Toward an Understanding
of Suicidal Conduct
Part 1 of 3

1.

Suicide has unique moral, social, and emotional meanings, because suicide is choosing to be death's simultaneous agent and victim. This conscious choice to be one's own assassin is inconceivable to many people, deeply offensive to others, and shattering for survivors. It is also agonizing to the person who contemplates making this choice. Suicide prevention is an important goal of all programs of Mental Health Services for Homeless Persons, Inc. (MHS), particularly of our Mobile Crisis Team. We work to help our clients understand their suicidal thinking, identify events and situations in their lives that contribute to suicidal risk, and take steps to achieve safety. We present information here to promote an informed and compassionate understanding of suicide, to foster frank discussions about it, and to encourage you to take action to help yourselves and others achieve safe conduct.

2.

Each suicide is the end result of a unique constellation of unfolding and changing thoughts, events, and situations. These thoughts, events, and situations influence each other. Some disappear. New ones emerge. Most leave no physical trace or marker. Therefore, the attempt to understand even a single suicide is an ambitious enterprise. An attempt to understand suicide as a general phenomenon is even more ambitious. If each suicidal act is unique, can we learn anything from one suicide that will help us to understand the next one? Can we learn enough from many suicides to reliably identify the person who is suicidal? Can we then take steps to help the person, and perhaps forestall a suicide?

3.

We can honestly answer only one of these questions with a "yes." To the first question, we can guardedly say that clinicians and researchers have learned things from their study of suicides that help us to understand suicide in ways that weren't possible before their research. What has been learned, however, does not allow us to reliably identify who will harm themselves. And although there are effective preventive measures that we can and should take, we cannot state that we know enough to prevent a suicide.

4.

We have learned that there are certain characteristics of the person, situation, or environment that are more common among suicidal persons than among others. We call these characteristics "risk factors," because careful research has shown that they are reliably associated with an increased risk of suicidal conduct. We will describe some of the most important risk factors, and their relationship to suicidal conduct. Learning to identify risk factors, and using them to guide our decisions, is a valuable enterprise. We also need to achieve an understanding that is both empathic and dispassionate of the unique thoughts, events, and situations that are leading the person to the suicidal plan.

5.

Among all deaths, suicidal deaths are relatively infrequent. There were 2,417,798 deaths in the U.S.A. in 2001 (Arias & Smith, 2003, p.4). Most were the result of heart disease, cancer, and other illnesses, as shown in the table below. Four per cent were from accidents. Fewer than one per cent were the result of homicide. Suicide was the cause of 29,423 deaths, accounting for about 1.2% of all deaths. However, suicide accounted for 12% of all deaths of those 15-24 years of age, 8% of those 25-44, and 4% of those 5-14 years of age (Arias & Smith, 2003, pp. 26-27).

Already, we have chanced upon one of the factors most reliably associated with suicidal risk: age. However, we need to clarify some statistical issues before we proceed.

Reference
Arias, E., & Smith, B.L. (2003, March 14). Deaths: Preliminary data for 2001 (DHHS Publication No. (PHS) 2003-1120). National vital statistics reports; Vol. 51, No. 5. Hyattsville, Maryland: National Center for Health Statistics.

6.

We use ratios and their cousins - percentages - to help us to understand how frequently an event occurs, or how large a subgroup is within a population. One way to grasp the magnitude of suicidal deaths is to compare suicidal deaths with deaths of all causes. In the table above, we see that 29,423 people died of suicide in the U.S. in 2001. These deaths accounted for 1.2% of all deaths.

A different way to understand the magnitude of suicidal deaths is to compare the number of suicidal deaths in one year, with the total population during that year. Recall that 29,423 people took their lives in the United States in 2001. The total population of the U.S. in 2001 was estimated to be 284,781,861. The number 29,423, divided by 284,781,861, is equal to 0.000103. In other words, the proportion of all people in the U.S. in 2001 who died of suicide in 2001 was 0.000103, or 0.0103 per cent, or about one one-hundredth of one percent. Most people find this to be a clumsy way to express a number, and a way that is likely to lead to errors and misunderstandings. If we multiply the quotient (0.000103) by 100,000, we get 10.3, a number that is expressed more easily and recorded more accurately. It expresses the fact that there were 10.3 suicidal deaths in 2001 for every 100,000 people who were living in 2001. The final column in the table - entitled "rate" - presents this ratio for the United States. It shows that suicide was the 11th most frequent cause of death among all people in the U.S. in 2001.

7.

The overall rate of suicidal death increases as age increases. This is shown in the next table, examining all deaths and suicidal deaths by age group. Among people of all ages, suicide accounted for just 1.2% of all deaths, and the rate was 10.3 per 100,000 people. Among those 15-24 years of age, however, suicide accounted for 12% of all deaths, even though the rate was only 9.6 people per 100,000 people of this age. This is because very few people of these ages (fewer than one-tenth of one percent of them) died of any cause during the year. Among those who died, however, suicide was the third most-frequent cause of death, after accidents (13,871 deaths), and homicides/assaults (5,126). The rate of 9.6 per 100,000 tells us that a smaller proportion of people in this age group took their lives than people of all age groups. In general, as age increases, the rate increases, with those of 65 years of age or greater having a rate more than 50% higher than those in the general population.

8.

However, this general association of increased age with increased rate completely breaks down when we include the factors of sex and race, as shown in the following bar graph. (Corresponding data for 2001 were not available at the time this was prepared.) The rate of suicidal deaths increased with age only for white males. Among African-Americans, both males and females of age 65 or greater had a lower rate than those of age 15-24 years.

What is most striking about this graph, however, is the impact of sex. Among African-Americans and whites, males had suicidal death rates from 324% higher than females (among all whites), to 650% higher than females (among whites age 65+). Race was also an important factor. White females had a rate of suicidal death (4.5 per 100,000) that was 181% higher than African-American females (1.6). White males had a rate (19.1) that was 91% higher than African-American males (10.0).

9.

Rates of suicidal deaths have generally decreased during the last ten years, as shown below. From 1990 to 2000, the overall rate decreased by 13.7%. For men, the rate dropped 14.2%; for women, 14.6%. For whites, the rate decreased by 13.3%; for African-Americans, 18.8%.

10.

The most striking declines in rates of suicidal deaths are apparent when the data are examined by age group, as presented below. Among those 15-24 years of age, the rate declined 21.2% from 1990 to 2000. The greatest declines were apparent for those age 55 and greater. Among those 55-64 years old, the decline was 23.1%. For those 65-74, the rate decreased by 29.6%. For those 75-84, the rate declined 28.9%.