suicide

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Current attitudes toward suicide derive from the debates of centuries long past. Aristotle condemned suicide on political grounds, arguing that the allegiance individuals owe to the state precludes them from taking their lives. Plato had likened the state to a parent in the Crito, a position which might seem to support a similar restriction of the individual's right to commit suicide. But Plato actually objected to self- destruction on religious grounds, claiming that human beings are the gods' possessions and risk punishment for daring to decide when to die. Nevertheless, a precedent for the right-to-die position may be found in the Phaedo, where Socrates argues against prolonging life at any cost.

The death of Socrates seemed to embody both reason and self control, qualities prized by the early Stoics, and euthanasia was practised among elderly members of the school. In theory, suicide was an option available to the Stoic at any time. In practice, however, only the first century statesman and philosopher Seneca glorified death to the point of advocating self-destruction as an end in itself. His own death at the command of the emperor Nero was entirely consistent with the principles he espoused. Witnesses described how he managed to stretch the event over the course of a full day, drinking wine and conversing with his friends while periodically opening his veins until he eventually bled to death. Seneca's willingness to end his career in cold blood earned the admiration of his contemporaries — and his was but one of the many heroic suicides that have come down to us from Roman antiquity. The legends of Lucretia, Cato, Brutus, Portia, Antony, and Cleopatra became models for the suicide of honour. To die for some higher ideal, for the sake of virtue, patriotism, or faith, as would become the case with the early Christians, was to make death a cause for celebration.

The Christian case against suicide was formally stated by St Augustine, who prohibited the act as a violation of the sixth commandment, ‘Thou shalt not kill’. But Augustine was actually ambivalent on the question of suicide, permitting it in instances where individuals behaved with divine sanction in ending their lives. This exception was necessary to allow for the voluntary sacrifice of Jesus, who freely chose to die on the cross for humanity's sins. In subsequent centuries the escape clause was widened to admit the martyrs of the early Church, whose sacrifices were essential to the mythology of medieval Christianity.

The Church policy regarding suicide that emerged during the Middle Ages was loosely based on Roman law. Picking up on ancient Greek traditions, the Romans had punished self- destruction, but only under certain conditions: when an individual killed himself to escape legal prosecution or in the case of a soldier or a slave. The act of suicide was not itself considered blameworthy. Rather, the suicide's civil status, combined with his presumed motivations — the cowardliness of the accused man who sought to pre-empt the law, the disobedience of the soldier or the audacity of the slave who disposed of a life that was not truly his — determined whether the act should be punished. (The legal status of Roman women was akin to that of the slave. An unmarried female was treated as her father's dependent; the pater familias held absolute power over his daughter's life. With marriage, this power was transferred to her husband.)

The Christian position was different. What made suicide a sin was its voluntary nature. Self- destruction was prohibited because it represented an individual's choice to do wrong, a deliberate challenge to divine authority. Following the publication of the Summa Theologiae of Thomas Aquinas, suicide came to be seen as a crime against society as well. Aquinas revived Aristotle's view of suicide as an act of political insubordination and also condemned self-destruction on the grounds that it went against the natural instinct for self-preservation. To the traditional religious objection, which served to deny the sinner a Christian burial, Aquinas thus added a provision which could be used to support the implementation of civil penalties against people who killed themselves. During the high Middle Ages, civil legislation against self-murder was enacted in the majority of Western European states. Under no circumstances were men or women permitted to sacrifice themselves without divine sanction or to place their needs above the needs of the community to which they belonged.

The Enlightenment brought into question the moral implications of self-destruction. For the eighteenth-century philosophes, the issue proved to be an effective weapon in their crusade against absolutism and the Christian religion. Voltaire and others revitalized the classical tradition in the name of rationalism and freedom, portraying Lucretius, Cicero, and Seneca — all advocates of the right to die — as early upholders of the secular cause. The Romantics turned self-destruction into a literary convention, further weakening the stigma attached to the act. Driven to despair by the death of their beloved or, worse still, loving and being loved by someone who belonged to another, countless characters in nineteenth-century fiction actively courted the solace which death alone could provide.

Suicide was decriminalized during the French Revolution, and neither Napoleon nor his monarchist successors reinstated the laws against it. And with the emergence of the psychiatric profession in the nineteenth century, the tendency to interpret the act as the inadvertent consequence of psychological problems, which could be diagnosed, treated, and cured, displaced the religious impulse to judge it in moral terms. Thus, while the Catholic Church continues to regard suicide as a sin, the modern inclination to attribute it to depression makes the deprivation of a religious funeral rare.

The greatest controversy today is over the question of assisted suicide. It is a felony to help someone commit suicide in Great Britain and in twenty-eight American states, but in neither country is it illegal to kill oneself. In effect, this means that only healthy people are allowed by the law to take their lives, since people who are seriously ill are often unable to kill themselves without assistance. Supporters of euthanasia aim to do nothing more than to decriminalize assisted suicide for the terminally ill, as has been done in the Netherlands. Opponents of the right to die range from Christian activists who invoke religious arguments against the taking of human life to physicians who think the need for assisted suicide would vanish with more effective strategies for pain management in the last months of life. On a policy level, some argue in favour of allocating limited health care resources toward people whose lives can be saved instead of prolonging the existence of someone already near death, particularly when that person no longer wishes to live. This line of argument has been criticized by those who envision the day when sick people will be hurried to their deaths for reasons of economic expediency.

Current thinking on suicide also owes much to the development of the social sciences, and to the work of Durkheim in particular. What distinguishes the sociological approach from the psychological is that it diminishes the importance of individual intentions in assessing the causes of suicide. Even the most private of human activities, the decision to end one's own life, turns out to be socially determined. Like other forms of collective behaviour, its incidence is governed by regular laws. To isolate the social factors conducive to high rates of self-destruction is the object of suicide prevention programmes today.

— Lisa Lieberman

Bibliography

• Kushner, H. I. (1989) Self-destruction in the Promised Land. Rutgers University Press, New Brunswick and London.
• Lieberman, L. (2003) Leaving You: the cultural meaning of suicide. Ivan R. Dee, Chicago

See also euthanasia.

Suicide is defined as the act of deliberately taking one's own life. It occurs most often in response to a crisis such as a death or the loss of a relationship or job. During a crisis people experience a wide range of feelings, and each person's response to crisis is different. It is normal to feel frightened or anxious or depressed. If a person feels overwhelmed or unable to cope, he or she may try to commit suicide.

Almost all people who kill themselves either suffered from depression or had substance abuse problems. People who are lonely and isolated or who have histories of previous suicide attempts are also at greater risk for attempting suicide.

In 1996, approximately 31,000 people died of suicide in the United States. Suicide is the eighth leading cause of death overall, and the third leading cause of death among American teenagers. In Canada, suicide is second only to motor-vehicle accidents as a cause of death among adolescents.

The suicide rate is twice the murder rate among those aged 15 to 24, and it has increased dramatically in recent years. Each year, two thousand adolescents commit suicide in the United States. The highest suicide rates in the United States are found in white men over age 85. Men are more than four times as likely as women to die by suicide, yet women are more likely to make a nonlethal suicide attempt.

Suicide is a major public health problem. The need for a public health approach to suicide can be found in the African-American community, where the suicide rate among youths more than doubled between 1980 and 1995. Further, the number of suicides in the United States outnumbered homicides in 1995. Each year, firearms are used as many times for suicide as they are for murder. In some other countries, 71 percent of all firearm deaths are suicide.

Attempted and completed suicides result in enormous social, economic, and medical costs. Suicide is very disruptive to the quality of life of survivors and their families and friends. In 1995 it was estimated that in the United States each suicide attempt costs approximately $33,000. The cost of a completed suicide has been estimated at almost $400,000. These estimates were derived from factors including the expense of hospitalization, medication, and more general social costs.

Public health professionals have a major role to play in addressing the problem of suicide. Public health programs and policies can play a part before, during, and after completed or attempted suicides. First, public health programs are an important aspect of the prevention of suicide. Education campaigns can be used to increase knowledge and to change people's attitudes, beliefs, and values about suicide, and about people who may have attempted suicide. People may have distorted ideas about suicidal persons. For example, it is a myth that people who commit suicide never talk about it first. Most people provide important warning signs that can help to reduce the risk of suicide.

Health education can be combined with counseling or support programs. These programs can be provided by trained public health professionals or by peer counselors. For example, teenagers can be trained to provide counseling and support for other teens. Suicide awareness or prevention programs can be delivered in a variety of settings such as schools, churches, or in the community as a whole. They can also be delivered in psychiatric settings.

A second aspect of the prevention of suicide lies in judging or assessing a person's risk for suicide. Public health professionals such as nurses or doctors can help to prevent completed suicides by identifying people who may be thinking about or planning to try to commit suicide. They can also provide support through crisis or suicide-prevention counseling.

Public health can also play a valuable role during a suicide attempt. A suicide attempt is often a person's response to a crisis, or to a time when they feel overwhelmed or hopeless. Public health professionals can help during a suicide attempt through suicide-prevention counseling. This type of short-term counseling involves providing support and guidance to an individual who is suicidal. Its purpose is to decrease the person's emotional pain, to make sure that the person is safe, and to help develop a plan for coping. Sometimes suicide-prevention counseling includes connecting a person to community or health services. These services can then provide longer-term support.

Suicide prevention counseling is a valuable tool for public health. It is relatively low-cost, flexible, and simple to provide. A wide variety of health professionals, including doctors, nurses, psychologists, and social workers, can be taught to help people with suicide-prevention counseling techniques. These services can be provided in a wide variety of places or settings, including hospitals, community clinics, and telephone-based crisis centers or helplines. Suicide-prevention services provide an important link between the community and the formal health care system.

Public health professionals who work in suicide prevention and counseling are faced with a growing variety of issues and clients. Most communities are home to an increased number of people from a wide variety of cultural and ethnic backgrounds. There are also more older people in society. New issues that might trigger a suicide attempt include elder abuse, racism or discrimination, bullying, or gay bashing. Police officers, firemen, paramedics, and others are being trained to deliver on-the-spot suicide prevention counseling.

There is also a role for public health following a completed or attempted suicide. A suicide attempt or death can have a traumatic effect on the quality of life of survivors and their families and friends. Public health programs can provide important support services to survivors of a suicide attempt and their families.

Public health is only one important part of society's response to suicide as a health and social problem. There is also a role for law enforcement, the education system, the government, and the formal health care system in prevention, treatment, and follow-up to a suicide attempt.

Law enforcement (police officers) and public health professionals can cooperate to help suicidal persons. Police officers are often the first ones on the scene of a suicide attempt. They may act to prevent a suicidal person from hurting themselves (or someone else) through suicide prevention counseling. The may detain someone who is at high risk for suicide and refer him or her to appropriate public health resources.

Legislators can also help to address the challenges of suicide by creating policies or laws to support the development of public health programs and the training of public health professionals. They can also work to change society's attitude toward suicide and suicidal people. One example of this type of work is the fact that in many countries suicide is no longer illegal. Attempting suicide is seen as a mental health issue, not a crime. In 1999 the United States Public Health Service issued the first-ever Surgeon General's Report on Mental Health, as well as a Call to Action on Suicide Prevention, charting out this new approach to suicide.

The educational and health care systems also have a role to play in the prevention, treatment, and follow-up to a suicide attempt. Schools provide access to most young people and provide a place for delivering suicide prevention or awareness programs. They can also teach young people to recognize the warning signs of a potential suicide attempt in their friends, to provide peer counseling, and how to get immediate help and support. This is important because young people are at higher risk of attempting suicide than most adults.

The formal health care system (hospitals, clinics, doctor's offices) can play an important role in two main ways. First, people who are suicidal may come to an emergency room or a physician's office. In these cases, the health system serves as a "first-response" and crisis service. Second, once a person has been identified by a public health or law enforcement professional as suicidal, they may need to be hospitalized for a period of time. Health professionals can provide medications and further counseling or support to a suicidal person and their family.

Once a suicidal person is released from a hospital, public health professionals may make home visits or provide follow-up support through a community-based clinic. The prevention of suicide and the provision of support to people who are suicidal play an important and increasing role in the health of individuals, families, and communities. The most comprehensive national strategies on suicide have been developed by Finland, Norway, Australia, New Zealand, and Sweden.

(SEE ALSO: Crisis Counseling; Gun Control; Hotlines, Helplines, Telephone Counseling; Mental Health; School Health; Social Work; Violence)

Bibliography

Carter, C., and Baume, P. (1999). "Suicide Prevention: A Public Health Approach." Australian and New Zealand Journal of Mental Health Nursing 8:45–50.

Harwitz, D., and Ravizza, L. (2000). "Suicide and Depression." Emergency Medical Clinics of North America 18:263–271.

Lester, D. "Estimating the True Economic Cost of Suicide." Perceptual and Master Skills 80:746.

Office of the Surgeon General (1999). Mental Health: A Report of the Surgeon General. Washington, DC: U.S. Public Health Service.

Potter, L. B.; Powell, K. P.; and Kachur, S. P. (1995). "Suicide Prevention from a Public Health Respective." Suicide and Life Threatening Behavior 25:82–91.

U.S. Public Health Service (1999). The Surgeon General's Call to Action to Prevent Suicide. Washington, DC: U.S. Public Health Service.

— C. JAMES FRANKISH; ROBBIN JEFFEREYS

Generally, as human life is considered of paramount value, one may not forfeit one's life to avoid breaking the laws of the Torah. In this spirit the sages comment on the verse in Leviticus 18:5, "You shall live by them [the commandments] and not die by them." Only in three cases is the rule that one must be prepared to die rather than violate the law: when forced into idolatry, murder, or sexual immorality.

Although there have been cases of mass suicide, such as following the fall of Masada to the Romans in 73 CE, the Halakhah does not approve of such a course of action, regardless of the circumstances.

According to halakhah, a suicide is to be buried in a separate part of the cemetery and is not to be mourned by his next of kin. Generally, rabbis seek to mitigate the severity of these provisions by ruling that the deceased took his own life while in an unbalanced state of mind and is therefore technically not a suicide.

There is some confusion about the burial of suicides, reflecting the fact that legally they were criminals if sane, but not if ‘the balance of mind was disturbed’. Up to 1823, those found guilty of the crime were given a degrading burial in the roadway, possibly at a crossroads, and/or staked; after that date, and at all periods for the insane, it was left to the clergy to decide whether churchyard burial could be allowed or not. One solution was to lay the suicide on the north side (MacDonald and Murphy, 1990).

See BURIAL, IRREGULAR, CROSSROADS, NORTH.

Intentional self-killing. Wide definitions would include martyrdom and self-sacrifice; narrower definitions would be motivated by the thought that these cases are frequently noble and heroic, whereas suicide is a common object of moral prohibition. This prohibition was shaky in the early Christian tradition, and uncommon in other cultures, where suicide in various circumstances may be institutionally embedded. The ban was fortified in the middle ages and it became a bone of contention between Enlightenment thinkers, notably Hume, and conservatives such as Kant. Suicide became fashionable in the Romantic era, but diagnosed as the result of either psychological illness (Freud) or the pressures of social conditions (Durkheim) by the 20th century. An awakening perception of the intolerable ways the medical profession manages death, especially in the United States, has led to death-with-dignity movements, assisted by sympathetic physicians and self-help groups.See also act/ommissions doctrine, euthanasia.

Suicide is seen by Buddhism as a futile act that will not provide a solution to suffering (duḥkha). By virtue of its belief in rebirth, Buddhism teaches that that suicide does not offer a permanent release from life's problems but merely postpones them to be faced at a later time. Moreover, the taking of any life (including one's own) is prohibited by the first of the Five Precepts (pañca-śīla). This means that suicide produces evil karma that will simply aggravate the difficulties rather than diminish them. Buddhism teaches that what it calls ‘a precious human rebirth’ is extremely difficult to attain, and that to cut it short is to waste an invaluable opportunity for spiritual development. It also deprives others of the benefits one might bring to them as a Bodhisattva, apart from the grief it brings to friends and relatives. There are two particular circumstances that have been thought to be exceptions to the above general rule. The first concerns suicide by Arhats, and some scholars have concluded that Buddhism regards this as morally permissible. This popular but doctrinally dubious notion has gained currency by being linked to the idea that the enlightened pass beyond conventional moral norms, a view that no longer commands wide respect. The second case is the practice of ritual suicide in Japan (hara kiri). This is a striking feature of Japanese culture that has no precedent in Indian Buddhism and is not sanctioned by mainstream Buddhist ethics. See also euthanasia; Vakkali.

Suicide is a symptomatic act connected most frequently to the framework of depression and melancholy. Its etiology is varied and complex, since it is characterized by the collapse of the ego, along with self-reproach and a diminution or a loss of self-esteem—and, at the same time, by a magic omnipotence which allows the annihilation of internal persecutors, as well as a manic feeling based on the denial of death itself. While suicide may appear to be a response to persecutory guilt, it is also a projection of this guilt onto objects as well as a liberation from their control through the death the subject has chosen for himself.

Suicide was discussed in the psychoanalytic literature as early as 1907, as recorded in the Minutes of the Vienna Psychoanalytic Society (Nunberg, Hermann, and Federn, Ernst, 1962-75), but it was a rather superficial discussion, centered on the fact that the differing choice of means by men and women reveals a primal sexual symbolism. From this came the formula that "suicide is the climax of negative autoeroticism" (Minutes, Vol. 1, February 13, 1907, p. 114). This should be understood in the context of the opposition between the ego instincts and sexual instincts in Freud's earliest theorization: "In suicide the life instinct is overwhelmed by the libido" (Vol. 2, April 20, 1910, p. 494).

In this approach, suicide, interpreted as a substitute for psychosis, seems linked both to an inability to tolerate reality and to autoerotic regression: "Suicide is an act of defense of the normal ego against psychosis" (June 6, 1907). Drive regression is equally central to Freud's ideas on the subject of the suicide of high school students; at school "Teachers. . . .must exercise a life-maintaining influence. [The function of] school is to give the child, in this stage of his detachment from his parents, a new footing within a larger relationship" (Vol. 2, April 20, 1910, p. 495). This should extend as far as not to "deny them the right to linger even in those phases of their development that seem vexing." There might well have been some evolution in Freud's thought here, especially if it is considered that, at the very beginning he insisted on the connection between neurasthenia, masturbation, and the risk of suicide. However, Freud also stressed that "in many cases it is the fear of incest itself that drives [children] to suicide" (p. 494), because of the enormous augmentation of their need for love at puberty; Freud went so far as to suggest, this being the case, that homosexuals make the best teachers, the worst being those whom the repression of their homosexuality has turned into sadists, pushing their students to suicide.

Later psychoanalytic thought on suicide followed the main ideas of Freud on the subject. First of all, in the depressive context, suicide was considered self-punishment for the desire to kill, primally directed toward another, as Freud himself stated in Totem and Taboo: "The law of talion, which is so deeply rooted in human feelings, lays it down that a murder can only be expiated by the sacrifice of another life: self-sacrifice points back to blood-guilt" (1912-13a, p. 154). Since then, the risk of self-mutilation or suicide with infantile or borderline personalities has been much emphasized (Kernberg, Otto, 1984); this risk is especially a factor during fits of rage following disappointments which are blamed on others; or else there is a risk of suicide because of failure to achieve success (guilt), or, even the failure of the cure (negative therapeutic reaction).

In fact, the idea that suicide is self-punishment for the desire to kill someone else cannot be understood completely apart from the process of melancholia, whereby the loved/hated object has been introjected within the ego and has become the target of the attack. More even than "self-punishment," suicide would be murder of the other within oneself. "Probably no one finds the mental energy required to kill himself unless, in the first place, in doing so he is at the same time killing an object with whom he has identified himself, and, in the second place, is turning against himself a death-wish which had been directed against someone else" (1920a, p. 162). Freud explained that "the ego is destroyed by the object."

The enigma constituted by suicide in relation to the self-preservative or ego instincts has also been approached in another way, through considering that it is accompanied paradoxically by a tentative intent to reappropriate vital energy, or, indeed, is even prompted by the fantasy of beginning a new life (Grinberg, León, 1983). Accordingly, suicide would result from a state of crisis dominated by the feeling that something must change. The person committing suicide "convokes death imaginally to assure himself paradoxically that life exists" (Triandafillidis, Alexandra, 1991). Ideal images of oneself and others can then survive, at the price of the death of the bad objects cluttering the ego.

The vital stakes involved in this symptomatic conduct have inclined authors not only to attempt to understand the suicidal mechanism, but also to describe its advance symptoms, evaluating the risk of suicide in order to decide on a therapeutic approach, especially in a care-giving institutional setting. León Grinberg (1983) emphasized suicidal premeditation and the fact that a suicidal plan follows the idea of suicide, which was at first only a way of dealing with anxiety. Continuing to the act of suicide depends on an "encounter," which might favor tipping the fantasy into reality. This author also examined factors of present or past vulnerability (feeling of culpability, narcissistic wound, loss of loved object, and so forth). Otto Kernberg (1984) emphasized the need for the therapist not to be fooled by an accentuation of the manic element; he stressed the seriousness of cases where "aggressiveness has infiltrated the grandiose Self," joined to an inability to enter into interpersonal relations and feel emotions. These considerations, however, concern psychotherapeutic strategies rather than the etiology of suicide.

Bibliography

Freud, Sigmund. (1912-13a). Totem and taboo. SE, 13: 1-161.

Grinberg, León. (1983). Culpabilité et dépression. Paris: Les Belles Lettres.

Kernberg, Otto. (1984). Les trouble graves de la personnalité. Paris: Presses Universitaires de France.

Nuberg, Hermann, and Federn, Ernst. (1962-1975). Minutes of the Vienna Psychoanalytic Society. New York: International Universities Press.

Triandafillidis, Alexandra. (1991). La dépression et son inquiétante familiarité. Paris:Éditions Universitaires.

Further Reading

Laufer, M. (Ed.). (1995). The suicidal adolescent. Madison, CT: International Universities Press.

—SOPHIEDE MIJOLLA-MELLOR

When early modern authors and intellectuals considered the topic of suicide, they started out with one salient contrast in mind: Whereas the ancient Greeks and Romans had often approved of suicide, Christians did not. For many, this contrast illustrated the superiority of Christian thinking, but throughout the Renaissance and into the seventeenth century, some who admired the ancients drew a more nuanced set of conclusions. Thomas More's Utopia (1516), for example, presents voluntary euthanasia for the terminally ill in a favorable light, although More condemned suicide vigorously in other works. The bishop of Guadix, Antonio de Guevara, took inspiration from the heroic suicides of classical antiquity (for example, Cato, Diogenes, Zeno, Lucretia, Seneca) and praised the nobility of barbarians who did not overvalue life in this world. Similarly, Michel de Montaigne touched on the question of suicide repeatedly and in "A Custom of the Island of Cea" considered the topic at considerable length, thoughtfully assembling moral, religious, social, and legal views. Although he admired the deaths of the noble ancients, he was reluctant to give his blanket approval to all who sought to escape shame or pain through suicide, and in the end he thought one might kill oneself only as a last resort to avoid intense pain or torture.

Shakespeare's characters commit suicide with remarkable frequency (there are fifty-two cases in his plays), and Hamlet's soliloquy ("To be or not to be") dwells on the topic, presenting arguments both for and against (although ignoring specifically Christian objections), before concluding, famously, that the future was too murky to make self-murder a safe option. In other plays Shakespeare presents suicide as the result of tragic misunderstanding (Romeo and Juliet) or as grand examples of freedom or despair (Julius Caesar, Antony and Cleopatra, and Othello). In 1610 John Donne went further, arguing in Biathanatos that sometimes suicide was justified or at least excusable. He did not proceed, as others had, from the example of ancient worthies but specifically considered the Christian grounds for condemning suicide. In a nutshell, he concluded that suicide did not necessarily and always violate the laws of nature, reason, or God. Despite the daring independence of this view, Donne forbade the publication of his book, and it only appeared in print in 1647, sixteen years after his death. This fact illustrates the ongoing and deep anxiety early modern Christians felt about suicide as both a crime and as the result of despair, the ultimate sin. Usually Protestants and Catholics united to condemn "self-murder" and to depict the devil as the prime mover or inspiration for most cases of self-destruction. As a result, throughout early modern Europe, suicides were denied burial in hallowed ground and often suffered desecration of their corpses. The worldly goods of suicides were sometimes confiscated by the crown, as was the case in England and Scotland.

In the seventeenth and eighteenth centuries, however, this legal and moral position decayed, not so much because suicide became positively defensible but more commonly because it seemed increasingly to be the result of melancholy madness. Moralists and theologians had regularly made provision for a sort of insanity defense of suicide. They viewed both sin and crime as actions that proceeded from free and voluntary decisions; condemning actions one could not prevent or avoid did not seem to make moral sense. Indeed, Martin Luther had carried this point so far that he thought suicides were driven to their deaths by the devil, thus extinguishing human responsibility: "I have known many cases of this kind, and I have had reason to think in most of them, that the parties were killed, directly and immediately killed by the devil, in the same way that a traveler is killed by a brigand." Most theologians, however, understood the role of the devil as that of a tempter or seducer, and therefore left ample room for the harsh condemnation of suicide, as long as it seemed clear that the victim had acted deliberately, intentionally, or voluntarily.

The Secularization of Suicide

By the late seventeenth century, suicide began to seem so alien to right reason, so much the product of melancholy or delusion (what we might call acute depression), that coroners, villagers, pastors, and magistrates were prepared to grant decent (even if quiet) burials inside the churchyard. Townsmen and villagers alike might also (as in England and Scotland) unite to portray a suspicious death as the result of illness or accident in order to circumvent the crown's efforts to confiscate a victim's estate, a move that usually added to the burdens on local poor relief. Thus from about 1650 onwards, we can mark the "secularization of suicide," that is, the development of medical or other naturalizing explanations and excuses for suicide. This evolution of public sentiment was supplemented during the eighteenth century by the moral philosophizing of the Enlightenment. Montesquieu's Persian Letters (1721), for example, sharply criticized the condemnation of suicide. Voltaire went further and saw suicide as a question of liberty. It could not harm God or society, in his view, to exit the world when one could no longer enjoy life or contribute to the welfare of others. David Hume also defended an individual's absolute right to suicide. Despite hesitations and equivocations, however, many philosophes were drawn to the medical conclusion that suicide was usually the result of madness or bodily disturbances.

The Social History of Suicide

Broadly speaking, this array of opinions on suicide has been well known and well described for several generations. In recent years, scholars have renewed their attention to suicide and have made several noteworthy contributions, not so much to high religious or intellectual history, but to the sociology or social distribution and cultural understandings of suicide. In this work they have often taken inspiration from the foundational work of Émile Durkheim, Le suicide (1897), which tried to demonstrate that social dynamics account for almost all the statistical variations in suicide found in modern countries. Roughly stated, Durkheim held that higher rates of suicide were prompted by increasing conditions of social isolation, so that tight webs of social support served to protect populations from the effects of urbanization, individualism, migration, and other conditions of modernity. It seemed to make sense, from this point of view, that Protestants (as part of a "modern," "secularizing," and "individualizing" movement) should always and everywhere have higher rates of suicide than presumably more traditional and more socially cohesive Catholics. This schema has inspired a great deal of modern sociological investigation, and recently scholars have extended these efforts to the early modern period. However, one supreme difficulty has been that neither the numbers of suicides nor early modern populations were reliably recorded, making the calculation of a suicide rate (the number of suicides per 100,000 population) doubly problematic.

Suicide in Britain and Germany. After an extraordinary and energetic attempt to count the number of suicides in early modern England, for example, Terence Murphy and Michael Mac Donald abandon the task of calculating the varying suicide rate from place to place and from time to time, turning instead to an examination of the varying meanings of suicide. In an excellent study of suicide in far northern Germany, Vera Lind draws similar conclusions, heaping criticism on those who have imagined that medieval or early modern rates of self-murder could be calculated unproblematically. In a vast and complex survey, Alexander Murray draws the same conclusion with respect to medieval Europe, but then curiously hazards the guess that whatever the medieval rate may have been, suicide became far more common in the sixteenth century.

Suicide in Switzerland. The most impressive recent attempt to scrutinize all the suicides in a fairly controlled population is Jeffrey Watt's study of early modern Geneva, where suicide remained rare until the end of the seventeenth century and then increased slowly in the early eighteenth century. After 1750, however, the rate jumped up by a factor of five or more, and it went even higher after 1780. Watt has been careful to count not only those cases regarded as suicide by the Genevan authorities, but to look for "disguised" suicides as well, deaths from falls or from drowning that may well have been self-inflicted even if contemporaries declined to label them self-murder. Watt's evidence is so rich and so complete that, at least for this city, a genuine suicide rate can probably be calculated. Recognizing a dramatic escalation after 1750 seems unavoidable. Rejecting an easy equation of Calvinism with higher rates of suicide, however, Watt points out that Geneva during the Reformation had promoted just as tight an integration of society as in any Catholic city or principality. Yet by the late eighteenth century, Genevans from top to bottom had grown more secular in their attitudes, abandoning belief in the devil and often in hell as well. These processes may have developed more quickly or more profoundly for men than for women, which might explain why the disproportion of male suicides became even more pronounced after 1750. On this reading, growing secularization accomplished more than just the decriminalization or medicalization of suicide; increasingly a more secular society relaxed its supportive web as well as its sanctions against self-killing. Taking one's own life became far easier to contemplate.

This finding runs counter to the conclusion of a study of suicide in Zurich, in which Markus Schär connects the rapidly escalating numbers of self-inflicted deaths in the eighteenth century not with increasingly secular attitudes but with the growth of acute religious despair among people who doubted that they could ever gain God's mercy. Oddly enough, however, both Watt and Schär agree in emphasizing the importance of religious and cultural changes, rather than social changes (such as demography, economy, and urbanization), as crucial stimulants to suicide.

The Eighteenth Century

As far as eighteenth-century Europeans were concerned, England was the classic land of melancholy and suicide. In the absence of reliable comparative studies, it is not clear that this stereotype was fully deserved. It does seem certain, however, that suicide notes and newspaper publicity about recent suicides first proliferated in England, for reasons well explored by Murphy and Mac Donald. In Germany, the popularity of Goethe's Sorrows of Young Werther (1774) led to a wave of widely publicized suicides supposedly inspired by the romantic death of that lovelorn protagonist. By the late eighteenth century suicide had been common enough that it seemed symptomatic of the cultural and social disruptions endured by nations undergoing rapid urbanization, industrialization, or secularization.

Bibliography

Bernardini, Paolo. Literature on Suicide, 1516–1815: A Bibliographical Essay. Lewiston, N.Y., 1996.

Donne, John. Biathanatos. Edited by Ernest W. Sullivan II. Newark, Del., and London, 1984.

Jansson, Arne. From Swords to Sorrow: Homicide and Suicide in Early Modern Stockholm. Stockholm, 1998.

Lind, Vera. Selbstmord in der frühen Neuzeit: Diskurs, Lebenswelt und kultureller Wandel am Beispiel der Herzogtümer Schleswig und Holstein. Göttingen, 1999.

Minois, Georges. The History of Suicide. Translated by L. Cochrane. Baltimore, 1999.

Murphy, Terence R., and Michael Mac Donald. Sleepless Souls: Suicide in Early Modern England. Oxford, 1990.

Murray, Alexander. Suicide in the Middle Ages. 2 vols. Oxford, 1998, 2000.

Schär, Markus. Seelennöte der Untertanen: Selbstmord, Melancholie und Religion im Alten Zürich, 1500–1800. Zurich, 1985.

Watt, Jeffrey R. Choosing Death: Suicide and Calvinism in Early Modern Geneva. Kirksville, Mo., 2001.

—H. C. ERIK MIDELFORT

The deliberate taking of one's own life.

Under common law, suicide, or the intentional taking of one's own life, was a felony that was punished by forfeiture of all the goods and chattels of the offender. Under modern U.S. law, suicide is no longer a crime. Some states, however, classify attempted suicide as a criminal act, but prosecutions are rare, especially when the offender is terminally ill. Instead, some jurisdictions require a person who attempts suicide to undergo temporary hospitalization and psychological observation. A person who causes the death of an innocent bystander or would-be rescuer while in the process of attempting suicide may be guilty of murder or manslaughter.

More problematic is the situation in which someone helps another to commit suicide. Aiding or abetting a suicide or an attempted suicide is a crime in all states, but prosecutions are rare. Since the 1980s the question of whether physician-assisted suicide should be permitted for persons with terminal illnesses has been the subject of much debate, but as yet this issue has not been resolved.

The debate over physician-assisted suicide concerns persons with debilitating and painful terminal illnesses. Under current laws a doctor who assists a person's suicide could be charged with aiding and abetting suicide. Opponents of decriminalizing assisted suicide argue that decriminalization would lead to a "slippery slope" that would eventually result in doctors being allowed to assist persons who are not terminally ill to commit suicide.

The debate on physician-assisted suicide has intensified since 1990 when Dr. Jack Kevorkian, a retired Michigan pathologist, began to attend many suicides. Kevorkian has admitted to obtaining carbon monoxide and instructing persons who suffered from terminal or degenerative diseases on how to administer the gas so they would die. Despite the efforts of Michigan legislators and prosecutors to convict Kevorkian of murder, the pathologist, who was dubbed "Doctor Death," successfully fought the charges. Three murder charges were dismissed by Michigan courts and in 1994 Kevorkian was acquitted of violating Michigan's assisted suicide law (Mich. Comp. Laws § 752.1021 et seq.). Despite Kevorkian's acquittals other assisted suicide advocates believe his methods have actually hurt the cause. In 1997 the U.S. Supreme Court held that neither the Due Process Clause (Washington v. Glucksberg, ___ U.S. ___, 117 S. Ct. 2258, 138 L. Ed. 2d 772) nor the Equal Protection Clause (Vacco v. Quill, ___ U.S. ___, 117 S. Ct. 2293, 138 L. Ed. 2d 834) of the Fourteenth Amendment includes a right to assisted suicide.

Since the 1970s, most large U.S. communities have established suicide prevention measures, including telephone hot lines where a person contemplating suicide can talk to a counselor.

See: Death and Dying; Patients' Rights; Physicians and Surgeons.

Quotes:

"No one is promiscuous in his way of dying. A man who has decided to hang himself will never jump in front of a train." - A. Alvarez

"If I commit suicide, it will not be to destroy myself but to put myself back together again. Suicide will be for me only one means of violently reconquering myself, of brutally invading my being, of anticipating the unpredictable approaches of God. By suicide, I reintroduce my design in nature, I shall for the first time give things the shape of my will." - Antonin Artaud

"If you must commit suicide... always contrive to do it as decorously as possible; the decencies, whether of life or of death, should never be lost sight of." - George Borrow

"One said of suicide, As long as one has brains one should not blow them out. And another answered, But when one has ceased to have them, too often one cannot." - Francis H. Bradley

"There is but one truly serious philosophical problem and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy. All the rest -- whether or not the world has three dimensions, whether the mind has nine or twelve categories -- comes afterwards. These are games; one must first answer." - Albert Camus

"It is not worth the bother of killing yourself, since you always kill yourself too late." - E. M. Cioran

See more famous quotes about Suicide

A dream about suicide may suggest that conditions in the dreamer's life are so frustrating that the dreamer is no longer willing or able to cope with a business or personal relationship in the same way as in the past.

Suicide was one of the acts universally associated with vampirism. In cultures as varied as in Russia , Romania , West Africa, and China , suicide was considered an individual's pathway into vampirism. In the West in Jewish, Christian, and Muslim cultures, suicide has traditionally been considered a sin. In most other cultures suicide was frowned upon in an equivalent manner. Japan has generally been considered unique in its designation of a form of suicide called hari-kari, as a means of reversing the dishonor that initially led to the suicide.

Suicide was among the anti-social actions a person could commit that caused vampirism. In Eastern Europe, those actions included being a quarrelsome person, a drunkard, or associated with heresy or sorcery/witchcraft. In each society, there were activities considered a threat to the community's well-being that branded a person as different. While these varied considerably from culture to culture, suicide was most ubiquitous in its condemnation.

Suicide signaled the existence of extreme unresolved tension in the social fabric of a community. It was viewed as evidence of the family's and the community's inability to socialize an individual, as well as a statement by the individual of complete disregard for the community's existence and its prescribed rituals. The community, in turn, showed its disapproval in its treatment of the suicide's corpse. In the West, it was often denied Christian burial and its soul considered outside of the realm of salvation (the subject had committed mortal sin without benefit of confession and forgiveness prior to death). Those who committed suicide were buried at a crossroads or at a distance from the village. The corpse might even be thrown in a river to be carried away by the current.

Those who committed suicide died leaving unfinished business with relatives and close acquaintances. They left people with unresolved grief, which became a factor, sometimes unspoken, in the survivors' personalities for the rest of their lives. Their corpses often returned to the living in dreams and as apparitions. They were the subjects of nightmares, and families and friends occasionally felt under attack from the presence of them. The deceased became a vampire, and actions had to be taken to break the connection that allowed the dead to disturb the living. The various actions taken against a corpse could be viewed as a means of emotional release for the survivors. The break in the connection was first attempted with harmless actions of protection, but, if ineffective, those efforts moved to a more serious level with mutilation (with a stake) or complete destruction (by fire) of the corpse.

Novelists and screenwriters have utilized suicide in their consideration of the problems faced by vampires who have found themselves bored with their long life, displaced in time, or have concluded that their vampire state is immoral. Immediately after becoming a vampire, for example, Lestat (The continuing character in Anne Rice's vampire novels) had to witness the suicide (by fire) of the vampire who had made him. Eventually, Armand, the leader of the Parisian community eventually committed suicide by basking into the sunlight. Placing oneself in the open as the dawn approaches is the suicide method of choice for vampires, as recently exemplified by Boya (in the 1996 movie Blood and Donuts) and Countess Maria Viroslav in Kathryn Reines' The Kiss (1996). Toward the end of Memnoch the Devil, the fifth of the Vampire Chronicles of Anne Rice, Armand walks into the sunlight out of his intense religious feelings after seeing Veronica's veil that Lestat had returned with for his adventure in heaven and hell.

Both the Cevaillier Futaine (the vampire in Henry Kuttner's 1037 pulp short story, "I, the Vampire" and Batman in the alternative universe Batman story Batman: Bloodstorm, committed suicide by leaving their sleeping place open for someone they knew would come in to kill them, Possibly the most ingeneous suicide device was devised for Yaksha, the original vampire in Christopher Pike's The Last Vampire series. Yaksha had made a deal to redeem himself by killing all of the vampires and then himself. The saved his former lover for last. She rigged a set of explosives in a room that would kill both of them but then cleverly concealed a shield that would protect her at the crucial moment. Yaksha was killed but she survived.

Barber, Paul. Vampires, Burial, and Death: Folklore and Reality. New Haven, CT: Yale University Press, 1988. 236 pp.
Moench, Doug, et al. Batman: Bloodstorm. New York: DC Comics, 1994. Perkowski, Jan L. The Darkling: A Treatise on Slavic Vampirism. Columbus, OH: Slavica Publishers, 1989. 174 pp.
Pike, Christopher. The Last vampire. New York: Archway/Pocket Book, 1994. 198 pp.
Reines, Kathryn. The Kiss. New York: Avon Books, 1996. 293 pp.
Senn, Harry A. Were-Wolf and Vampire in Romania. New York: Columbia University Press, 1982. 148 pp.

The intentional taking of one’s own life.

• Unnatural Deaths - suicide: taking of one’s own life
• Murder and Suicide - suicide: taking one’s own life; self-slaughter

For other uses, see Suicide (disambiguation).

Suicide
Classification and external resources
The Suicide by Édouard Manet 1877–1881
ICD-10	X60–X84
ICD-9	E950
MedlinePlus	001554
eMedicine	article/288598
MeSH	F01.145.126.980.875

Suicide (Latin suicidium, from sui caedere, "to kill oneself") is the act of intentionally causing one's own death. Suicide is often committed out of despair, the cause of which can attributed to a mental disorder such as depression, bipolar disorder, schizophrenia, alcoholism, or drug abuse.^[1] Stress factors such as financial difficulties or troubles with interpersonal relationships often play a significant role.^[2]

Over one million people die by suicide every year. The World Health Organization (WHO) estimates that it is the 13th leading cause of death worldwide^[3] and the National Safety Council rates it sixth in the United States.^[4] It is a leading cause of death among teenagers and adults under 35.^[5][6] The rate of suicide is far higher in men than in women, with males worldwide three to four times more likely to kill themselves than females.^[7][8] There are an estimated 10 to 20 million non-fatal attempted suicides every year worldwide.^[9]

Views on suicide have been influenced by broader cultural views on existential themes such as religion, honor, and the meaning of life. The Abrahamic religions traditionally consider suicide an offense towards God due to the belief in the sanctity of life. It was often regarded as a serious crime and that view remains commonplace in modern Western thought. However, before the rise of Christianity, suicide was not seen as automatically immoral in ancient Greek and Roman culture. Conversely, during the samurai era in Japan, seppuku was respected as a means of atonement for failure or as a form of protest. Sati is a Hindu funeral practice, now outlawed, in which the widow was expected to immolate herself on her husband's funeral pyre, either willingly or under pressure from the family and society.^[10] In the 20th and 21st centuries, suicide in the form of self-immolation has been used as a medium of protest, and the form of kamikaze and suicide bombings as a military or terrorist tactic.

Medically assisted suicide (euthanasia, or the right to die) is a controversial issue in modern ethics. The defining characteristic is the focus on people who are terminally ill, in extreme pain, or possessing (actual or perceived) minimal quality of life resulting from an injury or illness.

Self-sacrifice on behalf of another is not necessarily considered suicide; the subjective goal is not to end one's own life, but rather to save the life of another. However, in Émile Durkheim's theory, such acts are termed "altruistic suicide."^[11]

Contents 1 Classification 2 Risk factors 2.1 Medical conditions 2.2 Mental disorders 2.2.1 Biology 2.3 Perceived burdensomeness to others 2.4 Substance abuse 2.5 Problem gambling 2.6 Media coverage 3 Methods 4 Prevention 4.1 Screening 5 Treatment 6 Epidemiology 6.1 Gender 6.2 Alcohol and drug use 6.3 Ethnicity 7 Social aspects 7.1 Legislation 7.2 Religious views 7.3 Philosophy 7.4 Locations 7.5 Advocacy 7.6 Language 8 Other species 9 See also 10 Footnotes 11 Further reading 12 External links

Classification

Type	Description
Euthanasia	Individuals who wish to end their own lives may enlist the assistance of another party to achieve death. The other person, usually a family member or physician, may help carry out the act when the individual lacks the physical capacity to do so alone, even if supplied with the means. Assisted suicide is a contentious moral and political issue in many countries, as seen in the scandal surrounding Dr. Jack Kevorkian, a US medical practitioner who supported euthanasia and was convicted of having helped patients end their own lives, for which he served an eight year prison term.[12]
Murder–suicide	A murder–suicide is an act in which an individual kills one or more other persons immediately before or at the same time as him or herself. The motivation for the murder in murder–suicide can be purely criminal in nature or be perceived by the perpetrator as an act of care for loved ones in the context of severe depression.
Suicide attack	A suicide attack is an act in which an attacker perpetrates an act of violence against others, typically to achieve a military or political goal, which simultaneously results in his or her own death. Suicide bombings are often regarded as an act of terrorism by the targeted community. Historical examples include the assassination of Czar Alexander II, the kamikaze attacks launched by Japanese air pilots during the Second World War, and larger scale attacks, such as the September 11th attacks.
Mass suicide	Some suicides are performed under social pressure or coordinated among a group of individuals. Mass suicides can take place with as few as two people, often referred to as a suicide pact. An example of a larger group is the 1978 "Jonestown" cult suicide, in which 918 members of the Peoples Temple, an American cult led by Jim Jones, ended their lives by drinking grape Flavor Aid laced with cyanide.[13][14][15] Over 10,000 Japanese civilians committed suicide in the last days of the Battle of Saipan in 1944, some jumping from "Suicide Cliff" and "Banzai Cliff".[16]
Suicide pact	A suicide pact describes the suicides of two or more individuals in an agreed upon plan. The plan may be to die together, or separately and closely timed. Suicide pacts are generally distinct from mass suicides in that the latter refers to a larger number of people who kill themselves together for a common ideological reason, often within a religious, political, military or paramilitary context. In contrast, suicide pacts typically involve small groups of more intimately related people (commonly spouses, romantic partners, family members, or friends), whose motivations are intensely personal and individual.
Defiance or protest	Suicide is sometimes committed as an act of defiance or political protest such as the suicide of Mohamed Bouazizi in Tunisia whose treatment at the hands of the authorities led to a revolt that overthrew the ruling regime and touched off the Arab Spring. During the sectarian strife in Northern Ireland known as "The Troubles" a hunger strike was launched by the provisional IRA, demanding that their prisoners be reclassified as prisoners of war rather than as terrorists. The infamous 1981 hunger strikes, led by Bobby Sands resulted in 10 deaths. The cause of death was recorded as "starvation, self-imposed" rather than suicide by the coroner; this was modified to simply "starvation" on the death certificates after protest from the deceased striker's families.[17]
Dutiful suicide	Dutiful suicide is an act of fatal self violence at one's own hands done in the belief that it will secure a greater good, rather than to escape harsh or impossible conditions. It can be voluntary, to relieve some dishonor or punishment, or imposed by threats of death or reprisals on one's family or reputation as in the forced suicide of German general Erwin Rommel during World War II. He was found to have foreknowledge of the July 20 Plot on Hitler's life and was threatened with public trial, execution, and reprisals on his family unless he took his own life.[18] It is a traditional practice in some cultures, such as the heavily ritualized Japanese custom of seppuku.
Escape	In extenuating situations where continuing to live would be intolerable, some people use suicide as a means of escape. Some inmates in Nazi concentration camps are known to have killed themselves by deliberately touching the electrified fences.[19] Over 200,000 debt-ridden farmers in India have committed suicide since 1997.[20]

Risk factors

A representative listing of circumstances for suicide in 16 states in the United States. This chart does not include all possible circumstances.^[21]

Clinical studies have shown that underlying mental disorders are present in 87% to 98% of suicides, however, there are a number of other factors are correlated with suicide risk, including drug addiction, availability of means, family history of suicide, or previous head injury.^[22][23]

Socio-economic factors such as unemployment, poverty, homelessness, and discrimination may trigger suicidal thoughts.^[24] Poverty may not be a direct cause, but it can increase the risk of suicide, as impoverished individuals are a major risk group for depression.^[25] A history of childhood physical or sexual abuse^[26] or time spent in foster care.^[27][28][29]

Hopelessness, the feeling that there is no prospect of improvement in one's situation, is a strong indicator of suicide. One study found that among a group of people previously hospitalized for suicidal tendencies, 91% of those who scored a 10 or higher on the Beck Hopelessness Scale would eventually commit suicide.^[30] Perceived burdensomeness^[31] a feeling that one's existence is a burden to others such as family members is often coupled with hopelessness as are the feelings of loneliness,^[32] either subjectively (i.e., the feeling), or objectively (i.e., living alone or being without friends and lacking social support^[33]) and the feeling of not belonging^[34] as strong mediators of suicidal ideation.

Advocacy of suicide has been cited as a contributing factor. Intelligence may also be a factor. Initially proposed as a part of an evolutionary psychology explanation, which posited a minimum intelligence required for one to commit suicide, the positive correlation between IQ and suicide has been replicated in a number of studies.^{[35][36][37][38][39]} Some scientists doubt, however, that intelligence can be a cause of suicide,^[40] and intelligence is no longer a predictor of suicide when regressed with national religiousness and perceptions of personal health.^[41] According to the American Psychiatric Association, "religiously unaffiliated subjects had significantly more lifetime suicide attempts and more first-degree relatives who committed suicide than subjects who endorsed a religious affiliation."^[42] Moreover, individuals with no religious affiliation had fewer moral objections to suicide than believers.^[42]

One study found that a lack of social support, a deficit in feelings of belongingness and living alone were crucial predictors of a suicide attempt.^[43] One study found that among prison inmates, suicide was more likely among inmates who had committed a violent crime.^[44]

Medical conditions

In various studies a significant association was found between suicidality and underlying medical conditions including chronic pain,^[45] mild brain injury, (MBI) or traumatic brain injury (TBI).^[46][47] The prevalence of increased suicidality persisted after adjusting for depressive illness and alcohol abuse. In patients with more than one medical condition the risk was particulaly high, suggesting a need for increased screening for suicidality in general medical settings.^[48][49]

Sleep disturbances such as insomnia^[50] and sleep apnea have been cited in various studies as risk indicators for depression and suicide. In some instances the sleep disturbance itself may be the risk factor independent of depression.^[51]

A careful medical evaluation is recommended for all people presenting with psychiatric symptoms as many medical conditions present with psychiatric symptomatology. The major medical conditions presenting with psychiatric symptoms in order of frequency were infectious, pulmonary, thyroid, diabetic, hematopoietic, hepatic and CNS diseases.^[52] Conservative estimates are that 10% of all psychological symptoms may be due to undiagnosed medical conditions,^[53] with the results of one study suggesting that about 50% of individuals with a serious mental illness "have general medical conditions that are largely undiagnosed and untreated and may cause or exacerbate psychiatric symptoms".^[54][55]

Mental disorders

Certain mental disorders are often present at the time of suicide. It is estimated that from 87% to 98% of suicides are committed by people with some type of mental disorder.^[56] Broken down by type: mood disorders are present in 30%, substance abuse in 18%, schizophrenia in 14%, and personality disorders in 13% of suicides.^[57] About 5% of people with schizophrenia die of suicide.^[58] Major depression and alcoholism are the specific disorders most strongly correlated with suicide risk. Risk is greatest during the early stages of illness among people with mood disorders, such as major depression or bipolar disorder.^[59]

Depression is among the most commonly diagnosed psychiatric disorders;^[60][61] increasingly diagnosed across various segments of the worldwide population.^[62][63] 17.6 million Americans are affected each year; approximately 1 in 6 people. Within the next twenty years, depression is expected to become the leading cause of disability in developed nations and the second leading cause of disability worldwide.^[64] While the psychological and medical communities no longer classify acts of self-harm as suicide attempts, recent research has indicated that the presence of self-injurious behavior may be correlated to increased suicide risk.^[65] While there is a correlation between self-harm and suicide, it is not believed to be causal; both are most likely a joint effect of depression.^[66] This may also be classified as deliberate self-harm and is most common in younger people, but has been increasing in recent years in people of all ages.^[67]

Most people who attempt suicide do not complete the act on their first attempt. However, a history of suicide attempts is correlated with increased risk of eventual completion of a suicide.^[68]

Biology

Some mental disorders identified as risk factors for suicide often may have an underlying biological basis.^[69][70] Serotonin is a vital brain neurotransmitter; in those who have attempted suicide it has been found that they have lower serotonin levels, and individuals who have completed suicide have the lowest levels.^[71][72] This dysregulation in the serotonin pathway has been identified, in the ventromedial prefrontal cortex. This alteration in the brain has been found to be a risk factor for suicide independent of a history of a major depression "indicating that it is involved in the predisposition to suicide in many psychiatric disorders."^[73][74][75]

There is evidence that there may be an underlying neurobiological basis for suicide risk independent of the inheritable genetic factors responsible for the major psychiatric disorders associated with suicide.^[76] Genetic inheritance accounts for roughly 30–50% of the variance in suicide risk between individuals.^[77][78][78] Having a parent who has committed suicide is a strong predictor of suicide attempts.^[79][80][81]

Epigenetics, the study of changes in genetic expression in response to environmental factors which do not alter the underlying DNA, may also play a role in determining suicide risk.^[82][83][84]

Perceived burdensomeness to others

Several studies have found perceived burdensomeness to others to be a particularly strong risk factor. It also differentiates between attempted vs. completed suicide and predicts lethality of suicide method unlike feelings of hopelessness and emotional pain. Likely related to this, completed suicides are characterized by altruistic feelings while non-lethal self-injuries are characterized by feelings of anger or self-punishment.^[85]

An evolutionary psychology explanation for this is that suicide may under some circumstances improve inclusive fitness. This may occur if the person committing suicide will not have more children (even if not committing suicide) and takes away resources from relatives by staying alive. An objection is that some suicides, such as healthy adolescents committing suicide, likely do not increase inclusive fitness. One response is that adaptations to the very different ancestral environment may be maladaptive in the current one."^[85][86]

Substance abuse

Substance abuse is the second most common risk factor for suicide after major depression and bipolar disorder.^[87] Both chronic substance misuse as well as acute substance abuse are associated with suicide.^[88] This is attributed to the intoxicating, disinhibiting, and dissociative effects of many psychoactive substances. When combined with personal grief, such as bereavement, the risk of suicide is greatly increased.^[89] More than 50% of suicides have some relation to alcohol or drug use and up to 25% of suicides are committed by drug addicts and alcoholics. This figure is even higher with alcohol or drug use among adolescents, playing a role in up to 70% of suicides. It has been recommended that all drug addicts or alcoholics undergo investigation for suicidal thoughts due to their high risk of suicide.^[90] An investigation in the New York Prison Service found that 90% of inmates who committed suicide had a history of substance abuse.^[91]

Substance abused	Effects related to suicide
Cocaine	Misuse of drugs such as cocaine have a high correlation with suicide. Suicide is most likely to occur during the "crash" or withdrawal phase in chronic cocaine-dependent users. Polysubstance misuse is more often associated with suicide in younger adults, whereas suicide from alcoholism is more common in older adults. In San Diego it was found that 30% of suicides by people under the age of 30 had used cocaine. In New York City in the early 1990s, during the height of a crack epidemic, 1 in 5 people who committed suicide were found to have recently consumed cocaine. The "come down" or withdrawal phase of cocaine use can result in intense, acute depressive symptoms as well as other distressing mental effects, all of which contribute to an increased risk of suicide.[92][93]
Methamphetamine	Methamphetamine use has a strong association with depression and suicide as well as a range of other adverse effects on physical and mental health.[94]
Opioids	Heroin users have a death rate nearly 13 times that of their non-using peers. Deaths among heroin users attributed to suicide range from 3% to 35%, though determining the difference between a suicide and an accidental overdose can be impossible without evidence of state of mind. Overall, heroin users are 14 times more likely than their non-using peers to die from suicide.[95] Major depressive disorder was found in 25% of entrants to treatment for heroin dependence in Australia.[96]
Benzodiazepines	Chronic use or abuse of prescribed benzodiazepines is associated with depression as well as increased suicide risk. Care should be taken when prescribing to at-risk individuals and patient populations.[97][98][99] Depressed adolescents who were taking benzodiazepines were found to have a greatly increased risk of self harm or suicide, though the sample size in this study was too small to provide generalizable conclusions. The effects of benzodiazepines in individuals under the age of 18 is not well understood. Additional caution may be required for depressed adolescents using benzodiazepines.[100] Benzodiazepine dependence often results in an increasingly deteriorating clinical picture which includes social deterioration leading to comorbid alcoholism and drug abuse. Suicide is a common outcome of chronic benzodiazepine dependence. Benzodiazepine misuse or misuse of other CNS depressants increases the risk of suicide in drug misusers.[101][102] 11% of males and 23% of females with a sedative hypnotic misuse habit commit suicide.[103] Benzodiazepine withdrawal also leads to an increased risk of suicide.[104] See also: Long-term effects of benzodiazepines and Long-term effects of alcohol
Cigarettes	There have been various studies showing a positive link between smoking, suicidal ideation and suicide attempts.[105][106] In a study conducted among nurses, those smoking between 1 to 24 cigarettes per day had twice the suicide risk; 25 cigarettes or more, 4 times the suicide risk, as compared with those who had never smoked.[107][108] In a study of 300,000 male U.S. Army soldiers, a definitive link between suicide and smoking was observed with those soldiers smoking over a pack a day having twice the suicide rate of non-smokers.[109]
Alcohol	Alcohol misuse is associated with a number of mental health disorders, and alcoholics have a very high suicide rate.[110] It has been found that drinking 6 drinks or more per day results in a sixfold increased risk of suicide.[92][93] High rates of major depressive disorder occur in heavy drinkers and those who misuse alcohol. Controversy has previously surrounded whether those who misused alcohol who developed major depressive disorder were self medicating (which may be true in some cases), but recent research has now concluded that chronic excessive alcohol intake itself directly causes the development of major depressive disorder in a significant number of alcoholics.[111]

Problem gambling

Problem gambling is often associated with increased suicidal ideation and attempts compared to the general population.^{[112][113][114]}

Early onset of problem gambling increases the lifetime risk of suicide.^[115] However, gambling-related suicide attempts are usually made by older people with problem gambling.^[116] Both comorbid substance use^[117][118] and comorbid mental disorders increase the risk of suicide in people with problem gambling.^[116]

A 2010 Australian hospital study found that 17% of suicidal patients admitted to the Alfred Hospital's emergency department were problem gamblers.^[119]

Media coverage

Main article: Copycat suicide

Various studies have suggested that how the media presents depictions of suicide may have a negative effect^[120] and trigger the possibility of suicide contagion also known as the Werther effect, named after the protagonist in Goethe's The Sorrows of Young Werther who committed suicide.^[121][122] This risk is greater in adoloescents who may romantacize death.^{[123][124][125]} It appears that while news media has a significant effect, that of entertainment media is equivocal.^[126]

The opposite of the Werther effect is the Papageno effect in which coverage of effective coping mechanisms, coping in adverse circumstances, as covered in the media about suicidal ideation, may have protective effects. The term is based upon a character in Mozart’s opera The Magic Flute named Papageno who fearing the loss of a loved one was going to commit suicide until three boys showed him different ways to cope.^[127]

Methods

The most common methods of suicide in the United States.

Main article: Suicide methods

The leading method of suicide varies dramatically between countries. The leading methods in different regions include hanging, pesticide poisoning, and firearms.^[128] A 2008 review of 56 countries based on WHO mortality data found that hanging was the most common method in most of the countries,^[129] accounting for 53% of the male suicides and 39% of the female suicides.^[130] Worldwide 30% of suicides are from pesticides. The use of this method however varies markedly from 4% in Europe to more than 50% in the Pacific region.^[131] In the United States 52% of suicides involve the use of firearms.^[132] Asphyxiation (such as with a suicide bag) and poisoning are fairly common as well. Together they comprised about 40% of U.S. suicides. Other methods of suicide include blunt force trauma (jumping from a building or bridge, self-defenestrating, stepping in front of a train, or car collision, for example). Exsanguination or bloodletting (slitting one's wrist or throat), intentional drowning, self-immolation, electrocution, and intentional starvation are other suicide methods. Individuals may also intentionally provoke another person into administering lethal action against them, as in suicide by cop.

Whether or not exposure to suicide is a risk factor for suicide is controversial.^[133] A 1996 study was unable to find a relationship between suicides among friends,^[134] while a 1986 study found increased rates of suicide following the television of news stories regarding suicide.^[135]

Prevention

Main article: Suicide prevention

A United States Army suicide prevention poster

Suicide prevention is a term used for the collective efforts to reduce the incidence of suicide through preventive measures. Various strategies restrict access to the most common methods of suicide, such as firearms or toxic substances like pesticides, and have proved to be effective in reducing suicide rates. Studies supported by empirical data have indicated that adequate prevention, diagnosis and treatment of depression and alcohol and substance abuse can reduce suicide rates, as does follow-up contact with those who have made a suicide attempt.^[136] Although crisis hotlines are common there is little evidence to support or refute their effectiveness.^[137][138]

The Best Practices Registry (BPR) For Suicide Prevention is a registry of various suicide intervention programs maintained by the American Association of Suicide Prevention. The programs are divided, with those in Section I listing evidence-based programs: interventions which have been subjected to indepth review and for which evidence has demonstrated positive outcomes. Section III programs have been subjected to review.^[139][140]

In various countries, individuals who are at imminent risk of harming themselves or others may voluntarily check themselves into a hospital emergency department; this may also be done on an involuntary basis on the referral of various individuals acting in an official capacity such as the police. This is referred to by various names such as being "committed" or "sectioned". They will be placed on suicide watch until an emergency physician or mental health professional determines whether inpatient care at a mental health care facility is warranted and may hold the individual for a period of usually three days duration. A court hearing may be held to determine the individual's competence. In most states, a psychiatrist may hold the person for a specific time period without a judicial order. If the psychiatrist determines the person to be a threat to himself or others, the person may be admitted involuntarily to a psychiatric treatment facility. After this time the person must be discharged or appear in front of a judge.^[141]

Screening

The U.S. Surgeon General has suggested that screening to detect those at risk of suicide may be one of the most effective means of preventing suicide in children and adolescents.^[142] There are various screening tools in the form of self-report questionnaires to help identify those at risk such as the Beck Hopelessness Scale and Is Path Warm? A number of these self-report questionnaires have been tested and found to be valid for use among adolescents and young adults.^[143] There is, however, a high rate of false-positive identification and those deemed to be at risk should ideally have a follow-up clinical interview.^[144] The predictive quality of these screening questionnaires has not been conclusively validated, so it is not possible to determine if those identified at risk of suicide will actually commit suicide.^[145] Asking about or screening for suicide does not appear to increase the risk.^[146]

In approximately 75% of completed suicides the individuals had seen a physician within the year before their death, including 45% to 66% within the prior month. Approximately 33% to 41% of those who completed suicide had contact with mental health services in the prior year, including 20% within the prior month. These studies suggest an increased need for effective screening.^{[147][148][149][150][151]}

Treatment

There are various treatment modalities to reduce the risk of suicide by addressing the underlying conditions causing suicidal ideation, including, depending on case history, medical,^[152] pharmacological,^[153] and psychotherapeutic talk therapies.^[154]

The conservative estimate is that 10% of individuals with psychiatric disorders may have an undiagnosed medical condition causing their symptoms,^[155] upwards of 50% may have an undiagnosed medical condition which if not causing is exacerbating their psychiatric symptoms.^[156][157] Illegal drugs and prescribed medications may also produce psychiatric symptoms.^[158] Effective diagnosis and if necessary medical testing which may include neuroimaging^[159] to diagnose and treat any such medical conditions or medication side effects may reduce the risk of suicidal ideation as a result of psychiatric symptoms, most often including depression, which are present in up to 90-95% of cases.^[160]

Recent research has shown that treatment with lithium has been effective with lowering the risk of suicide in those with bipolar disorder to the same levels as the general population.^[161] Low doses of Lithium with minimal side effects has also proven effective in lowering the suicide risk in those with unipolar depression as well.^[162]

There are multiple evidence-based psychotherapeutic talk therapies available to reduce suicidal ideation such as dialectical behaviour therapy (DBT) for which multiple studies have reported varying degrees of clinical effectiveness in reducing suicidality. Benefits include a reduction in self-harm behaviours and suicidal ideations.^[163][164] Cognitive Behavior Therapy for Suicide Prevention (CBT-SP) is a form of DBT adapted for adolescents at high risk for repeated suicide attempts.^[165]

Epidemiology

Main article: Epidemiology of suicide

Deaths for self inflicted injuries per 100,000 inhabitants in 2004.^[166]

unknown   <3   3–6   6–9   9–12   12–15   15–18

18–21   21–24   24–27   27–30   30–33   >33

Worldwide suicide rates have increased by 60% in the past 45 years, mainly in the developing countries and is currently the tenth leading cause of death^[1] with about a million people dying by suicide annually, a global mortality rate of 16 suicides per 100,000 people, or a suicide every 40 seconds.^[167] According to 2007 data, suicides in the U.S. outnumber homicides by nearly 2 to 1. Suicide ranks as the 11th leading cause of death in the country, ahead of liver disease and Parkinson's.^[168]

Gender

Main article: Gender and suicide

Suicide rate per 100,000 males (left) and female (right) (data from 1978–2008).   no data   < 1   1–5   5–5.8   5.8–8.5   8.5–12   12–19   19–22.5   22.5–26   26–29.5   29.5–33   33–36.5   >36.5

In the Western world, males die much more often by means of suicide than do females, although females attempt suicide more often. Some medical professionals believe this stems from the fact that males are more likely to end their lives through effective violent means, while women primarily use less severe methods such as overdosing on medications. In most countries, drug overdoses account for about two-thirds of suicides among women and one-third among men.^[67]

Alcohol and drug use

In the United States 16.5% of suicides are related to alcohol.^[169] Alcoholics are 5 to 20 times more likely to kill themselves, while the misuse of other drugs increases the risk 10 to 20 times. About 15% of alcoholics commit suicide, and about 33% of suicides in the under 35 age group have a primary diagnosis of alcohol or other substance misuse; over 50% of all suicides are related to alcohol or drug dependence. In adolescents alcohol or drug misuse plays a role in up to 70% of suicides.^[90][170]

Ethnicity

See also: Finno-Ugrian suicide hypothesis

National suicide rates differ significantly between countries and amongst ethnic groups within countries.^[171] For example, in the U.S., non-Hispanic Caucasians are nearly 2.5 times more likely to kill themselves than African Americans or Hispanics.^[172]

Social aspects

Legislation

Main article: Suicide legislation

A tantō knife prepared for seppuku.

In some jurisdictions, an act or incomplete act of suicide is considered to be a crime. More commonly, a surviving party member who assisted in the suicide attempt will face criminal charges.

In Brazil, if the help is directed to a minor, the penalty is applied in its double and not considered as homicide. In Italy and Canada, instigating another to suicide is also a criminal offense. In Singapore, assisting in the suicide of a mentally handicapped person is a capital offense. In India, abetting suicide of a minor or a mentally challenged person can result in a maximum 1 year prison term with a possible fine.^[173]

In Germany, the following laws apply to cases of suicide:^[174]

• Active euthanasia (killing on request) is prohibited by article 216 of the StGB (Strafgesetzbuch, German Criminal Code), punishable with six months to five years in jail
• German law interprets suicide as an accident and anyone present during suicide may be prosecuted for failure to render aid in an emergency. A suicide legally becomes an emergency when a suicidal person loses consciousness. Failure to render aid is punishable under article 323c of the StGB, with a maximum one year jail sentence.

Switzerland has recently taken steps to legalize assisted suicide for the chronically mentally ill. The high court in Lausanne, in a 2006 ruling, granted an anonymous individual with longstanding psychiatric difficulties the right to end his own life. At least one leading American bioethicist, Jacob Appel of Brown University, has argued that the American medical community ought to condone suicide in certain individuals with mental illness.^[175]

Religious views

Main article: Religious views on suicide

In most forms of Christianity, suicide is considered a sin, based mainly on the writings of influential Christian thinkers of the Middle Ages, such as St. Augustine and St. Thomas Aquinas; suicide was not considered a sin under the Byzantine Christian code of Justinian, for instance.^[176][177] In Catholic doctrine, the argument is based on the commandment "Thou shalt not kill" (made applicable under the New Covenant by Jesus in Matthew 19:18), as well as the idea 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.^[178] However, it is believed that mental illness or grave fear of suffering diminishes the responsibility of the one completing suicide.^[179] Counter-arguments include the following: that the sixth commandment is more accurately translated as "thou shalt not murder", not necessarily applying to the self; that God has given free will to humans; that taking one's own life no more violates God's Law than does curing a disease; and that a number of suicides by followers of God are recorded in the Bible with no dire condemnation.^[180]

A Hindu widow burning herself with the corpse of her husband, 1820s.

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, Jews have committed individual suicide or mass suicide (see 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 both as examples of heroic martyrdom, whilst others state that it was wrong for them to take their own lives in anticipation of martyrdom.^[181]

Suicide is not allowed in Islam.^{[182][dubious – discuss]}

In Hinduism, suicide is generally frowned upon and is considered equally sinful as murdering another in contemporary Hindu society. Hindu Scriptures state that one who commits suicide will become part of the spirit world, wandering earth until the time one would have otherwise died, had one not committed suicide.^[183] However, Hinduism accept a man's right to end one's life through the non-violent practice of fasting to death, termed Prayopavesa.^[184] But Prayopavesa is strictly restricted to people who have no desire or ambition left, and no responsibilities remaining in this life.^[184] Jainism has a similar practice named Santhara. Sati, or self-immolation by widows was prevalent in Hindu society during the Middle Ages.

Philosophy

Main article: Philosophy of suicide

The Way Out, or Suicidal Ideation: George Grie, 2007.

Some see suicide as a legitimate matter of personal choice and a human right (colloquially known as the right to die movement). 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 that have no possibility of improvement. Proponents of this view 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.^[185] This perspective is most popular and has a good deal of support in continental Europe, where euthanasia and other such topics are commonly discussed in parliament.^[186]

A narrower segment of this group considers suicide something between a grave but condonable choice in some circumstances and a sacrosanct right for anyone (even a young and healthy person) who believes they have rationally and conscientiously come to the decision to end their own lives. Notable supporters of this school of thought include Friedrich Nietzsche, and Scottish empiricist David Hume.^[187] Bioethicist Jacob Appel has become the leading advocate for this position in the United States.^[188][189] Adherents of this view often advocate the abrogation of statutes that restrict the liberties of people known to be suicidal, such as laws permitting their involuntary commitment to mental hospitals.

Locations

See also: List of suicide sites

Some landmarks have become known for high levels of suicide attempts. The four most popular locations in the world are reportedly San Francisco's Golden Gate Bridge, Toronto's Bloor Street Viaduct (before the construction of the Luminous Veil),^[190] Japan's Aokigahara Forest and England's Beachy Head.^[191] In 2005 the Golden Gate Bridge had a count exceeding 1,200 jumpers since its construction in 1937.^[192] In 1997 the Bloor Street Viaduct had one suicide every 22 days,^[193] and in 2002 Aokigahara had a record of 78 bodies found within the forest, replacing the previous record of 73 in 1998.^[194] The suicide rate of these places is so high that numerous signs, urging potential victims of suicide to seek help, have been posted.^[195]

Advocacy

See also: Advocacy of suicide

Advocacy of suicide has occurred in many cultures and subcultures. The Japanese military during World War II encouraged and glorified kamikaze attacks, and Japanese society as a whole has been described as suicide 'tolerant' (see Suicide in Japan).

William Francis Melchert-Dinkel, 47 years old in May 2010, from Faribault, Minnesota, a licensed nurse from 1991 until February 2009, stands accused of encouraging people to commit suicide while he watched on a webcam.^{[196][197][198][199]}

A study by the British Medical Journal found that Web searches for information on suicide are likely to return sites that encourage, and even facilitate, suicide attempts.^[200] There is some concern that such sites may push the suicidal over the edge.^[201] Some people form suicide pacts with people they meet online.^[202] Becker writes, "Suicidal adolescent visitors risk losing their doubts and fears about committing suicide. Risk factors include peer pressure to commit suicide and appointments for joint suicides. Furthermore, some chat rooms celebrate chatters who committed suicide."^[203]

Language

Because suicide was a crime in various countries, including in England and Wales which decriminalized it in 1961, the word 'commit' has traditionally been used in reference to it. Organisations such as the BBC and the Samaritans have stopped using this word because of its negative connotation. 'Attempt' suicide or other phrases are preferred.^[204] The Guardian and The Observer also avoid the phrase, preferring the use of "killed him or herself".^[205]

Other species

"Suicide" has been observed in salmonella seeking to overcome competing bacteria by triggering an immune system response against them.^[206] Suicidal defences by workers are also noted in a 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.^[207]

Pea aphids, when threatened by a ladybug, can explode themselves, scattering and protecting their brethren and sometimes even killing the lady bug.^[208] Some species of termites have soldiers that explode, covering their enemies with sticky goo.^[209][210]

Asian black bears being used as "bile bears" are known to frequently try to kill themselves as a result of the severe pain caused by the permanent holes in their abdomen and gall bladder.^[211][212]

There have been anecdotal reports of dogs, horses, and dolphins committing suicide, but with little conclusive evidence.^[213] There has been little scientific study of animal suicide.^[214]

See also

Bullycide Parasuicide Rational suicide Senicide Stigmatized property Suicide bridge Suicide note Suicide survivor

Suicide prevention organizations Samaritans (charity) American Foundation for Suicide Prevention Suicide Prevention Action Network USA Campaign Against Living Miserably National Suicide Prevention Lifeline

Books & Film The Complete Manual of Suicide Final Exit The Peaceful Pill Handbook Suicide The Bridge (2006 film)

Lists List of suicide crisis lines List of countries by suicide rate List of suicide sites List of suicides

Footnotes

1. ^ ^{a b} Hawton K, van Heeringen K (April 2009). "Suicide". Lancet 373 (9672): 1372–81. doi:10.1016/S0140-6736(09)60372-X. PMID 19376453. 
2. ^ "www.uvm.edu" (PDF). http://www.uvm.edu/~fmagdoff/PrecariousExistence.pdf. 
3. ^ Bruce Gross, Forrensic Examiner, Summer, 2006
4. ^ see the PDF
5. ^ "CIS: UN Body Takes On Rising Suicide Rates – Radio Free Europe / Radio Liberty 2006". http://www.rferl.org/content/article/1071203.html. 
6. ^ O'Connor, Rory; Sheehy, Noel (29 Jan 2000). Understanding suicidal behaviour. Leicester: BPS Books. pp. 33–37. ISBN 978-1-85433-290-5. http://books.google.com/?id=79hEYGdDA3oC. 
7. ^ http://books.google.co.uk/books?id=VB3OezIoI44C&pg=PA311&dq=rates+of+suicide+of+men+are+three+to+four+times+higher+than+for+women&hl=en&ei=ke2dTuiCAZH6sgaO9uj5CA&sa=X&oi=book_result&ct=result&resnum=4&ved=0CD8Q6AEwAw#v=onepage&q&f=false
8. ^ Gelder et al, 2005 p169. Psychiatry 3rd Ed. Oxford: New York
9. ^ Bertolote JM, Fleischmann A (October 2002). "Suicide and psychiatric diagnosis: a worldwide perspective". World Psychiatry 1 (3): 181–5. PMC 1489848. PMID 16946849. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1489848. 
10. ^ "Indian woman commits sati suicide". Bbc.co.uk. 2002-08-07. http://www.bbc.co.uk/worldservice/learningenglish/news/words/general/020807_witn.shtml. Retrieved 2010-08-26. 
11. ^ Blake JA (1978 Spring). "Death by hand grenade: altruistic suicide in combat". Suicide & life-threatening behavior (Suicide Life Threat Behav.) 8 (1): 46–59. PMID 675772 
12. ^ Monica Davey. "Kevorkian Speaks After His Release From Prison". The New York Times. June 4, 2007. Note: Kevorkian was sentenced to 10-25 years in prison 1999, but was released on parole on June 1, 2007; 4 years before his death on June 3, 2011.
13. ^ Hall 1987, p.282
14. ^ "Jonestown Audiotape Primary Project." Alternative Considerations of Jonestown and Peoples Temple. San Diego State University. Archived 24 January 2011 at WebCite
15. ^ "1978: Mass Suicide Leaves 900 Dead". Retrieved 9 November 2011.
16. ^ John Toland, The Rising Sun: The Decline and Fall of the Japanese Empire 1936–1945, Random House, 1970, p. 519
17. ^ Suicide and Self-Starvation, Terence M. O'Keeffe, Philosophy, Vol. 59, No. 229 (Jul., 1984), pp. 349–363
18. ^ Watson, Bruce (2007). Exit Rommel: The Tunisian Campaign, 1942–43. Stackpole Books. p. 170. ISBN 978-0-8117-3381-6. 
19. ^ Yisrael Gutman, Michael Berenbaum; Anatomy of the Auschwitz death camp, p. 400: Indiana University Press (1998) ISBN 0-253-20884-X
20. ^ "Activist: Farmer suicides in India linked to debt, globalization". CNN. January 05, 2010
21. ^ Centers for Disease Control and Prevention: Suicide: Data Sources
22. ^ Teasdale TW, Engberg AW (October 2001). "Suicide after traumatic brain injury: a population study". J. Neurol. Neurosurg. Psychiatr. 71 (4): 436–40. doi:10.1136/jnnp.71.4.436. PMC 1763534. PMID 11561024. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1763534. 
23. ^ Simpson G, Tate R (December 2007). "Suicidality in people surviving a traumatic brain injury: prevalence, risk factors and implications for clinical management". Brain Inj 21 (13-14): 1335–51. doi:10.1080/02699050701785542. PMID 18066936. 
24. ^ Qin P, Agerbo E, Mortensen PB (April 2003). "Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial factors: a national register-based study of all suicides in Denmark, 1981–1997". Am J Psychiatry 160 (4): 765–72. doi:10.1176/appi.ajp.160.4.765. PMID 12668367. 
25. ^ Birtchnell J, Masters N (September 1989). "Poverty and depression". Practitioner 233 (1474): 1141–6. PMID 2616460. 
26. ^ Dube SR, Anda RF, Felitti VJ, Chapman DP, Williamson DF, Giles WH (December 2001). "Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study". JAMA 286 (24): 3089–96. PMID 11754674. 
27. ^ "Child Protection and Child Outcomes: Measuring the Effects of Foster Care" (PDF). http://www.mit.edu/~jjdoyle/doyle_fosterlt_march07_aer.pdf. Retrieved 2011-11-01. 
28. ^ Koch, Wendy (2007-07-03). "Study: Troubled homes better than foster care". Usatoday.Com. http://www.usatoday.com/news/nation/2007-07-02-foster-study_N.htm. Retrieved 2011-11-01. 
29. ^ Lawrence, CR; Carlson, EA; Egeland, B (2006). "The impact of foster care on development". Development and Psychopathology 18 (1): 57–76. doi:10.1017/S0954579406060044. PMID 16478552. 
30. ^ Beck AT, Steer RA, Kovacs M, Garrison B (May 1985). "Hopelessness and eventual suicide: a 10-year prospective study of patients hospitalized with suicidal ideation". Am J Psychiatry 142 (5): 559–63. PMID 3985195. 
31. ^ Jahn DR, Cukrowicz KC, Linton K, Prabhu F (March 2011). "The mediating effect of perceived burdensomeness on the relation between depressive symptoms and suicide ideation in a community sample of older adults". Aging Ment Health 15 (2): 214–20. doi:10.1080/13607863.2010.501064. PMID 20967639. 
32. ^ Stravynski A, Boyer R (2001). "Loneliness in relation to suicide ideation and parasuicide: a population-wide study". Suicide Life Threat Behav 31 (1): 32–40. PMID 11326767. 
33. ^ Vanderhorst RK, McLaren S (November 2005). "Social relationships as predictors of depression and suicidal ideation in older adults". Aging Ment Health 9 (6): 517–25. doi:10.1080/13607860500193062. PMID 16214699. 
34. ^ McLaren S, Gomez R, Bailey M, Van Der Horst RK (February 2007). "The association of depression and sense of belonging with suicidal ideation among older adults: applicability of resiliency models". Suicide Life Threat Behav 37 (1): 89–102. doi:10.1521/suli.2007.37.1.89. PMID 17397283. 
35. ^ Voracek, M. (2003). "Risk of suicide in twins: intelligence of twins and singletons may explain risk". BMJ (Clinical research ed.) 327 (7424): 1168–116a–1168. doi:10.1136/bmj.327.7424.1168-a. PMC 261853. PMID 14615358. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=261853.  edit
36. ^ Voracek, M. (2004). "National intelligence and suicide rate: an ecological study of 85 countries". Personality and Individual Differences 37 (3): 543–553. doi:10.1016/j.paid.2003.09.025.  edit
37. ^ Voracek, M. (2005). "National intelligence, suicide rate in the elderly, and a threshold intelligence for suicidality: an ecological study of 48 Eurasian countries". Journal of biosocial science 37 (6): 721–740. doi:10.1017/S0021932004006959. PMID 16221322.  edit
38. ^ Voracek, M. (2006). "Smart and Suicidal? The Social Ecology of Intelligence and Suicide in Austria". Death Studies 30 (5): 471–485. doi:10.1080/07481180600614591. PMID 16610159.  edit
39. ^ Voracek, M. (2009). "National Intelligence, Suicide Rate, and Subjective Well-Being1". Perceptual and Motor Skills 109 (3): 718–720. doi:10.2466/pms.109.3.718-720. PMID 20178270.  edit
40. ^ Only the bright commit suicide. Does a controversial theory linking intelligence with suicide rates help to explain why so many scientists kill themselves?
41. ^ Minkov, M. (2010). "Predictors of National Suicide Rates: A Reply to Voracek (2004, 2006, 2009)1". Psychological Reports 106 (3): 718–720. doi:10.2466/pr0.106.3.718-720. PMID 20712159.  edit
42. ^ ^{a b} Michael Martin. "Religious Affiliation and Suicide Attempt". Cambridge University Press. http://ajp.psychiatryonline.org/cgi/content/abstract/161/12/2303. Retrieved 13 November 2010. "Religiously unaffiliated subjects had significantly more lifetime suicide attempts and more first-degree relatives who committed suicide than subjects who endorsed a religious affiliation. Unaffiliated subjects were younger, less often married, less often had children, and had less contact with family members. Furthermore, subjects with no religious affiliation perceived fewer reasons for living, particularly fewer moral objections to suicide. In terms of clinical characteristics, religiously unaffiliated subjects had more lifetime impulsivity, aggression, and past substance use disorder." 
43. ^ You, S.; Van Orden, K. A.; Conner, K. R. (2010). "Social connections and suicidal thoughts and behavior". Psychology of Addictive Behaviors 25 (1): 180–184. doi:10.1037/a0020936. PMC 3066301. PMID 21142333. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3066301.  edit
44. ^ Way, B.; Miraglia, R.; Sawyer, D.; Beer, R.; Eddy, J. (2005). "Factors related to suicide in New York state prisons". International Journal of Law and Psychiatry 28 (3): 207–221. doi:10.1016/j.ijlp.2004.09.003. PMID 15950281.  edit
45. ^ Ilgen MA, Zivin K, McCammon RJ, Valenstein M (2008). "Pain and suicidal thoughts, plans and attempts in the United States". Gen Hosp Psychiatry 30 (6): 521–7. doi:10.1016/j.genhosppsych.2008.09.003. PMC 2601576. PMID 19061678. http://linkinghub.elsevier.com/retrieve/pii/S0163-8343(08)00164-3. 
46. ^ Simpson GK, Tate RL (August 2007). "Preventing suicide after traumatic brain injury: implications for general practice". Med. J. Aust. 187 (4): 229–32. PMID 17708726. http://www.mja.com.au/public/issues/187_04_200807/sim11240_fm.html. 
47. ^ Teasdale TW, Engberg AW (October 2001). "Suicide after traumatic brain injury: a population study". J. Neurol. Neurosurg. Psychiatr. 71 (4): 436–40. doi:10.1136/jnnp.71.4.436. PMC 1763534. PMID 11561024. http://jnnp.bmj.com/cgi/pmidlookup?view=long&pmid=11561024. 
48. ^ Druss B, Pincus H (May 2000). "Suicidal ideation and suicide attempts in general medical illnesses". Arch. Intern. Med. 160 (10): 1522–6. doi:10.1001/archinte.160.10.1522. PMID 10826468. http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=10826468. 
49. ^ Braden JB, Sullivan MD (December 2008). "Suicidal thoughts and behavior among adults with self-reported pain conditions in the national comorbidity survey replication". J Pain 9 (12): 1106–15. doi:10.1016/j.jpain.2008.06.004. PMC 2614911. PMID 19038772. http://linkinghub.elsevier.com/retrieve/pii/S1526-5900(08)00624-X. 
50. ^ Ribeiro JD, Pease JL, Gutierrez PM, et al. (October 2011). "Sleep problems outperform depression and hopelessness as cross-sectional and longitudinal predictors of suicidal ideation and behavior in young adults in the military". J Affect Disord 136 (3): 743–50. doi:10.1016/j.jad.2011.09.049. PMID 22032872. 
51. ^ Bernert RA, Joiner TE, Cukrowicz KC, Schmidt NB, Krakow B (September 2005). "Suicidality and sleep disturbances". Sleep 28 (9): 1135–41. PMID 16268383. 
52. ^ Hall RC, Popkin MK, Devaul RA, Faillace LA, Stickney SK (November 1978). "Physical illness presenting as psychiatric disease". Arch. Gen. Psychiatry 35 (11): 1315–20. doi:10.1001/archpsyc.1978.01770350041003. PMID 568461. http://archpsyc.ama-assn.org/cgi/pmidlookup?view=long&pmid=568461. 
53. ^ Morrison, James O. (1999). When Psychological Problems Mask Medical Disorders: A Guide for Psychotherapists. New York: The Guilford Press. ISBN 1-57230-539-8. 
54. ^ Rothbard AB, Blank MB, Staab JP et al (April 2009). "Previously undetected metabolic syndromes and infectious diseases among psychiatric inpatients". Psychiatr Serv 60 (4): 534–7. doi:10.1176/appi.ps.60.4.534. PMID 19339330. http://psychservices.psychiatryonline.org/cgi/content/full/60/4/534. 
55. ^ Hall RC, Gardner ER, Stickney SK, LeCann AF, Popkin MK (September 1980). "Physical illness manifesting as psychiatric disease. II. Analysis of a state hospital inpatient population". Archives of General Psychiatry 37 (9): 989–95. doi:10.1001/archpsyc.1980.01780220027002. PMID 7416911. 
56. ^ Arsenault-Lapierre G, Kim C, Turecki G (Nov 2004). "Psychiatric diagnoses in 3275 suicides: a meta-analysis" (Free full text). BMC Psychiatry 4: 37. doi:10.1186/1471-244X-4-37. PMC 534107. PMID 15527502. http://www.biomedcentral.com/1471-244X/4/37. 
57. ^ Bertolote JM, Fleischmann A, De Leo D, Wasserman D (2004). "Psychiatric diagnoses and suicide: revisiting the evidence". Crisis 25 (4): 147–55. doi:10.1027/0227-5910.25.4.147. PMID 15580849. 
58. ^ Palmer BA, Pankratz VS, Bostwick JM (March 2005). "The lifetime risk of suicide in schizophrenia: a reexamination". Arch. Gen. Psychiatry 62 (3): 247–53. doi:10.1001/archpsyc.62.3.247. PMID 15753237. 
59. ^ Gliatto, Michael F.; Rai, Anil K. (March 1999). "Evaluation and Treatment of Patients with Suicidal Ideation". American Family Physician 59 (6): 1500–6. PMID 10193592. http://www.aafp.org/afp/990315ap/1500.html. Retrieved 2007-01-08. 
60. ^ Sharp LK, Lipsky MS (September 2002). "Screening for depression across the lifespan: a review of measures for use in primary care settings". American family physician 66 (6): 1001–8. PMID 12358212. 
61. ^ Torzsa P, Szeifert L, Dunai K, Kalabay L, Novák M (September 2009). "A depresszió diagnosztikája és kezelése a családorvosi gyakorlatban". Orvosi Hetilap 150 (36): 1684–93. doi:10.1556/OH.2009.28675. PMID 19709983. 
62. ^ "College Students Exhibiting More Severe Mental Illness, Study Finds". Apa.org. 2010-08-12. http://www.apa.org/news/press/releases/2010/08/students-mental-illness.aspx. Retrieved 2010-08-26. 
63. ^ Lambert KG (2006). "Rising rates of depression in today's society: Consideration of the roles of effort-based rewards and enhanced resilience in day-to-day functioning". Neuroscience & Biobehavioral Reviews 30 (4): 497–510. doi:10.1016/j.neubiorev.2005.09.002. PMID 16253328. 
64. ^ World health Organization:Depression
65. ^ Whitlock J, Knox KL (July 2007). "The relationship between self-injurious behavior and suicide in a young adult population". Arch Pediatr Adolesc Med 161 (7): 634–40. doi:10.1001/archpedi.161.7.634. PMID 17606825. 
66. ^ "Rethink – About self harm". http://www.rethink.org/living_with_mental_illness/coping_in_a_crisis/suicide_self_harm/self_harming/index.html. 
67. ^ ^{a b} Gelder, Mayou, Geddes (2005). Psychiatry: Page 170. New York, NY; Oxford University Press Inc.
68. ^ Shaffer D (September 1988). "The epidemiology of teen suicide: an examination of risk factors". J Clin Psychiatry 49 (Suppl): 36–41. PMID 3047106. 
69. ^ Krishnan, V.; Nestler, E. (2008). "The molecular neurobiology of depression". Nature 455 (7215): 894–902. Bibcode 2008Natur.455..894K. doi:10.1038/nature07455. PMC 2721780. PMID 18923511. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2721780. 
70. ^ Phillips J, Murray P, Kirk P., The biology of disease; pp.5-9 ISBN 978-0-632-05404-6
71. ^ David M. Stoff, Elizabeth J. Susman: Developmental psychobiology of aggression; Cambridge University Press (2005) ISBN 0-521-82601-2
72. ^ S. Hossein Fatemi, Paula J. Clayton:The medical basis of psychiatry. p.562 Springer(1994);, ISBN 978-1-58829-917-8
73. ^ J. John Mann, M.D., Neurobiological Aspects of Suicide
74. ^ Roberto Tatarelli, Maurizio Pompili, Paolo Girardi: Suicide in psychiatric disorders. p.266; Nova Science Pub Inc;(2007) ISBN 1-60021-738-9
75. ^ Alan F. Schatzberg: The American Psychiatric Publishing textbook of mood disorders. p.489; American Psychiatric Publishing; (2005) ISBN 1-58562-151-X
76. ^ Mann JJ, Brent DA, Arango V (May 2001). "The neurobiology and genetics of suicide and attempted suicide: a focus on the serotonergic system". Neuropsychopharmacology 24 (5): 467–77. doi:10.1016/S0893-133X(00)00228-1. PMID 11282247. 
77. ^ Brezo J, Klempan T, Turecki G (June 2008). "The genetics of suicide: a critical review of molecular studies". Psychiatr. Clin. North Am. 31 (2): 179–203. doi:10.1016/j.psc.2008.01.008. PMID 18439443. 
78. ^ ^{a b} Goldsmith, Sara K. (2002). Reducing suicide: a national imperative. Washington, D.C: National Academies Press. p. 141. ISBN 0-309-08321-4. 
79. ^ . PMID 271079606.  edit
80. ^ Agerbo E, Nordentoft M, Mortensen PB (July 2002). "Familial, psychiatric, and socioeconomic risk factors for suicide in young people: nested case-control study". BMJ 325 (7355): 74. PMC 117126. PMID 12114236. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=117126. 
81. ^ Qin P, Agerbo E, Mortensen PB (October 2002). "Suicide risk in relation to family history of completed suicide and psychiatric disorders: a nested case-control study based on longitudinal registers". Lancet 360 (9340): 1126–30. doi:10.1016/S0140-6736(02)11197-4. PMID 12387960. 
82. ^ Krishnan, V.; Nestler, E. (2009). "Epigenetics in Suicide and Depression". Biological Psychiatry 66 (9): 812–813. doi:10.1016/j.biopsych.2009.08.033. PMC 2770810. PMID 19833253. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2770810. 
83. ^ Trygve Tollefsbol: Handbook of Epigenetics: The New Molecular and Medical Genetics. p.562: Elsevier Science;(2010);ISBN 0-12-375709-6
84. ^ Arturas Petronis: Brain, Behavior and Epigenetics, p.61 Springer (2011);ISBN 3-642-17425-6
85. ^ ^{a b} Joiner, T. E.; Brown, J. S.; Wingate, L. R. (2005). "The Psychology and Neurobiology of Suicidal Behavior". Annual Review of Psychology 56: 287–314. doi:10.1146/annurev.psych.56.091103.070320. PMID 15709937.  edit
86. ^ Confer, J. C.; Easton, J. A.; Fleischman, D. S.; Goetz, C. D.; Lewis, D. M. G.; Perilloux, C.; Buss, D. M. (2010). "Evolutionary psychology: Controversies, questions, prospects, and limitations". American Psychologist 65 (2): 110–126. doi:10.1037/a0018413. PMID 20141266. http://homepage.psy.utexas.edu/homepage/Group/BussLAB/pdffiles/evolutionary_psychology_AP_2010.pdf.  edit
87. ^ D., PhD Frank, Jerome; Levin, Jerome D; S., PhD Piccirilli, Richard; Perrotto, Richard S; Culkin, Joseph (28 Sep 2001). Introduction to chemical dependency counseling. Northvale, NJ: Jason Aronson. pp. 150–152. ISBN 978-0-7657-0289-0. http://books.google.com/?id=felzn3Ntd-cC&pg=RA1-PA151. 
88. ^ Giner L, Carballo JJ, Guija JA, et al. (2007). "Psychological autopsy studies: the role of alcohol use in adolescent and young adult suicides". Int J Adolesc Med Health 19 (1): 99–113. PMID 17458329. 
89. ^ Fadem, Barbara (1 Dec 2003). Behavioral science in medicine. Philadelphia: Lippincott Williams Wilkins. p. 217. ISBN 978-0-7817-3669-5. http://books.google.com/?id=KB-g-oBfApsC. 
90. ^ ^{a b} Miller, NS; Mahler, JC; Gold, MS (1991). "Suicide risk associated with drug and alcohol dependence". Journal of addictive diseases 10 (3): 49–61. doi:10.1300/J069v10n03_06. PMID 1932152. 
91. ^ Way, B.; Miraglia, R.; Sawyer, D.; Beer, R.; Eddy, J. (2005). "Factors related to suicide in New York state prisons". International Journal of Law and Psychiatry 28 (3): 207–221. doi:10.1016/j.ijlp.2004.09.003. PMID 15950281.  edit
92. ^ ^{a b} O'Donohue, William T.; R. Byrd, Michelle; Cummings, Nicholas A.; Henderson, Deborah P. (2005). Behavioral integrative care: treatments that work in the primary care setting. New York: Brunner-Routledge. p. 115. ISBN 978-0-415-94946-0. http://books.google.com/?id=PO5u2w3qL68C. 
93. ^ ^{a b} Ayd, Frank J (31 May 2000). Lexicon of psychiatry, neurology, and the neurosciences. Philadelphia: Lippincott-Williams Wilkins. p. 256. ISBN 978-0-7817-2468-5. http://books.google.com/?id=ea_QVG2BFy8C. 
94. ^ Darke, S.; Kaye, S.; McKetin, R.; Duflou, J. (May 2008). "Major physical and psychological harms of methamphetamine use". Drug Alcohol Rev 27 (3): 253–62. doi:10.1080/09595230801923702. PMID 18368606. 
95. ^ Darke S, Ross J (November 2002). "Suicide among heroin users: rates, risk factors and methods". Addiction 97 (11): 1383–94. doi:10.1046/j.1360-0443.2002.00214.x. PMID 12410779. http://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0965-2140&date=2002&volume=97&issue=11&spage=1383. 
96. ^ Teesson M, Havard A, Fairbairn S, Ross J, Lynskey M, Darke S (June 2005). "Depression among entrants to treatment for heroin dependence in the Australian Treatment Outcome Study (ATOS): prevalence, correlates and treatment seeking". Drug Alcohol Depend 78 (3): 309–15. doi:10.1016/j.drugalcdep.2004.12.001. PMID 15893162. http://linkinghub.elsevier.com/retrieve/pii/S0376-8716(04)00350-3. 
97. ^ Professor C Heather Ashton (1987). "Benzodiazepine Withdrawal: Outcome in 50 Patients". British Journal of Addiction 82: 655–671. http://www.benzo.org.uk/ashbzoc.htm. 
98. ^ Neutel CI, Patten SB (November 1997). "Risk of suicide attempts after benzodiazepine and/or antidepressant use". Ann Epidemiol 7 (8): 568–74. doi:10.1016/S1047-2797(97)00126-9. PMID 9408553. http://linkinghub.elsevier.com/retrieve/pii/S1047279797001269. 
99. ^ Taiminen TJ (January 1993). "Effect of psychopharmacotherapy on suicide risk in psychiatric inpatients". Acta Psychiatr Scand 87 (1): 45–7. doi:10.1111/j.1600-0447.1993.tb03328.x. PMID 8093823. 
100. ^ Brent DA, Emslie GJ, Clarke GN et al (April 2009). "Predictors of spontaneous and systematically assessed suicidal adverse events in the treatment of SSRI-resistant depression in adolescents (TORDIA) study". Am J Psychiatry 166 (4): 418–26. doi:10.1176/appi.ajp.2008.08070976. PMID 19223438. http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=19223438. 
101. ^ Allgulander C, Borg S, Vikander B (December 1984). "A 4–6-year follow-up of 50 patients with primary dependence on sedative and hypnotic drugs". Am J Psychiatry 141 (12): 1580–2. PMID 6507663. 
102. ^ Wines JD, Saitz R, Horton NJ, Lloyd-Travaglini C, Samet JH (December 2004). "Suicidal behavior, drug use and depressive symptoms after detoxification: a 2-year prospective study". Drug Alcohol Depend 76 (Suppl): S21–9. doi:10.1016/j.drugalcdep.2004.08.004. PMID 15555813. http://linkinghub.elsevier.com/retrieve/pii/S0376-8716(04)00211-X. 
103. ^ Allgulander C, Ljungberg L, Fisher LD (May 1987). "Long-term prognosis in addiction on sedative and hypnotic drugs analyzed with the Cox regression model". Acta Psychiatr Scand 75 (5): 521–31. doi:10.1111/j.1600-0447.1987.tb02828.x. PMID 3604738. 
104. ^ Colvin, Rod (26 August 2008). Overcoming Prescription Drug Addiction: A Guide to Coping and Understanding (3 ed.). United States of America: Addicus Books. pp. 74–76. ISBN 978-1-886039-88-9. http://books.google.com/?id=lalhQgAACAAJ. "I have treated ten thousand patients for alcohol and drug problems and have detoxed approximately 1,500 patients for benzodiazepines – the detox for the benzodiazepines is one of the hardest detoxes we do. It can take an extremely long time, about half the length of time they have been addicted – the ongoing relentless withdrawals can be so incapacitating it can cause total destruction to one’s life – marriages break up, businesses are lost, bankruptcy, hospitalization, and of course suicide is probably the most single serious side effect." 
105. ^ Iwasaki M, Akechi T, Uchitomi Y, Tsugane S (April 2005). "Cigarette Smoking and Completed Suicide among Middle-aged Men: A Population-based Cohort Study in Japan". Annals of Epidemiology 15 (4): 286–92. doi:10.1016/j.annepidem.2004.08.011. PMID 15780776. 
106. ^ Miller M, Hemenway D, Rimm E (May 2000). "Cigarettes and suicide: a prospective study of 50,000 men". American journal of public health 90 (5): 768–73. doi:10.2105/AJPH.90.5.768. PMC 1446219. PMID 10800427. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1446219. 
107. ^ Hemenway D, Solnick SJ, Colditz GA (February 1993). "Smoking and suicide among nurses". American journal of public health 83 (2): 249–51. doi:10.2105/AJPH.83.2.249. PMC 1694571. PMID 8427332. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1694571. 
108. ^ Thomas Bronischa, Michael Höflerab, Roselind Liebac (May 2008). "Smoking predicts suicidality: Findings from a prospective community study". Journal of Affective Disorders 108 (1): 135–145. doi:10.1016/j.jad.2007.10.010. PMID 18023879. 
109. ^ Miller M, Hemenway D, Bell NS, Yore MM, Amoroso PJ (June 2000). "Cigarette smoking and suicide: a prospective study of 300,000 male active-duty Army soldiers". American Journal of Epidemiology 151 (11): 1060–3. PMID 10873129. 
110. ^ Chignon JM, Cortes MJ, Martin P, Chabannes JP (July 1998). "[Attempted suicide and alcohol dependence: results of an epidemiologic survey]" (in French). Encephale 24 (4): 347–54. PMID 9809240. 
111. ^ Fergusson DM, Boden JM, Horwood LJ (March 2009). "Tests of causal links between alcohol abuse or dependence and major depression". Arch. Gen. Psychiatry 66 (3): 260–6. doi:10.1001/archgenpsychiatry.2008.543. PMID 19255375. http://archpsyc.ama-assn.org/cgi/pmidlookup?view=long&pmid=19255375. 
112. ^ Moreyra, P., Ibanez A., Saiz-Ruiz J., Nissenson K., Blanco C. (2000). "Review of the phenomenology, etiology and treatment of pathological gambling". German Journal of Psychiatry 3: 37–52. 
113. ^ Pallanti, Stefano; Rossi, Nicolò Baldini; Hollander, Eric (2006). "11. Pathological Gambling". In Hollander, Eric; Stein, Dan J.. Clinical manual of impulse-control disorders. American Psychiatric Pub. pp. 251–289. ISBN 978-1-58562-136-1. http://books.google.com/books?id=u2wVP8KJJtcC&pg=PA251. 
114. ^ Volberg, R.A. (2002). "The epidemiology of pathological gambling". Psychiatric Annals 32: 171–8. 
115. ^ Kaminer Y, Burleson JA, Jadamec A (September 2002). "Gambling behavior in adolescent substance abuse". Subst Abus 23 (3): 191–8. doi:10.1080/08897070209511489. PMID 12444352. http://www.tandfonline.com/doi/abs/10.1080/08897070209511489?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed. 
116. ^ ^{a b} Kausch O (2003). "Suicide attempts among veterans seeking treatment for pathological gambling". Journal of Clinical Psychiatry 64 (9): 1031–8. doi:10.4088/JCP.v64n0908. PMID 14628978. 
117. ^ Kausch O (2003). "Patterns of substance abuse among treatment-seeking pathological gamblers". Journal of Substance Abuse Treatment 25 (4): 263–70. doi:10.1016/S0740-5472(03)00117-X. PMID 14693255. 
118. ^ Ladd, G. T., Petry N. M. (2003) A comparison of pathological gamblers with and without substance abuse treatment histories. Experimental and Clinical Psychopharmacology, 11, 202-9.
119. ^ Hagan, Kate (2010-04-21). "Gambling linked to one in five suicidal patients". Melbourne: Theage.com.au. http://www.theage.com.au/national/gambling-linked-to-one-in-five-suicidal-patients-20100420-srri.html. Retrieved 2010-08-26. 
120. ^ Niederkrotenthaler T, Herberth A, Sonneck G (2007). "[The "Werther-effect": legend or reality?]" (in German). Neuropsychiatr 21 (4): 284–90. PMID 18082110. 
121. ^ Stack S (April 2003). "Media coverage as a risk factor in suicide". J Epidemiol Community Health 57 (4): 238–40. doi:10.1136/jech.57.4.238. PMC 1732435. PMID 12646535. http://jech.bmj.com/cgi/pmidlookup?view=long&pmid=12646535. 
122. ^ O'Carroll PW, Potter LB (April 1994). "Suicide contagion and the reporting of suicide: recommendations from a national workshop. United States Department of Health and Human Services". MMWR Recomm Rep 43 (RR–6): 9–17. PMID 8015544. http://www.cdc.gov/mmwr/preview/mmwrhtml/00031539.htm. 
123. ^ Thomas H. Ollendick, Carolyn S. Schroeder: Encyclopedia of clinical child and pediatric psychology, p.61; Springer;(2003) ISBN 0-306-47490-5
124. ^ Marion Crook: Out of the darkness: teens and suicide p.56 Arsenal Pulp Press (2004) ISBN 1-55152-141-5
125. ^ Stack S (April 2005). "Suicide in the media: a quantitative review of studies based on non-fictional stories". Suicide Life Threat Behav 35 (2): 121–33. doi:10.1521/suli.35.2.121.62877. PMID 15843330. 
126. ^ Pirkis J (July 2009). 72X "Suicide and non-fatal self-harm". Psychiatry 8 (7): 269–271. doi:10.1016/j.mppsy.2009.04.009. http://www.sciencedirect.com/science/article/pii/S1476179309000 72X. 
127. ^ Niederkrotenthaler T, Voracek M, Herberth A et al (September 2010). "Role of media reports in completed and prevented suicide: Werther v. Papageno effects". Br J Psychiatry 197 (3): 234–43. doi:10.1192/bjp.bp.109.074633. PMID 20807970. http://bjp.rcpsych.org/cgi/pmidlookup?view=long&pmid=20807970. 
128. ^ Ajdacic-Gross V, Weiss MG, Ring M et al (September 2008). "Methods of suicide: international suicide patterns derived from the WHO mortality database". Bull. World Health Organ. 86 (9): 726–32. doi:10.2471/BLT.07.043489. PMC 2649482. PMID 18797649. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2649482. 
129. ^ Ajdacic-Gross, Vladeta, et al. "Methods of suicide: international suicide patterns derived from the WHO mortality database"PDF (267 KB). Bulletin of the World Health Organization 86 (9): 726–732. September 2008. Accessed 2 August 2011. Archived 2 August 2011. See html version.
     • The data can be seen here.
130. ^ O'Connor, Rory C.; Platt, Stephen; Gordon, Jacki, eds. (1 June 2011). International Handbook of Suicide Prevention: Research, Policy and Practice. John Wiley and Sons. pp. 34. ISBN 978-1-119-99856-3. http://books.google.com/books?id=3fDGLWQtwFkC&pg=PA34. 
131. ^ Gunnell D, Eddleston M, Phillips MR, Konradsen F (2007). "The global distribution of fatal pesticide self-poisoning: systematic review". BMC Public Health 7: 357. doi:10.1186/1471-2458-7-357. PMC 2262093. PMID 18154668. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2262093. 
132. ^ "U.S. Suicide Statistics (2005)". http://www.suicide.org/suicide-statistics.html. Retrieved 2008-03-24. 
133. ^ "UpToDate Inc.". http://www.uptodate.com/online/content/topic.do?topicKey=adol_med/7847&selectedTitle=3~150&source=search_result#H17. 
134. ^ Brent DA, Moritz G, Bridge J, Perper J, Canobbio R (May 1996). "Long-term impact of exposure to suicide: a three-year controlled follow-up". J Am Acad Child Adolesc Psychiatry 35 (5): 646–53. doi:10.1097/00004583-199605000-00020. PMID 8935212. 
135. ^ Phillips DP, Carstensen LL (September 1986). "Clustering of teenage suicides after television news stories about suicide". N. Engl. J. Med. 315 (11): 685–9. doi:10.1056/NEJM198609113151106. PMID 3748072. 
136. ^ World Health Organization: Suicide prevention (SUPRE)
137. ^ Sakinofsky, I (2007 Jun). "The current evidence base for the clinical care of suicidal patients: strengths and weaknesses". Canadian Journal of Psychiatry 52 (6 Suppl 1): 7S–20S. PMID 17824349. 
138. ^ "Suicide". The United States Surgeon General. http://www.surgeongeneral.gov/library/mentalhealth/chapter3/sec5_1.html. Retrieved 4 September 2011. 
139. ^ Best Practices Registry (BPR) For Suicide Prevention
140. ^ Rodgers PL, Sudak HS, Silverman MM, Litts DA (April 2007). "Evidence-based practices project for suicide prevention". Suicide Life Threat Behav 37 (2): 154–64. doi:10.1521/suli.2007.37.2.154. PMID 17521269. 
141. ^ Giannini, A. James; Slaby, Andrew Edmund; Giannini, Matthew C. (1982). Handbook of overdose and detoxification emergencies. New Hyde Park, N.Y.: Medical Examination Pub. Co. ISBN 0-87488-182-X. 
142. ^ Office of the Surgeon General:The Surgeon General's Call To Action To Prevent Suicide 1999 [1]
143. ^ Rory C. O'Connor, Stephen Platt, Jacki Gordon: International Handbook of Suicide Prevention: Research, Policy and Practice, p. 510 [2]
144. ^ Rory C. O'Connor, Stephen Platt, Jacki Gordon, International Handbook of Suicide Prevention: Research, Policy and Practice, p.361; Wiley-Blackwell (2011), ISBN 0-470-68384-8
145. ^ Alan F. Schatzberg: The American Psychiatric Publishing textbook of mood disorders, p. 503: American Psychiatric Publishing; (2005) ISBN 1-58562-151-X
146. ^ Crawford, MJ; Thana, L, Methuen, C, Ghosh, P, Stanley, SV, Ross, J, Gordon, F, Blair, G, Bajaj, P (2011 May). "Impact of screening for risk of suicide: randomised controlled trial". The British journal of psychiatry : the journal of mental science 198 (5): 379–84. doi:10.1192/bjp.bp.110.083592. PMID 21525521. 
147. ^ Depression and Suicide Andrew B. Medscape
148. ^ González HM, Vega WA, Williams DR, Tarraf W, West BT, Neighbors HW (January 2010). "Depression Care in the United States: Too Little for Too Few". Archives of General Psychiatry 67 (1): 37–46. doi:10.1001/archgenpsychiatry.2009.168. PMC 2887749. PMID 20048221. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2887749. 
149. ^ Luoma JB, Martin CE, Pearson JL (June 2002). "Contact with mental health and primary care providers before suicide: a review of the evidence". The American Journal of Psychiatry 159 (6): 909–16. doi:10.1176/appi.ajp.159.6.909. PMID 12042175. 
150. ^ Lee HC, Lin HC, Liu TC, Lin SY (June 2008). "Contact of mental and nonmental health care providers prior to suicide in Taiwan: a population-based study". Canadian Journal of Psychiatry 53 (6): 377–83. PMID 18616858. 
151. ^ Pirkis J, Burgess P (December 1998). "Suicide and recency of health care contacts. A systematic review". The British journal of psychiatry : the journal of mental science 173 (6): 462–74. doi:10.1192/bjp.173.6.462. PMID 9926074. 
152. ^ Randolph B. Schiffer, Stephen M. Rao, Barry S. Fogel, Neuropsychiatry: Neuropsychiatry of suicide, pp. 706-713, (2003)ISBN 0781726557
153. ^ Cipriani A, Pretty H, Hawton K, Geddes JR (October 2005). "Lithium in the prevention of suicidal behavior and all-cause mortality in patients with mood disorders: a systematic review of randomized trials". Am J Psychiatry 162 (10): 1805–19. doi:10.1176/appi.ajp.162.10.1805. PMID 16199826. 
154. ^ Linehan MM, Comtois KA, Murray AM, et al. (July 2006). "Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder". Arch. Gen. Psychiatry 63 (7): 757–66. doi:10.1001/archpsyc.63.7.757. PMID 16818865. 
155. ^ Hall RC, Popkin MK, Devaul RA, Faillace LA, Stickney SK (November 1978). "Physical illness presenting as psychiatric disease". Arch. Gen. Psychiatry 35 (11): 1315–20. doi:10.1001/archpsyc.1978.01770350041003. PMID 568461. 
156. ^ Chuang L., Mental Disorders Secondary to General Medical Conditions; Medscape;2011 [3]
157. ^ Felker B, Yazel JJ, Short D (December 1996). "Mortality and medical comorbidity among psychiatric patients: a review". Psychiatr Serv 47 (12): 1356–63. PMID 9117475. 
158. ^ Kamboj MK, Tareen RS (February 2011). "Management of nonpsychiatric medical conditions presenting with psychiatric manifestations". Pediatr. Clin. North Am. 58 (1): 219–41, xii. doi:10.1016/j.pcl.2010.10.008. PMID 21281858. 
159. ^ Andreas P. Otte, Kurt Audenaert, Kathelijne Peremans, Nuclear medicine in psychiatry: Functional imaging of Suicidal Behavior, pp.475-483, Springer (2004);ISBN 3-540-00683-4
160. ^ Patricia D. Barry, Suzette Farmer; Mental health & mental illness,p.282, Lippincott Williams & Wilkins;(2002) ISBN 0-7817-3138-0
161. ^ Baldessarini RJ, Tondo L, Hennen J (2003). "Lithium treatment and suicide risk in major affective disorders: update and new findings". J Clin Psychiatry 64 Suppl 5: 44–52. PMID 12720484. 
162. ^ Coppen A (2000). "Lithium in unipolar depression and the prevention of suicide". J Clin Psychiatry 61 Suppl 9: 52–6. PMID 10826662. 
163. ^ Canadian Agency for Drugs nd technology in Health: Dialectical Behaviour Therapy in Adolescents for Suicide Prevention: Systematic Review of Clinical-Effectiveness, CADTH Technology Overviews, Volume 1, Issue 1, March 2010 [4]
164. ^ National Institute of Mental Health: Suicide in the U.S.: Statistics and Prevention [5]
165. ^ Stanley B, Brown G, Brent DA et al (October 2009). "Cognitive-behavioral therapy for suicide prevention (CBT-SP): treatment model, feasibility, and acceptability". J Am Acad Child Adolesc Psychiatry 48 (10): 1005–13. doi:10.1097/CHI.0b013e3181b5dbfe. PMC 2888910. PMID 19730273. http://linkinghub.elsevier.com/retrieve/pii/S0890-8567(09)60165-9. 
166. ^ "Mortality and Burden of Disease Estimates for WHO Member States in 2002" (xls). World Health Organization. 2002. http://www.who.int/entity/healthinfo/statistics/bodgbddeathdalyestimates.xls. Retrieved 2009-12-13. 
167. ^ "Suicide prevention". WHO Sites: Mental Health. World Health Organization. February 16, 2006. http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/. Retrieved 2008-09-16. 
168. ^ "2007 Data" (PDF). Suicide Prevention. Suicidology.org. 2007. http://www.suicidology.org/c/document_library/get_file?folderId=232&name=DLFE-232.pdf. Retrieved 2011-01-13. 
169. ^ Centers for Disease Control and Prevention (CDC) (July 2006). "Homicides and suicides—National Violent Death Reporting System, United States, 2003–2004". MMWR Morb. Mortal. Wkly. Rep. 55 (26): 721–4. PMID 16826158. 
170. ^ Louis Appleby (Foreword), David Duffy (Editor), Tony Ryan (Editor) (25 August 2004). New Approaches to Preventing Suicide. Jessica Kingsley Publishers. pp. 31–32. ISBN 978-1-84310-221-2. 
171. ^ La Vecchia C, Lucchini F, Levi F (July 1994). "Worldwide trends in suicide mortality, 1955–1989". Acta Psychiatr Scand 90 (1): 53–64. doi:10.1111/j.1600-0447.1994.tb01556.x. PMID 7976451. ; Lester, Patterns, 1996, pp. 28–30.
172. ^ Hoyert DL, Heron MP, Murphy SL, Kung HC (April 2006). "Deaths: final data for 2003" (PDF 3.72 MB). Natl Vital Stat Rep 54 (13): 1–120. PMID 16689256. http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_13.pdf. 
173. ^ "Laws – IPC – Section 309". Vakilno1.com. 2006-10-10. http://www.vakilno1.com/bareacts/IndianPenalCode/S309.htm. Retrieved 2009-05-06. 
174. ^ "German politician Roger Kusch helped elderly woman to die" Times Online July 2, 2008
175. ^ Appel, JM (May 2007). "A Suicide Right for the Mentally Ill? A Swiss Case Opens a New Debate". Hastings Center Report 37 (3): 21–23. doi:10.1353/hcr.2007.0035. PMID 17649899. 
176. ^ Dr. Ronald Roth, D.Acu.. "Suicide & Euthanasia – a Biblical Perspective". Acu-cell.com. http://www.acu-cell.com/suicide.html. Retrieved 2009-05-06. 
177. ^ "Norman N. Holland, Literary Suicides: A Question of Style". Clas.ufl.edu. http://www.clas.ufl.edu/users/nholland/suicide.htm. Retrieved 2009-05-06. 
178. ^ "Catechism of the Catholic Church – PART 3 SECTION 2 CHAPTER 2 ARTICLE 5". Scborromeo.org. 1941-06-01. http://www.scborromeo.org/ccc/p3s2c2a5.htm#2280. Retrieved 2009-05-06. 
179. ^ "Catechism of the Catholic Church – PART 3 SECTION 2 CHAPTER 2 ARTICLE 5". Scborromeo.org. 1941-06-01. http://www.scborromeo.org/ccc/p3s2c2a5.htm#2282. Retrieved 2009-05-06. 
180. ^ "The Bible and Suicide". Religioustolerance.org. http://www.religioustolerance.org/sui_bibl.htm. Retrieved 2009-05-06. 
181. ^ "Euthanasia and Judaism: Jewish Views of Euthanasia and Suicide". ReligionFacts.com. http://www.religionfacts.com/euthanasia/judaism.htm. Retrieved 2008-09-16. 
182. ^ "Euthanasia and suicide in Islam". BBC. 7 September 2009. Accessed 11 August 2011.
183. ^ Hindu Website. Hinduism and suicide
184. ^ ^{a b} "Hinduism - Euthanasia and Suicide". BBC. 2009-08-25. http://www.bbc.co.uk/religion/religions/hinduism/hinduethics/euthanasia.shtml. 
185. ^ Raymond Whiting: A natural right to die: twenty-three centuries of debate, pp. 13-17; Praeger (2001) ISBN 0-313-31474-8
186. ^ By SIMON ROBINSON (Sunday, Mar. 27, 2005). "Europe's Way of Death". TIME. http://www.time.com/time/magazine/article/0,9171,901050404-1042414,00.html. Retrieved 2009-05-06. 
187. ^ "Suicide (Stanford Encyclopedia of Philosophy)". Plato.stanford.edu. http://plato.stanford.edu/entries/suicide/. Retrieved 2009-05-06. 
188. ^ Appel, JM. A Suicide Right for the Mentally Ill? A Swiss Case Opens a New Debate, The Hastings Center Report. 2007;37(3):21-23
189. ^ Wesley J. Smith, Death on Demand: The assisted-suicide movement sheds its fig leaf, The Weekly Standard, June 5, 2007
190. ^ Dennis, Richard (2008). Cities in modernity : representations and productions of metropolitan space, 1840 - 1930 (Repr. ed.). Cambridge [u.a.]: Cambridge Univ. Press. pp. 20. ISBN 978-0-521-46841-1. http://books.google.ca/books?id=Gq9_uNNkmKUC&pg=PA20. 
191. ^ Amazeen, Sandy. "Book Review: Cliffs of Despair A Journey to Suicide's Edge," Monsters & Critics.December 21, 2005
192. ^ "Jumpers: The fatal grandeur of the Golden Gate Bridge". The New Yorker. 2003. http://www.newyorker.com/archive/2003/10/13/031013fa_fact. Retrieved October 24, 2006. 
193. ^ . Schizophrenia Society of Ontario. 1997. 
194. ^ "'Suicide forest' yields 78 corpses". Japan Times. 2003-02-07. http://search.japantimes.co.jp/member/member.html?nn20030207b1.htm. Retrieved 2008-09-16. 
195. ^ "Beachy Head – Suicide Spot". BBC Inside Out. 2003-06-23. http://www.bbc.co.uk/insideout/southeast/series3/beachy_head_suicide_eastbourne.shtml. Retrieved 2009-04-22. 
196. ^ Davey, Monica (May 13, 2010). "Online Talk, Suicides and a Thorny Court Case". The New York Times. http://www.nytimes.com/2010/05/14/us/14suicide.html. Retrieved June 26, 2010. 
197. ^ "Nurse may be linked to multiple suicides, tracker says". The Globe and Mail. http://www.theglobeandmail.com/news/national/article973900.ece. Retrieved June 26, 2010. 
198. ^ Doolittle, Robyn (May 9, 2009). "Nurse urged 5 to commit suicide, U.S. police say". The Toronto Star. http://www.thestar.com/news/gta/article/631689. Retrieved June 26, 2010. 
199. ^ "William Melchert-Dinkel charged with encouraging suicides, The Sunday Times
200. ^ <Please add first missing authors to populate metadata.> (April 14, 2008). World Wide Suicide: A Self-Termination Community Grows on the Web. Scientific American. http://www.scientificamerican.com/podcast/episode.cfm?id=4D4415E7-0BB5-F377-FCD222D85009C84B 
201. ^ Hunter, Aina. Death by Chat Room?. ABC News. http://abcnews.go.com/Health/Depression/story?id=4630504&page=1 
202. ^ Jonathan Owen (10 September 2006). "Teens die after logging into 'suicide chat rooms'". The Independent. http://www.independent.co.uk/news/uk/this-britain/teens-die-after-logging-into-suicide-chat-rooms-415386.html 
203. ^ When Kids Seek Help On-Line: Internet Chat Rooms and Suicide Journal article by Katja Becker, Martin H. Schmidt; Reclaiming Children and Youth, Vol. 13, 2005
204. ^ Holt, Gerry. "When suicide was illegal". BBC News. 3 August 2011. Accessed 11 August 2011.
205. ^ "Guardian & Observer style guide". Guardian website. The Guardian. http://www.guardian.co.uk/styleguide/s. Retrieved 29 November 2011. 
206. ^ Chang, Kenneth (August 25, 2008). In Salmonella Attack, Taking One for the Team. New York Times. http://www.nytimes.com/2008/08/26/science/26obsalm.html?ref=science 
207. ^ Tofilski,Adam; Couvillon, MJ;Evison, SEF; Helantera, H; Robinson, EJH; Ratnieks, FLW (2008). "Preemptive Defensive Self-Sacrifice by Ant Workers" (PDF). The American Naturalist 172 (5): E239–E243. doi:10.1086/591688. PMID 18928332. http://www.cyf-kr.edu.pl/~rotofils/Tofilski_etal_2008.pdf. 
208. ^ Larry O'Hanlon (Mar 10, 2010). Animal Suicide Sheds Light on Human Behavior. Discovery News. http://news.discovery.com/animals/animal-suicide-behavior.html 
209. ^ <Please add first missing authors to populate metadata.>. Life In The Undergrowth. BBC. http://www.bbc.co.uk/pressoffice/pressreleases/stories/2005/10_october/20/life_horrors.shtml 
210. ^ Bordereau, C; Robert, A.; Van Tuyen, V.; Peppuy, A. (August, 1997). "Suicidal defensive behaviour by frontal gland dehiscence in Globitermes sulphureus Haviland soldiers (Isoptera)". Insectes Sociaux (Birkhäuser Basel) 44 (3): 289. doi:10.1007/s000400050049. http://www.springerlink.com/content/m727aywa4mdf04ln/ 
211. ^ "Mother bear kills cub and then itself". AsiaOne (Singapore). 5 August 2011. http://news.asiaone.com/News/Latest%2BNews/Asia/Story/A1Story20110805-292947.html. 
212. ^ "The ultimate sacrifice: Mother bear kills her cub and then herself to save her from a life of torture". Daily Mail (London). 12 August 2011. http://www.dailymail.co.uk/news/article-2025388/China-Tortured-mother-bear-kills-cub-herself.html?ito=feeds-newsxml. 
213. ^ Nobel, Justin (Mar. 19, 2010). Do Animals Commit Suicide? A Scientific Debate. Time. http://www.time.com/time/health/article/0,8599,1973486,00.html 
214. ^ Stoff, David; Mann, J. John (1997). "Suicide Research". Annals of the New York Academy of Sciences (Annals of the New York Academy of Sciences) 836 (Neurobiology of Suicide, The : From the Bench to the Clinic): 1–11. doi:10.1111/j.1749-6632.1997.tb52352.x. http://www3.interscience.wiley.com/journal/120752899/abstract 

Further reading

• Berrios G E, Mohanna M (1990). "Durkheim and French Psychiatric Views on Suicide during the 19th century: a conceptual history". British Journal of Psychiatry 156: 1–9. doi:10.1192/bjp.156.1.1. PMID 2404534. 
• Gambotto, Antonella (2004). The Eclipse: A Memoir of Suicide. Australia: Broken Ankle Books. ISBN 0-9751075-1-8. 
• Goeschel, Christian (2009). Suicide in Nazi Germany. Oxford University Press. ISBN 0-19-953256-7. http://books.google.com/books?id=EIjccRg7_UYC&pg=PA5&lpg=PA5. 
• Jamison, Kay Redfield (2000). Night Falls Fast: Understanding Suicide. New York: Vintage. ISBN 0-375-40145-8. 
• Simpson, George Gaylord; Durkheim, Emile (1997). Suicide: a study in sociology. New York: Free Press. ISBN 0-684-83632-7. 
• McDowell, Eugene E.; Stillion, Judith M. (1996). Suicide across the life span: premature exits. Washington, DC: Taylor & Francis. ISBN 1-56032-304-3. 
• Stone, Geo (2001). Suicide and attempted suicide. New York, NY: Carroll & Graf. ISBN 0-7867-0940-5. 
• Hakim, David (2008). Man Down CineSource Magazine. 

External links

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• Suicide at the Open Directory Project

v t e Suicide Suicide crisis Risk assessment Crisis hotline List of crisis hotlines Suicidal ideation Suicide intervention Suicide prevention Suicide watch Social aspects Legislation Philosophy Religious views Euthanasia Right to die Benevolent suicide Among LGBT youth Suicide types Bullycide Copycat Cult Familicide Forced Honor Internet Mass Murder-suicide Parasuicide Suicide attack By cop Pact Youth suicide Epidemiology Gender List of countries by suicide rate List of OECD countries by suicide rate Suicide rate LGBT-related suicides History Suicide in antiquity List of suicides Related phenonoma Failed suicide attempt Self-harm Suicide methods Suicide note Locations By country Canada China France India Japan Pakistan South Korea United States

v t e Death and related topics In medicine Abortion Autopsy Brain death Clinical death End-of-life care Euthanasia Lazarus syndrome Terminal illness Mortal wound Lists Causes of death by rate Expressions related to death Natural disasters People by cause of death Premature obituaries Preventable causes of death Notable deaths in 2008 in 2009 in 2010 in 2011 in 2012 Unusual deaths Mortality Child mortality Immortality Infant mortality Legal death Maternal death Mortality displacement Mortality rate Perinatal mortality After death Body Burial Coffin birth Cremation Cryonics Decomposition Disposal Mummification Promession Putrefaction Resomation Other aspects Afterlife Cemetery Customs Death certificate Funeral Grief Intermediate state Mourning Vigil Paranormal Near-death experience Near-death studies Out-of-body experience Reincarnation research Séance Legal Abortion law Administration of an estate on death Capital punishment Death in absentia Death row Murder Right to die Trust law Will Other Death and culture Personification of death Fascination with death Genocide Last Rites Martyr Necrophilia Sacrifice human animal Suicide Assisted suicide Thanatology War Category Portal WikiProject

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Dansk (Danish)
n. - selvmord, selvmorder
v. intr. - begå selvmord

idioms:

• commit suicide    begå selvmord
• suicide pact    selvmordspagt

Nederlands (Dutch)
zelfmoord, zelfmoordenaar

Français (French)
n. - (lit, fig) suicide
v. intr. - se suicider

idioms:

• commit suicide    se suicider
• suicide pact    engagement de se suicider ensemble

Deutsch (German)
n. - Selbstmord, Selbstmörder
v. - Selbstmord verüben

idioms:

• commit suicide    Selbstmord verüben
• suicide pact    Selbstmordpakt

Ελληνική (Greek)
n. - αυτοκτονία, αυτοχειρία, αυτόχειρας
v. - αυτοκτονώ

idioms:

• commit suicide    αυτοκτονώ
• suicide pact    συμφωνία για ταυτόχρονη αυτοκτονία

Italiano (Italian)
suicidio, suicida

idioms:

• commit suicide    suicidarsi
• suicide pact    patto suicida

Português (Portuguese)
n. - suicídio (m)
v. - suicidar-se

idioms:

• commit suicide    suicidar-se
• suicide pact    pacto de suicídio

Русский (Russian)
самоубийство, суицид, самоубийца, провал планов, крах надежд по собственной вине

idioms:

• commit suicide    по своей вине потерять положение в обществе
• suicide pact    групповое самоубийство по сговору

Español (Spanish)
n. - suicidio, suicida
v. intr. - suicidarse

idioms:

• commit suicide    suicidarse, matarse
• suicide pact    pacto suicida

Svenska (Swedish)
n. - självmord
v. - begå självmord

中文（简体）(Chinese (Simplified))
试图自杀者, 自杀性行为, 自毁, 自杀

idioms:

• commit suicide    自杀
• suicide pact    二人以上约定一同自杀的, 自杀合约

中文（繁體）(Chinese (Traditional))
n. - 試圖自殺者, 自殺性行為, 自毀
v. intr. - 自殺

idioms:

• commit suicide    自殺
• suicide pact    二人以上約定一同自殺的, 自殺合約

한국어 (Korean)
n. - 자살 , 자살 행위, 자살자
v. intr. - 자살하다

日本語 (Japanese)
n. - 自殺, 自殺行為, 自殺者, 自殺的行為

idioms:

• suicide pact    心中

العربيه (Arabic)
‏(الاسم) انتحار (فعل) ينتحر‏

עברית (Hebrew)
n. - ‮התאבדות, מתאבד, מעשה או מסלול של הרס עצמי‬
v. intr. - ‮התאבד‬

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