Suicide attempt

A suicide attempt is an attempt where a person tries to die by suicide but survives.[1] It may be referred to as a failed suicide attempt or nonfatal suicide attempt, but the latter terms are subject to debate among researchers.[2] Suicide attempts include parasuicide such as self-harm where there is no actual intention of killing oneself.

Not to be confused with suicide survivor.

Epidemiology

In the U.S., the NIMH reports there are 11 nonfatal suicide attempts for every suicide death.[3] The American Association of Suicidology reports higher numbers, stating that there are 25 suicide attempts for every suicide completion.[4] By these numbers, approximately 92–95% of suicide attempts end in survival.

In the United States, ratio of suicide attempts to suicide death is about 25:1 in youths, compared to about 4:1 in elderly.[5] Compared to adolescents in developed countries, suicide attempt is more common among adolescents in developing countries where the 12-month prevalence of suicide attempt was reported as 17%.[6]

A 2008 review found that nonfatal self-injury is more common in women.[7] A study in the United States of the 2008/2009 time period found suicidal thoughts higher among females, as well as significant differences between genders for suicide planning and suicide attempts.[8]

Parasuicide and self-injury

Main article: Suicide terminology

Without commonly agreed-upon operational definitions, some suicidology researchers regard many suicide attempts as parasuicide or self harm behavior, rather than "true" suicide attempts, as in lacking suicidal intent.

Methods

Some suicide methods have higher rates of lethality than others. The use of firearms results in death 90% of the time. Wrist-slashing has a much lower lethality rate, comparatively. 75% of all suicide attempts are by drug overdose, a method that is often thwarted because the drug is nonlethal, or is used at a nonlethal dosage. These people survive 97% of the time.[9]

Repetition

A nonfatal suicide attempt is the strongest known clinical predictor of eventual suicide.[10] Suicide risk among self-harm patients is hundreds of times higher than in the general population.[11] It is often estimated that about 10–15% of attempters eventually die by suicide.[12] The mortality risk is highest during the first months and years after the attempt: almost 1% of individuals who attempt suicide are successful in ending their lives if the attempt is repeated within one year.[13] Recent meta-analytic evidence suggests that the association between suicide attempt and suicidal death may not be as strong as it was thought before.[14]

Outcomes

Suicide attempts can result in serious and permanent injuries and/or disabilities. 700,000 (or more) Americans survive a suicide attempt each year. People who attempt either hanging or charcoal grill carbon monoxide poisoning and survive can face permanent brain damage due to cerebral anoxia. People who take a drug overdose and survive can face severe organ damage (e.g., liver failure). Individuals who jump from a bridge and survive may face irreversible damage to multiple organs, as well as the spine and brain.

While a majority sustain injuries that allow them to be released following emergency room treatment, a significant minority—about 116,000—are hospitalized, of whom 110,000 are eventually discharged alive. Their average hospital stay is 79 days. Some 89,000, 17% of these people, are permanently disabled, restricted in their ability to work.[15]

Suicide attempts are also present in some subcultures. In recent times for example in the emo subculture. The qualitative research has shown emo respondents reported “attitudes including high acceptance for suicidal behavior and self-injury”. And concluded: “The identification with the emo youth subculture is considered to be a factor strengthening vulnerability towards risky behaviors.”[16]

Criminalization of attempted suicide

Main article: Suicide legislation

Historically in the Christian church, people who attempted suicide were excommunicated because of the religiously polarizing nature of the topic.[17] While previously criminally punishable, attempted suicide no longer is in most Western countries. It remains a criminal offense in most Islamic countries.[18] In the late 19th century in Great Britain, attempted suicide was deemed to be equivalent to attempted murder and could be punished by hanging. In the United States, suicide is not illegal and almost no country in Europe currently considers attempted suicide to be a crime.[17] In some cases of completed suicide, the person's property can be seized by the government and bills for treatment of the corpse can be sent to the person's survivors or living family members.

In Singapore, a person who attempts to commit suicide can be imprisoned for up to one year.[19]

In India, attempted suicide was an offense punishable under the following Section 309 of the Indian Penal Code until December 2014, when it was repealed:[20][21]

Attempt to commit suicide.—Whoever attempts to commit suicide and does any act towards the commission of such offence, shall be punished with simple imprisonment for a term which may extend to one year or with fine, or with both.[22]

In Japan it is illegal to attempt suicide but not punishable. In Cyprus, the only European country where it is illegal, attempted suicide constitutes a misdemeanour.

As of 2012, attempted suicide is a criminal offense in Uganda.[23]

As of 2013, attempted suicide is criminalized in Ghana.[24]

Many other countries still prosecute suicide (whether completed or not).[25]

In Maryland, it is an open question as to whether suicide is illegal. In 2018, a Maryland man was convicted of attempted suicide.[26][27][28]

See also

• National Survivors of Suicide Day
• World Suicide Prevention Day

References

1. Danuta Wasserman (2016). Suicide: An unnecessary death. Oxford University Press. p. 63. ISBN 978-0191026843. Retrieved September 27, 2017.
2. Rory C. O'Connor, Jane Pirkis (2016). The International Handbook of Suicide Prevention. John Wiley & Sons. pp. 13–14. ISBN 978-1118903230. Retrieved September 27, 2017.CS1 maint: uses authors parameter (link)
3. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS): https://www.cdc.gov/ncipc/wisqars
4. USA suicide 2006 Official final data: JL McIntosh for the American Association of Suicidology 2009. Many figures there taken from Reducing suicide: a national imperative, Goldsmith SK, Pellmar TC, Kleinman AM, Bunney WE, editors.
5. "Suicide Statistics — AFSP". American Foundation for Suicide Prevention. Retrieved 3 September 2016.
6. Uddin, R; Burton, NW; Maple, M; Khan, SR; Khan, A (2019). "Suicidal ideation, suicide planning, and suicide attempts among adolescents in 59 low-income and middle-income countries: a population-based study". The Lancet Child & Adolescent Health. 3 (4): 223–233. doi:10.1016/S2352-4642(18)30403-6. hdl:10072/387579. PMID 30878117.
7. Nock, M. K.; Borges, G.; Bromet, E. J.; Cha, C. B.; Kessler, R. C.; Lee, S. (14 May 2008). "Suicide and Suicidal Behavior". Epidemiologic Reviews. 30 (1): 133–154. doi:10.1093/epirev/mxn002. PMC 2576496. PMID 18653727.
8. Crosby, AE; Han, B; Ortega, LA; Parks, SE; Gfroerer, J; Centers for Disease Control and Prevention, (CDC). (21 October 2011). "Suicidal thoughts and behaviors among adults aged ≥18 years--United States, 2008-2009". Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C. : 2002). 60 (13): 1–22. PMID 22012169.
9. Schwartz, Allan N. (Apr 12, 2007), Guns and Suicide
10. Harris EC, Barraclough B: Suicide as an outcome for mental disorders: a meta-analysis. Br J Psychiatry 1997; 170:205–228
11. Owens D, Horrocks J, House A: Fatal and non-fatal repetition of self-harm: systematic review. Br J Psychiatry 2002; 181:193–199
12. Suominen et al. (2004). Completed Suicide After a Suicide Attempt: A 37-Year Follow-Up Study. Am J Psychiatry, 161, 563–564.
13. Hawton K, Catalan J. Attempted suicide: a practical guide to its nature and management, 2nd ed. Oxford, Oxford University Press, 1987.
14. Ribeiro, JD; Franklin, JC; Fox, KR; Bentley, KH; Kleiman, EM; Chang, BP; Nock, MK (2016). "Self-injurious thoughts and behaviors as risk factors for future suicide ideation, attempts, and death: a meta-analysis of longitudinal studies". Psychological Medicine. 46 (2): 225–236. doi:10.1017/S0033291715001804. PMC 4774896. PMID 26370729.
15. Stone, Geo (September 1, 2001). Suicide and Attempted Suicide. Da Capo Press. ISBN 978-0-7867-0940-3.
16. Trnka, Radek; Kuška, Martin; Balcar, Karel; Tavel, Peter (2018-07-03). "Understanding death, suicide and self-injury among adherents of the emo youth subculture: A qualitative study". Death Studies. 42 (6): 337–345. doi:10.1080/07481187.2017.1340066. ISSN 0748-1187. PMID 28590823.
17. McLaughlin, Columba (2007). Suicide-related behaviour understanding, caring and therapeutic responses. Chichester, England: John Wiley & Sons. p. 24. ISBN 978-0-470-51241-8.
18. Aggarwal, N (2009). "Rethinking suicide bombing". Crisis. 30 (2): 94–7. doi:10.1027/0227-5910.30.2.94. PMID 19525169.
19. Singapore Penal Code(Cap 224, Rev Ed 2008), s 309
20. "Government decriminalizes attempt to commit suicide, removes section 309 - Times of India ►".
21. "Govt decides to repeal Section 309 from IPC; attempt to suicide no longer a crime". 2014-12-10.
22. http://lawcommissionofindia.nic.in/reports/report210.pdf
23. Hjelmeland, Heidi; Kinyanda, Eugene; Knizek, Birthe Loa (2012). "Mental health workers' views on the criminalization of suicidal behaviour in Uganda". Medicine, Science and the Law. 52 (3): 148–151. doi:10.1258/msl.2012.011107. PMID 22528562.
24. Hjelmeland, H; Osafo, J; Akotia, C. S.; Knizek, B. L. (2014). "The law criminalizing attempted suicide in Ghana: The views of clinical psychologists, emergency ward nurses, and police officers". Crisis: The Journal of Crisis Intervention and Suicide Prevention. 35 (2): 132–36. doi:10.1027/0227-5910/a000235. PMID 24197485.
25. Mishara, BL; Weisstub, DN (2016). "The legal status of suicide: a global review". International Journal of Law and Psychiatry. 44: 54–74. doi:10.1016/j.ijlp.2015.08.032. PMID 26375452.
26. "Attempting suicide is not a crime under Maryland law. But an Eastern Shore man was convicted of it".
27. "Rare attempted suicide charge goes through Caroline court".
28. "Attempted suicide likely not a crime".