Suicide involves the taking of one's own life. As articulated by a prominent suicidologist: "the common stimulus to suicide is intolerable psychological pain. Suicide represents an escape or release from that pain." (Suicidology.ORG, 2003) It defines suicide rates as: (number of suicides per group/population of group) x 100,000. The AAS list suicide as the 11th highest cause of death -- cardiovascular disease being the first; homicide however, ranked 14th. 1.2% of deaths in the United States are due to suicides. People usually attempt suicide to block unbearable emotional pain, which is caused by a wide variety of problems. It is often a cry for help. A person attempting suicide is often so distressed that they are unable to see that they have other options: we can help prevent a tragedy by trying to understand how they feel and helping them to look for better choices that they could make. Suicidal people often feel terribly isolated; because of their distress, they may not think of anyone they can turn to, furthering this isolation.

Difficulties with relationships, well-being in oneself or a love one, image, job or career, finances, environment, loss of a loved one or a relationship and self-esteem can contribute. Other important factors stem from abuse: emotional and psychological, sexual, social and neglect.

For every year of the nineties (1990-1999), the suicide rates for age groups have virtually remained the same. Suicide rates for those over 75 are the highest of all age groups at over 20. Among the pre-teen, teenage and young adult population, the rates are 1.2, 8.2 and 12.7, respectively. Suicidal tendencies are in the young are relatively less than the older age groups.

Of 29,199 deaths by suicide in the United States in 1999, an overwhelmingly large number were male- 23,458 (rate of 17.6) and females were 5,741 (rate 4.1). Interestingly, along the racial divide, suicide-rates among whites were almost twice that of the non-white and/or black population. For each race, the suicide rates are higher for males -- four to five times higher than females.

For the groups mentioned above -- Age, Sex and Race -- the use of firearms was the suicidal method of choice. Except for females who used firearms approximately 37% of the time, every other group used firearms more than 55% than any other method. According to the AAS: for every successful suicide there is an average of six people intimate to the deceased that are adversely affected. Extrapolating this statistic for 1999 -- there were 175,000 survivors.

While the above provides some general information that helps recognize the societal impact and implications of suicide, this research project will examine the emotional conditions that might lead to suicide-attempts. This study is critical in understanding suicide so that an adequate infrastructure might be set up to minimize suicide attempts by addressing the various causes. Most attempters of suicide would opt not to attempt suicide if they are able to overcome their distress and are able evaluate alternatives objectively. The intent of most suicides is not dying but seeking a stop to their emotional pain.

Literature Review

While a successful or unsuccessful suicide attempt carries with it the stigma of mental illness, this assessment is not always true. People who attempt suicide are often acutely distressed; most are depressed to various extents. There are two kinds of depression: The first is a normal reaction to trying circumstances -- reactive depression. The next type is due to a diagnosable mental illness or clinical depression as the cause. Sometimes reactive depression and clinical depression can combine; i.e., a person suffering from chronic depression might be pushed over the edge following a triggering circumstance.

Identifying a specific illness with suicide can be difficult. Both kinds of depressions have similar symptoms and effects. (Breitbart, 1990) Besides, diagnosing and treating psychological conditions are difficult because the subject (psychology and psychiatry) is mostly subjective So whether a person who is distressed enough to attempt suicide would be diagnosed as suffering from clinical depression may vary in different peoples opinions, and may also vary between cultures. The statistics based on demographics in the earlier paragraphs will provide are an indication of how tracing mental condition can be difficult.

Researchers aver that the better option is to distinguish between and treat each type of depression than diagnose depression between two types of depression. Appleby and Condonis write that the majority of people who commit or attempt suicide do not have a diagnosable mental illness. Suicidal thoughts and actions may be the result of life's stresses and losses that the individual feels they just can't cope with. A 15% rare of suicide is expressed in individuals with clinical, or major, depression....

Ten percent of schizophrenics commit suicide. Alcoholism has a 4-6% risk. (Doheny, 2002)
People who suffer psychological reactions to an intense sad event like a disaster or close personal loss are diagnosed with Post Traumatic Stress Disorder. The main symptom of this anxiety disorder is persistently reliving the traumatic event. Even those not diagnosed with full-blown PTSD have clinical impairment and show symptoms. Symptoms can include recurrent and distressing recollections of the event, efforts to avoid feelings and reminders associated with the trauma, and severe anxiety. A study led by Randall Marshall of New York State Psychiatric Institute and Columbia University showed that the presence of PTSD symptoms raised the risk of suicide. More than three times as many people suffering PTSD reported current suicidal ideation than people who did not have PTSD symptoms. (Marshall et al., 2001) predictor of suicide is a general feeling of hopelessness and helplessness. Hopelessness and lack of insight are the common factor that links depression and suicide in the general population. (Fawcett, Clark and Busch, 1993)

Depression has an important consideration among men and women. Overall, women have higher rates of depression than men. Major considerations are post-partum, hormonal changes and symptoms of menopause might be conditions specific to women. Depressive symptoms are detectable in approximately 12% to 16% of patients with another non-psychiatric medical condition. (Long, 1997) The presence of illness or disease can psychologically cause depression, as is often observed in patients with cancer. Finally, especially for cancer patients, some treatments or medications have side effects that cause depressive moods or symptoms. Patients with neurological disorders such as Parkinson's, Huntington's, and Alzheimer's diseases have higher rates of major depression.

For some patients, uncontrolled pain is an important contributing factor for suicide and suicidal ideas. Patients with uncontrolled pain may see death as the only escape from the pain they are experiencing. Different types of pain vary both in the way they affect patients and in their responsiveness to treatment. Acute pain is of limited duration but higher intensity. Chronic pain persists and often escalates progressively. The latter is more seen as a cause of suicide. However, pain is usually not an independent risk factor. The significant variable in the relationship between pain and suicide is the interaction between pain and feelings of hopelessness and depression. Suffering represents a more global phenomenon of psychic distress. Suffering is often associated with pain. Physical symptoms, such as difficulty in breathing can lead to suffering. Suffering may also arise from diverse social factors such as isolation, loss, and despair. (Bruera and Portenoy, 2003)

New approaches to assess and report pain involve self-reporting of pain by patients. This concept is important to pain assessment. It can be supplemented by physiological and behavioral observation. (Bruera and Portenoy, 2003)

Having recognized the importance of contributory (physical and mental) factors to suicide, an important point is Physician-Assisted Suicide. Though this is perhaps out of the scope of the proposal statement, this potentially divisive and debatable action will contribute greatly to societal perceptions of the notion of suicide. Advocates suggest that it provides autonomy and personal control to the afflicted. The danger exists that the same afflicted may have this decision made for them. The question arises if is someone being denied death or denied life. In Holland, (olde Scheper and Duursma, 1994), where physician-assisted suicide has been allowed for a number of years, more people assisted in killing themselves without any explicit request than those who request assisted suicide in a ration of more than two to one. The danger also lies in the fact that the afflicted person is poorly informed about objective options. There are legal ramifications also: Dr. Kevorkian faces life imprisonment for assisting a terminally ill patient on national TV.

Quality of Life plays an important role in suicide prevention. By studying the cause and effect circumstances of suicide we can create conditions to rid the world of the scourge of suicides offering those lacking in physical, emotional and mental well-being with the tools to overcome their conditions.

Bibliography

Breitbart, W. "Cancer Pain and Suicide." Advances in Pain Research and Therapy. Ed K.M. Foley. New York: Raven Press, 1990. 399-412.

Suicide Risk and Pain in Cancer and Aids Patients." Current and Emerging Issues in Cancer Pain Research and Practice: The Bristol-Myers Squibb Symposium on Pain Research. Eds. C. Richard Chapman and Kathleen M. Foley. New York: Raven Press, 1993. xvii, 441.

Bruera, Eduardo, and Russell K. Portenoy.…