Epidemiology and methodology of suicide

Incidence of suicide
Suicide
Suicide is the act of intentionally causing one's own death. Suicide is often committed out of despair or attributed to some underlying mental disorder, such as depression, bipolar disorder, schizophrenia, alcoholism, or drug abuse...

is under-reported due to both religious and social pressures, and possibly completely unreported in some areas. Nevertheless, from reported cases, certain trends are apparent. Since the data is skewed, comparing suicide rates between nations is statistically unsound. The trends themselves are not the cause, but may be indicative of a root cause.

Epidemiology

**Suicides per 100,000 people per year:**
Rank	Country	Year	Males	Females	Total
1.	Lithuania Lithuania Lithuania , officially the Republic of Lithuania is a country in Northern Europe, the biggest of the three Baltic states. It is situated along the southeastern shore of the Baltic Sea, whereby to the west lie Sweden and Denmark...	2005	68.1	12.9	38.6
2.	Belarus Belarus Belarus , officially the Republic of Belarus, is a landlocked country in Eastern Europe, bordered clockwise by Russia to the northeast, Ukraine to the south, Poland to the west, and Lithuania and Latvia to the northwest. Its capital is Minsk; other major cities include Brest, Grodno , Gomel ,...	2003	63.3	10.3	35.1
3.	Russia Russia Russia or , officially known as both Russia and the Russian Federation , is a country in northern Eurasia. It is a federal semi-presidential republic, comprising 83 federal subjects...	2004	61.6	10.7	34.3
4.	Kazakhstan Kazakhstan Kazakhstan , officially the Republic of Kazakhstan, is a transcontinental country in Central Asia and Eastern Europe. Ranked as the ninth largest country in the world, it is also the world's largest landlocked country; its territory of is greater than Western Europe...	2003	51.0	8.9	29.2
5.	Slovenia Slovenia Slovenia , officially the Republic of Slovenia , is a country in Central and Southeastern Europe touching the Alps and bordering the Mediterranean. Slovenia borders Italy to the west, Croatia to the south and east, Hungary to the northeast, and Austria to the north, and also has a small portion of...	2003	45.0	12.0	28.1
6.	Hungary Hungary Hungary , officially the Republic of Hungary , is a landlocked country in Central Europe. It is situated in the Carpathian Basin and is bordered by Slovakia to the north, Ukraine and Romania to the east, Serbia and Croatia to the south, Slovenia to the southwest and Austria to the west. The...	2003	44.9	12.0	27.7
7.	Latvia Latvia Latvia , officially the Republic of Latvia , is a country in the Baltic region of Northern Europe. It is bordered to the north by Estonia , to the south by Lithuania , to the east by the Russian Federation , to the southeast by Belarus and shares maritime borders to the west with Sweden...	2004	42.9	8.5	24.3
8.	Japan Japan Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...	2004	35.6	12.8	24.0
9.	Ukraine Ukraine Ukraine is a country in Eastern Europe. It has an area of 603,628 km², making it the second largest contiguous country on the European continent, after Russia...	2004	43.0	7.3	23.8
10.	Sri Lanka Sri Lanka Sri Lanka, officially the Democratic Socialist Republic of Sri Lanka is a country off the southern coast of the Indian subcontinent. Known until 1972 as Ceylon , Sri Lanka is an island surrounded by the Indian Ocean, the Gulf of Mannar and the Palk Strait, and lies in the vicinity of India and the...	1996	NA	NA	21.6

A 2006 report by the World Health Organisation (WHO) states that nearly a million people take their own lives every year, more than those murdered or killed in war. WHO figures show a suicide takes place somewhere in the world every 40 seconds. Suicide rates are highest in Europe's Baltic states

Baltic states

The term Baltic states refers to the Baltic territories which gained independence from the Russian Empire in the wake of World War I: primarily the contiguous trio of Estonia, Latvia, Lithuania ; Finland also fell within the scope of the term after initially gaining independence in the 1920s.The...

, where around 40 people per 100,000 die by suicide each year, second in line is in the Sub-Saharan Africa

Sub-Saharan Africa

Sub-Saharan Africa as a geographical term refers to the area of the African continent which lies south of the Sahara. A political definition of Sub-Saharan Africa, instead, covers all African countries which are fully or partially located south of the Sahara...

where 32 people per 100,000 die by suicide each year. The lowest rates are found mainly in Latin America and a few countries in Asia.

In 1998, the World Health Organization

World Health Organization

The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

ranked suicide as the twelfth leading cause of death worldwide.

In most countries the incidence of suicides is higher than the incidence of intentional homicide

Homicide

Homicide refers to the act of a human killing another human. Murder, for example, is a type of homicide. It can also describe a person who has committed such an act, though this use is rare in modern English...

s.

As many as 60,000 people commit suicide in Russia

Russia

Russia or , officially known as both Russia and the Russian Federation , is a country in northern Eurasia. It is a federal semi-presidential republic, comprising 83 federal subjects...

every year; approximately 30,000 people die by suicide each year in the United States

United States

The United States of America is a federal constitutional republic comprising fifty states and a federal district...

; over 30,000 kill themselves in Japan

Japan

Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...

; and about 250,000 commit suicide each year in China

China

Chinese civilization may refer to:* China for more general discussion of the country.* Chinese culture* Greater China, the transnational community of ethnic Chinese.* History of China* Sinosphere, the area historically affected by Chinese culture...

. In western countries men commit suicide at four times the rate of women. Women are more likely to attempt suicide

Parasuicide

Parasuicide refers to suicide attempts or gestures and self-harm where there is no result in death. It is a non-fatal act in which a person deliberately causes injury to himself or ingests any prescribed or generally recognised therapeutic dose in excess...

than men. The countries of the former Soviet Bloc have the highest suicide rate in the world. The region with the lowest suicide rate is Latin America

Latin America

Latin America is a region of the Americas where Romance languages – particularly Spanish and Portuguese, and variably French – are primarily spoken. Latin America has an area of approximately 21,069,500 km² , almost 3.9% of the Earth's surface or 14.1% of its land surface area...

.
Up to at least the 1950s, it was the Republic of Ireland which had the lowest suicide rate in the world, as reported by an Irish TV news report in 2007. China

China

is the only country in the world where the rate of suicide by women matches that of men, with statistics even showing a slightly higher number of female cases.

According to the National Institute of Mental Health

National Institute of Mental Health

The National Institute of Mental Health is one of 27 institutes and centers that make up the National Institutes of Health...

, suicide contagion is a serious problem, especially for young people. Suicide can be facilitated in vulnerable teens by exposure to real or fictional accounts of suicide, including media coverage of suicide, such as intensive reporting of the suicide of a celebrity or idol.

Gender and suicide

In the United States

United States

The United States of America is a federal constitutional republic comprising fifty states and a federal district...

, male

Male

Male refers to the biological sex of an organism, or part of an organism, which produces small mobile gametes, called spermatozoa. Each spermatozoon can fuse with a larger female gamete or ovum, in the process of fertilization...

s are four times more likely to die by suicide than female

Female

Female is the sex of an organism, or a part of an organism, which produces non-mobile ova .- Defining characteristics :The ova are defined as the larger gametes in a heterogamous reproduction system, while the smaller, usually motile gamete, the spermatozoon, is produced by the male...

s, although more women than men report suicide attempts. Male suicide rates are higher than females in all age groups (the ratio varies from 3:1 to 10:1). In other western countries, males are also much more likely to die by suicide than females (usually by a factor of 3–4:1). It was the 8th leading cause of death for males, and 19th leading cause of death for females. Excess male mortality from suicide is also evident from data from non-Western countries.

Race and suicide

In 2003, in the United States, whites were nearly 2.5 times more likely to kill themselves than were blacks or Hispanics. There is a marked divergence by age as seen in the chart below. In the eastern portion of the world (primarily in Asian or Pacific-Island countries) the numbers of reported suicides is growing every year. Of all ethnic groups in the United States, Native Americans

Native Americans in the United States

Native Americans in the United States are the indigenous peoples in North America within the boundaries of the present-day continental United States, parts of Alaska, and the island state of Hawaii. They are composed of numerous, distinct tribes, states, and ethnic groups, many of which survive as...

, Multiracial American

Multiracial American

Multiracial Americans, US residents who identify themselves as of "two or more races", were numbered at around 9 million, or 2.9% of the population, in the census of 2010. However there is considerable evidence that the real number is far higher. Prior to the mid-20th century many people hid their...

s, and Filipino American

Filipino American

Filipino Americans are Americans of Filipino ancestry. Filipino Americans, often shortened to "Fil-Ams", or "Pinoy",Filipinos in what is now the United States were first documented in the 16th century, with small settlements beginning in the 18th century...

s have the highest risk of suicide.

Sexual orientation and suicide

The likelihood of suicide attempts are increased in both gay males and lesbians, as well as bisexuals of both sexes when compared to their heterosexual counterparts. The trend of having a higher incident rate

Gender and suicide

The relationship between gender and suicide has been extensively researched by Western sociologists, given that males die much more often by means of suicide than do females, although reported suicide attempts are 3 times more common among females than males...

among females is no exception with lesbians or bisexual females and when compared with homosexual males, lesbians are more likely to attempt than gay or bisexual males.

Studies vary with just how increased the risk is compared to heterosexuals with a low of 0.8-1.1 times more likely for females and 1.5-2.5 times more likely for males. The highs reach 4.6 more likely in females and 14.6 more likely in males.

Race and age play a factor in the increased risk. The highest ratios for males are attributed to caucasians when they are in their youthhood. By the age of 25, their risk is down to less than half of what it was however black gay males risk steadily increases to 8.6 times more likely. Through a lifetime the risks are 5.7 for white and 12.8 for black gay and bisexual males. Lesbian and bisexual females have opposite effects with less attempts in youthhood when compared to heterosexual females. Through a lifetime the likelihood to attempt nearly triple the youth 1.1 ratio for caucasian females, however for black females the rate is affected very little (less than 0.1 to 0.3 difference) with heterosexual black females having a slightly higher risk throughout most of the age-based study.

Gay and lesbian youth who attempt suicide are disproportionately subject to anti-gay attitudes, and have weaker skills for coping with discrimination, isolation, and loneliness, and were more likely to experience family rejection than those who do not attempt suicide. Another study found that gay and bisexual youth who attempted suicide had more feminine gender roles, adopted an LGB identity at a young age and were more likely than peers to report sexual abuse, drug abuse, and arrests for misconduct.

One study found that same-sex sexual behavior, but not homosexual attraction or homosexual identity, was significantly predictive of suicide among Norwegian adolescents. In Denmark, the age-adjusted suicide mortality risk for men in registered domestic partnerships was nearly eight times greater than for men with positive histories of heterosexual marriage and nearly twice as high for men who had never married.

Social factors and suicide

Higher levels of social and national cohesion reduce suicide rates. Suicide levels are highest among the retired, unemployed

Unemployment

Unemployment , as defined by the International Labour Organization, occurs when people are without jobs and they have actively sought work within the past four weeks...

, impoverished

Poverty

Poverty is the lack of a certain amount of material possessions or money. Absolute poverty or destitution is inability to afford basic human needs, which commonly includes clean and fresh water, nutrition, health care, education, clothing and shelter. About 1.7 billion people are estimated to live...

, divorce

Divorce

Divorce is the final termination of a marital union, canceling the legal duties and responsibilities of marriage and dissolving the bonds of matrimony between the parties...

d, the childless, urbanites, empty nesters, and other people who live alone. Suicide rates also rise during times of economic uncertainty (although poverty

Poverty

is not a direct cause, it can contribute to the risk of suicide). Epidemiological

Epidemiology

Epidemiology is the study of health-event, health-characteristic, or health-determinant patterns in a population. It is the cornerstone method of public health research, and helps inform policy decisions and evidence-based medicine by identifying risk factors for disease and targets for preventive...

studies generally show a relationship between suicide or suicidal behaviors and socio-economic disadvantage, including limited educational achievement, homelessness

Homelessness

Homelessness describes the condition of people without a regular dwelling. People who are homeless are unable or unwilling to acquire and maintain regular, safe, and adequate housing, or lack "fixed, regular, and adequate night-time residence." The legal definition of "homeless" varies from country...

, unemployment, economic dependence and contact with the police

Police

The police is a personification of the state designated to put in practice the enforced law, protect property and reduce civil disorder in civilian matters. Their powers include the legitimized use of force...

or justice system. War

War

War is a state of organized, armed, and often prolonged conflict carried on between states, nations, or other parties typified by extreme aggression, social disruption, and usually high mortality. War should be understood as an actual, intentional and widespread armed conflict between political...

is traditionally believed to be associated with a fall in suicide rates, however this has been questioned in recent studies, showing a more complex picture than previously conceived.

Health and suicide

Depression, either unipolar or as part of bipolar disorder

Bipolar disorder

Bipolar disorder or bipolar affective disorder, historically known as manic–depressive disorder, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or...

, is an especially common cause. Substance abuse

Substance abuse

A substance-related disorder is an umbrella term used to describe several different conditions associated with several different substances .A substance related disorder is a condition in which an individual uses or abuses a...

, severe physical disease or infirmity are also recognized causes.

An unknown amount of suicide fatalities are misdiagnosed as consequences of severe illness.

Season and suicide

The idea that suicide is more common during the winter holidays (including Christmas

Christmas

Christmas or Christmas Day is an annual holiday generally celebrated on December 25 by billions of people around the world. It is a Christian feast that commemorates the birth of Jesus Christ, liturgically closing the Advent season and initiating the season of Christmastide, which lasts twelve days...

in the northern hemisphere

Northern Hemisphere

The Northern Hemisphere is the half of a planet that is north of its equator—the word hemisphere literally means “half sphere”. It is also that half of the celestial sphere north of the celestial equator...

) is actually a myth, generally reinforced by media coverage associating suicide with the holiday season. The National Center for Health Statistics

National Center for Health Statistics

National Center for Health Statistics is a division of the United States federal agency the Centers for Disease Control and Prevention . As such, NCHS is under the United States Department of Health and Human Services...

found that suicides drop during the winter months, and peak during spring and early summer. Considering that there is a correlation between the winter season and rates of depression, there are theories that this might be accounted for by capability to commit suicide and relative cheerfulness. Suicide has also been linked to other seasonal factors.

The variation in suicides by day of week is actually greater than any seasonal variation. In the United States, more people die by suicide on Monday than any other day; Saturday is the day with the least number of suicides.

Suicide trends

Certain time trends can be related to the type of death. In the United Kingdom

United Kingdom

The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...

, for example, the steady rise in suicides from 1945 to 1962-63 was probably to some extent curtailed following the removal of carbon monoxide

Carbon monoxide

Carbon monoxide , also called carbonous oxide, is a colorless, odorless, and tasteless gas that is slightly lighter than air. It is highly toxic to humans and animals in higher quantities, although it is also produced in normal animal metabolism in low quantities, and is thought to have some normal...

from domestic gas supplies which occurred with the change from coal gas

Coal gas

Coal gas is a flammable gaseous fuel made by the destructive distillation of coal containing a variety of calorific gases including hydrogen, carbon monoxide, methane and volatile hydrocarbons together with small quantities of non-calorific gases such as carbon dioxide and nitrogen...

to natural gas

Natural gas

Natural gas is a naturally occurring gas mixture consisting primarily of methane, typically with 0–20% higher hydrocarbons . It is found associated with other hydrocarbon fuel, in coal beds, as methane clathrates, and is an important fuel source and a major feedstock for fertilizers.Most natural...

during the sixties. Methods vary across cultures, and the easy availability of lethal agents and materials plays a role.

It is estimated that global annual suicide fatalities could rise to 1.5 million by 2020.
Worldwide, suicide ranks among the three leading causes of death among those aged 15–44 years. Suicide attempts are up to 20 times more frequent than completed suicides.

Suicide and body mass index

Risk of suicide decreases with increased weight and is low in obese persons

Obesity

Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems...

. The connection is not well understood, but it is hypothesized that elevated body weight results in higher circulating levels of tryptophan

Tryptophan

Tryptophan is one of the 20 standard amino acids, as well as an essential amino acid in the human diet. It is encoded in the standard genetic code as the codon UGG...

, serotonin

Serotonin

Serotonin or 5-hydroxytryptamine is a monoamine neurotransmitter. Biochemically derived from tryptophan, serotonin is primarily found in the gastrointestinal tract, platelets, and in the central nervous system of animals including humans...

, and leptin

Leptin

Leptin is a 16 kDa protein hormone that plays a key role in regulating energy intake and energy expenditure, including appetite and metabolism. It is one of the most important adipose derived hormones...

, which in turn reduces impulsivity

Impulsivity

Impulsivity is a personality trait characterized by the inclination of an individual to initiate behavior without adequate forethought as to the consequences of their actions, acting on the spur of the moment. Eysenck and Eysenck related impulsivity to risk-taking, lack of planning, and making up...

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