Demographics
Economic Factors Suicide and suicide attempts are relatively equal in low-income and high-income countries, with some variance among gender and age groups. In high- income countries, such as the United States, suicide is most common among adults over the age of 45. 18 Economic crises Economic crises (e.g., unemployment and decreased personal income) have been positively associated with suicide. Poverty rates have been found to have a strong association with suicide death rates among men and women above the age of 20 years. While initial unemployment has been identified as a risk factor for suicide, it should also be noted that the subsequent poverty and reduced or persistent limited access to resources also contribute to the risk of death by suicide. 23 Other studies have found that U.S. suicide rates are associated with economic cycles, with the rate decreasing during periods of economic expansion and increasing during contraction. These findings are supported by a study that found that, after controlling for depression, change in financial status was a more significant correlate of suicidal ideation than chronic poverty. 23 Industry and occupation Interestingly, suicide rates are also correlated with industry and occupation. The industry groups that have a higher rate of suicide are listed in Table 3. 24 PLEASE COMPLETE CASE STUDY 1 ON THE NEXT PAGE. Family and Home Factors According to the Washington State Department of Health (WA DOH), 15 the emotional toll of a suicide within the family increases the risk of death by suicide in the surviving family members. The data also supports that the risk of suicide attempts is higher in relatives of people who have died by suicide, and that the risk of dying by suicide is higher in relatives of people with a history of suicide
attempts. 21 Further, family conflicts, abuse, violence, lack of family connectedness and parents’ mental health disorders can also increase an individual’s suicide risk. Lastly, a history of foster care or adoption is also linked to higher suicide risk. 25 Mental Health Factors Depression and substance use disorders are the most common diagnoses among suicide victims. While depression is a strong risk factor for suicidal ideation and attempts, it lacks specificity as a predictor, and little is known about the specific characteristics that increase this risk. Comorbid psychiatric disorders also correlate with high suicide risk. A study examined comorbid disorders and suicide risk in severe depression/melancholia and found that the most common comorbidity was obsessive-compulsive behaviors, anxiety, and schizophrenia. 17 Impulsivity is a tendency to act without thinking through a plan or its consequences. It has been linked to suicidal behavior because of its association with mental health disorders and/or substance abuse. Impulsivity also has been associated with aggression and other violent behaviors, including suicide. 26 Multiple other factors, such as alcohol- and drug-related disorders, are common in people who die by suicide and exacerbate underlying risks or interact with depression to increase suicidal behavior. 18 Patients recently discharged from inpatient psychiatric units are at elevated risk for subsequent completed suicide, especially within the first week of discharge. Although rates decline relative to time after discharge, they do remain higher compared to the non-hospitalized population even several years after discharge, which provides a case for ongoing suicide safety assessments at discharge and several years after a discharge. 27 Previous studies have shown that 90 to 95% of individuals who die by suicide also suffer from at least one severe psychological problem 5 ; consequently, seeking and receiving psychological help is presumed to be a protective factor against suicide.
Children A well-characterized risk factor for death by suicide is exposure to early-life adversity, generally defined as parental neglect or childhood physical, sexual, or emotional abuse. Early-life adversity might also be transmitted through families, partly explaining the familial aggregation of suicidal behavior. Young people who die by suicide often have a high burden of adversity and a history of childhood abuse or neglect. 15 Children are most vulnerable to influences that may eventually lead to suicide. The Adverse Childhood Experiences (ACE) study, first conducted in the mid-1990s, examined the long-term health effects of trauma exposure, violence, and loss during childhood. The higher the person’s ACE score, the greater chance of a wide range of chronic health problems, including depression, anxiety, suicide, and PTSD. 16 A study of ACE data showed that ACEs were positively associated with reported suicide ideation and attempts, and the occurrence of at least three ACEs increased the likelihood of suicidal ideation and attempts threefold. 17 Elderly Eighty percent of suicide deaths in the U.S. are among men and women aged 45-54. However, the highest rate of suicides occurs among men aged 85 years and older 18 Death by suicide exists among the elderly and is directly linked to symptoms of depression and anxiety. 19 The developmental aspect of older Americans is often overlooked and considered a “natural part” of life; however, it is suspected that isolation, loss of loved ones, and untreated depression contribute to an increased risk of death by suicide in this age group.
Cultural and Geographic Factors
Immigrants It is essential to recognize that immigrants are at a higher risk for suicide. Risk factors include language barriers, worrying about the family at home, and separation, often leading to hopelessness, depression, and anxiety. Additionally, the lack of information on the way the healthcare system works, loss of status, loss of social networks, as well as acculturation challenges are identified as other potential contributing factors. 13 The U.S. suicide rate is highest amongst American Indian and Alaskan Native populations. 5 These ethnic groups tend to live in rural areas where suicide rates are higher compared to urban areas. 20 Rural areas often have lower availability of mental health services because of clinician shortages and social barriers, including stigma and lack of culturally competent care. 21 Geographic origin as a source of variation in the incidence of suicide underscores the importance of implementing suicide prevention strategies in rural areas. American Indian and Alaskan Native populations and Rural Areas
Table 3. Suicide Rates by Industry and Occupation Groups Industry Male
Female
Mining, Quarrying, and Oil and Gas Extraction
54.2 45.3 39.1 36.1 29.8 49.4 36.9 32.0 30.4
- - - -
Construction
Other Services (such as automotive repair) Agriculture, Forestry, Fishing, and Hunting Transportation and Warehousing Construction and Extraction Installation, Maintenance, and Repair Arts, Design, Entertainment, Sports, and Media
10.1 25.5
- -
Transportation and Material Moving
12.5 14.0 10.6
Protective Service Healthcare Support
- -
Note. Numbers in Male/Female columns indicate suicide rates per 100,000.
43
Powered by FlippingBook