Later On

A blog written for those whose interests more or less match mine.

Suicide and impulse

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Suicide can be a considered choice — for example, an elderly person in the grasp of a painful and incurable terminal illness might decide to end his life early rather than suffer — or it can be a passing impulse — for example, a person with clinical depression who encounters a temporary setback and impulsively makes a suicide attempt.

In the US the most common suicide method is with a firearm. Consider this chart (source):

If a person has a suicidal impulse and has easy access to a firearm (not unusual in the US), the firearm is likely to be used in an attempt at suicide, and the outcome is almost always fatal. Indeed, in looking at gun deaths in the US, suicide outnumbers homicide (source):

In discussing deaths due to gun violence, some object to including suicides in the total because (they believe) “if a person’s going to commit suicide, they’ll find a way to do it, with or without a gun.” That belief is false for as impulsive suicide, and impulsive suicide is much more common than considered suicide.

If a person experiencing a suicidal impulse picks a method that requires several steps and involves time and effort, the impulse is likely to dissipate before the attempt is made, and if the method is not instantly fatal so that recovery is possible (as in taking an overdose of medicine), the person may possibly be saved and not reattempt suicide.

Years ago I read an account by a man who, walking across the Golden Gate bridge and feeling depressed about his current situation (as I recall, he had just lost his job), decided to kill himself by jumping off the bridge. He was, as he later wrote, fully committed, but he wanted to face the city lights when he jumped, and he was on the side of the bridge away from the city, so that he would be facing only darkness.

He could not cross immediately to the other side because of traffic and traffic barriers, so he decided to walk to the end of the bridge, cross there, and return to jump, facing the city. By the time he reached the end of the bridge, however, the impulse had dissipated, and he simply continued on his way home (which is why we know the story). The impulse never returned.

The Harvard School of Public Health has an article that speaks to this:

Nine out of ten people who attempt suicide and survive will not go on to die by suicide at a later date. This has been well-established in the suicidology literature. A literature review (Owens 2002) summarized 90 studies that have followed over time people who have made suicide attempts that resulted in medical care. Approximately 7% (range: 5-11%) of attempters eventually died by suicide, approximately 23% reattempted nonfatally, and 70% had no further attempts.

Even studies that focused on medically serious attempts–such as people who jumped in front of a train (O’Donnell 1994)–and studies that followed attempters for many decades found similarly low suicide completion rates. At least one study, published after the 90-study review, found a slightly higher completion rate. This was a 37-year follow-up of self-poisoners in Finland that found an eventual completion rate of 13% (Suominen 2004).

This relatively good long-term survival rate is consistent with the observation that suicidal crises are often short-lived, even if there may be underylying, more chronic risk factors present that give rise to these crises.

The relationship between suicide attempts and completions is a complex one.

  • Most people who die by suicide in the U.S. did not make a previous attempt. Prevention efforts that focus only on those who attempt suicide will miss the majority of completers. An international review of psychological autopsy studies found that approximately 40% of those dying by suicide had previously attempted (Cavanagh 2003). The proportion was lower (25-33%) among studies of youth suicide in the U.S. (Brent 1993, Shaffer 1996). A history of previous attempts is lower among those dying by firearm suicide and higher among those dying by overdose (NVISS data).
  • Most people who attempt suicide will not go on to complete suicide. [Though if a gun is used, the suicide attempt almost always results in death. – LG]
  • Still, history of suicide attempt is one of the strongest risk factors for suicide. 5% to 11% of hospital-treated attempters do go on to complete suicide, a far higher proportion than among the general public where annual suicide rates are about 1 in 10,000.

Footnotes and sources are found at the link. The big problem with guns is that a suicide attempt using a gun is almost always successful.

This came to mind this morning as I read a New Yorker article by D.T. Max, which includes this passage:

Suicide is often a response to extreme personal struggles, but the immediate catalyst can be little more than a bad grade on a test or a weekend when a student’s friends have gone out of town. A widely cited 1978 study of some five hundred people who were stopped from jumping off the Golden Gate Bridge suggests how impulsive the urge to kill oneself can be: only about five per cent of the subjects later died by suicide [that is, 95% did not later commit suicide – LG]. (Studies such as this helped lead to the now ubiquitous signs on bridges with the National Suicide Prevention Lifeline number: 1-800-273-8255.)

In the past two decades, the suicide rate in the United States has risen by some thirty-five per cent, and the problem is especially acute among the young. According to the Centers for Disease Control and Prevention, by 2018 suicide had become the second most common cause of death among Americans between the ages of ten and twenty-four, exceeded only by accidental death. Experts describe as precipitating factors everything from mounting economic pressures to the broadcasting of distress on social media. At the University of Pennsylvania, more than a dozen students have died by suicide since 2013, and in late 2019 the director of the school’s mental-health services jumped from the seventeenth floor of a building. A 2018 study by researchers affiliated with Harvard University found that one in five American college students had had suicidal thoughts the previous year. Will Newman, a professor of forensic psychiatry at Saint Louis University, told me, “The percentage of freshmen seeking mental-health services is on a steady incline, and universities have to quickly adjust to keep up.” Meanwhile, the covid-19 pandemic has deepened the isolation of many Americans. More than ten per cent of respondents to a C.D.C. survey last June said that in the previous month they had seriously considered killing themselves.

Written by LeisureGuy

12 April 2021 at 3:08 pm

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