Frequently Asked Questions about Suicide

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Are African American youth at great risk for suicide?

Historically, African Americans have had much lower rates of suicides compared to white Americans.  However, beginning in the 1980s, the rates for African American male youth began to rise at a much faster rate than their white counterparts.  The most recent trends suggest a decrease in suicide across all gender and racial groups, but health policy experts remain concerned about the increase in suicide by firearms for all young males.  Whether African American male youth are more likely to engage in “victim-precipitated homicide” by deliberately getting in the line of fire of either gang or law enforcement activity, remains an important research question, as such deaths are not typically classified as suicides.

Is suicide related to impulsiveness?

Impulsiveness is the tendency to act without thinking through a plan or its consequences.  It is a symptom of a number of mental disorders, and therefore, it is associated with suicidal behavior usually through its association with mental disorders and/or substance abuse.  The mental disorders with impulsiveness most linked to suicide include borderline personality disorder among young females, conduct disorder among young males and antisocial behavior in adult males, and alcohol and substance abuse among young and middle-aged males.  Impulsiveness appears to have a lesser role in older adult suicides.  Attention deficit hyperactivity disorder that has impulsiveness as a characteristic is not a strong risk factor for suicide by itself.  Impulsiveness has been linked with aggressive and violent behaviors including homicide and suicide.  However, impulsiveness without aggression or violence present has also been found to contribute to risk for suicide.

Is there such a thing as “rational” suicide?

Some right-to-die advocacy groups promote the idea that suicide, including assisted suicide, can be a rational decision.  Others have argued that suicide is never a rational decision and that it is the result of depression, anxiety and fear of being dependent or a burden. Surveys of terminally ill persons indicate that very few consider taking their own life, and when they do, it is in the context of depression.  Attitude surveys suggest that assisted suicide is more acceptable by the public and health providers for the old and sick, compared to the young who are ill or disabled. At this time, there is limited research on the frequency with which persons with terminal illness have depression and suicidal ideation, whether they would consider assisted suicide, the characteristics of such persons, and the context of their depression and suicidal thoughts, such as family stress, or availability of palliative care.   Neither is it yet clear what effect other factors such as the availability of social support, access to care, and pain relief may have on end-of-life preferences.  This public debate will be better informed after such research is conducted.

What biological factors increase risk for suicide?

Researchers believe that both depression and suicidal behavior can be linked to decreased serotonin in the brain.  Low levels of a serotonin metabolite, 5-HIAA, have been detected in cerebral spinal fluid in persons who have attempted suicide, as well as by postmortem studies examining certain brain regions of suicide victims.  One of the goals of understanding the biology of suicidal behavior is to improve treatments.  Scientists have learned that serotonin receptors in the brain increase their activity in persons with major depression and suicidality, which explains why medications that desensitize or down-regulate these receptors (such as the serotonin reuptake inhibitors, or SSRIs) have been found effective in treating depression.  Currently, studies are underway to examine to what extent medications like SSRIs can reduce suicidal behavior.

Can the risk for suicide be inherited?

There is growing evidence that familial and genetic factors contribute to the risk for suicidal behavior.  Major psychiatric illnesses, including bipolar disorder, major depression, schizophrenia, alcoholism and substance abuse, and certain personality disorders, which run in families, increase the risk for suicidal behavior.  This does not mean that suicidal behavior is inevitable for individuals with this family history; it simply means that such persons may be more vulnerable and should take steps to reduce their risk, such as getting evaluation and treatment at the first sign of mental illness. 

Does alcohol and other drug abuse increase the risk for suicide?

A number of recent national surveys have helped shed light on the relationship between alcohol and other drug use and suicidal behavior.  A review of minum-age drinking laws and suicides among youths age 18 to 20 found that lower minimum-age drinking laws was associated with higher youth suicide rates.  In a large study following adults who drink alcohol, suicide ideation was reported among persons with depression.  In another survey, persons who reported that they had made a suicide attempt during their lifetime were more likely to have had a depressive disorder, and many also had an alcohol and/or substance abuse disorder.  In a study of all nontraffic injury deaths associated with alcohol intoxication, over 20 percent were suicides.

In studies that examine risk factors among people who have completed suicide, substance use and abuse occurs more frequently among youth and adults, compared to older persons.  For particular groups at risk, such as American Indians and Alaskan Natives, depression and alcohol use and abuse are the most common risk factors for completed suicide.   Alcohol and substance abuse problems contribute to suicidal behavior in several ways.  Persons who are dependent on substances often have a number of other risk factors for suicide.  In addition to being depressed, they are also likely to have social and financial problems.  Substance use and abuse can be common among persons prone to be impulsive, and among persons who engage in many types of high risk behaviors that result in self-harm.  Fortunately, there are a number of effective prevention efforts that reduce risk for substance abuse in youth, and there are effective treatments for alcohol and substance use problems.  Researchers are currently testing treatments specifically for persons with substance abuse problems who are also suicidal, or have attempted suicide in the past.

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