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Suicide

Suicide is when someone takes their own life. It is the 8th leading cause of death in the US. Suicide kills 30,000 Americans each year from 500,000 attempts.

5,000 of these suicides occur among 15 to 24 year-olds.

Suicide is the 3rd leading cause of death among adolescents & the 2nd leading cause of death among college-age people.

After heart disease & cancer, more years of life are lost to suicide than from anything else. It's speculated that substance abuse may be involved in as many as half of all suicides.

Warning Signs of Possible Suicidal Thoughts

Around 80% of all suicidal people show some sign of their intentions. Every depressed person will not become suicidal; however, most who attempt suicide have been depressed.

Warning signs:

  • Previous suicide attempts

  • Actual threats of suicide, either direct or indirect

  • Off-handed comments such as "maybe you're better off without me"

  • Risky, daring actions & behaviors

  • Little interest in future plans

  • Repeated thoughts of death, an obsession with death

  • Poems, essays, or drawings involving death

  • Major changes in appearance or behavior

  • Great sense of shame, guilt or rejection

  • Changes in eating or sleeping patterns

  • Significant drop in school or work performance

  • Giving away belongings

It's very important to understand that the danger isn't over if someone has survived a suicide attempt. The possibility of suicide is actually highest the first year after an attempt!

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What to do if You Suspect Someone is Suicidal

Trust your instincts. If you believe someone you know or are close to may be suicidal:

  • Encourage them to seek professional help
  • If this is your child, take them to a counselor or another mental health professional
  • Do not act shocked or judge them
  • Talk to them openly and lovingly
  • Do not agree to keep secrets that may endanger the life of a suicidal person
  • Do not leave them alone
  • Do not attempt to counsel them yourself

Parent Tips

If you're the parent of a child or teenager, it's important to understand the stresses & changes in your child's life & to know the friends they spend time with. Many experts now believe that suicide in young people is brought on by some triggering event after an extended time of underlying stress & depression.

Young people who are depressed or experiencing great conflict may believe their situation will never change. Because of their limited life experiences, they need extra attention & help to cope with negative circumstances. So, if you suspect your child may be suicidal, seek professional help immediately.

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TEEN SUICIDE

Suicides among young people nationwide have increased dramatically in recent years. Each year in the U.S., thousands of teenagers commit suicide. Suicide is the third leading cause of death for 15-to-24-year-olds, and the sixth leading cause of death for 5-to-14-year-olds.

Teenagers experience strong feelings of stress, confusion, self-doubt, pressure to succeed, financial uncertainty, and other fears while growing up. For some teenagers, divorce, the formation of a new family with step-parents and step-siblings, or moving to a new community can be very unsettling and can intensify self-doubts. For some teens, suicide may appear to be a solution to their problems and stress.

Depression and suicidal feelings are treatable mental disorders. The child or adolescent needs to have his or her illness recognized and diagnosed, and appropriate treatment plans developed. When parents are in doubt whether their child has a serious problem, a psychiatric examination can be very helpful.

Many of the symptoms of suicidal feelings are similar to those of depression.

Parents should be aware of the following signs of adolescents who may try to kill themselves:

  • change in eating and sleeping habits
  • withdrawal from friends, family, and regular activities
  • violent actions, rebellious behavior, or running away
  • drug and alcohol use
  • unusual neglect of personal appearance
  • marked personality change
  • persistent boredom, difficulty concentrating, or a decline in the quality of schoolwork
  • frequent complaints about physical symptoms, often related to emotions, such as stomachaches, headaches, fatigue, etc.
  • loss of interest in pleasurable activities
  • not tolerating praise or rewards
A teenager who is planning to commit suicide may also:
  • complain of being a bad person or feeling rotten inside
  • give verbal hints with statements such as: I won't be a problem for you much longer, Nothing matters, It's no use, and I won't see you again
  • put his or her affairs in order, for example, give away favorite possessions, clean his or her room, throw away important belongings, etc.
  • become suddenly cheerful after a period of depression
  • have signs of psychosis (hallucinations or bizarre thoughts)
If a child or adolescent says, I want to kill myself, or I'm going to commit suicide, always take the statement seriously and immediately seek assistance from a qualified mental health professional. People often feel uncomfortable talking about death. However, asking the child or adolescent whether he or she is depressed or thinking about suicide can be helpful. Rather than putting thoughts in the child's head, such a question will provide assurance that somebody cares and will give the young person the chance to talk about problems.

If one or more of these signs occurs, parents need to talk to their child about their concerns and seek professional help when the concerns persist. With support from family and professional treatment, children and teenagers who are suicidal can heal and return to a more healthy path of development.

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Suicide Risk Factors

It is important to note that many people experience one or more risk factors and are not suicidal.

  • One or more diagnosable mental or -Family violence, including physical or sexual abuse
  • substance abuse disorder-Prior suicide attempt
  • Impulsivity -Firearm in the home
  • Adverse life events-Incarceration
  • Family history of mental or substance abuse disorder-Exposure to the suicidal behavior of others,
  • Family history of suicide including family, peers, or in news or fiction stories
  • Family violence, including physical or sexual abuse
  • Prior suicide attempt
  • Firearm in the home
  • Incarceration
  • Exposure to the suicidal behavior of others, including family, peers, or in the news or fiction stories

                                    
                                    How To Help

It is not true that if a person talks about suicide, they will not attempt it. Seriously suicidal people make such comments for a variety of reasons--it is extremely important to take these remarks seriously and help that person seek a mental health evaluation and treatment. A person in crisis may not be aware that they are in need of help or be able to seek it on their own. They may also need to be reminded that effective treatment for depression is available, and that many people can very quickly begin to experience relief from depressive symptoms.

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UNDERSTANDING AND HELPING THE SUICIDAL PERSON

Be Aware of the Warning Signs

Are you or someone you love at risk of suicide? Get the facts and take appropriate action.

Get help immediately by contacting a mental health professional or calling 1-800-273-8255 for a referral should you witness, hear, or see anyone exhibiting any one or more of the following:

                Someone threatening to hurt or kill him/herself, or talking of wanting to hurt or kill 
                him/herself.

                Someone looking for ways to kill him/herself by seeking access to firearms, available pills,
                or other means.

                Someone talking or writing about death, dying or suicide, when these actions are out of the 

                ordinary for the person.

Seek help as soon as possible by contacting a mental health professional or calling 1-800-273-8255 for a referral should you witness, hear, or see someone you know exhibiting any one or more of the following:

                Hopelessness
                Rage, uncontrolled anger, seeking revenge
                Acting reckless or engaging in risky activities, seemingly without thinking
                Feeling trapped - like there's no way out
                Increased alcohol or drug use
                Withdrawing from friends, family and society
                Anxiety, agitation, unable to sleep or sleeping all the time
                Dramatic mood changes
                No reason for living; no sense of purpose in life

Here is an easy mnemonic to remember these warning signs:
                             IS PATH WARM?

          I         Ideation
         S        Substance Abuse
         P        Purposelessness
         A        Anxiety
         T        Trapped
         H        Hopelessness
         W       Withdrawal
         A        Anger
         R        Recklessness
         M        Mood Changes

What To Do

Here are some ways to be helpful to someone who is threatening suicide:

  • Be direct. Talk openly and matter-of-factly about suicide.
  • Be willing to listen. Allow expressions of feelings. Accept the feelings.
  • Be non-judgmental. Don’t debate whether suicide is right or wrong, or whether feelings are good or bad. Don’t lecture on the value of life.
  • Get involved. Become available. Show interest and support.
  • Don’t dare him or her to do it.
  • Don’t act shocked. This will put distance between you.
  • Don’t be sworn to secrecy. Seek support.
  • Offer hope that alternatives are available but do not offer glib reassurance.
  • Take action. Remove means, such as guns or stockpiled pills.
  • Get help from persons or agencies specializing in crisis intervention and suicide prevention.

Be Aware of Feelings

Many people at some time in their lives think about completing suicide. Most decide to live because they eventually come to realize that the crisis is temporary and death is permanent. On other hand, people having a crisis sometimes perceive their dilemma as inescapable and feel an utter loss of control. These are some of the feelings and thoughts they experience:

  • Can’t stop the pain
  • Can’t think clearly
  • Can’t make decisions
  • Can’t see any way out
  • Can’t sleep, eat or work
  • Can’t get out of depression
  • Can’t make the sadness go away
  • Can’t see a future without pain
  • Can’t see themselves as worthwhile
  • Can’t get someone’s attention
  • Can’t seem to get control

If you experience these feelings, get help!

If someone you know exhibits these symptoms, offer help!

Contact:

  • A community mental health agency
  • A private therapist or counselor
  • A school counselor or psychologist
  • A family physician
  • A suicide prevention or crisis center

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Buddhism and Suicide Grief: A Unique Perspective

By Ginny Sparrow

The 2006 conference planning committee acquired an amazing speaker to address survivors at lunch on Saturday’s Healing Day. The Venerable Thubten Chodron is a person so unique that she was unavailable to be interviewed for this article due to being in silent retreat since December. Luckily, her retreat is over in March, in plenty of time to attend the conference in April.

My first encounter with Buddhism was in Atlanta, GA, when I was doing home visits to families after suicides for The Link Counseling Center’s National Resource Center for Suicide Prevention & Aftercare.

This particular home visit was to a Buddhist woman who had lost her sister. Specific details, of course, remain confidential, but I remember leaving her feeling like I had just met a wonderful person with creative healing rituals & fresh ideas of the mind & rebirth. This was my first experience with the Buddhist philosophy & I left that home visit with a lot of new ideas to consider.

What was special about this woman was how open she was about her grief. Her grieving process seemed quite positive, which was in extreme contrast with most grieving people I had encountered. I was curious to discover her secret!

She was laughing, she was crying, she was remembering great times with her loved one. She was expressing her sadness at having no more time with her sister, but felt she wasn't really gone. She believed her sister’s misfortunes that led to her suicide were due to negative actions from a past life; that she was beautiful & full of positive actions in this life, therefore, she would benefit karmically in her next rebirth. This gave the woman much comfort.

She kept herself busy making her sister’s favorite foods & setting a plate for her. She ate her meals as if she were sharing with her sister, joining together for a last meal before both were ready to say goodbye.

She shared with my home visit partner & me her beautiful mantel display with candles, framed pictures, letters, trinkets, everything she could think of that reflected her sister’s memory.

We were honored to witness this beautiful concoction of items that reminded me of the displays in London after Princess Diana died. (Sadly, why is it that many families go to the other extreme & put away the pictures? I know my family no longer has many pictures or mementos around of my mother – it’s obviously too painful, or too embarrassing, I’m unsure which.)

These lovely Buddhist rituals amazed me. I felt like our work here was done. This woman knew how to grieve constructively.

I decided to do a little research on how Buddhists feel about suicide. From what I can ascertain, they feel much like the rest of us, declaring suicide as an extreme human tragedy. Buddhists believe in rebirth & think that actions of past lives affect what their rebirth becomes. For this reason, they do fear that death at such an obviously painful state of mind such as suicide could transpire to misfortune in a future life.

I prefer to refer to the opinions of the woman I met on the home visit. She truly believed her sister was in a happier life & what more can we ask for after a loss?

What I have found inspiring in the Buddhist faith is its ability to let the Buddhist woman I met have her unique opinion. They encourage questioning & don’t have the hard fast rules & regulations of most religions. Their goal is to be of service, to be beneficial & not to judge or preach.

As survivors of suicide, we often re-evaluate our religious beliefs. Some of us cling to old values that offer comfort, consistency & hope. Others find they have new ideas about the universe, spirituality & reasons for being. Grieving is a time for true reflection & what we learn about ourselves can become a "gift" during this tragic time.

Discovering new ideas & religions is something we never may had considered doing before. We do it now with a fresh outlook. So often our beliefs come into question after such tragic loss & this becomes the best time to open our hearts & listen to others’ ideas.

A little background on Venerable Thubten Chodron

Born in 1950, she grew up in California near Los Angeles & led a very ordinary life. She went to college & became an elementary school teacher & married a similarly socially conscience lawyer. They worked together to better their community & after a few years of marriage were led to Buddhism together.

Then the Venerable Thubten Chodron did something that most of us might never consider. After traveling Europe & Asia & studying Buddhism, she left her life in 1977 & became ordained as a Buddhist nun. She since has studied with the great Tibetan masters, including the Dalai Lama. Her studies & teaching led her to places like India, Nepal & France.

She was a resident teacher at Amitabha Buddhist Centre in Singapore & at Dharma Friendship Foundation in Seattle & was co-organizer of "Life as a Western Buddhist Nun," an educational program in Bodhgaya in 1996. In 2003, she returned to her home country & founded Sravasti Abbey, one of the few Buddhist monasteries in the US, near Newport, WA.

She's involved in interfaith dialogue, prison work, conferences between scientists & Buddhists, meetings of Western Buddhist teachers & gatherings of Western Buddhist monastics.

She teaches Buddhist philosophy, psychology & meditation worldwide. Her books include Open Heart, Clear Mind; Buddhism for Beginners; Working with Anger; Taming the Mind; Cultivating a Compassionate Heart & How to Free Your Mind.

Venerable Chodron is known for her clear, humorous & practical lectures. She teaches the Dharma tirelessly in the US & many places worldwide. For more information on Venerable Chodron, visit www.thubtenchodron.org.

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Reaching Out Through the Darkness: Survivors Drawn Together in Grief

By Susanne Johnson-Berns

I think we all know how difficult it is to reach out to someone for help. How do we explain our feelings? I too struggled with sharing how I truly felt after my bother’s suicide. I began to isolate myself from friends & coworkers. I felt that everyone was watching me, judging me & I didn't care much about how I truly felt. I answered, "How are you?" with "fine, thanks."

I hid my tears, even from my husband & son. There were times when I'd come home from work with tear streaked cheeks & swollen eyes & my husband would ask, "What’s wrong honey?" I would do what I now know was the wrong thing. I simply said "Nothing."

Inside, however, I wanted to scream out loud, "My brother is still dead, nothing has changed from last month. I still hurt. I still miss him terribly. I still feel guilty. I wished I had gone to see him. I wished I could have been there for him."

By answering his concern with "nothing," I closed the door on him. Had I been honest & let the screams out, I would have allowed him to hold me, to understand, to help me. I pushed everyone away for a long time & it only made things worse.

I was punishing myself & I suffered until I allowed myself to share what was truly in my heart with a stranger. One of the nurses I work with called me at the office several months after my brother’s death. I knew her by name but was surprised that she would call me & ask to meet me after work for a cup of coffee.

Reluctantly, I agreed, knowing that she had most likely heard about my brother’s suicide & just wanted to know more about it.

When we met, she began to tell me the story of her best friend Stephanie who lives in Iowa. Stephanie lost her son Jeremy to suicide in December 1999, 2 years before my brother. She shared with me how helpless she felt watching the agony her friend was going thru.

She offered to be there for me, but most of all she wanted to know if I thought it would be all right for Stephanie to call me. I agreed, even if I didn't think that someone who lived several states away could be helpful to me.

It didn't take long before Stephanie called. She had a very pleasant voice & she shared her story with me. She allowed me to see that I wasn't alone & that what I was feeling was normal. She was able to reach me & go deep inside the darkness. She understood what was there in that dark corner, the place where I hid from everyone else.

She knew that I was afraid & often felt that life seemed to be too much trouble. I didn't care much about anything & Stephanie skillfully managed to make me see what I was feeling & why.

She had been there & everything I was telling her was familiar. She too had experienced all the same emotions, the same agony, sadness & pain. We began to talk regularly & at times the conversations would last hours.

Over time, I even managed to comfort her when she had a bad day. Stephanie became my light in the darkness; I knew she would be there whenever I needed her, without judgment, without issuing unrealistic advice. She just listened to what I was truly feeling, she wasn't afraid to hear real emotions because she had felt them herself.

When Christmas arrived, I wanted to send a special gift to her. But Jeremy had died only a few days before Christmas & naturally it’s the most difficult time for Stephanie. I began to think about how I was feeling & during our conversation around the holidays, I realized that we both missed shopping for Christmas gifts.

She also told me how difficult it was for her to look at everyone’s Christmas trees & the wrapped gifts under them. Many of her friends didn't understand why she was trying to stop Christmas from coming. So I began to write about how I felt & created The Christmas Gift, dedicated to Jeremy. I printed it on paper that was outlined by angels & sent it to Stephanie for Christmas. She loved it.

I later submitted it to a company that publishes poetry & exactly a year later "The Christmas Gift" was published in a book of poetry by Nobel House. I sent her the book for Christmas last year. To me it still seems like a small gift considering all she gave me & continues to give. We have even managed to see each other a couple of times.

It’s been 2 years & 5 months since that terrible day in May that changed my life forever. To this day, there hasn't been one single day that isn't filled with the memory of my brother. Each day I wake up to the reality that he's gone, that it did happen, he took his life & his reasons will forever remain buried in his soul.

I know that only those who have personally been affected by a loved one’s suicide can truly understand the devastation it causes. Stephanie & I often said that we've become members of a club for which someone else paid the membership.

No one could return my life to the way it was before. I began to deal with everyday life a lot better once I understood that completely. I have stopped resisting & trying to change how I feel, I've begun to accept the person I've become.

I've learned so much about myself & others. I've lost friends & met a lot of others. I've learned to be more open about my feelings & even if I often answer my husband’s question of "What’s wrong?" with "I don’t want to talk about it right now," it’s a lot better then saying "nothing."

At least that way I leave room to discuss it later.

About a month ago I phoned Stephanie & we talked about her garden, as she is a Master Gardener that is a huge honor in her town. We talked for a long time about all sorts of things. At the end of our conversation we both realized that we had shed no tears, we actually found ourselves laughing & sharing memories of times past.

It was a great conversation & it made me see how we'd grown & changed.

The rawness of my pain has subsided & there's now room to mourn in a new & different way. Time to look back at my childhood & see my brother next to me without the anguish, to see him smile & to walk with him thru the memories that I've learned to treasure. His memories, like a precious gift, will be with me forever.

The Christmas Gift

It’s time again for that holiday cheer

My only wish, that you were here

Christmas has again arrived

To remind me of the void left in my lifeI have no gift to give you

I only have my tears

My heart that’s split and broken

In search of all your fears

The tree is lit so bright and pretty

It’s beauty so hard for me to see

The gifts are neatly wrapped beneath it

The gift I seek not there for me

There is no present that awaits you

None but my beating heart

Where yours that lays forever silent

In thought we’re never far apart

I have no gift to give you

But merely a promise to make

To carry on your sweet sweet memory

Though all the seasons of my life

By Susanne Johnson-Berns

In Memory of Jeremy Harden (December 2000)

Older Adults: Depression & Suicide Facts


Depression, one of the most common conditions associated with suicide in older adults,1 is a widely under-recognized & undertreated medical illness.

In fact, several studies have found that many older adults who die by suicide - up to 75% - have visited a primary care physician within a month of their suicide.2

These findings point to the urgency of improving detection & treatment of depression as a means of reducing suicide risk among older persons.

Older Americans are disproportionately likely to die by suicide.

Comprising only 13% of the U.S. population, individuals age 65 & older accounted for 18% of all suicide deaths in 2000. Among the highest rates (when categorized by gender & race) were white men age 85 & older: 59 deaths per 100,000 persons in 2000, more than 5 times the national U.S. rate of 10.6 per 100,000.3

Of the nearly 35 million Americans age 65 & older, an estimated 2 million have a depressive illness (major depressive disorder, dysthymic disorder, or bipolar disorder) & another 5 million may have “subsyndromal depression,” or depressive symptoms that fall short of meeting full diagnostic criteria for a disorder.4,5

Subsyndromal depression is especially common among older persons & is associated with an increased risk of developing major depression.6

In any of these forms, however, depressive symptoms are not a normal part of aging. In contrast to the normal emotional experiences of sadness, grief, loss, or passing mood states, they tend to be persistent & to interfere significantly with an individual's ability to function.

Depression often co-occurs with other serious illnesses such as:

  • heart disease
  • stroke
  • diabetes
  • cancer
  • Parkinson’s disease7

Because many older adults face these illnesses as well as various social & economic difficulties, health care professionals may mistakenly conclude that depression is a normal consequence of these problems - an attitude often shared by patients themselves.8

These factors together contribute to the underdiagnosis & undertreatment of depressive disorders in older people. Depression can & should be treated when it co-occurs with other illnesses, for untreated depression can delay recovery from or worsen the outcome of these other illnesses.

The relationship between depression & other illness processes in older adults is a focus of ongoing research.

Both doctors & patients may have difficulty identifying the signs of depression. NIMH-funded researchers are currently investigating the effectiveness of a depression education intervention delivered in primary care clinics for improving recognition & treatment of depression & suicidal symptoms in elderly patients.9

Research & Treatment

Research has revealed varying patterns of clinical & biological features among older adults with depression.8 As compared to older persons whose depression began earlier in life, those whose depression first appears in late life are likely to have a more chronic course of illness.

In addition, there's growing evidence that depression beginning in late life is associated with vascular changes in the brain.

Both antidepressant medications & short-term psychotherapies are effective treatments for late-life depression.8 Existing antidepressants are known to influence the functioning of certain neurotransmitters in the brain.

The newer medications, chiefly the selective serotonin reuptake inhibitors (SSRIs), are generally preferred over the older medications, including tricyclic antidepressants (TCA's) & monoamine oxidase inhibitors (MAOI's), because they have fewer & less severe potential side effects.10

Both generations of medications are effective in relieving depression, although some people will respond to one type of drug, but not another.

Research has shown that certain types of short-term psychotherapy, particularly cognitive-behavioral therapy & interpersonal therapy, are effective treatments for late-life depression.8

In addition, psychotherapy alone has been shown to prolong periods of good health free from depression. Combining psychotherapy with antidepressant medication, however, appears to provide maximum benefit.

In one study, approximately 80% of older adults with depression recovered with combination treatment.11 The combination treatment was also found to be more effective than either treatment alone in reducing recurrences of depression.12

More studies are in progress on the efficacy & longer-term effectiveness of SSRI's & specific psychotherapies for depression in older persons. Findings from these studies will provide important data regarding the clinical course & treatment of late-life depression.

Further research will be needed to determine the role of hormonal factors in the development of depression in older adults & to find out whether hormone replacement therapy with estrogens or androgens is of benefit in the treatment of late-life depression.

Older Adults...

Before you say, "I'm fine"...

Ask yourself if you feel:

Or if you are:

  • sleeping more or less than usual
  • eating more or less than usual
  • having persistent headaches, stomach aches, or chronic pain

These may be syptoms of Depression, a treatable medical illness.

But your doctor can only treat you if you say how you're really feeling.

Depression isn't a normal part of aging.

Talk to your doctor

Survivors of Elderly Suicide: Opportunities Lost

By John McIntosh, Ph.D.

At least among the general public, most individuals are unaware that the highest risk group by age for suicide is actually the older adult population, particularly elderly white males.

In fact, while those aged 65 years & above have suicide rates more than 40% above the nation as a whole & over 50% higher than those for young people ages 15-24 years, the rate for elderly white males is over 200% higher than the national rate (34 per 100,000 compared to 11, respectively).

The over 5,500 older adults who die annually by suicide are survived by their spouses, siblings, adult children, grandchildren & even great-grandchildren, as well as other important individuals in their lives.

Given these facts & high risk, it might be assumed that survivors of elderly suicides would be well-represented among the groups of survivors who have been studied. However, as I & others have observed when reviewing the larger literature on suicide survivors, more questions than answers exist.

Among the topics for which there are far more questions than answers is survivorship following the suicide death of an elderly individual. In fact, over 10 years ago, when reviewing this topic in a book with colleagues (McIntosh, Santos, Hubbard, & Overholser, 1994, pp. 45-53), the literature was so sparse specifically on elderly survivors, that a review of the available knowledge about widows as survivors had to be utilized as a proxy for elderly suicide, even though most of the studies hadn't focused specifically on widows of elderly suicides.

Little progress has been made in the last decade regarding survivors of elderly suicides. In 1994, practically the only studies done were by one of AAS’s founding members & pioneers in suicidology, Dr. Norman Farberow & his colleagues (1987, 1992).

Not only did the study focus on elderly widows specifically, but it remains one of the few studies that included what is called a longitudinal design. This term refers to a study that follows the same individuals & studies their behavior on more than one occasion over time.

Dr. Farberow’s studies, over a 2 year period, revealed that widows whose spouses died by suicide, compared to widows who survived the natural death of their spouses, received less support in their grief & for their depressive feelings.

All the widows (suicide & natural deaths) experienced a low point in the support they received from others, particularly practical help, 6 months after the death. One of the most interesting findings, only able to be determined directly because the design was longitudinal, was that by 2 years after the death, levels of support had returned to what they were at the time immediately after the death.

A final point supported by this study was that, the findings above notwithstanding, there were many similarities among widows of both causes of death, a finding observed for widows of other ages & other studies as well.

As a gerontologist as well as a suicidologist, I'm sad to say that the literature on elderly survivors has remained ignored since this promising study was published. Thus, it may not be too surprising that my interest was piqued when in a recent issue of AAS’s outstanding professional journal, Suicide and Life-Threatening Behavior, an article appeared with the title "Suicides Among Family Members of Elderly Suicide Victims: An Exploratory Study." Don’t misunderstand me.

As I will note, this study provided some quite interesting results. However, I had originally anticipated a study focusing on the grief & bereavement reactions among survivors of elderly suicides.

Instead, the study focused on elderly suicides for whom a family member had died by suicide compared to elderly suicides forwhom no family member had died by suicide. The focus, therefore, was on the person who died by suicide & not the family members who survived their death.

Once my disappointment passed, I read the entire article & found that the study provided some important evidence.The exploratory study, though including a small number of suicides who had a family member die by suicide, supported a long noted statement in the survivor literature about higher risk of suicidal behavior among survivors (remember, the suicides in one of the groups studied here are survivors).

The results found a significantly greater likelihood of previous suicidal behavior among those elderly suicides who had a history of a family member who had died by suicide. Dr. Margda Waern, the author of the study, argued that, "This suggests a suicidal diathesis, a tendency to react with suicidal behavior in times of stress, which might be related to a familial susceptibility to suicide" (p. 361). While this may not have been the study I had hoped for, it contributes to our knowledge about survivors.

The true focus of the present article is to highlight one of the least researched topics in the body of knowledge about survivors. The above study talked to informants that included "23 spouses, 27 adult children, 7 siblings, 9 other relatives, 9 close friends" (p. 357) & 10 health care individuals.

I believe this researcher, like many others before, missed an opportunity here. It's easy from my perspective to observe that, perhaps without compromising the original study, it may have been possible to have studied grief & bereavement among these various survivors of these elderly suicides as well.

Just as we have a limited picture of the variety of experiences among survivors in general, we have an even more limited picture of the diversity that exists (as well as the commonalities) when the suicide death was by an elder.

As we focus on improving the quality & quantity of survivor research findings, to improve our knowledge & support, one of the groups that should be included as a special focus should be survivors of the highest risk group for suicide, older adults.

Purposeful opportunities to study these survivors are needed, of course, but when studying other aspects of suicide among elders, the inclusion of studies of survivors should more often be done as well.

Suicide: Fact Sheet

Occurrence

  • Most popular press articles suggest a link between the winter holidays & suicides (Annenberg Public Policy Center of the Univ. of Pennsylvania 2003). However, this claim is just a myth. In fact, suicide rates in the US are lowest in the winter & highest in the spring (CDC 1985, McCleary et al. 1991, Warren et al. 1983).

  • Suicide took the lives of 30,622 people in 2001 (CDC 2004).

  • Suicide rates are generally higher than the national average in the western states & lower in the eastern & midwestern states (CDC 1997).

  • In 2002, 132,353 individuals were hospitalized following suicide attempts; 116,639 were treated in emergency departments & released (CDC 2004).

  • In 2001, 55% of suicides were committed with a firearm (Anderson & Smith 2003). 

Groups At Risk

Males

  • Suicide is the 8th leading cause of death for all U.S. men (Anderson & Smith 2003).

  • Males are 4 times more likely to die from suicide than females (CDC 2004).

  • Suicide rates are highest among Whites & 2nd highest among American Indian & Native Alaskan men (CDC 2004).

  • Of the 24,672 suicide deaths reported among men in 2001, 60% involved the use of a firearm (Anderson & Smith 2003).

Females

  • Women report attempting suicide during their lifetime about 3 times as often as men (Krug et al. 2002).

Youth
The overall rate of suicide among youth has declined slowly since 1992 (Lubell, Swahn, Crosby & Kegler 2004). However, rates remain unacceptably high.

Adolescents & young adults often experience stress, confusion & depression from situations occurring in their families, schools & communities. Such feelings can overwhelm young people & lead them to consider suicide as a “solution.”

Few schools & communities have suicide prevention plans that include screening, referral & crisis intervention programs for youth.

  • Suicide is the 3rd leading cause of death among young people ages 15 to 24.
  • In 2001, 3,971 suicides were reported in this group (Anderson and Smith 2003).
  • Of the total number of suicides among ages 15 to 24 in 2001, 86% (n=3,409) were male & 14% (n=562) were female (Anderson and Smith 2003).

  • American Indian & Alaskan Natives have the highest rate of suicide in the 15 to 24 age group (CDC 2004).

  • In 2001, firearms were used in 54% of youth suicides (Anderson and Smith 2003).

The Elderly
Suicide rates increase with age and are very high among those 65 years and older. Most elderly suicide victims are seen by their primary care provider a few weeks prior to their suicide attempt and diagnosed with their first episode of mild to moderate depression (DHHS 1999). Older adults who are suicidal are also more likely to be suffering from physical illnesses and be divorced or widowed (DHHS 1999; Carney et al. 1994; Dorpat et al. 1968).

  • In 2001, 5,393 Americans over age 65 committed suicide. Of those, 85% (n=4,589) were men and 15% (n=804) were women (CDC 2004).

  • Firearms were used in 73% of suicides committed by adults over the age of 65 in 2001 (CDC 2004).


Risk Factors

The first step in preventing suicide is to identify and understand the risk factors. A risk factor is anything that increases the likelihood that persons will harm themselves. However, risk factors are not necessarily causes. Research has identified the following risk factors for suicide (DHHS 1999):

  • Previous suicide attempt(s)

  • History of mental disorders, particularly depression

  • History of alcohol and substance abuse

  • Family history of suicide

  • Family history of child maltreatment

  • Feelings of hopelessness

  • Impulsive or aggressive tendencies

  • Barriers to accessing mental health treatment

  • Loss (relational, social, work, or financial)

  • Physical illness

  • Easy access to lethal methods

  • Unwillingness to seek help because of the stigma attached to mental health and substance abuse disorders or suicidal thoughts

  • Cultural and religious beliefs—for instance, the belief that suicide is a noble resolution of a personal dilemma

  • Local epidemics of suicide

  • Isolation, a feeling of being cut off from other people
     

Protective Factors

Protective factors buffer people from the risks associated with suicide. A number of protective factors have been identified (DHHS 1999):

  • Effective clinical care for mental, physical, and substance abuse disorders

  • Easy access to a variety of clinical interventions and support for help seeking

  • Family and community support
  • Support from ongoing medical and mental health care relationships

  • Skills in problem solving, conflict resolution, and nonviolent handling of disputes

  • Cultural and religious beliefs that discourage suicide and support self-preservation instincts

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