England and Wales decriminalized suicide via the Suicide Act 1961 and the Republic of Ireland in 1993.<ref name="McL2007" /> The word "commit" was used in reference to its being illegal, but many organisations have stopped it because of the negative connotation.<ref>Holt, Gerry.[https://www.bbc.co.uk/news/magazine-14374296 "When suicide was illegal"] {{webarchive|url=https://web.archive.org/web/20140207074649/http://www.bbc.co.uk/news/magazine-14374296|date=7 February 2014}}. BBC News. 3 August 2011. Accessed 11 August 2011.</ref><ref name="guardian_style">{{cite news|title=Guardian & Observer style guide|url=https://www.theguardian.com/styleguide/s|work=Guardian website|publisher=The Guardian|access-date=29 November 2011|url-status=live|archive-url=https://web.archive.org/web/20131019070418/http://www.theguardian.com/styleguide/s|archive-date=19 October 2013|date=31 December 2015}}</ref>

In the United States, suicide is not illegal, but may be associated with penalties for those who attempt it.<ref name="McL2007" />{{Better source needed|reason=A source that's more authoritative on legal matters would be better.|date=May 2025}} Physician-assisted suicide is legal in the state of Washington for people with terminal diseases.<ref>{{cite news|url=http://apps.leg.wa.gov/RCW/default.aspx?cite=70.245|title=Chapter 70.245 RCW, The Washington death with dignity act|work=Washington State Legislature|archive-url=https://web.archive.org/web/20100708000006/http://apps.leg.wa.gov/RCW/default.aspx?cite=70.245|archive-date=8 July 2010|url-status=live}}</ref> In Oregon, people with terminal diseases may request medications to help end their lives.<ref>{{cite web|url=https://public.health.oregon.gov/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Pages/ors.aspx|title=Oregon Revised Statute – 127.800 s.1.01. Definitions|publisher=Oregon State Legislature|archive-url=https://web.archive.org/web/20151007062220/http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/ors.aspx|archive-date=7 October 2015|url-status=live}}</ref> Canadians who have attempted suicide may be barred from entering the United States. U.S. laws allow border guards to deny access to people who have a mental illness, including those with previous suicide attempts.<ref>{{cite web|url=http://www.cbc.ca/m/news/#!/content/1.1034903|title=CBCNews.ca Mobile|date=1 February 1999|publisher=Cbc.ca|archive-url=https://web.archive.org/web/20140807054409/http://www.cbc.ca/m/news/#!/content/1.1034903|archive-date=7 August 2014|url-status=live|access-date=6 August 2014}}</ref><ref>{{cite web|url=http://globalnews.ca/news/1271798/us-border-suicide-profiling-must-stop-report/|title=US border suicide profiling must stop: Report| vauthors = Adams C |date=15 April 2014|website=globalnews.ca|archive-url=https://web.archive.org/web/20140808055456/http://globalnews.ca/news/1271798/us-border-suicide-profiling-must-stop-report/|archive-date=8 August 2014|url-status=live|access-date=7 August 2014}}</ref>{{Update inline|date=May 2025}}

In Australia, suicide is not a crime,<ref>{{cite book | vauthors = Lanham D, Bartal BF, Evans RC, Wood D |title=Criminal laws in Australia|year=2006|publisher=The Federation Press|location=Annandale, N.S.W. |isbn=978-1-86287-558-6 |page=229|url=https://books.google.com/books?id=D97doQ1iZx4C&pg=PA229 }}</ref> however it is a crime to counsel, incite, or aid and abet another in attempting to die by suicide, and the law explicitly allows any person to use "such force as may reasonably be necessary" to prevent another from taking their own life.<ref>{{cite book |last1=Godwin |first1=John |last2=Costa |first2=Michael |last3=Duffy |first3=Mark |title=Australian HIV/AIDS Legal Guide |date=1991 |publisher=Federation Press |isbn=978-1-86287-060-4 |page=315 }}</ref> The Northern Territory of Australia briefly had legal physician-assisted suicide from 1996 to 1997.<ref>{{cite book |last1=Putnam |first1=Constance |title=Hospice Or Hemlock?: Searching for Heroic Compassion |date=2002 |publisher=Bloomsbury Academic |isbn=978-0-89789-921-5 |page=143 }}</ref>

In India, suicide was illegal until 2014, and surviving family members used to face legal difficulties.<ref>{{cite book| vauthors = Dogra M, Srivastava S |title=Climate change and disease dynamics in India|publisher=The Energy and Resources Institute|location=New Delhi|isbn=978-81-7993-412-8|page=256|url=https://books.google.com/books?id=UGrUgX-nKTIC&pg=PA256|date=1 January 2012|url-status=live|archive-url=https://web.archive.org/web/20150928054921/https://books.google.com/books?id=UGrUgX-nKTIC&pg=PA256|archive-date=28 September 2015}}</ref><ref>{{cite news|url=http://zeenews.india.com/news/india/govt-decides-to-repeal-section-309-from-ipc-attempt-to-suicide-no-longer-a-crime_1512479.html|title=Govt decides to repeal Section 309 from IPC; attempt to suicide no longer a crime|publisher=Zee News|date=10 December 2014|access-date=10 December 2014|url-status=live|archive-url=https://web.archive.org/web/20150515222001/http://zeenews.india.com/news/india/govt-decides-to-repeal-section-309-from-ipc-attempt-to-suicide-no-longer-a-crime_1512479.html|archive-date=15 May 2015}}</ref> It remains a criminal offense in most Muslim-majority nations.<ref name="Islam2006" />

In Malaysia, suicide ''per se'' is not a crime; however, attempted suicide is. Under Section 309 of the Penal Code, a person convicted of attempting suicide can be punished with imprisonment of up to one year, fined, or both. There are ongoing efforts to decriminalise attempted suicide, although rights groups and non-governmental organisations such as the local chapter of Befrienders say that progress has been slow.<ref>{{cite web|url=https://www.freemalaysiatoday.com/category/nation/2022/06/19/why-so-long-to-decriminalise-suicide-says-befrienders/|title=Why so long to decriminalise suicide, says Befrienders|date=19 June 2022|website=Free Malaysia Today|access-date=9 February 2023|archive-date=14 August 2023|archive-url=https://web.archive.org/web/20230814145305/https://www.freemalaysiatoday.com/category/nation/2022/06/19/why-so-long-to-decriminalise-suicide-says-befrienders/|url-status=live}}</ref><ref>{{cite web|url=https://www.channelnewsasia.com/asia/decriminalising-suicides-lies-malaysias-cabinet-2971011|title=Decision on decriminalising suicide attempts in Malaysia lie with cabinet: Khairy|date=28 September 2022|website=Channel News Asia|access-date=9 February 2023|archive-date=9 February 2023|archive-url=https://web.archive.org/web/20230209035753/https://www.channelnewsasia.com/asia/decriminalising-suicides-lies-malaysias-cabinet-2971011|url-status=live}}</ref> Proponents of decriminalisation argue that suicide legislation may deter people from seeking help, and may even strengthen the resolve of would-be suicides to end their lives to avoid prosecution.<ref>{{cite web|url=https://www.academia.edu/45126006|title=Malaysia's Pathway to the Decriminalisation of Suicides: Students' Opinion and Discussions (pdf)|date=27 December 2020|website=academia.edu|access-date=9 February 2023|archive-date=30 June 2023|archive-url=https://web.archive.org/web/20230630064725/https://www.academia.edu/45126006|url-status=live}}</ref> The first reading of a bill to repeal Section 309 of the Penal Code was tabled in Parliament in April 2023, bringing Malaysia one step closer towards decriminalising attempted suicide.<ref>{{cite web|url=https://www.malaymail.com/news/malaysia/2023/04/07/as-decriminalisation-nears-a-brief-look-at-how-suicide-became-a-crime-in-malaysia/63525|title=As decriminalisation nears, a brief look at how suicide became a crime in Malaysia|date=7 April 2023|website=Malay Mail|access-date=5 May 2023|archive-date=5 May 2023|archive-url=https://web.archive.org/web/20230505024216/https://www.malaymail.com/news/malaysia/2023/04/07/as-decriminalisation-nears-a-brief-look-at-how-suicide-became-a-crime-in-malaysia/63525|url-status=live}}</ref>

Suicide became a trending crisis in North Korea in 2023; a secret order criminalized suicide as treason against the socialist state.<ref>{{cite web |last=Zitser |first=Joshua |title=Kim Jong Un orders North Koreans to stop killing themselves after number of suicides skyrocketed |url=https://www.businessinsider.com/kim-jong-un-bans-suicide-after-numbers-skyrocketed-report-2023-6 |access-date=2023-06-12 |website=Business Insider |language=en-US |archive-date=12 June 2023 |archive-url=https://web.archive.org/web/20230612042655/https://www.businessinsider.com/kim-jong-un-bans-suicide-after-numbers-skyrocketed-report-2023-6 |url-status=live }}</ref>

=== Religious views === {{Main|Religious views on suicide}}

==== Christianity ==== {{Main|Christian views on suicide}}

Most forms of Christianity consider suicide sinful, based mainly on the writings of influential Christian thinkers of the Middle Ages, such as St. Augustine and St. Thomas Aquinas, but suicide was not considered a sin under the Byzantine Christian code of Justinian, for instance.<ref>{{cite web | vauthors = Roth R |url=http://www.acu-cell.com/suicide.html |title=Suicide & Euthanasia – a Biblical Perspective |publisher=Acu-cell.com |access-date=6 May 2009 |archive-url=https://web.archive.org/web/20090418073913/http://acu-cell.com/suicide.html |archive-date=18 April 2009 }}</ref><ref>{{cite web |url=http://www.clas.ufl.edu/users/nholland/suicide.htm |title=Norman N. Holland, Literary Suicides: A Question of Style |publisher=Clas.ufl.edu |access-date=6 May 2009 |url-status=live |archive-url=https://web.archive.org/web/20090528090133/http://www.clas.ufl.edu/users/nholland/suicide.htm|archive-date=28 May 2009}}</ref> In Catholic and Orthodox doctrine, suicide is considered to be murder, violating the commandment "Thou shalt not kill," and historically neither church would even hold a burial service for a member that died by suicide, deeming it an act that condemned the person to hell, since they died in a state of mortal sin.<ref>{{cite web|url=https://uscatholic.org/articles/201410/is-suicide-a-sin/|access-date=14 April 2022|title=Is suicide a sin?|date=28 October 2014|archive-date=9 April 2022|archive-url=https://web.archive.org/web/20220409080537/https://uscatholic.org/articles/201410/is-suicide-a-sin/|url-status=live}}</ref> The basic idea being that life is a gift given by God which should not be spurned, and that suicide is against the "natural order" and thus interferes with God's master plan for the world.<ref>{{cite web |url=http://www.scborromeo.org/ccc/p3s2c2a5.htm#2280 |title=Catechism of the Catholic Church – Part 3 Section 2 Chapter 2 Article 5 |publisher=Scborromeo.org |date=1 June 1941 |access-date=6 May 2009 |url-status=live |archive-url=https://web.archive.org/web/20090425163428/http://www.scborromeo.org/ccc/p3s2c2a5.htm#2280 |archive-date=25 April 2009 }}</ref> However, according to the Catechism of the Catholic Church, it is believed that mental illness or grave fear of suffering diminishes the responsibility of the one committing suicide.<ref>{{cite web |url=http://www.scborromeo.org/ccc/p3s2c2a5.htm#2282 |title=Catechism of the Catholic Church – Part 3 Section 2 Chapter 2 Article 5 |publisher=Scborromeo.org |date=1 June 1941 |access-date=6 May 2009 |url-status=live |archive-url=https://web.archive.org/web/20090425163428/http://www.scborromeo.org/ccc/p3s2c2a5.htm#2282 |archive-date=25 April 2009 }}</ref>

==== Judaism ==== {{Main|Jewish views on suicide}}

Judaism focuses on the importance of valuing this life, and as such, suicide is tantamount to denying God's goodness in the world. Despite this, under extreme circumstances when there has seemed no choice but to either be killed or forced to betray their religion, there are several accounts of Jews having died by suicide, either individually or in groups (see Holocaust, Masada, First French persecution of the Jews and York Castle for examples), and as a grim reminder there is even a prayer in the Jewish liturgy for "when the knife is at the throat", for those dying "to sanctify God's Name" (see Martyrdom). These acts have received mixed responses by Jewish authorities, regarded by some as examples of heroic martyrdom, while others state that it was wrong for them to take their own lives in anticipation of martyrdom.<ref>{{cite web |url=http://www.religionfacts.com/euthanasia/judaism.htm |title=Euthanasia and Judaism: Jewish Views of Euthanasia and Suicide |access-date=16 September 2008 |publisher=ReligionFacts.com |url-status=live |archive-url=https://web.archive.org/web/20060506200930/http://www.religionfacts.com/euthanasia/judaism.htm |archive-date=6 May 2006 }}</ref>{{Better source needed|reason=The current source is insufficiently reliable (WP:NOTRS).|date=March 2025}}

==== Islam ==== Islam religious views condemn suicide<ref name="Islam2006"/> and consider it haram. Hadith manuscripts state that suicide is unlawful and a sin,<ref name="Islam2006"/> and the Quran explicitly forbids it.<ref>{{cite web |title=Surah An-Nisa - 29 |url=https://quran.com/an-nisa/29 |access-date=2023-02-25 |website=Quran.com |language=en |archive-date=25 February 2023 |archive-url=https://web.archive.org/web/20230225024901/https://quran.com/an-nisa/29 |url-status=live }}</ref><ref name="Gear2009">{{cite journal | vauthors = Gearing RE, Lizardi D | title = Religion and suicide | journal = Journal of Religion and Health | volume = 48 | issue = 3 | pages = 332–41 | date = September 2009 | pmid = 19639421 | doi = 10.1007/s10943-008-9181-2 }}</ref> In Islamic countries, suicide is often stigmatized;<ref name=Gear2009/> it is believed that those that successfully die by suicide are forbidden from entering Jannah.

==== Hinduism ==== [[File:A Hindoo Widow Burning Herself with the Corpse of her Husband.jpg|thumb|A Hindu widow burning herself with her husband's corpse, 1820s]] In Hinduism, suicide is generally disdained and is considered equally sinful as murdering another in contemporary Hindu society. Hindu Scriptures state that one who dies by suicide will become part of the spirit world, wandering earth until the time one would have otherwise died, had one not taken one's own life.<ref>Hindu Website. [http://www.hinduwebsite.com/hinduism/h_suicide.asp Hinduism and suicide] {{webarchive|url=https://web.archive.org/web/20080507034203/http://www.hinduwebsite.com/Hinduism/h_suicide.asp |date=7 May 2008 }}</ref> However, Hinduism accepts a man's right to end one's life through the non-violent practice of fasting to death, termed ''Prayopavesa'';<ref name="hindu">{{cite web|url= http://www.bbc.co.uk/religion/religions/hinduism/hinduethics/euthanasia.shtml|title= Hinduism – Euthanasia and Suicide|date= 25 August 2009|publisher= BBC|url-status=live|archive-url= https://web.archive.org/web/20090225155507/http://www.bbc.co.uk/religion/religions/hinduism/hinduethics/euthanasia.shtml|archive-date= 25 February 2009}}</ref> but ''Prayopavesa'' is strictly restricted to people who have no desire or ambition left, and no responsibilities remaining in this life.<ref name="hindu"/>

====Jainism==== Jainism has a similar practice named ''Santhara''. Sati, or self-immolation by widows, is a rare and illegal practice in Hindu society.<ref>{{cite news |title=India wife dies on husband's pyre |url=http://news.bbc.co.uk/2/hi/south_asia/5273336.stm |access-date=30 June 2019 |date=22 August 2006 |archive-date=20 October 2018 |archive-url=https://web.archive.org/web/20181020103737/http://news.bbc.co.uk/2/hi/south_asia/5273336.stm |url-status=live }}</ref>

==== Ainu ==== Within the Ainu religion, someone who dies by suicide is believed to become a ghost (tukap) who would haunt the living,<ref name="yamada">Takako Yamada: ''The Worldview of the Ainu. Nature and Cosmos Reading from Language'', p. 25–37, p. 123.</ref> to come to fulfillment from which they were excluded during life.<ref name="adami">Norbert Richard Adami: ''Religion und Schaminismus der Ainu auf Sachalin (Karafuto)'', Bonn 1989, p. 45.</ref> Also, someone who insults another so they kill themselves is regarded as co-responsible for their death.<ref name="adami-2">Adami: ''Religion und Schaminismus der Ainu auf Sachalin (Karafuto)'', p. 79, p. 119.</ref> According to Norbert Richard Adami, this ethic exists due to the case that solidarity within the community is much more important to Ainu culture than it is to the Western world.<ref name="adami-2" />

=== Philosophy === {{Main|Philosophy of suicide}}

A number of questions are raised within the philosophy of suicide, including what constitutes suicide, whether or not suicide can be a rational choice, and the moral permissibility of suicide.<ref name="StanfordSuicide">{{cite book |chapter-url=http://plato.stanford.edu/entries/suicide/ |title=Suicide (Stanford Encyclopedia of Philosophy) |publisher=Plato.stanford.edu |access-date=6 May 2009 |chapter=Suicide |year=2017 |archive-date=7 October 2008 |archive-url=https://web.archive.org/web/20081007202319/http://plato.stanford.edu/entries/suicide |url-status=live }}</ref> Arguments as to acceptability of suicide in moral or social terms range from the position that the act is inherently immoral and unacceptable under any circumstances, to a regard for suicide as a sacrosanct right of anyone who believes they have rationally and conscientiously come to the decision to end their own lives, even if they are young and healthy.

Opponents to suicide include philosophers such as Augustine of Hippo, Thomas Aquinas,<ref name="StanfordSuicide"/> Immanuel Kant<ref>Kant, Immanuel. (1785) ''Kant: The Metaphysics of Morals'', M. Gregor (trans.), Cambridge: Cambridge University Press, 1996. {{ISBN|978-0-521-56673-5}}. p. 177.</ref> and, arguably, John Stuart Mill – Mill's focus on the importance of liberty and autonomy meant that he rejected choices which would prevent a person from making future autonomous decisions.<ref>{{cite journal | vauthors = Safranek John P | year = 1998 | title = Autonomy and Assisted Suicide: The Execution of Freedom | journal = The Hastings Center Report | volume = 28 | issue = 4| pages = 32–36 | doi = 10.2307/3528611 | jstor = 3528611 | pmid = 9762538 }}</ref> Others view suicide as a legitimate matter of personal choice. Supporters of this position maintain that no one should be forced to suffer against their will, particularly from conditions such as incurable disease, mental illness, and old age, with no possibility of improvement. They reject the belief that suicide is always irrational, arguing instead that it can be a valid last resort for those enduring major pain or trauma.<ref>{{cite book | vauthors = Whiting R | title = A natural right to die: twenty-three centuries of debate | pages = 13–17 | publisher = Praeger | date = 2001 | isbn = 0-313-31474-8 }}</ref> A stronger stance would argue that people should be allowed to autonomously choose to die regardless of whether they are suffering. Notable supporters of this school of thought include Scottish empiricist David Hume,<ref name="StanfordSuicide"/> who accepted suicide so long as it did not harm or violate a duty to God, other people, or the self,<ref name="Reed-2020" /> and American bioethicist Jacob Appel.<ref name=pmid17649899/><ref>{{cite journal | author-link1 = Wesley J. Smith | vauthors = Smith WJ | title = Death on Demand: The assisted-suicide movement sheds its fig leaf | journal = NRL News | date = August 2007 | volume = 34 | issue = 8 | page = 18 | url = https://www.nrlc.org/archive/news/2007/NRL08/Smith.html | access-date = 25 July 2020 | archive-date = 16 April 2021 | archive-url = https://web.archive.org/web/20210416021221/https://www.nrlc.org/archive/news/2007/NRL08/Smith.html }}</ref>

=== Adverse attitudes=== Society may have negative attitudes towards suicide, which can lead to suicidal people experiencing discrimination, stigmatization, exclusion, pathologization, and incarceration. They may be hospitalized or drugged without their consent, have difficulties in finding jobs or housing, and have their parental rights revoked. Suicide is not seen as a positive human right or a logical decision given circumstances. Suicidal people are not seen as having potentially valuable messages to convey.<ref>{{Cite web|url=https://templepress.wordpress.com/2023/05/31/a-qa-with-alexandre-baril/|title=A Q&A with Alexandre Baril|date=31 May 2023|access-date=17 October 2024|archive-date=3 December 2024|archive-url=https://web.archive.org/web/20241203215857/https://templepress.wordpress.com/2023/05/31/a-qa-with-alexandre-baril/|url-status=live}}</ref><ref>{{Cite web|url=https://www.nationwidechildrens.org/family-resources-education/700childrens/2019/11/suicide-is-not-a-choice|title=Don't Say It's Selfish: Suicide Is Not a Choice|website=www.nationwidechildrens.org|access-date=17 October 2024|archive-date=3 October 2024|archive-url=https://web.archive.org/web/20241003093523/https://www.nationwidechildrens.org/family-resources-education/700childrens/2019/11/suicide-is-not-a-choice|url-status=live}}</ref><ref>{{cite journal |last1=Baril |first1=Alexandre |title=Suicidism: A new theoretical framework to conceptualize suicide from an anti-oppressive perspective |journal=Disability Studies Quarterly |date=10 September 2020 |volume=40 |issue=3 |doi=10.18061/dsq.v40i3.7053 |doi-access=free |quote=an oppressive system (stemming from non-suicidal perspectives) functioning at the normative, discursive, medical, legal, social, political, economic, and epistemic levels in which suicidal people experience multiple forms of injustice and violence… }}</ref>

===Advocacy === {{See also|Advocacy of suicide}} [[File:Alexandre-Gabriel Decamps - The Suicide - Walters 3742.jpg|thumb|In this painting by Alexandre-Gabriel Decamps, the palette, pistol, and note lying on the floor suggest that the event has just taken place; an artist has taken his own life.<ref>{{cite web |publisher= The Walters Art Museum |url= http://art.thewalters.org/detail/1589 |title= The Suicide |url-status=live |archive-url= https://web.archive.org/web/20130116021944/http://art.thewalters.org/detail/1589 |archive-date= 16 January 2013 }}</ref>]] Advocacy of suicide has occurred in many cultures and subcultures. The Japanese military during World War II encouraged and glorified kamikaze attacks, which were suicide attacks by military aviators from the Empire of Japan against Allied naval vessels in the closing stages of the Pacific Theater of World War II. Japanese society as a whole has been described as "suicide-tolerant"<ref name="ozawa-desilva">{{cite journal | vauthors = Ozawa-de Silva C | title = Too lonely to die alone: internet suicide pacts and existential suffering in Japan | journal = Culture, Medicine and Psychiatry | volume = 32 | issue = 4 | pages = 516–51 | date = December 2008 | pmid = 18800195 | doi = 10.1007/s11013-008-9108-0 }}</ref> (see Suicide in Japan).

Internet searches for information on suicide return webpages that, in a 2008 study, about 50% of the time provide information on suicide methods. A similar study found that 11% of sites encouraged suicide attempts.<ref>{{cite journal |last1=Luxton |first1=David D. |last2=June |first2=Jennifer D. |last3=Fairall |first3=Jonathan M. |date=May 2012 |title=Social Media and Suicide: A Public Health Perspective |journal=American Journal of Public Health |volume=102 |issue=Suppl 2 |pages=S195–S200 |doi=10.2105/AJPH.2011.300608 |pmc=3477910 |pmid=22401525}}</ref> There is some concern that such sites may push those already predisposed to attempt suicide. Some people form suicide pacts online, either with pre-existing friends or people they have recently encountered in chat rooms or message boards. The Internet, however, may also help prevent suicide by providing a social group for those who are isolated.<ref name=Dur2011>{{cite journal | vauthors = Durkee T, Hadlaczky G, Westerlund M, Carli V | title = Internet pathways in suicidality: a review of the evidence | journal = International Journal of Environmental Research and Public Health | volume = 8 | issue = 10 | pages = 3938–52 | date = October 2011 | pmid = 22073021 | pmc = 3210590 | doi = 10.3390/ijerph8103938 | doi-access = free }}</ref>

=== Locations === {{See also|List of suicide sites|Suicides at the Golden Gate Bridge}} Some landmarks have become known for high levels of suicide attempts.<ref name=Robinson2012/> These include China's Nanjing Yangtze River Bridge,<ref>{{cite web|url=https://www.thenationalnews.com/world/asia/a-voice-of-reason-on-yangtze-bridge-1.228563|title=A voice of reason on Yangtze bridge|website=The National|date=8 July 2008|language=en|access-date=16 October 2019}}</ref> San Francisco's Golden Gate Bridge, Japan's Aokigahara Forest,<ref>{{cite book | vauthors = Robinson P, Heitmann S, Dieke PU |title=Research themes for tourism|year=2010|publisher=CABI|location=Oxfordshire [etc.]|isbn=978-1-84593-684-6|page=172|url=https://books.google.com/books?id=219aFMSRPqgC&pg=PA172 }}</ref> England's Beachy Head,<ref name=Robinson2012>{{cite book |vauthors=Picard D, Robinson M |title=Emotion in motion: tourism, affect and transformation |publisher=Ashgate Publishing |location=Farnham, Surrey |isbn=978-1-4094-2133-7 |page=176 |url=https://books.google.com/books?id=PjuY_4Vy_UUC&pg=PT176 |date=28 November 2012}}</ref> and Toronto's Bloor Street Viaduct.<ref name=Dennis2008>{{cite book |vauthors=Dennis R |title=Cities in modernity: representations and productions of metropolitan space, 1840–1930 |year=2008 |publisher=Cambridge University Press |location=Cambridge [u.a.] |isbn=978-0-521-46841-1 |page=20 |url=https://books.google.com/books?id=Gq9_uNNkmKUC&pg=PA20 |edition=Repr. |archive-date=1 October 2024 |access-date=27 June 2015 |archive-url=https://web.archive.org/web/20241001061935/https://books.google.com/books?id=Gq9_uNNkmKUC&pg=PA20 |url-status=live }}</ref> {{As of|2010}}, the Golden Gate Bridge has had more than 1,300 suicides by jumping since its construction in 1937.<ref name="McDougall2010">{{cite book |vauthors=McDougall T, Armstrong M, Trainor G |title=Helping children and young people who self-harm: an introduction to self-harming and suicidal behaviours for health professionals |year=2010 |publisher=Routledge |location=Abingdon, Oxon |isbn=978-0-415-49913-2 |page=23 |url=https://books.google.com/books?id=2VfP1-o0BgcC&pg=PA23}}</ref> Many locations where suicide is common have constructed barriers to prevent it;<ref name="Bateson2008">{{cite book |url=https://archive.org/details/buildinghopelead0000bate |url-access=registration |title=Building hope: leadership in the nonprofit world |vauthors=Bateson J |publisher=Praeger |year=2008 |isbn=978-0-313-34851-8 |location=Westport, CT |page=[https://archive.org/details/buildinghopelead0000bate/page/180 180]}}</ref> this includes the Luminous Veil in Toronto,<ref name="Dennis2008" /> the Eiffel Tower in Paris, the West Gate Bridge in Melbourne, and Empire State Building in New York City.<ref name="Bateson2008" /> They generally appear to be effective.<ref name="Miller2011">{{cite book |vauthors=Miller D |title=Child and Adolescent Suicidal Behavior: School-Based Prevention, Assessment, and Intervention |year=2011 |isbn=978-1-60623-997-1 |page=46 |publisher=Guilford Press |url=https://books.google.com/books?id=bAHcIUDoVEoC&pg=PA46}}</ref>

=== Notable cases === {{Main|List of suicides|List of suicides (A–M)|List of suicides (N–Z)}}

An example of mass suicide is the 1978 Jonestown mass murder/suicide in which 909 members of the Peoples Temple, an American new religious movement led by Jim Jones, ended their lives by drinking grape Flavor Aid laced with cyanide and various prescription drugs.<ref>Hall 1987, p.282</ref><ref name="tape">{{cite web |title=Alternative Considerations of Jonestown and Peoples Temple |url=http://jonestown.sdsu.edu/AboutJonestown/Tapes/Tapes/DeathTape/death.html | publisher=San Diego State University |access-date=10 November 2011 |archive-url=https://web.archive.org/web/20110220005202/http://jonestown.sdsu.edu/AboutJonestown/Tapes/Tapes/DeathTape/death.html |archive-date=20 February 2011 }}</ref><ref>"1978:[http://news.bbc.co.uk/onthisday/hi/dates/stories/november/18/newsid_2540000/2540209.stm Mass Suicide Leaves 900 Dead] {{webarchive|url=https://web.archive.org/web/20121104074001/http://news.bbc.co.uk/onthisday/hi/dates/stories/november/18/newsid_2540000/2540209.stm |date=2012-11-04 }}". Retrieved 9 November 2011.</ref>

Thousands of Japanese civilians took their own lives in the last days of the Battle of Saipan in 1944, some jumping from "Suicide Cliff" and "Banzai Cliff".<ref>John Toland, ''The Rising Sun: The Decline and Fall of the Japanese Empire 1936–1945'', Random House, 1970, p. 519</ref> The 1981 Irish hunger strikes, led by Bobby Sands, resulted in 10 deaths. The cause of death was recorded by the coroner as "starvation, self-imposed" rather than suicide; this was modified to simply "starvation" on the death certificates after protest from the dead strikers' families.<ref name="Philosophy59OKeeffe">{{cite journal |jstor=3750951 |title=Suicide and Self-Starvation |journal=Philosophy |volume=59 |issue=229 |pages=349–363 |vauthors=O'Keeffe TM |year=1984 |doi=10.1017/S0031819100069941 }}</ref> During World War II, Erwin Rommel was found to have foreknowledge of the 20 July plot on Adolf Hitler's life; he was threatened with public trial, execution, and reprisals on his family unless he killed himself.<ref>{{cite book |vauthors=Watson B |title=Exit Rommel: The Tunisian Campaign, 1942–43 |publisher=Stackpole Books |year=2007 |page=170 |isbn=978-0-8117-3381-6}}</ref>

== Other species == {{Main|Animal suicide}}

As suicide requires a wilful attempt to die, some feel it therefore cannot be said to occur in non-human animals.<ref name=Maris2000>{{cite book |vauthors=Maris R |title=Comprehensive textbook of suicidology |year=2000 |publisher=Guilford Press |location=New York [u.a.] |isbn=978-1-57230-541-0 |pages=97–103 |url=https://books.google.com/books?id=Zi-xoFAPnPMC&pg=PA97}}</ref> Suicidal behavior has been observed in ''Salmonella'' seeking to overcome competing bacteria by triggering an immune system response against them.<ref>{{cite news|url=https://www.nytimes.com/2008/08/26/science/26obsalm.html |title=In Salmonella Attack, Taking One for the Team |work=The New York Times |vauthors=Chang K |date=25 August 2008 |url-status=live |archive-url=https://web.archive.org/web/20170805103824/http://www.nytimes.com/2008/08/26/science/26obsalm.html?ref=science |archive-date=5 August 2017}}</ref> Suicidal defenses by workers are also seen in the Brazilian ant ''Forelius pusillus'', where a small group of ants leaves the security of the nest after sealing the entrance from the outside each evening.<ref>{{cite journal |last1=Tofilski |first1=Adam |last2=Couvillon |first2=Margaret J. |last3=Evison |first3=Sophie E. F. |last4=Helanterä |first4=Heikki |last5=Robinson |first5=Elva J. H. |last6=Ratnieks |first6=Francis L. W. |title=Preemptive Defensive Self-Sacrifice by Ant Workers |journal=The American Naturalist |date=November 2008 |volume=172 |issue=5 |pages=E239–E243 |doi=10.1086/591688 |pmid=18928332 |bibcode=2008ANat..172E.239T }}</ref>

Pea aphids, when threatened by a ladybug, can explode themselves, scattering and protecting their brethren and sometimes even killing the ladybug; this form of suicidal altruism is known as autothysis.<ref>{{cite news |url=http://news.discovery.com/animals/animal-suicide-behavior.html |title=Animal Suicide Sheds Light on Human Behavior |vauthors=O'Hanlon L |date=10 March 2010 |publisher=Discovery News |url-status=live |archive-url=https://web.archive.org/web/20100725200146/http://news.discovery.com/animals/animal-suicide-behavior.html |archive-date=25 July 2010}}</ref> Some species of termites (for example ''Globitermes sulphureus'')<ref name="Bordereau-1997">{{cite journal |vauthors=Bordereau C, Robert A, Van Tuyen V, Peppuy A |date=1 August 1997 |title=Suicidal defensive behaviour by frontal gland dehiscence in Globitermes sulphureus Haviland soldiers (Isoptera) |journal=Insectes Sociaux |volume=44 |issue=3 |pages=289–297 |doi=10.1007/s000400050049 |bibcode=1997InSoc..44..289B }}</ref> have soldiers that explode, covering their enemies with sticky goo.<ref>{{cite web |url=http://www.bbc.co.uk/pressoffice/pressreleases/stories/2005/10_october/20/life_horrors.shtml |title=Life In The Undergrowth |publisher=BBC |access-date=10 July 2010 |archive-date=15 February 2006 |archive-url=https://web.archive.org/web/20060215125044/http://www.bbc.co.uk/pressoffice/pressreleases/stories/2005/10_october/20/life_horrors.shtml |url-status=live }}</ref><ref name="Bordereau-1997"/>

There have been anecdotal reports of dogs, horses, and dolphins killing themselves,<ref>{{cite magazine |title=Do Animals Commit Suicide? A Scientific Debate |magazine=Time |date=19 March 2010 |vauthors=Nobel J |url=http://www.time.com/time/health/article/0,8599,1973486,00.html |archive-url=https://web.archive.org/web/20100322192029/http://www.time.com/time/health/article/0,8599,1973486,00.html |archive-date=22 March 2010}}</ref> but little scientific study has been done regarding animal suicide.<ref name="pmid9616791">{{cite journal |vauthors=Stoff DM, Mann JJ |title=Suicide research. Overview and introduction |journal=Annals of the New York Academy of Sciences |volume=836 |issue=1 |pages=1–11 |date=December 1997 |pmid=9616791 |doi=10.1111/j.1749-6632.1997.tb52352.x |bibcode=1997NYASA.836....1S }}</ref> Animal suicide is usually put down to romantic human interpretation and is not generally thought to be intentional. Some of the reasons animals are thought to unintentionally kill themselves include: psychological stress, infection by certain parasites or fungi, or disruption of a long-held social tie, such as the ending of a long association with an owner and thus not accepting food from another individual.<ref>{{cite web |vauthors=Hogenboom M |date=6 July 2016 |access-date=20 July 2017 |title=Many animals seem to kill themselves, but it is not suicide |website=BBC |url=http://www.bbc.com/earth/story/20160705-many-animals-seem-to-kill-themselves-but-it-is-not-suicide |url-status=live |archive-url=https://web.archive.org/web/20170226233605/http://www.bbc.com/earth/story/20160705-many-animals-seem-to-kill-themselves-but-it-is-not-suicide |archive-date=26 February 2017}}</ref>

== References == {{Reflist}}

== Further reading == {{Library resources box}} * {{cite book |vauthors=Gambotto A |title=The Eclipse: A Memoir of Suicide |publisher=Broken Ankle Books |location=Australia |year=2004 |isbn=978-0-9751075-1-5 |title-link=The Eclipse: A Memoir of Suicide}} * {{cite book |title=Suicide in Nazi Germany |vauthors=Goeschel C |publisher=Oxford University Press |year=2009 |isbn=978-0-19-953256-8 |url=https://books.google.com/books?id=EIjccRg7_UYC}}

== External links == * {{cite book |title=Preventing suicide: a global imperative |date=2014 |publisher=WHO |isbn=978-92-4-156477-9 |hdl=10665/131056 |hdl-access=free }} * Freakonomics podcast: [http://freakonomics.com/podcast/new-freakonomics-radio-podcast-the-suicide-paradox/ The Suicide Paradox]

{{Medical resources | ICD10 = {{ICD10|X60-X84}} | ICD9 = {{ICD9|E950}} | DiseasesDB=12641 | MedlinePlus = 001554 | eMedicineSubj = article | eMedicineTopic = 288598 | MeshName = Suicide | MeshNumber = F01.145.126.980.875 }} {{Suicide navbox}} {{Death}} {{Sister bar|display=Suicide}} {{Authority control}}

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