Suicide is the act of intentionally taking one’s life. This definition, however, has been expanded to describe the range of thoughts and behaviors that are exhibited by individuals who are in some manner considering suicide. Suicidal ideation involves having thoughts of killing oneself or of being dead. Suicidal intent involves having a plan for how to kill oneself and intending to carry that plan out. Suicidal behavior is a broad term that includes all actions related to suicide (i.e., all the terms in this paragraph), but also includes some behaviors not captured by the other terms listed here, including actions related to suicide that did not result in an attempt, such as gathering bottles of pills (without taking them), or tying a noose (without using it). A suicide attempt occurs when an individual intends to take his or her own life, acts on that intent, but does not die. A suicide completion occurs when an individual intends to take his or her own life and dies as a result.
One way to understand suicidal behavior is to think of it as a continuum with ideation at the far left and completion to the far right: In this way, behaviors toward the left of the continuum are relatively less severe and behaviors to the right are relatively more severe because of their differing proximities to suicide completions. This continuum view has not been empirically validated (e.g., it is possible that suicidal ideation differs from suicide attempt in kind rather than just in degree), and in any event, all suicidal behaviors are serious and warrant assessment by a mental health professional.
Importance and Context of Suicide
Suicide is a serious health problem worldwide, including in the United States. In 2002, it is estimated that 31,655 individuals died by suicide, making suicide the 11th leading cause of death (homicide ranks 14th). Although rates vary somewhat year to year, approximately 30,000 people in the United States, and almost a million people die by suicide each year worldwide. On one hand, 30,000 U.S. deaths per year—one every 18 minutes or so—is a lot. On the other hand, suicide is a rare cause of death compared with other causes of death in the United States. For example, given that a person has died, the chance that the cause was heart disease or cancer is 52%. Given that someone has died, the chance that the cause of death was suicide is a little over 1%. However, the number of deaths by suicide (i.e., the number of suicide completions), though an accurate representation of the fact that death by suicide is rare, also greatly underestimates the magnitude of the problem: For every death by suicide, there are as many as 25 nonfatal attempts. Suicidal ideation is even more common than attempts: Estimates suggest that approximately 13% of individuals in the United States will experience substantial suicidal ideation at some point in their lifetime. Thus, suicide completions are relatively rare in the United States, but attempts are more common, and ideation is even more common.
The prevalence of suicidal behavior (i.e., how common it is) differs for men and women. Males complete suicide more often than females do, but females attempt suicide more often than males do. More specifically, men are approximately 4 times more likely than are women to die by suicide; women are approximately 3 times as likely as men to attempt suicide. This pattern can be explained in part by research showing that, in general, men engage in more violent behavior than women. Suicide attempts by women, on average, use methods that are less violent, and therefore are less likely to be lethal. For example, 2 of 3 male suicide victims in the United States die by firearm, whereas 1 of 3 female suicide victims in the United States die by firearm. The most common method for female victims is overdosing or poisoning.
Although attempts and completions can be investigated with medical records, the other aspects of suicidality (i.e., ideation and intent) cannot be measured in such a straightforward manner. One commonly used measure is the Beck Suicide Scale, a self-report measure with 21 questions. For each of the questions, respondents pick one of three statements that best describes how he or she has been feeling; each statement is scored as 0, 1,2 with increasing level of severity. For example, one of the items that indicates suicidal ideation is as follows: “I have no desire to kill myself (0 point response), “I have a weak desire to kill myself (1 point response), and “I have a moderate to strong desire to kill myself (2 point response). Higher scores on the Beck Suicide Scale indicate more severe suicidal ideation or intent.
Theories of Suicide
One of the most prominent theorists of suicide is Edwin Shneidman. His theory states that suicide results from the perception of unendurable psychological pain, which he calls psychache. Another researcher of suicide, Aaron Beck, theorizes that our thoughts (i.e., cognitions) play a causal role in the development of suicidal behavior. This theory proposes that suicide results from cognitions that involve hopelessness—beliefs that things will not get better in the future. Roy Baumeister proposed that suicide results from a desire to escape from painful self-awareness resulting from discrepancies between expectations and actual events. A more recent theory was proposed by Thomas Joiner. This theory states that suicide results from the combination of three factors: thwarted belongingness, perceived burdensomeness (i.e., the belief that one is a burden on others), and an acquired ability to enact lethal self-injury. The last component of the theory, acquired ability, involves the idea that it is difficult to overcome the most basic instinct of all—self-preservation—and that individuals acquire this capability through experience with painful and provocative events. Through these experiences, individuals get used to the pain of self-injury, become less afraid of self-injury, and build knowledge that facilitates self-injury.
Suicide Risk Assessment
Suicide risk assessment is a process conducted by a mental health professional to determine if an individual is at risk for engaging in suicidal behavior. Two main questions guide suicide risk assessment: Is the individual being assessed a danger to himself or herself and is the danger both immediate and severe? The answer to these questions can come from the use of standardized assessment measures (such as the Beck Suicide Scale) as well as clinical interviews. A thorough risk assessment for suicide gathers information from the individual on both present suicidal symptoms as well as past suicidal behavior, current stressors, and other psychological symptoms (e.g., hopelessness). For example, individuals who suffer psychiatric disorders are at higher risk for suicide. A disorder with one of the highest rates is major depressive disorder. One of the strongest predictors of completed suicide is a prior attempt; thus, considering presenting symptoms is not sufficient for thorough risk assessment.
If risk is deemed to be immediate or severe, emergency mental health services are used, most often involving hospitalization until the individual is no longer at imminent risk for suicide. If risk is not deemed immediate or severe, alternatives to emergency mental health can be used. For example, with the help of a trained mental health professional, individuals may be helped to create a coping card that lists concrete steps to take in the event that suicidal symptoms intensify.
Suicide Warning Signs
Members of the American Association of Suicidology are researchers and clinicians who research and treat suicidal behavior. This group devised a list of warning signs for suicide that indicate severe and immediate risk for suicide. These warning signs are designed for the friends, family members, and any other people who may come into contact with a suicidal individual. The warning signs instruct that a person should get help immediately if he or she witnesses, hears, or sees any one or more of the following:
- Someone threatening to hurt or kill himself or herself
- Someone looking for ways to kill himself or herself by seeking access to pills, weapons, or other means
- Someone talking or writing about death, dying, or suicide
The warning signs also instruct that should seek immediate help if one witnesses, hears, or sees someone exhibiting any one or more of the following:
- Rage, anger, seeking revenge
- Acting reckless or engaging in risky activities, seemingly without thinking
- Feeling trapped—like there’s no way out
- Increasing alcohol or drug use
- Withdrawing from friends, family, or society
- Anxiety, agitation, unable to sleep or sleeping all the time
- Dramatic changes in mood
- No reason for living
- No sense of purpose in life
- American Association of Suicidology. (n.d.). http://www.suicidology.org/
- Joiner, T. E. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press.