Mental Health Issues Self-Harming / Suicide Social Support

Suicide: Statistics, Characteristics and Myths

June 14, 2012
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Psychoanalyst Sigmund Freud called suicide “murder turned around 180 degrees”, or more wryly, “a very poor response to a very bad day”. Also called “self-murder” or “self-killing”, suicide is the act of deliberately or intentionally taking one’s own life. It is an attempt to solve a problem of intense emotional pain with impaired problem-solving skills (Kalafat, J. & Underwood, M., n.d.).

Suicidal behaviour is any deliberate action that has potentially life-threatening consequences, such as taking a drug overdose or deliberately crashing a car (Dyer, 2006). Attempted suicide is a potentially self-injurious act committed with at least some intent to die as a result of the act. Individuals of all races, creeds, incomes, and educational levels die by suicide (Kalafat, J. & Underwood, M, n.d.; Clayton, J., n.d.).

Little of the above information will be new to most readers. What may be new and surely more challenging is to come to grips with the what, how, and why of this tragic human act of self-inflicted, self-intentioned cessation. Who tends to complete suicide: are they men or women? How old are they? Where do they come from? How do they do it? How does Australia stack up in terms of suicide frequency relative to other countries? What are some elements that most suicides have in common?

This article will give you more details of the demographics of suicide in Australia, what factors tend to correlate with completed suicide, and what some of the common myths surrounding suicides and the suicidal are.

Suicide statistics in Australia

Number of suicides: The Australian Bureau of Statistics (ABS) keeps records on the causes of death in Australia. In any given year, the number of people who killed themselves can only be a preliminary statistic, because the door is kept open for two years for additional suicides that will be determined by coroners’ reports which are ongoing at the close of the year. Thus, in 2009 (the latest year for which finished data are available, published in 2011), 2132 deaths by suicide were registered in Australia (ABS, 2011).

Some of the more salient trends in the breakdown of that overall number are:

  • This is a rate of 9.6 per 100,000 people (compared to, say, the Bahamas: one of the lowest countries, at 1.2; the United Kingdom, at 6.9; the United States at 11; New Zealand at 11.7; or Lithuania, the highest at 34.1 per 100,000) (WHO, 2007).
  • Male suicides accounted for 77 per cent of the deaths.
  • Suicide comprises 22.1 per cent of all deaths among young men between 15 and 24.
  • By comparison, 1417 people died by motor vehicle accidents in the same period.

Age and gender of suicides: In breaking down the statistics by age group and gender, we see that:

  • Men have the most significant variations between age groups, with 85+ year old men committing suicide at a rate of 28.2 per 100,000.
  • 15 – 19 year old men are the lowest male group, at 9.3 per 100,000.
  • The highest age group for women is the 50 – 54 year old age group, at 8.8 per 100,000.
  • The lowest age group for women is 15 – 19 years of age, at 3.4 per 100,000.

Suicide rates by state/ territory: If we compare suicide rates by state/territory, we find, in ascending order per 100,000 people for the years of 2005 to 2009:

  • New South Wales: 7.9
  • Victoria: 9.3
  • Queensland: 11.2
  • Western Australia: 11.8
  • South Australia: 12.1
  • Tasmania, 15.1
  • Northern Territory, 20.1
  • Australian Capital Territory, 9.7 (ABS, 2011)

Percentage of all deaths: Looking at suicide as a percentage of all deaths, we find that 1.6 per cent of all deaths were due to suicide in 2004, but that varied greatly between age groups. Suicide accounted for 22 per cent of all deaths for those aged 20 to 34, and 27 per cent of deaths for men age 25 to 29 years (Heuvel, 2006).

How are they doing it (method of suicide):

  • Nearly half (49 per cent) of male suicide deaths in 2004 were by hanging.
  • Poisoning accounted for 28 per cent of male suicide deaths.
  • Hanging and poison accounted for the same percentage (40 per cent each) in female suicides.
  • Death by firearms and explosives has continued to decline from 420 suicides in 1994 (19 per cent of suicide deaths in that year) to 169 deaths by these methods in 2004 (representing 8 per cent of suicide deaths). (Heuvel, 2006)

Suicide among Aboriginal people: The Australian Bureau of Statistics does not publish statistics for suicide deaths of Aboriginal people for Victoria, Tasmania, and the ACT due to comparatively small numbers, but for the other states, suicide accounted for 4.2 per cent of all deaths of Aboriginal people in the remaining states and territories, compared to 1.5 per cent of deaths among non-Aboriginal people (Heuvel, 2006).

Common elements of suicide 

A leading authority on suicide, psychologist Edwin Shneidman, has described ten characteristics that are commonly associated with completed suicide. While he notes that no single explanation can account for all self-destructive behaviour, the following list includes frequently-occurring features that may help us to get a handle on what suicide is often about to the suicidal.

We have re-interpreted Dr Shneidman’s ten characteristics into a mnemonic to help you remember them. The acronym is COPPINGOUT, as follows:

Constriction is the cognitive state.
Oblivion is the goal: the cessation of consciousness.
Psychological pain is the stimulus.
Purpose is to seek a solution.
Intention is communicated interpersonally beforehand.
Needs are frustrated. Getting out – escaping – is the desired action.
Overriding emotion is hopelessness-helplessness.
Underlying attitude is ambivalence.
Time-worn coping patterns are again employed.

Let’s unpack those a little bit.

Constriction is the cognitive state: A person thinking of dying by suicide often has a rigid and narrow pattern of cognition: like tunnel vision. Rather than engaging in problem-solving behaviours, the person tends to see his or her options in extreme, all-or-nothing terms. The person’s cognitive state is not conducive to good decision-making.

Oblivion is the goal: the cessation of consciousness: Rather than continue to be obsessed with hugely distressing thoughts, the person who would die by suicide seeks the end of conscious experience. Suicide appears to offer oblivion.

Psychological pain is the stimulus: Suicidal people feel intense and excruciating emotions of guilt, shame, sadness, anger, and fear, often arising from multiple sources, and it is the pain of these that motivates the desire to suicide.

Purpose is to seek a solution: When people find themselves in an unbearable situation, suicide may appear to be a preferable solution to continuing in the dire circumstances. Emotional distress and/or physical disability may be feared by the person more than death. Perpetrators of criminal acts about to be caught by authorities have sometimes preferred suicide (such as by jumping in front of a train or shooting themselves) to facing justice and a life behind bars (or possibly being executed by the death penalty). Whatever the horrific situation, suicide is not a random or pointless act; it is an answer to a seemingly insolvable problem.

Intention is what is communicated interpersonally: One of the most dangerous misconceptions about suicide is the idea that people who really want to kill themselves don’t talk about it. Schneidman estimates that in at least 80 per cent of completed suicides, people have communicated their lethal intentions to others, usually by telling people about their plans, but also by behavioural means (more on pre-suicide behaviours later).

Needs are frustrated: Frustrated psychological needs make someone more vulnerable to suicidal ideation. People who have very high standards and expectations can feel especially disappointed when progress towards their goals is thwarted. If they attribute the failure or disappointment to their own shortcomings, they may come to see themselves as worthless, unlovable, or incompetent: a perfect set-up for suicide.  For young people, particularly, career/employment issues, family conflict, and other interpersonal frustrations can precipitate suicide. Similarly, studies have found that, in periods of high unemployment, suicide rates go up (Yang, B., Motohashi, Y., & Lester, D., 1992).

Getting out – escaping – is the desired action: Suicide seems to provide a way out of painful self-awareness and/or intolerable circumstances: a definite way out.

Overriding emotion is hopelessness-helplessness: Even more central to predicting suicidal behaviour than intense negative emotions (such as fear, anger, or sadness), is the pervasive sense that the future is hopeless, and that no one can do anything to help. Pessimism breeds suicide.

Underlying attitude is ambivalence: For all the intensity of negative emotion and sincere desire to die, however, there is simultaneously in most suicides an equally strong wish to find a way out of the dilemma. Thus, suicide contemplation is about intense ambivalence. The skilled social support person can tap into this ambivalence, helping the person to swing to the “want to find a way out of the dilemma” pole.

Time-worn coping patterns are again employed: Not surprisingly, people thinking about killing themselves generally use the same patterns of thought and ways of coping to deal with the current crisis as they have always used. If someone is habitually a loner, refusing to ask others for help or believing that no one can help, that person is likely to act from a stance of isolation in the lead-up to the suicide as well (Oltmanns & Emery, n.d.).

Common misconceptions about suicide 

The World Health Organization estimates that about million people die by suicide each year (World Health Organization, 2004). Understanding what drives people to take their own life is not easy for those who are not enmeshed in intolerable pain themselves; thus, myths and misconceptions tend to proliferate about this very final act. It is important to de-bunk these, however, if we would extend genuinely compassionate support.

Myth Number 1: The people who talk about it don’t do it. 

Fact: Research has shown that 75 – 80 per cent of all people who died by suicide and almost every person who attempted suicide made attempts to communicate to others in the weeks or months leading up to the attempt/suicide that they were in deep despair. Sometimes the only warning was in statements like, “You’ll be sorry when I’m gone” or “I can’t see any way out” (Smith, M., Segal, J., & Robinson, L., 2012; Ainsworth, 2011).   Unfortunately, because most suicidal people are ambivalent about dying, they may make such statements either in a joking manner or in some way which is not congruent with the seriousness of the situation – and they are not taken seriously. The person hearing the statement discounts or otherwise dismisses it.

Myth Number 2: Anyone that would kill themselves is just insane. 

Fact: The U.S. Department of Health and Human Services estimates that, while 90 per cent of people who commit suicide suffer from one or more mental disorders (including depression, bipolar disorder, schizophrenia, and alcoholism), only an estimated 10 per cent of suicidal people are actually psychotic or possessing delusional beliefs about reality (Smith et al, 2012; Florida Office of Drug Control, 2009).   The other 90 per cent are depressed, anxious, grief-stricken, or despairing, but not mentally ill, apart from the depression or anxiety (Ainsworth, 2011). Many depressed people go about their daily business quite adequately. It is important for the support person to note, however, that the absence of craziness does not mean the absence of suicide risk.

Myth Number 3: If someone is going to kill himself, nothing can stop him. 

Fact: Even the most severely depressed person has intensely conflicting feelings about dying by suicide, and most waver in indecision until the very last moment. That ambivalence is shown by the fact that the person is still in the flesh. The fact that he or she is alive right now is proof that at least part of him or her still wants to live. As we have noted, there is another part that wants not death so much as the cessation of pain. The impulse to end it all is overpowering, but it does not last forever. Your job as support person, should you choose to accept it, is to strengthen the part of the person that wants to live, by helping them to understand that suicide applies a permanent solution to what is a temporary problem; other solutions can be found.

Myth Number 4: People who commit suicide are people who were unwilling to seek help.

Fact: Studies show that over half of the people who died by suicide sought medical help in the six months before their deaths. Statistics available for the elderly show that 80 per cent of seniors who suicide visited their general practitioner (G.P.) within 30 days; 40 per cent were seen within the previous week; and 20 per cent saw their G.P. on the same day as the suicide (The Statewide Office of Suicide Prevention, 2008).  Yes, it’s true that many depressed people who contemplate ending their pain through suicide are afraid that, by trying to get help, they will bring more pain on themselves in the form of criticism (such as being told that they are stupid, selfish, sinful, or manipulative), rejection, punishment (such as suspension from school or work), or involuntary commitment.

But the slender hope to find a different solution will keep many pressing ahead despite these risks. By talking to you, a suicidal person is taking a huge risk, but it is a compliment to you, too. It is a statement that, somehow, you seem to be more caring, more capable of coping with adversity, or more able to protect the person’s confidentiality than others. It is a cry for help, and it is a positive, courageous thing that the person is doing in confiding in you about their suicidal urges.

Myth Number 5: Talking about suicide may give someone the idea to do it. 

Fact: A suicidal person doesn’t get morbid ideas by talking about suicide; the person already has them. The opposite is true; by bringing up the question and discussing it openly, you are showing the person that you care about them, that you take them seriously, and that you are willing to let them share their pain with you. By asking whether the person is suicidal, you are giving them the opportunity to release pent-up and painful feelings. Any discussion will help you to determine how far along the way to completion their plans are.

Myth Number 6: The problems weren’t enough to commit suicide over.  

Remember, it is not how bad the problem is; it is how badly it is hurting the person who has it (Ainsworth, 2011). As human beings, we all have our strengths and growing edges. It is those edges – our “Achilles heels” – that function as the weak links in our chain of problem-solving. What is a nuisance factor to one person might be an overwhelming problem for someone else.

Myth Number 7: Improvement following a suicide attempt or crisis means that the risk is over.

Fact: Most suicides occur within days or weeks of “improvement” when the individual has the energy and motivation to actually follow through with his/her suicidal thoughts (Clayton, J., n.d.).

This article is an extract of the upcoming Mental Health Social Support Specialty “Supporting the Suicidal and Suicide-Bereaved”. For more information on MHSS, visit www.mhss.net.au.  

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