Despite the widespread use of antidepressants, the worldwide rate of suicide has not changed, which reinforces the importance of recognizing who's at risk. You may save a life!

Suicide is one of the leading causes of death worldwide. In the U.S. around ninety people a day take their own lives. When anyone takes their own life, we must wonder if there were any warning signs.¹

What do you know about suicide? Answer these questions true or false:

1. Most successful suicide attempts are in young impulse-prone women.
2. Locking firearms securely out of reach reduces the incidence of suicide. 
3. Suicide in adolescents has stabilized over the last few years.
4. Suicide “completers” usually have a history of prior attempts.

If you answered true on any of the questions you were wrong, wrong, wrong.

Suicide is the leading cause of death in young men aged 13 to 17, and the incidence for this age group has quadrupled since 1960. It is the leading cause of death in women going to college. Locking up firearms in closets and drawers only falsely reassures. The suicide rates are staying the same and other means are being used including hanging, carbon monoxide poisoning, cutting, and medicines - both prescription and over the counter. Acetaminophen is particularly deadly and often overlooked in the assessment of patients because it is considered “just” an over the counter medicine, or included in an innocuous formulation like Alka-Seltzer.

On November 12th, 2008 the body of former American Idol contestant Paula Goodspeed was found in front of American Idol judge Paula Abdul's Sherman Oaks home along with some prescription pill bottles, momentos and pictures of Abdul. She had reportedly been obsessed with Ms. Abdul. Although no note was found, Goodspeed's mother had reported a concern to the sheriff's office regarding her daughter's capacity for self-harm. We're not aware of any prior attempts at suicide or any known psychological disorders though she was often reported as being different or "off the wall."

Three years prior Goodspeed had been a contestant on the American Idol show and was thoroughly humiliated by some of the judges leading to speculation that her suicide may have been the result of self-hatred, guilt and hopelessness, although revenge is always a possible motivator in such cases.

Risk factors for completion include use of alcohol, psychiatric diagnoses such as bipolar disorder, borderline personality, major depression, family history, drug abuse (especially cocaine), recent personal loss and hopelessness. Most suicide attempts involve the use of alcohol in people with a history of psychiatric disorders. Research also confirms that a small percentage of police officer-involved shootings are confirmed death-wish fulfillment on the part of the victims.

Ms. Goodspeed’s death was not typical. Young women characteristically use suicide attempts as a gesture, a message of frustration, remorse or self-hatred. Some studies report success in one out of 30 attempts. Most attempts are seen in adolescent girls. Although poisoning by prescription drugs used to be the leading cause of women committing suicide, recently increased use of firearms may eventually assume that dubious honor.

We know Ms. Goodspeed was on antidepressants, the use of which has never been shown to decrease suicide rates. Some say this is because patients are often under dosed or noncompliant with their prescriptions. Nonetheless, 20% of people with major depression will commit suicide, one out of every 5 patients.

We don’t know if Ms. Goodspeed had any prior attempts. Most suicide completers have no history of such and they do it with their first attempt, 60 to 80 percent depending on the study. Family history of suicide doubles the risk of successful suicide. Identical twins share a risk, where paternal twins do not. And neurobiologists believe they have discovered chemical changes in the brain of suicide patients.

And there is a distinct difference between an impulsive act done without much planning, the so-called gesture-suicide, and the manic driven, purposeful behavior of someone with no ambivalence or doubt about what he wants to do. And as expected the latter group is usually successful.

The highest risk patient for successful suicide is an older man with access to firearms who has had a recent loss or diagnosis of cancer. These are people who have none of the ambivalence about death that we see in the gesture-suicide, they are hell-bent on it. Older men who are chronically ill or have lost a loved can be virtually unstoppable at completing their goal.

And a particular high risk group are young men who have little or no sense of their own mortality and an adolescent reasoning structure which produces suicide notes saying “tell everybody I had a seizure, it’ll be alright.” Other impulsive suicide attempters without ambivalence include bipolar patients whose moods are on the rise, or people recently started on antidepressants that have the initial “mobilization of energy and still want to end their lives.

So, how can we help turn this around?

Anytime you have concerns about a family member or friend who seems depressed, worried or hopeless and who has had a recent loss or conflict, get them help. Especially if they have any of the predispositions or warning signs including psychiatric disorders, family history, alcoholism, suicide notes or prior attempts. But a word to the wise...if you are asked to be a “sitter” or watchdog at a hospital or psychiatric facility - refuse. You can’t be objective enough to do a good job. Multiple resources dedicated to suicide prevention are available. Use them.^2-5

And lastly, health care professionals should always ask 'Why now?' besides the usual medical evaluation.^6-7

The Bottom Line

We may never have all the answers regarding Ms. Goodspeed’s death or someone we knew, but we can become sensitized by such tragedies, remembering the signs for recognizing the risk of suicide. You may save a life!

Published November 1, 2008, updated August 19, 2012

References

1. Suicide in the U.S.: Statistics and Prevention, National Institute of Mental Health
2. American Foundation for Suicide Prevention
3. International Association for Suicide Prevention (IASP)
4. Suicide Awareness Voices of Education (SAVE)
5. American Association of Suicidology
6. Doshi A et al, National Study of US Emergency Department Visits for Attempted Suicide and Self-Inflicted Injury, Annals of Emergency Medicine, Oct. 2005, pp 369-375
7. Buzan, RD et al, Suicide Risk Factors and Management, J Emerg Med. 1992 May-Jun;10(3):335-43

J. Linder Jones MD MHA practiced emergency medicine for over two decades in Southern California and now writes on occasion for HealthWorldNet.