Suicide

Men At Risk is actively compiling information on Suicide. If you are crisis, 1st call 911 while you're looking in the front of your local yellow pages for the number of the local suicide prevention hotline. If you can't get through to either of those, click on Emergency Numbers. Also visit www.metanoia.org/suicide which contains conversations and writings for suicidal persons to read, gay youth suicide at www.sws.soton.ac.uk/gay-youth-suicide and youth: suicide at www.virtualcity.com/youthsuicide .

Disclaimer - Information is designed for educational purposes only and is not engaged in rendering medical advice or professional services. Any medical decisions should be made in conjunction with your physician. We will not be liable for any complications, injuries or other medical accidents arising from or in connection with, the use of or reliance upon any information on the web.

Crisis Text Hotline 741741

Want to talk?
800.273.TALK (8255) or TDD 800.448.1833
Curry County Crisis Line - 877-519-9322

Are You Feeling Suicidal?
When Someone Feels Suicidal
Warning Signs
How to Help
Teen Suicide
Gay Suicide
Surgeon General's Report on Suicide - 1999: National Suicide Prevention Plan
Euthanasia - Dying with Honor and Pride
Divorce Doubles Suicide Risk in Men

Deaths by Suicide and Self-inflicted Injury per 100K age 15-24, 1991-93
Use of Firearms in Youth Suicides
Suicide -- Washington, 1980-1995
Snippets
Related Issues:
Talking With Kids About Tough Issues, Guns, Poison
Journals - on Child, Elder, Emotional, Religious, and Sexual Abuse and Trauma
Resources
Books and the related topics of Depression and Death & Dying. and Stress


Are You Feeling Suicidal?


We are strictly a library and resource center. We do not do crisis intervention or counseling. The information that follows is not a substitute for professional counseling. It is strongly recommended that you seek guidance from a professional caregiver. If you are feeling suicidal, please contact your local crisis line or counseling center or click here NOW.

If you are feeling suicidal now, please stop long enough to read this. It will only take about five minutes. I do not want to talk you out of your bad feelings. I am not a therapist or other mental health professional - only someone who knows what it is like to be in pain.

I don’t know who you are, or why you are reading this page. I only know that for the moment, you’re reading it, and that is good. I can assume that you are here because you are troubled and considering ending your life. If it were possible, I would prefer to be there with you at this moment, to sit with you and talk, face to face and heart to heart. But since that is not possible, we will have to make do with this.

I have known a lot of people who have wanted to kill themselves, including myself, so I have some small idea of what you might be feeling. I know that you might not be up to reading a long book, so I am going to keep this short. While we are together here for the next five minutes, I have five simple, practical things I would like to share with you. I won’t argue with you about whether you should kill yourself. But I assume that if you are thinking about it, you feel pretty bad.

Well, you’re still reading, and that’s very good. I’d like to ask you to stay with me for the rest of this page. I hope it means that you’re at least a tiny bit unsure, somewhere deep inside, about whether or not you really will end your life. Often people feel that, even in the deepest darkness of despair. Being unsure about dying is okay and normal. The fact that you are still alive at this minute means you are still a little bit unsure. It means that even while you want to die, at the same time some part of you still wants to live. So let’s hang on to that, and keep going for a few more minutes.

Start by considering this statement: “Suicide is not chosen; it happens when pain exceeds resources for coping with pain.”

That’s all it’s about. You are not a bad person, or crazy, or weak, or flawed, because you feel suicidal. It doesn’t even mean that you really want to die - it only means that you have more pain than you can cope with right now. If I start piling weights on your shoulders, you will eventually collapse if I add enough weights... no matter how much you want to remain standing. (That’s why it’s useless for someone to say to you, “cheer up!” - of course you would, if you could.)

Don’t accept it if someone tells you, “that’s not enough to be suicidal about”. There are many kinds of pain that may lead to suicide. Whether or not the pain is bearable may differ from person to person. What might be bearable to someone else, may not be bearable to you. The point at which the pain becomes unbearable depends on what kinds of coping resources you have. Individuals vary greatly in their capacity to withstand pain.

When pain exceeds pain-coping resources, suicidal feelings are the result. Suicide is neither wrong nor right; it is not a defect of character; it is morally neutral. It is simply an imbalance of pain versus coping resources.

You can survive suicidal feelings if you do either of two things: (1) find a way to reduce your pain, or (2) find a way to increase your coping resources. Both are possible.

Now I want to tell you five things to think about.

1 The first thing you need to hear is that people do get through this -- even people who feel as badly as you are feeling now. Statistically, there is a very good chance that you are going to live. I hope that this information gives you some sense of hope.

2 The next thing I want to suggest to you is to give yourself some distance. Say to yourself, “I will wait 24 hours before I do anything.” Or a week. Remember that feelings and actions are two different things - just because you feel like killing yourself, doesn’t mean that you have to actually do it right this minute. Put some distance between your suicidal feelings and suicidal action. Even if it’s just 24 hours. You have already done it for 5 minutes, just by reading this page. You can do it for another 5 minutes by continuing to read this page. Keep going, and realize that while you still feel suicidal, you are not, at this moment, acting on it. That is very encouraging to me, and I hope it is to you.

3 The third thing is this: people often turn to suicide because they are seeking relief from pain. Remember that relief is a feeling. And you have to be alive to feel it. You will not feel the relief you so desperately seek, if you are dead.

4 The fourth thing is this: some people will react badly to your suicidal feelings, either because they are frightened, or angry; they may actually increase your pain instead of helping you, despite their intentions, by saying or doing thoughtless things. You have to understand that their bad reactions are about their fears, not about you.

But there are people out there who can be with you in this horrible time, and will not judge you, or argue with you, or send you to a hospital, or try to talk you out of how badly you feel. They will simply care for you. Find one of them. Now. Use your 24 hours, or your week, and tell someone what’s going on with you. It is okay to ask for help. Try The Samaritans by phone or e-mail worldwide, or look in the front of your phone book for a crisis line), call your family doctor or a psychotherapist, carefully choose a friend or a minister or rabbi, someone who is likely to listen. But don’t give yourself the additional burden of trying to deal with this alone. Just talking about how you got to where you are, releases an awful lot of the pressure, and it might be just the additional coping resource you need to regain your balance.

5 The last thing I want you to know right now is this: Suicidal feelings are, in and of themselves, traumatic. After they subside, you need to continue caring for yourself. Therapy is a really good idea. So are the various self-help groups available both in your community and on the Internet and various online services.

Well, it’s been a few minutes and you’re still with me. I’m really glad.

Since you have made it this far, you deserve a reward. I think you should reward yourself by giving yourself a gift. The gift you will give yourself is a coping resource. Remember, back up near the top of the page, I said that the idea is to make sure you have more coping resources than you have pain. So let’s give you another coping resource, or two, or ten...! until they outnumber your sources of pain.

Now, while this page may have given you some small relief, the best coping resource we can give you is another human being to talk with. If you find someone who wants to listen, and tell them how you are feeling and how you got to this point, you will have increased your coping resources by one. Hopefully the first person you choose won’t be the last. There are a lot of people out there who really want to hear from you. It’s time to start looking around for one of them.

Now: I’d like you to call someone.

And while you’re at it, you can still stay with me for a bit. Check out these sources of online help.

Additional things to read at this site:

How serious is our condition? ..."he only took 15 pills, he wasn’t really serious...” if others are making you feel like you’re just trying to get attention... read this.

Why is it so hard for us to recover from being suicidal? ...while most suicidal people recover and go on, others struggle with suicidal thoughts and feelings for months or even years. Suicide and post-traumatic stress disorder (PTSD).

Recovery from grief and loss ...has anyone significant in your life recently died? You would be in good company... many suicidal people have recently suffered a loss.

The stigma of suicide that prevents suicidal people from recovering: we are not only fighting our own pain, but the pain that others inflict on us... and that we ourselves add to. Stigma is a huge complicating factor in suicidal feelings.

Resources about depression ...if you are suicidal, you are most likely experiencing some form of depression. This is good news, because depression can be treated, helping you feel better.

When Someone Feels Suicidal Do you know someone who is suicidal... or would you like to be able to help, if the situation arises? Learn what to do, so that you can make the situation better, not worse.

How to Help What can I do to help someone who may be suicidal? ...a helpful guide, includes Suicide Warning Signs.

Other online sources of help:
Resources
Books


When Someone Feels Suicidal


We are born with the ability to take our own lives. Each year a million people make that choice. Even in societies where suicide is illegal or taboo, people still kill themselves.

For many people who feel suicidal, there seems to be no other way out. Death describes their world at that moment and the strength of their suicidal feelings should not be underestimated – they are real and powerful and immediate. There are no magic cures. But it is also true that: Suicide is often a permanent solution to a temporary problem.

When we are depressed, we tend to see things through the very narrow perspective of the present moment. A week or a month later, things may look completely different.

Most people who once thought about killing themselves are now glad to be alive. They say they didn’t want to end their lives – they just wanted to stop the pain.

The most important step is to talk to someone. People who feel suicidal should not try to cope alone. They should seek help NOW. Talk to family or friends. Just talking to a family member or a friend or a colleague can bring huge relief.

Talk to a befriender. Some people cannot talk to family or friends. Some find it easier to talk to a stranger. There are befriending centers all over the world, with volunteers who have been trained to listen. If calling is too difficult, the person can send an email.

Talk to a doctor. If someone is going through a longer period of feeling low or suicidal, he or she may be suffering from clinical depression. This is a medical condition caused by a chemical imbalance, and can usually be treated by a doctor through the prescription of drugs and/or a referral to therapy.

However, some people cannot talk to family or friends. Some find it easier to talk to a stranger. There are befriending centers all over the world, with volunteers who have been trained to listen. If calling is too difficult, the person can send an email. They should seek help NOW

Time is an important factor in ‘moving on’, but what happens in that time also matters. When someone is feeling suicidal, they should talk about their feelings immediately.


Warning Signs


Suicide is rarely a spur of the moment decision. In the days and hours before people kill themselves, there are usually clues and warning signs.

The strongest and most disturbing signs are verbal – ‘I can’t go on,’ ‘Nothing matters any more’ or even ‘I’m thinking of ending it all.’ Such remarks should always be taken seriously. Of course, in most cases these situations do not lead to suicide. But, generally, the more signs a person displays, the higher the risk of suicide.

Situations

Behaviors

Physical Changes

Thoughts and Emotions

If you are worried about someone you know, make sure you read the following How To Help Someone Else.


How to Help Someone Else


If someone is feeling depressed or suicidal, our first response is to try to help. We offer advice, share our own experiences, try to find solutions. We’d do better to be quiet and listen. People who feel suicidal don’t want answers or solutions. They want a safe place to express their fears and anxieties, to be themselves.

Listening – really listening – is not easy. We must control the urge to say something – to make a comment, add to a story or offer advice. We need to listen not just to the facts that the person is telling us but to the feelings that lie behind them. We need to understand things from their perspective, not ours.

Here are some points to remember if you are helping a person who feels suicidal.

What do people who feel suicidal not want?

So, if you are concerned that someone you know may be thinking of suicide, you can help. Remember, as a helper, do not promise to do anything you do not want to do or that you cannot do.

First of all...

If the person is actively suicidal, get help immediately. Call your local crisis service or the police, or take the person to the emergency room of your local hospital. Do not leave the person alone.

If the person has attempted suicide and needs medical attention, call 9-1-1 or your local emergency services number.

The following are suggestions for helping someone who is suicidal:

Ask the person - "Are you thinking of suicide?" Ask them if they have a plan and if they have the means. Asking someone if they are suicidal will not make them suicidal. Most likely they will be relieved that you have asked. Experts believe that most people are ambivalent about their wish to die.

Listen actively to what the person is saying to you. Remain calm and do not judge what you are being told. Do not advise the person not to feel the way they are.

Reassure the person that there is help for their problems and reassure them that they are not "bad" or "stupid" because they are thinking about suicide.

Help the person break down their problem(s) into more manageable pieces. It is easier to deal with one problem at a time.

Emphasize that there are ways other than suicide to solve problems. Help the person to explore these options, for example, ask them what else they could do to change their situation.

Offer to investigate counselling services.

Do not agree to keep the person's suicidal thoughts or plans a secret. Helping someone who is suicidal can be very stressful. Get help - ask family members and friends for their assistance and to share the responsibility.

Suggest that the person see a doctor for a complete physical. Although there are many things that family and friends can do to help, there may be underlying medical problems that require professional intervention. Your doctor can also refer patients to a psychiatrist, if necessary.

Try to get the person to see a trained counselor. Do not be surprised if the person refuses to go to a counselor - but be persistent. There are many types of caregivers for the suicidal. If the person will not go to a psychologist, or a psychiatrist, suggest, for example, they talk to a clergyperson, a guidance counselor or a teacher.

Teen Suicide


Youth and elderly suicides are on the increase in the US. And, according to The World Health Organization (WHO) over 786,000 people committed suicide around the world in 1997. This is an effective suicide rate of around 10.7 per 100,000 population per year. To put this statistic in perspective, that is the equivalent of one suicide every forty seconds, somewhere in the world.

Suicide is the ninth leading cause of death in the US with 31,204 deaths recorded in 1995. This approximates to around one death every seventeen minutes. There are more suicides than homicides each year in the US.

From 1952 to 1992, the incidence of suicide among teens and young adults tripled. Today, it is the third leading cause of death for teenagers aged 15-19 (after motor vehicle accidence and unintentional injury). Two-thirds of all suicides under 25 were committed with firearms (accounts for most of the increase in suicides from 1980 to 1992). The second most common method was hanging, third was poisoning. Suicide is increasing, particularly for those under 14 and in those over 65, while not the leading cause of death, the suicide rate is extremely high.

Young men commit suicide successfully at a higher rate than women in all 30 countries listed below. In the US, the ratio between men and women was 4.1:1 while in young people 15-24 the average ratio is 5.5:1 and the ratio increases with age within this group. In white males over 85, the suicide rate was 73.6/100,000 in 1993. For more information:  www.cdc.gov/ncipc/pub-res/10lc92c.htm ; www.nosuicide.com:80/stats.htm ; www/nimh.nih.gov/ ; www.nosoidice.com

"So You Wanna Kill Yourself?  Gays and Suicide."


Gay men are six times more likely to attempt suicide than their straight counterparts and the numbers increase exponentially during the holidays. This story appears in the Dec/Jan 99 issue of Genre and examines the issues behind why they are taking their own lives, and offers some solutions to the holiday blues. (Also see our own # 7 Happy Holidaze A report from P-FLAG (Parents and Friends of Lesbians and Gays) states that in a study of 5,000 gay men and women, 35 percent of gay men and 38 percent of lesbians have considered or attempted suicide. The statistics are even higher among gay teens: The Department of Health study indicates that gay youth are up to six times more likely to attempt suicide than straight teens, and gay teenagers account for up to 30 percent of all teenage suicides in the nation.

"Far more women suffer from depression that men do, so it seems odd that women would commit suicide at only one-fourth the rate of men. The key difference between the two sexes may be that women talk out their problems. George E. Murphy, an emeritus professor of psychiatry at Washington University School of Medicine in St. Louis, says that women may be protected because they are more likely to consider the consequences of suicide on family members or others. Women also approach personal problems differently than men and more often seek help long before they reach the point of considering suicide. 'As a result, women get better treatment for their depressions,' Murphy says. To reduce the rate of suicide in men, Murphy suggests that physicians should be alert for risk factors in men and refer them into treatment. Writing in the Journal of Comprehensive Psychiatry, he says that identifying men at risk require mental health professionals to recognize that depressed men may understate emotional distress or difficulty with their problems."  Black Men, 3/99. Source:  HealthScout, www.healthscout.com

It's important for people with suicidal feelings to let themselves be assisted in overcoming deep depression. It's also a good idea to talk about your feelings with friends. No man is an island and there's nothing wrong with leaning on people who love you in times of need.

See Suicide Prevention Services available locally. Dial 411 for your city's Suicide Prevention Hotline, or try your local Gay & Lesbian Center, which offers referrals for counseling, domestic violence and suicide prevention.

Divorce Doubles Suicide Risk in Men By Michelle Beaulieu


New York, Mar 15 (Reuters Health) -- Divorced or separated men are more than twice as likely to commit suicide as men who remain married, a US researcher reports. But divorce and separation do not appear to affect suicide risk in women, according to Dr. Augustine J. Kposowa, of the University of California at Riverside. Kposowa examined the link between suicide and marital status using data on nearly 472,000 men and women included in the National Longitudinal Mortality study. Between 1979 and 1989, 545 of these individuals committed suicide.

'Men were nearly 4.8 times as likely to commit suicide as women,' the researcher writes in the March 15th issue of the Journal of Epidemiology and Community Health. Whites were at greater risk of suicide than African Americans, and individuals with household incomes between $5,000 and $9,999 were more likely to commit suicide than others. Suicide rates were also higher in older age groups, especially those aged 65 and older, and in residents of Western states.

In addition, divorce or marital separation more than doubled the risk of suicide in men, whereas in women, marital status was unrelated to suicide. Kposowa suspects that this difference is related to the social networks men and women form outside their marriages, which may be stronger or more meaningful in women than in men. 'Women have better ways of communicating,' Kposowa told Reuters Health in an interview. 'They may have more social support networks, friends and relatives that they talk to, whereas men don't have social support networks.'

Primary care physicians should educate men about the risk of suicide following a divorce, and encourage them to seek counseling or group therapy, Kposowa added. Parents can also play an important role in addressing the divorce-suicide link in men, he believes. Raising boys to 'be themselves, talk about their problems' and express their emotions can help reduce the cultural constraints on men to hold back their feelings, he suggested.

Source: Journal of Epidemiology and Community Health 2000;54:254-261.


Deaths by Suicide and Self-inflicted Injury per 100,000 age 15-24, 1991-1993


Note that religious and social strictures against suicide may result in some underreporting in some nations. i.e., China is believed to represent over 46% of the suicides in the world. And, no information is currently available on Denmark and France.

Ranked by

Ranked by

Ranked by

Country

Males

Females

Ratio M/F

Males

Females

Highest Ratio M/F

Australia

27.3

5.6

5/1

9

11

7

Austria

21.1

6.5

3/1

15

7

21

Belarus

24.2

5.2

5/1

12

14

7

Bulgaria

15.4

5.6

3/.1

20

11

21

Canada

24.7

6.0

4/1

11

10

15

Czech Rep

16.4

4.3

4/1

19

18

25

Estonia

29.7

10.6

3/1

7

1

21

Finland

33.0

3.2

10/1

6

22

2

Germany

12.7

3.4

4/1

21

21

15

Greece

3.8

0.8

5/1

30

30

7

Hungary

19.1

6.5

3/1

16

7

21

Ireland

21.5

2.0

11/1

14

27

1

Israel

11.7

2.5

5/1

23

23

7

Italy

5.7

1.6

4/1

28

29

15

Japan

10.1

4.4

2/1

24

14

27

Latvia

35.0

9.3

4/1

5

2

15

Lithuania

44.9

6.7

7/1

1

5

3

Netherlands

9.1

3.8

2/1

26

19

27

New Zealand

39.9

6.2

51

3

9

5

Norway

28.2

5.2

5/1

8

14

7

Poland

16.6

2.5

7/1

18

23

3

Portugal

4.3

2.0

2/1

29

30

27

Russian Fed

41.7

7.9

5/1

2

4

7

Slovenia

37.0

8.4

4/1

4

3

15

Spain

7.1

2.2

3/1

27

26

21

Sweden

10.0

6.7

1/1

25

5

30

Switzerland

25.0

4.8

5/1

10

16

7

Ukraine

17.2

5.3

3/1

17

13

21

UK

12.2

2.3

5/1

22

25

7

US

21.9

3.8

6/1

13

19

5

Source: WHO, World Health Statistics Annual 1993 and 1994, 1994 and 1995, Center for Disease Control, National Center for Injury Prevention and Control; National Institute for Mental Health.

The following is the same information for those with browser's that cannot read tables:

Suicide -- Washington State, 1980-1995


The ongoing assessment of health data and health data sources is essential to the development of effective prevention strategies for priority health issues. In Washington, assessment efforts include the analysis of suicide data. In 1995, suicide was the eighth leading cause of death in Washington (1), and most (58%) were firearm related. To determine trends in suicide during 1980-1995, the Injury Prevention Program of the Washington Department of Health (WDOH) analyzed death-certificate data. This report presents the findings of the analysis, which indicate that, while overall suicide rates in Washington remained relatively stable during 1980-1995, suicides became more common among persons aged 15-24 years and greater than or equal to 75 years and less common among persons aged 25-74 years.

Computerized death-certificate data and external cause-of-injury codes (E-codes) were used to identify all suicides (E950-E959) among Washington residents. Population data were derived from the 1980 and 1990 U.S. census and from intercensal and postcensal estimates from the Office of Management of Washington state. Contiguous age categories with similar death rates were grouped, and patterns within age groups were examined.

The average 1-year change in mortality was estimated using negative binomial regression in models that accounted for changes in the age, sex distribution, and size of the population. This regression method is useful for analyzing count data that do not meet the restrictive assumptions of Poisson models (2). Results are expressed as the overall percentage change in mortality from 1980 to 1995. Trends are presented graphically using robust locally weighted regression (3). Because suicide methods might change over time, trends in firearm-related suicides were compared with those in non firearm-related suicides.

During 1980-1995, a total of 10,650 suicides occurred in Washington, representing an overall average rate of 14.2 per 100,000 population. The most common method of suicide was use of firearms (E950.0-E955.4) (56%), followed by poisoning (E950-E954) (23%), suffocation (E953) (13%), and other or unspecified means (8%). Most (78%) suicides occurred among males. Although the overall average rate of suicide in the total population remained relatively constant during the 16-year period, the rate of firearm-related suicide increased 8% (p=0.2), and the rate of suicide by other means decreased 15% (p less than 0.01) (Table 1). Changes in the overall suicide rate varied by age, increasing by 127% for children aged 5-14 years (all except one suicide in this age group during 1980-1995 occurred among children aged 10-14 years); by 16% for persons aged 15-24 years; and by 42% for persons aged greater than or equal to 75 years (Figure 1). For persons aged 25-74 years, the rate declined substantially. The increase for children aged 5-14 years primarily reflected an increase in non firearm-related suicide, the increase for persons aged 15-24 years and greater than or equal to 75 years reflected an increase in firearm-related suicide, and the decrease for persons aged 25-74 years reflected a decrease in both firearm-related and non firearm-related suicide (Figure 2). Reported by: M LeMier, MPH, D Keck, Injury Prevention Program, Washington Dept of Health; P Cummings, MD, Harborview Injury Prevention and Research Center, Seattle. Div of Violence Prevention, National Center for Injury Prevention and Control, CDC.

Editorial Note: The analysis by WDOH illustrates the usefulness of death-certificate data in assessing trends in suicide. Although overall suicide rates remained stable among residents of Washington during 1980-1995, age-specific analyses indicate that the rate of non firearm-related suicide increased significantly for children aged 5-14 years, and the rate of firearm-related suicide increased for persons aged 15-24 years and the elderly (aged greater than or equal to 75 years). Suicide rates for persons aged 25-74 years declined, reflecting a decrease in both firearm-related and non firearm-related suicide. These findings can assist in identifying risk factors for suicide and high-risk groups; such analyses should be considered by other state and local health departments to better understand local suicide trends and guide prevention efforts.

The high proportion of firearm-related suicides in Washington is consistent with national patterns during the 1980s and 1990s (4). The increases in Washington in the overall rates of suicide for youths and for the elderly and in the rate of firearm-related suicide for persons aged greater than or equal to 75 years also were consistent with national trends. Although reasons for these increasing trends in suicide are unknown, potential explanations include changes in the prevalence of depression, the use of more lethal methods, and changes in societal attitudes toward suicide among the elderly.

The findings in this analysis may have underestimated the true rate of suicide. The intent of some persons who commit suicide may be unknown or unrecognized; therefore, their deaths may not be reported as suicides. The magnitude of underreporting associated with these misclassification errors is unknown. In contrast, a previous report indicated that coding a non suicide death as a suicide probably is uncommon; in that study, 90% of deaths coded as suicides were coded correctly (5).

Routine collection of the circumstances of injury events may assist in more accurate coding of suicides on death certificates and in developing effective prevention strategies. In Washington, efforts to improve basic injury data collection include the reporting of firearm injury data to WDOH by all hospitals (admissions and emergency department visits), coroners, and medical examiners. In addition, WDOH is collecting information about the intent and circumstances of shootings and the types of firearms involved.

An important prevention measure for persons who are suicidal is to restrict access to highly lethal methods of suicide (6). For example, measures associated with reductions in suicide rates without compensatory increases in the use of other methods include removal of carbon monoxide from domestic gas (7), limiting the size of prescriptions to barbiturates and other drugs commonly used in self-poisonings (8), and restricting access to handguns (9). In addition to means restrictions, other interventions for reducing the risk for suicide include 1) training of clergy, tribal leaders, school personnel, healthcare professionals, and others who have contact with persons who may be contemplating suicide to recognize persons at risk for suicide and refer them for appropriate counseling; 2) educating the general public about warning signs for suicide and opportunities to seek help; 3) implementing screening programs for identifying and referring persons at highest risk for suicide; 4) improving access to or promoting crisis centers, hotlines, and peer support groups (including family and friends) for high-risk persons; and 5) implementing post-suicide actions to reduce the probability of cluster suicides (5). The effectiveness of each of these suicide-prevention strategies requires further assessment.

WDOH, in collaboration with the University of Washington School of Nursing, has developed a Youth Suicide Prevention Plan (10) that includes a public education campaign to heighten awareness among adults about the increasing problem of youth suicide and to teach adults how to recognize common suicide warning signs and how to respond to youth who exhibit these signs. In addition, the program provides adults working with high-risk youth with information about effective screening and crisis-intervention strategies. The goals of this plan are to 1) prevent both fatal and nonfatal suicide behaviors among youth; 2) reduce the impact of suicide and suicidal behaviors on individuals, families, and communities; and 3) improve access to and availability of appropriate prevention services for at-risk persons and groups. Although this program is designed to prevent suicide among youths, some elements of the program may be useful to prevent suicide among the elderly.

References
1. Estee S, Starzyk P, Harmon L, Parker C. Washington state vital statistics, 1994 and 1995. Olympia, Washington: Washington Department of Health, 1996.
2. McCullagh P, Neider HA. Generalized linear models. New York, New York: Chapman and Hall, 1989.
3. Cleveland WS. The elements of graphing data. Murray Hill, New Jersey: Bell Telephone Laboratories, 1985.
4,. Kachur SP, Potter LB, James SP, Powell KE. Suicide in the United States, 1980-1992. Atlanta, Georgia: US Department of Health and Human Services, Public Health Service, CDC, National Center for Injury Prevention and Control, 1995. (Violence surveillance summary series, no. 1).
5. Moyer LA, Boyle CA, Pollock DA. Validity of death certificates for injury-related causes of death. Am J Epidemiol 1989;130:1024-32.
6. CDC. Youth suicide prevention programs: a resource guide. Atlanta, Georgia: US Department of Health and Human Services, Public Health Service, 1992.
7. Kreitman N, Platt S. Suicide, unemployment, and domestic gas detoxification in Britain. J Epidemiol Community Health 1984;38:1-6.
8. Harrison J, Moller J, Dolinis J. Suicide in Australia: past trends and current patterns. Australian Injury Prevention Bulletin 1994; issue no. 5.
9. Loftin C, McDowall D, Wiersema B, Cottey TJ. Effects of restrictive licensing of handguns on homicide and suicide in the District of Columbia. N Engl J Med 1991;325:1615-20.
10. Eggert LL, Thompson EA, Randall BP, McCauley E. Youth Suicide Prevention Plan for Washington State. Olympia, Washington: Washington Department of Health, 1995.


Snippets


Suicide Among the Elderly

Suicide Among the Young

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We can't tear out a single page from our life, but we can throw the whole book into the fire. - George Sand



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