Epidemiological Diagnosis

“There are a number of epidemiological factors that act as risk factors of suicide among youth and the elderly. These factors do not predict suicide rather they are part of a suicide assessment because of their demonstrated statistical correlation with suicide” (Pare Michael Myths About Suicide And The Truth). “A risk factor is anything that increases the likelihood that persons will harm themselves” (Suicide: Fact Sheet). There are several important risk factors associated with youth suicide:

Previous suicide attempt(s) – if a young person has attempted suicide in the past, he or she is likely to attempt suicide again in the past. A male teen with a past attempt is more than thirty times more likely to complete suicide, while a female in this case has about three times the risk (Youth Suicide Fact Sheet).

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History of mental (psychiatric) disorders, particularly depression, – “over 90% of young people who complete suicide have a diagnosable mental or substance abuse disorder or both, and the majority have depressive illness” (Youth Suicide Fact Sheet). Hopelessness is the most serious warning sign that a person is considering suicide (Pare Michael). Among risk factors of elderly suicide are:

Serious physical illness – the overwhelming majority of the elderly dealing with a serious physical illness aren’t suicidal, but factors such as chronic pain, functional impairment, disfigurement, the person’s own perception of their condition or prognosis, and the presence of other stressful conditions and life situations must also be considered. Mental (psychiatric) illness, especially depression, alcohol abuse, previous suicide attempts, hopelessness are the same risk factors for the elderly as for the young (As We Age).

All in all, risk factors for suicide among older persons differ from those among the young. In addition to a higher prevalence of depression, older persons are more socially isolated and more frequently use highly lethal methods. They also make fewer attempts per completed suicide, have a higher-male-to-female ratio than other groups, have often visited a health-care provider before their suicide, and have more physical illnesses (The Surgeon General’s Call To Action To Prevent Suicide, 1999)

Behavioral Diagnosis

Behavioral diagnosis examines the behavioral and nonbehavioral (genetic and environmental) causes of suicide. Nonbehavioral factors contribute to committing suicide but are not controlled by the individual (Human Behavior and Community and Population Health Education).

As an example of a behavioral factor in both age groups that influences suicide we can cite family history of suicide – “a high proportion of suicides and attempters have had a close family member who attempted or completed suicide. Many of the mental illnesses which contribute to suicide risk appear to have a genetic component” (Youth Suicide Fact Sheet). Nonbehavioral factors include: Stressful life event or loss – loss of a parent, getting into trouble at school or with a law enforcement agency; breaking up with a boyfriend or a girlfriend; and fighting with friends (Youth Suicide Fact Sheet). As to the elderly, “according to the Center for Disease Control and Prevention, suicide rates are most common for divorced or widowed persons, with the highest rates found in nursing homes and assisted living facilities” (Trend Watch. Suicide Among the Elderly). Exposure to the suicidal behaviour of others – suicide can be facilitated in vulnerable teens by exposure to real or fictional accounts of suicide, including media coverage of suicide, such as intensive reporting of the suicide of a celebrity, or the fictional representation of a suicide in a popular movie or TV show. In addition, there is evidence of suicide clusters, that is, local epidemics of suicide that have a contagious influence. Incarceration – suicide in juvenile detention and correctional facilities is more than four times greater than youth suicide overall. Gay and lesbian youth are at higher risk to complete suicide than others and a significant percent of all attempted or completed youth suicides are related to issues of sexual identity. Cultural and religious beliefs about suicide – the belief that suicide is a noble resolution of a personal dilemma. Availability of a firearm –

firearms are the most popular method of suicide of both age groups (Youth Suicide Fact Sheet).

Possible remedies to prevent suicide in both age groups include limitation of people’s access to firearms and medications; describing and monitoring the problem, understanding risk factors and causes of suicidal behavior; family and community support; effective clinical care for mental, physical, and substance abuse disorders. As for the young, following exposure to suicide or suicidal behaviors within one’s family or peer group, suicide risk can be minimized by having family members, friends, peers, and colleagues of the victim evaluated by a mental health professional (Suicide: Fact Sheet).

Educational Diagnosis

Educational diagnosis identifies predisposing, enabling and reinforcing factors of suicide for both the young and the elderly.

1.      Predisposing factors include knowledge, beliefs and attitudes relating to the motivation to act. Relevant factors for suicide are:  Knowledge of modifiable risk factors – people need knowledge of risk factors to modify their personal risk. Belief in professional help-seeking – to seek help, people must believe that seeking help is useful and also know a source of help (Parslow, Ruth A ; Jorm, Anthony F Preventing Depression. Improving Australians’ depression literacy).

Enabling factors are the environmental conditions that facilitate performance of an action. Among relevant factors for suicide we can cite: Availability of information – promotion of suicide literacy requires the availability of high quality information whose accessibility and quality may be limited. Availability of effective interventions – encouraging suicidal people to seek help from suicide prevention groups or crisis centers and use effective treatments (Parslow R ; Jorm A).

Reinforcing factors determine whether the person receives positive or negative feedback and social support for their action. Important reinforcing factors for suicide can be: Societal attitudes to suicide – people may be reluctant to seek help because they believe they will be stigmatised. These beliefs can affect the willingness of suicidal people to seek help and their treatment adherence.

Significant knowledge of other people and attitudes to help-seeking and treatments – family and friends’ willingness to encourage help-seeking will be limited by their own knowledge and attitudes towards professional help and treatments available (Parslow R & Jorm A).
Suicide Among Youth

“Youth suicide is a major public health problem in the United States” (Youth Suicide Fact Sheet). Over the last several decades, the suicide rate in young people has increased dramatically. From 1952 – 1996, the incidence of suicide among adolescents and young adults nearly tripled, although there has been a general decline in youth suicides since 1994. From 1980 – 1996, the rate of suicide among persons aged 15 – 19 years increased by 14% and among persons aged 10 – 14 years by 100%. For African-American males aged 15 – 19, the rate increased by 105%. For young people 15 – 24 years old, suicide is the third leading cause of death, behind unintentional injury and homicide (The Surgeon General’s Call To Action To Prevent Suicide, 1999).

Adolescents and young adults often experience stress, confusion, and depression from situations occurring in their families, schools, and communities. Such feelings can overwhelm young people and lead them to consider suicide as a “solution.” Few schools and communities have suicide prevention plans that include screening, referral, and crisis intervention programs for youth. American Indian and Alaskan Natives have the highest rate of suicide in the 15 to 24 age group (CDC 2004) (Suicide: Fact Sheet).

The risk for suicide among young people is greatest among young white males; however, from 1980 through 1996, suicide rates increased most rapidly among young black males. Suicide is extremely rare in young children, and the suicide rate among 10 to 14 year olds, while increasing rapidly, is still much lower than the rate for older teens. Younger children may be less likely to complete suicide because they do not have the cognitive ability to plan and carry out a suicide

attempt. But research also suggests that the increase in suicide rates with age may be due to the increased likelihood of exposure to critical risk factors, such as serious depression and drugs an alcohol, with age. Studies have found that for younger children exposed to such risk factors, the suicide rate is similar to that for older teens (Youth Suicide Fact Sheet).

Firearms are the most common method of suicide by youth. This is true for both males and females, younger and older adolescents, and for all races. More than 60 percent of youth suicides (between the ages of 10-19 years) are firearm-related suicides (Youth Suicide Fact Sheet).
Suicide Among the Elderly

Suicide among the elderly has reached epidemic proportions. It is the eighth-leading cause of death in the United States, and its rates are highest among the elderly, with 40% of suicides occurring in those older than age 60. After age 75, that rate becomes three times higher than average (approximately 11 per 100,000 persons in all age groups). Older males are at the highest risk in almost all industrialized nations, and between 1980 and 1990, older American men accounted for 81% of the suicides occurring in those persons older than age 65. The rate among the elderly might be even higher, as those who stop taking their medications or eating in order to end their lives, are not grouped in with deaths caused by suicide. In addition, more than 20% of the population over age 65 report persistent thoughts of a desired death (Trend Watch. Suicide Among the Elderly).

Suicide rates are higher in the elderly than at any other point in the life course. The suicide rates for men are relatively constant from ages 25 – 64, but increase significantly after age 65. White men 85 and older have a suicide rate that is six times that of the overall national rate (Suicide Among The Elderly). While this age group accounts for only 13 percent of the U.S. population, Americans 65 or older account for 20% of all suicide deaths (The Surgeon General’s Call To Action To Prevent Suicide, 1999).

The ten-year period 1980 – 1990 was the first decade since the 1940s that the suicide rate for older Americans rose instead of declined, although that rate again declined during the 1990’s.

Suicide rates among the elderly are highest for those who are divorced or widowed (The Surgeon General’s Call To Action To Prevent Suicide, 1999).

There is an average of one suicide among the elderly every 90 minutes. 81% of elderly suicides are male; that is 13 times greater than for females. Firearms (71%), overdose (liquids, pills or gas) (11%) and suffocation (11%) are the three most common methods of suicide used by persons aged 65+ years (Risk Factors of Suicide Among the Elderly).

Older adults are the fastest growing segment of our population.  In coming decades, as increasing numbers of people age into the stages of life that carries the greatest risk for suicide, the absolute number of seniors that take their own life may expand dramatically. Only by identifying suicide as a major public health concern, will we better recognize elderly people with suicidal tendencies (Risk Factors of Suicide Among the Elderly).