Report on the Epidemiology of Suicide: Causes, Risks, and Trends

This report provides a comprehensive overview of the epidemiology of suicide, examining its global prevalence and specific trends within Australia. It defines key terms such as suicidal ideation, suicidal plans, and self-harm, and presents statistical data on suicide rates, including the number of deaths and demographic breakdowns. The report explores significant risk factors associated with suicide, including mental disorders (such as depression, bipolar disorder, and personality disorders), substance misuse, previous suicide attempts, and psychosocial factors like hopelessness and poor coping skills. Additionally, the report highlights the impact of media portrayals and the importance of suicide prevention strategies. It emphasizes the devastating effects of suicide on families and communities, the stigma surrounding suicide, and the need for collective efforts to reduce suicide risk through mental health interventions and improved support systems. The report aims to inform readers about the complexities of suicide and the importance of addressing this critical public health concern.

Running head: ASSIGNMENT
Epidemiology of Suicide
Name of the Student
Name of the University
Author Note

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Introduction and statement of objectives
Suicide refers to the act that involves causing intentional harm to one that results in
death. Several mental disorders such as, bipolar disorder, schizophrenia, depression, personality
disorder, substance abuse, and anxiety disorder have been identified as major risk factors for
suicides (Douglas, 2015). Some suicides are considered as impulsive act that occur due to stress,
relationship difficulties, or financial problem. People who have previously attempted such
suicidal acts are generally considered to be at increased risk for future suicidal attempts.
Effective suicide prevention approaches generally comprise of restricting the access of the
people to different methods of committing suicide such as, knife, poison and firearms, in
addition to treatment of substance misuse and mental disorders, and improvement of economic
conditions (Turecki& Brent, 2016). The most commonly implemented method of suicide
generally differs between different nations and is associated to availability of the means. Non-
fatal suicidal behaviour or attempted suicide refers to self-injury, which in turn is concomitant
with some desire for ending the life of a person that eventually does not result in death.
This is in contrast to assisted suicide that generally occurs when a person provides help to
another individual to bring about imminent death in an indirect method, by providing the means
to end their life or suggesting advice. This is in clear contrast to the concept of euthanasia, where
another individual adorns an active role in bringing about death of a person. Suicidal ideations
typically encompass considering or thinking about, or planning suicide and the range of suicidal
thoughts generally vary from extensive to fleeting thoughts and detailed planning (Klonsky, May
& Saffer, 2016).

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The objective of this paper is to elaborate on the epidemiology of suicide on a global scale,
particularly in reference to the Australian population. Another objective is to conduct a
comprehensive literature review in order to determine the causes, pathophysiology, and
techniques for suicide.
Significance
Although suicide is a problematic topic to discuss, it is of major significance since the
prevention methods require improvement, and it has been identified as a major concern in the
broad field of psychiatric medicine for several decades. The impact of suicide by a person is
generally devastating, and the effect on the loved ones and family members of the person who
has committed the act is far reaching and severe (Kõlves, Ross, Hawgood, Spence & De Leo,
2017). People who are left behind by suicide are generally known as suicide survivors, and while
their circumstances extremely difficult, they are likely to move forward and heal. Significance of
the problem can also be associated with the fact that learning about the death of a loved one due
to suicide is an absolutely traumatic event, and gives rise to additional feelings of extreme guilt,
for not being able to prevent the incident. Moreover, it also results in anger or resentment at the
individual who opted to end his or her life (Lee, Kim, Kim & Enright, 2017). Also, suicide
makes the family members identify their failure in not providing the necessary support and love
to the deceased person, thereby resulting in distress over and unresolved issues. The prominence
of the event can also be accredited to the fact that parents, who have lost their child to suicide,
generally demonstrate an increase rate of depression, low income, and physical problems
(Foggin et al., 2016). In addition depression and anxiety among the parents are extremely
common signs after suicide of their child.

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Other research studies also demonstrated that children of parents, who have died due to
suicide, attain increased likelihood of committing suicide themselves (Soole, Kolves & De Leo,
2015). At the time of death of a person, the society and the community typically offer
compassion and empathy. However, when an individual dies due to suicide, there is an
associated stereotype and stigma around that particular person and the society often treats the
family members of the deceased person differently. The existing stigma also prevents the loved
ones to talk about suicide for fear of contamination and judgment, or being blamed due to death
of dear friend or family member, thereby resulting in extreme isolation (Batterham, Han, Calear,
Anderson & Christensen, 2019). Furthermore, more individuals who might not have personally
known the deceased person can also be impacted due to the incident, such as, law enforcement,
emergency and medical personnel, and the clergy who respond and/or provide assistance to the
community and family members either during the death or afterwards. When an individual dies
due to suicide, the aftermath opens an immediate opportunity to discuss about the event, as a
matter of public health concern. This creates an impact on all people. This calls for the need of
suicide prevention that comprises of collective efforts for reducing the risk of suicide, and
extends beyond direct interventions such as, treatment of mental illness, improvement of coping
skills, reduction of risk factors, and providing hope to the survivors and family members to lead
a meaningful and purposeful life after the incident (Husky et al., 2017). Significance of the issue
can also be associated to the fact that conducting risks assessment such as, screening helps in the
detection of warning signs, which in turn provides the comprehensive overview of the underlying
condition that might make an individual resort to such an activity.

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Definition
 Suicidal ideation- Self-reported thoughts of participating in any suicide associated
behaviour.
 Suicidal ideation- Having deliberate self-killing or suicide as ones objective
 Suicidal threat- Any interpersonal, verbal, or non-verbal action without a direct self-
ensuring element that a reasonable individual would comprehend as suggesting or
communicating about the occurrence of suicidal behaviour in near future (Douglas,
2015).
 Suicidal plan- Proposed approach of executing a design that will result in potentially self-
injurious health consequence.
 Self-harm- Potentially injurious and self-inflicted behaviour for which there exists
evidence that the individual did not want to kill her or himself (Turecki & Brent, 2016).
Population of focus and statistical population-
According to the World Health Organisation (2018) an estimated 800,000 individuals die
every year due to suicide, of which one individual dies in every 40 seconds. Suicide has been
identified as a global phenomenon and can occur throughout the lifespan of an individual. It has
been identified as second leading reason of death on a global basis among 15-29 year old people.
Moreover, 79% suicides occurred in middle and low income countries in the year 2016. It also
accounted for roughly 1.4 % of all global deaths in the same year, thereby making it the 8th
major reason of death. The population of interest is Australia and in 2016 suicide rate was found
to be 5.7 deaths per 100,000 individuals, which decreased from 6.6 deaths per 100,000
individuals in the year 2007. Suicide resulted in death of 2,866 individuals in Australia in 2016
and the standardized death rate for females was 5.8 deaths, in comparison to 17.8 deaths for

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males per 100,000 people. Reports from the year 2015 suggest that 3,027 people died due to
suicide in that year that accounted for not less than eight deaths due to suicide each day in the
nation. Suicide among people belonging to the Aboriginal and Torres Strait Islander population
is more than twice that of the national rate, and it accounted for 5.2% of death among the
indigenous people, in comparison to 1.8% among their non-indigenous counterparts, in the year
2015 (Lifeline Organisation, 2019).
According to the Australian Bureau of Statistics (2017) preliminary data obtained in the
year 2018 suggested that there were 3,046 deaths that occurred due to suicide, of which 726
deaths were among females and 2,320 deaths were among males, which accounted for 5.8 and
18.7 people per 100,000. In contrast, 780 female deaths occurred due to suicide at a rate of 6.3
per 100,000 people, among females in 2017 (Mindframe, 2018). Showing consistency with data
over the past decade, the number of suicide associated deaths was found to be roughly thrice
among males, when compared to their female counterparts. In addition, all territories and states
in Australia also demonstrated a reduction in the number of suicide related death, apart from
New South Wales, where the number increased from 880 in the year 2017 to 899 deaths in 2018.
The lowest suicide rate was found in Australian Capital Territory and Northern Territory, where
there were only 47 suicide related deaths in 2018 (Mindframe, 2019). In the same year, a
decrease was also observed in suicide death, when compared to 3,128 deaths in 2017.
Literature
Risk factors of suicide
Factors that increase the risk of suicide among individuals include drug misuse, mental
disorders, and psychological state, social, cultural, and family situation, previous experiences of

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loss or trauma, and genetics. According to researchers, mental disorders are prevalent at the time
of suicide in most of the deceased individuals, and often people who are generally hospitalized
for suicidal behaviour demonstrate a high lifetime risk for completed suicide (Hjelmeland &
Knizek, 2017). Researchers also argue that non-suicidal people when hospitalized for the
treatment of affective disorder demonstrate more suicide risks, and half of all the individuals
who died due to suicide suffer from major depressive disorder, which is more common in
comparison to other conditions such as bipolar disorder or schizophrenia (Hoertel et al.,
2015). Research evidences elaborate on the fact that people who are diagnosed with borderline
personality disorder also suffer from suicidal ideations, and that eating disorder has also been
associated with an increased risk of suicide (Linehan et al., 2015; Smith et al., 2016). In addition,
it has also been found that consumption of prescribed antidepressants that belong to the category
of selective serotonin reuptake inhibitor also increase the frequency of death due to suicide
among children (Cheung t al., 2015). However such risks have not been observed in their adult
counterparts. Apart from mental disorders, previous history of failed suicide attempts have also
been identified as predictors of accomplished suicides, and some individuals who self-harm also
end their life by suicide, thereby confirming the fact that there exists and overlap between the
risk of suicide and self harm.
According to Rimes et al. (2018) there are ranges of psychosocial factors that make
people more vulnerable to suicide such as, loss of pleasure in life, hopelessness, anxiousness,
depression, anxiety, rumination, poor coping skills, and thought suppression. It is generally
postulated that poor proficiency in solving life problems, loss of the expertise and capabilities
that were once present, and non-existence of impulse control also play an important role in
increasing suicide. According to researchers particular personality factors that is increased level

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of introvertedness and neurotoxicity have also been associated with suicide awareness, and this
often makes the people who are sensitive and isolated become distressed, thus making them
more likely to commit suicide (Christodoulouet al., 2017). Researches also suggested substance
misuse is one of the most common risks for attempting suicide after mental disorder, and when
associated with personal loss like death of a loved one or bereavement, there risk increases
manifold (Backman, Stockeld, Rasmussen, Näslund & Marsk, 2016). Individuals who are under
the influence of particular sedative hypnotic drugs such as, benzodiazepine and alcohol try to
commit suicide, which in turn can be credited to the neurological effects of the drugs that lead to
psychiatric disturbances. There also exists high correlation of suicide with misuse of
methamphetamine and cocaine with greater risk during the withdrawal period (Darke, Kaye,
Duflou & Lappin, 2019).
Increased risk of suicide can also be accredited to the media, particularly television and
internet where particular definitions of suicide such as, repetitive coverage, romanticizing or
glorifying suicide increase the prevalence. Media portrayals often comprise of detailed
description of the steps that are most effective in killing one, thereby creating a negative impact
on the emotional wellbeing of the person who are vulnerable, thus influencing them to commit
suicide (Mueller, 2017). Several researchers have focused on the concept of copycat suicide that
is usually defined as an imitation of suicide that a person who is attempting the act knows about,
either by acquiring local knowledge or from the depiction or accounts of original suicide that is
telecast in media (Choi & Oh, 2016). This risk factor gained attention in recent years after the
widely publicised Werther effect. Genetics also plays an important role in increasing suicide risk,
with presence of family history of suicide particularly in the mother creating an impact on
children and adolescents (Roy, 2015). Findings from adoption studies have also suggested that

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history of suicide in biological relatives, increase the risk of the same in the existing family
members, and this is particularly explained by the role that it plays on improving inclusive
fitness (Turecki & Brent, 2016). This in turn can be accredited to the fact that inclusive fitness
occurs when an individual dying by suicide fails to have any more children or takes away
necessary resources from relatives and acquaintances by staying alive (Queller, 2016).
Pathophysiology
Although there is no comprehensive pathophysiology for suicide, researchers have often
postulated that the event occurs as a result of an interaction between socio-environmental,
psychiatric, and behavioural factors. Decreased levels of the brain-derived neurotrophic factor
(BDNF) has often been associated with suicide, owing to the role that it creates on mental
disorders such as, post traumatic stress disorder, major depressive disorder, obsessive
compulsive disorder, and schizophrenia (Youssef et al., 2018). Research studies have also
elaborated that the amount of BDNF is low in the prefrontal cortex and hippocampus of several
people who have been diagnosed with psychiatry condition (Eisen et al., 2016). In addition, the
amount of the neurotransmitter serotonin is also postulated to be low among individuals who die
by suicide, which in turn can be accredited to an increase in the amount of 5-HT2A receptors in
the brain (Mann et al., 2019).
Methods of suicide
Evidence suggests that suicide by cutting generally involves infarction, septic shock, and
exsanguination from particular rupture such as, appendicitis. In addition, exsanguination has
also been postulated to be the consequence of damage that is inflicted on the arteries and results
in decrease in the pressure and volume of the blood below the critical levels, by promoting
massive loss of blood from the body (Živković, Cvetković & Nikolić, 2019). According to

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researchers wrist cutting is another common practice of suicide that results in copious breathing,
which if unchecked leads to cardiac arrhythmia, circulatory collapse, and severe hypovolemia,
thus leading to death of the person (Carroll et al., 2016).
Although death due to dehydration takes several days of the week, this method is also
practiced by several individuals, and has been associated with less pain and suffering, in
comparison to physician assisted suicide (Lachman, 2015). According to Humphreys, Gasparrini
and Wiebe (2017) usage of a firearm is another method where the bullet generally gets in point
blank range, under the chin or inside the mouth, thus highlighting the wide availability of
firearms in different culture. This self-inflicted gunshot typically results in chronic pain for the
victim, and also reduces motor function and cognitive abilities, besides triggering the onset of
subdural hematoma, cerebrospinal fluid leakage and pneumocephalus. There exists a positive
correlation between increased suicidal risks and availability of firearms, particularly in the
United States and other developed countries (Curtin, Warner & Hedegaard, 2016). Evidences
also suggest that suicide by hanging is another common method, and has been in practice since
time immemorial. Hanging by using a cord or a rope, in order to develop a noose around the
throat often makes the victim strangle and leads to a broken neck, thus causing acute respiratory
acidosis, convulsions, shock, narrowing of vision, and hypoxia (Arya et al., 2019). This
eventually leads to death of the individual due to shortage of oxygen.
Recommendations
One effective way to assess the risk for suicide in an individual is by initiating direct talk
with the person that will help in discussing about depression and assessing suicidal plans, as to
when and how it can be implemented. Demonstration of empathy and compassion towards the
vulnerable indivisible is essential, prior to holding such discussion, in order to provide the

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assurance that his/her concerns are being addressed (Betz et al., 2019). These discussions must
be gradual and particularly executed, when the individual feels comfortable about talking about
personal feelings. The ICARE approach must be followed which generally comprises of
identification of the thought, connecting with the thoughts, assessing evidence, restructuring
thoughts of the person in a positive direction, and providing room for expression of feelings
(Reiff et al., 2019). Identification of warning signs is another key strategy that can be adopted to
reduce suicide risk.
Typical warning signs comprise of feelings of purposelessness, agitation, anxiety,
impulsiveness and recklessness, social withdrawal, and mood changes that is depression, settling
of outstanding affair, and increased consumption of alcohol or drugs (Tucker, Crowley,
Davidson & Gutierrez, 2015). Furthermore, self reported questionnaires must also be used in
order to identify people who are at risk of suicide. Common questionnaires that can be used for
the purpose are namely, ‘Is Path Warm?’ and the Beck Hopelessness Scale (BHS). Obtaining
responses for these questionnaires will facilitate identification of different aspects of
hopelessness, and will provide an overview about the extent of pessimism and/or negative
attitude in the individual (McGlothlin, Page & Jager, 2016; Troister, D'Agata & Holden, 2015).
In addition, providing confidential service in the form of a suicide helpline to all people of the
community will also prove beneficial.
Trained counsellors must be present who will provide suicide prevention services and
crisis intervention to all people who have suicidal ideations (Mokkenstorm et al., 2017). In
addition, restricting unauthorised access to particular methods of suicide such as, toxins like
pesticides and opioid, firearms, knifes, and rope will help in reducing the prevalence rate.
Implementation of school and university based programs that focus on cognitive behavioural

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therapy will also help in increasing mental health literacy, and will thereby create a positive
impact on suicidal rate reduction.
Conclusion
Thus, it n be concluded that suicide is amid one of the leading causes of death all across
the globe and every year millions of people die from suicide. The impacts of suicide extend
beyond the individual who acts to end his or her own life, and creates lasting impact on friends,
family, and community members. The event occurs when individuals inflict violent behaviour
upon them, with the primary intention of ending their lives and die due to their actions. It often
leads to failed suicide attempt when individuals harm themselves for ending their life, however
do not die. People of all age, gender, and ethnicity are at a risk of committing suicide. However,
those who have been diagnosed with mental disorder, are addicted to drugs and alcohol, have a
family history of suicide, or have suffered trauma in their childhood demonstrate an increase
likelihood of being affected with the condition. Results from the government data suggest that
men are more likely to die due to suicide, when compared to women. Some of the common
methods that are used for committing suicide are dehydration, firearm, poison, substance abuse
and hanging. The findings also suggested that individuals who attempt suicide often react to
particular events and make decisions differently, when compared to those who are not subjected
to such instances. Therefore, it is essential to keep the risk factors in mind in order to
immediately identify a person who is vulnerable to such situation.

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019-00151-0

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Appendix
Figure 1- search of SCOPUS database
Figure 2- search of SCOPUS database

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Figure 3- search of SCOPUS database