Suicide attempt

A suicide attempt is an act in which an individual tries to kill themselves but survives.^[1][2] Mental health professionals discourage describing suicide attempts as "failed" or "unsuccessful", as doing so may imply that a suicide resulting in death is a successful or desirable outcome.^[3][4][5][6]

Epidemiology

In the United States, the National Institute of Mental Health reports there are 11 nonfatal suicide attempts for every suicide death.^[7] The American Association of Suicidology reports higher numbers, stating that there are 25 suicide attempts for every suicide completion.^[8] The ratio of suicide attempts to suicide death is about 25:1 in youths, compared to about 4:1 in elderly.^[9] A 2008 review found that nonfatal self-injury is more common in women,^[10] and a separate study from 2008/2009 found suicidal thoughts higher among females, as well as significant differences between genders for suicide planning and suicide attempts.^[11]

Suicide attempts are more common among adolescents in developing countries than developed ones. A 12-month prevalence of suicide attempt in developing countries between 2003 and 2015 was reported as 17%.^[12]

Parasuicide and self-injury

Main article: Suicide terminology

Without commonly agreed-upon operational definitions, some suicidology researchers regard many suicide attempts as parasuicide (para- meaning near)^[13] 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.^[14]

Repetition

A nonfatal suicide attempt is the strongest known clinical predictor of eventual suicide.^[15] Suicide risk among self-harm patients is hundreds of times higher than in the general population.^[16] However, it is estimated that only about 10–15% of suicide attempt survivors eventually die by suicide.^[17] The mortality risk is highest during the first months and years after the attempt: almost 1% of individuals who attempt suicide will die by suicide if the attempt is repeated within one year.^[18] Recent meta-analytic evidence suggests that the association between suicide attempt and suicidal death may not be as strong as it was thought before.^[19]

Outcomes

Suicide attempts can result in serious and permanent injuries and/or disabilities. At least 700,000 Americans survive a suicide attempt each year. People who attempt either hanging or 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 height 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.^[20]

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.^[21] While previously criminally punishable, attempted suicide is no longer illegal in most Western countries. It remains a criminal offense in most Islamic countries.^[22] In the late 19th century in Great Britain, attempted suicide was deemed to be equivalent to attempted murder and could be punished by hanging.^[23] In the United States, suicide is not illegal and almost no country in Europe currently considers attempted suicide to be a crime.^[21]

In India, attempted suicide was decriminalized by the Mental Healthcare Act, 2017,^[24][25] while Singapore removed attempted suicide from their criminal code in 2020;^[26] previously it had been punishable by up to one-year in prison.^[27]

Many other countries still prosecute suicide attempts.^[28] As of 2012, attempted suicide is a criminal offense in Uganda,^[29] and as of 2013, it is criminalized in Ghana.^[30]

Despite having its own laws, Maryland still reserves the right to prosecute people under the English Common laws that were in place when America declared independence in 1776. These laws were used to convict a man for attempted suicide in 2018, resulting in a three-year suspended sentence and two years of supervised probation.^[31][32][33]

See also

• International Survivors of Suicide Loss Day
• Mental health first aid
• Suicidal ideation
• Suicide crisis
• World Suicide Prevention Day

References

1. Danuta Wasserman (2016). Suicide: An unnecessary death. Oxford University Press. p. 63. ISBN 978-0-19-102684-3. Retrieved September 27, 2017.
2. "Facts About Suicide". 7 September 2021.
3. Rory C. O'Connor; Jane Pirkis (2016). The International Handbook of Suicide Prevention. John Wiley & Sons. pp. 13–14. ISBN 978-1-118-90323-0. Retrieved September 27, 2017.
4. Sommer-Rotenberg, D (1998). "Suicide and language". Canadian Medical Association Journal. 159 (3): 239–240. PMC 1229556. PMID 9724978.
5. Beaton, Susan (2013). "Suicide and language: Why we shouldn't use the 'C' word". Australian Psychological Society. Archived from the original on 1 May 2021.
6. Silverman, M. M. (2006). "The language of suicidology". Suicide and Life-Threatening Behavior. 36 (5): 519–532. doi:10.1521/suli.2006.36.5.519. PMID 17087631.
7. 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
8. 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.
9. "Suicide Statistics — AFSP". American Foundation for Suicide Prevention. Archived from the original on 2 September 2016. Retrieved 3 September 2016.
10. 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.
11. 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". MMWR. Surveillance Summaries. 60 (13): 1–22. PMID 22012169.
12. 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" (PDF). The Lancet Child & Adolescent Health. 3 (4): 223–233. doi:10.1016/S2352-4642(18)30403-6. hdl:10072/387579. PMID 30878117. S2CID 81982117.
13. "para- - Wiktionary". Wiktionary. Retrieved August 18, 2020.
14. Schwartz, Allan N. (Apr 12, 2007), Guns and Suicide
15. Harris EC, Barraclough B: Suicide as an outcome for mental disorders: a meta-analysis. Br J Psychiatry 1997; 170:205–228
16. Owens D, Horrocks J, House A: Fatal and non-fatal repetition of self-harm: systematic review. Br J Psychiatry 2002; 181:193–199
17. Suominen et al. (2004). Completed Suicide After a Suicide Attempt: A 37-Year Follow-Up Study. Am J Psychiatry, 161, 563–564.
18. Hawton K, Catalan J. Attempted suicide: a practical guide to its nature and management, 2nd ed. Oxford, Oxford University Press, 1987.
19. 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.
20. Stone, Geo (September 1, 2001). Suicide and Attempted Suicide. Da Capo Press. ISBN 978-0-7867-0940-3.
21. McLaughlin, Columba (2007). Suicide-related behaviour understanding, caring and therapeutic responses. Chichester, England: John Wiley & Sons. p. 24. ISBN 978-0-470-51241-8.
22. Aggarwal, N (2009). "Rethinking suicide bombing". Crisis. 30 (2): 94–7. doi:10.1027/0227-5910.30.2.94. PMID 19525169.
23. "When suicide was illegal". BBC News. 2011-08-03. Retrieved 2021-12-08.
24. Jain, Bharti (11 December 2014). "Government decriminalizes attempt to commit suicide, removes section 309". The Times of India. Archived from the original on 8 January 2021.
25. "Govt decides to repeal Section 309 from IPC; attempt to suicide no longer a crime". 2014-12-10.
26. Ng, Charmaine (27 December 2019). "Watch that cigarette butt and BBQ embers - firestarters to feel more heat from the law from Jan 1". The Straits Times. Retrieved 31 December 2019.
27. Singapore Penal Code(Cap 224, Rev Ed 2008), s 309
28. 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. S2CID 205283662.
29. 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. S2CID 7820312.
30. 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.
31. Andrews, Abby (March 1, 2018). "Rare attempted suicide charge goes through Caroline court". Kent County News. Archived from the original on December 2, 2020.
32. Dufour, Christine B. (March 7, 2018). "Attempted suicide likely not a crime". The Star Democrat. Archived from the original on August 24, 2021. Retrieved August 24, 2021.
33. Fenton, Justine (February 23, 2018). "Attempting suicide is not a crime under Maryland law. But an Eastern Shore man was convicted of it". The Baltimore Sun. Archived from the original on June 24, 2021.