Suicide is a tragic and potentially preventable public health problem. In 1996, the most recent year for which statistics are available, suicide was the 9th leading cause of death in the United States. Specifically, 10.8 out of every 100,000 persons died by suicide. The total number of suicides was approximately 31,000, or 1.3 percent of all deaths, which was about the same number of deaths as from AIDS. It was estimated that there were 500,000 suicide attempts. Taken together, the numbers of suicide deaths and attempts reflect the magnitude of the problem and the need for well-designed prevention efforts.

Suicidal behavior is complex. Some risk factors vary with age, gender and ethnic group and may even change over time. The risk factors for suicide frequently occur in combination. Research has shown that 90 percent of people who kill themselves have depression or another diagnosable mental or substance abuse disorder. In addition, research has shown that alterations in neurotransmitters such as serotonin are associated with the risk for suicide. Diminished levels have been found in patients with depression, impulsive disorders, a history of violent suicide attempts, and also in postmortem brains of suicide victims.

Adverse life events in combination with other strong risk factors, such as depression may lead to suicide. However, suicide and suicidal behavior are not normal responses to the stresses experienced by most people. Many people experience one or more risk factors and are not suicidal. Other risk factors include: prior suicide attempt; family history of mental or substance abuse disorder; family history of suicide; family violence, including physical or sexual abuse; firearms in the home; incarceration; and exposure to the suicidal behavior of others, including family members, peers, and/or via the media in news or fiction stories.

Gender Differences

More than four times as many men than women die by suicide. However, women report attempting suicide about twice as often as men. Suicide by firearms is the most common method for both men and women, accounting for 59 percent of all suicides in 1996. Seventy-three percent of all suicides are committed by white men, and 79 percent of all firearm suicides are committed by white men. The highest suicide rate was for white men over 85 years of age-65.3 per 100,000 persons.

Children, Adolescents, and Young Adults

Over the last several decades, the suicide rate in young people has increased dramatically. In 1996, suicide was the 3rd leading cause of death in 15 to 24 year olds-12.2 of every 100,000 persons-following unintentional injuries and homicide. Suicide was the 4th leading cause in 10 to 14 year olds, with 298 deaths among 18,949,000 children in this age group. For adolescents aged 15 to 19, there were 1,817 deaths among 18,644,000 adolescents. The gender ratio in this age group was 5:1 (males: females). Among young people 20 to 24 years of age, there were 2,541 deaths among 17,562,000 people in this age group. The gender ratio in this age group was 7:1 (males: females).

Attempted Suicides

No national surveillance data on attempted suicide are available; however, reliable scientific research has found that:

• There are an estimated 8 to 25 attempted suicides to 1 completion; the ratio is higher in women and youth and lower in men and the elderly.
• The strongest risk factors for attempted suicide in adults are depression, alcohol abuse, cocaine use, and separation or divorce.
• The strongest risk factors for attempted suicide in youth are depression, alcohol or other drug use disorder, and aggressive or disruptive behaviors.
• The majority of suicide attempts are expressions of extreme distress that need to be addressed, and not just a harmless bid for attention. A suicidal person should not be left alone and needs immediate mental health treatment.

All suicide prevention programs need to be scientifically evaluated to demonstrate whether or not they work. Preventive interventions for suicide must also be complex and intensive if they are to have lasting effects over time. Recognition and appropriate treatment of mental and substance abuse disorders for particular high-risk age, gender, and cultural groups is the most promising way to prevent suicide and suicidal behavior.

Because most elderly suicide victims-70 percent-have visited their primary care physician in the month prior to their suicides, recognition and treatment of depression in the medical setting is a promising way to prevent elderly suicide. Limiting young people's access to firearms, especially in conjunction with the prevention of mental and addictive disorders, also may be beneficial avenues for prevention of suicides. Most school-based, information-only, prevention programs focused solely on suicide have not been evaluated to see if they work, and research suggests that such programs may actually increase distress in the young people who are most vulnerable. School and community prevention programs designed to address suicide and suicidal behavior as part of a broader focus on mental health, coping skills in response to stress, substance abuse, aggressive behaviors, etc., are most likely to be successful in the long run.

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