The Biology of Suicide

Angelica S. Abille Bachelor of Science in Accountancy BSA 1-18N

INTRODUCTION:
The most disastrous consequence of depression is suicide. Not everyone who tempts or commits suicide is depressed, however, and suicidal thoughts and actions are alarmingly common. Nowadays, suicide is very common, most especially to teenagers having this so called depression. But there is no reason why people take their own lives. And as I said, it is often the result of problems building up to the point where the person can see no other way to cope up with what they are experiencing. Very often people (or the media) look for a cause as if there is one factor that has led someone to take their own life. In reality, the way someone feels is a result of many factors. The kinds of problems that might increase the risk of suicide include the following: 1. Recent loss or break-up to a close relationship, 2. An actual or expected unhappy change in circumstances, 3. Painful or/and disabling illness, 4. Heavy use of, or dependency on drugs/alcohol, 5. History of earlier suicide attempts or self-harming, 6. History of suicide in the family, and 7. Depression. When someone is distressed or feeling low it may be that a seemingly minor event is the trigger for them in attempting to kill themselves. It is estimated that across England and Wales there are as many as 140,000 attempted suicide every year; thats one attempt every 4 minutes. About 24,000 of these cases are by young people aged between 10-19. In the UK for people aged 15-24, suicide is the second biggest cause of death after road accidents. Approximately one out of three adolescents who die by suicide have been under influence of alcohol by the time of their death. More women than men say that they have considered suicide (females 21%, male 13%), though more men take their own lives. Young women talk about how they are feeling far more than men. Women are more likely than men to have stronger supports, and to seek psychiatric and other medical support.

Suicidal young men are 10 times more likely to use drugs to relieve stress. Suicidal young men also are more likely to feel that they have been pressurized into taking drugs. This group also spend far more on drugs than the non-suicidal group. Suicidal young men are significantly more likely to have a father who is absent. Women attempt to commit suicide about three times more often than men do, but men succeed more often than women in killing themselves. The greater number of suicide attempts by women is probably related to the greater incidence of depression among women. The fact that men are more successful in their attempts is related to the choice of method. Until recently, women have tended to use less lethal means, such as cutting their wrists or overdosing sleeping pills; men are more likely to use firearms or carbon monoxide fumes or to hang themselves (Crosby, Cheltenham, & Sacks, 1999). However, with the marked increase in the number of women owning guns, suicide by firearms has now become first choice of method of women. Consequently, the fatality rate or women is now changing. (Attempted suicides are successful 80% of the time when firearms are involved, but only 10% of drug or poison ingestions are fatal-a powerful argument for not keeping firearms in the home). Within the United Stated, there are substantial differences between ethnic-racial groups in rates of suicide (McIntosh, 1991; NIMH, 2000). Whites have higher suicide rates than all other groups except for Native Americans, whose suicide rate is more than twice the national average. There are also cross-national differences in suicide rates with higher rates in Hungary. Germany Austria, Denmark, and Japan and lower rates in Egypt, Mexico, Greece, and Spain, Canada, and England have suicide rates that fall between these two extremes. Among the reasons most frequently cited by those who have attempted suicide are depression, loneliness, ill health, marital problems, and financial or job difficulties (Jamison, 1999; NIHM, 1999). Another psychological problem contributing to suicide, in addition to depression is drug abuse. For example, a prospective study of suicide attempts found that 33% of attempters were identified as heavy drinkers, compared to less than 3% of nonattempters. When alcoholism cooccurs with depression, the risk of suicide is especially high (Waller, Lyons, & Constantini-

Ferrando, 1999). Alcohol lowers peoples inhibitions to engage in impulsive acts, even selfdestructive acts like suicide attempts. There have been theories of suicide risk. Much of the most recent research focuses on biological causes. There is some evidence that suicide runs in families (Tsuang, 1983), although this may not represent a specific genetic risk for suicide but rather a genetic risk for depression and other psychological problems. One twin study found a concordance rate for serious suicide attempts of 23% among identical twins and 0% among non-identical twins (Statham et al., 1998), providing stronger evidence of a genetic risk.

SUICIDE
Suicide (Latin suicidium, from sui caedere, "to kill oneself") is the act of intentionally causing one's own death. Suicide is often committed out of despair, the cause of which is attributed to a mental disorder such as depression, bipolar disorder, schizophrenia, alcoholism, or drug abuse. Stress factors such as financial difficulties or troubles with interpersonal relationships often play a significant role. Over one million people die by suicide every year. The World Health

Organization (WHO) estimates that it is the 13th leading cause of death worldwide and the National Safety Council rates it sixth in the United States. It is a leading cause of death among teenagers and adults under 35. The rate of suicide is far higher in men than in women, with males worldwide three to four times more likely to kill themselves than females. There are an estimated 10 to 20 million non-fatal attempted suicides every year worldwide. Views on suicide have been influenced by broader cultural views on existential themes such as religion, honor, and the meaning of life. The Abrahamic religions traditionally consider suicide an offense towards God due to the belief in the sanctity of life. It was often regarded as a serious crime and that view remains commonplace in modern Western thought. However, before the rise of Christianity, suicide was not seen as automatically immoral in ancient Greek and Roman culture. Conversely, during the samurai era in Japan, seppuku was respected as a means of atonement for failure or as a form of protest. Sati is a Hindu funeral practice, now outlawed, in which the widow was expected to immolate herself on her husband's funeral pyre, either willingly or under pressure from the family and society.[ In the 20th and 21st centuries, suicide in the form of self-immolation has been used as a medium of protest, and the form of kamikaze and suicide bombings as a military or terrorist tactic. Medically assisted suicide (euthanasia, or the right to die) is a controversial issue in modern ethics. The defining characteristic is the focus on people who are terminally ill, in extreme pain, or possessing (actual or perceived) minimal quality of life resulting from an injury or illness.

Self-sacrifice on behalf of another is not necessarily considered suicide; the subjective goal is not to end one's own life, but rather to save the life of another. However, in mile Durkheim's theory, such acts are termed "altruistic suicide."

RISK FACTORS
Clinical studies have shown that underlying mental disorders are present in 87% to 98% of suicides, however, there are a number of other factors are correlated with suicide risk, including drug addiction, availability of means, family history of suicide, or previous head injury. Socio-economic factors such as unemployment, poverty, homelessness,

and discrimination may trigger suicidal thoughts. Poverty may not be a direct cause, but it can increase the risk of suicide, as impoverished individuals are a major risk group for depression. A history of childhood physical or sexual abuse or time spent in foster care. Hopelessness, the feeling that there is no prospect of improvement in one's situation, is a strong indicator of suicide with the results of one study showing that 91% of those who scored a 10 or higher on the Beck Hopelessness Scale would eventually commit suicide. Perceived burdensomeness a feeling that one's existence is a burden to others such as family members is often coupled with hopelessness as are the feelings of loneliness, either subjectively (i.e., the feeling), or objectively (i.e., living alone or being without friends and lacking social support and the feeling of not belonging as strong mediators of suicidal ideation. Advocacy of suicide has been cited as a contributing factor. Intelligence may also be a factor. Initially proposed as a part of an evolutionary psychology explanation, which posited a minimum intelligence required for one to commit suicide, the positive correlation between IQ and suicide has been replicated in a number of studies. Some scientists doubt, however, that intelligence can be a cause of suicide, and intelligence is no longer a predictor of suicide when regressed with national religiousness and perceptions of personal health. According to the American Psychiatric Association, "religiously unaffiliated subjects had significantly more lifetime suicide attempts and more first-degree relatives who committed suicide than subjects

who endorsed a religious affiliation." Moreover, individuals with no religious affiliation had fewer moral objections to suicide than believers. One study found that a lack of social support, a deficit in feelings of belongingness and living alone were crucial predictors of a suicide attempt. One study found that among prison inmates, suicide was more likely among inmates who had committed a violent crime.

MEDICAL CONDITIONS
In various studies a significant association was found between suicidality and underlying medical conditions including chronic pain, mild brain injury, (MBI) or traumatic brain injury (TBI). The prevalence of increased suicidality persisted after adjusting for depressive illness and alcohol abuse. In patients with more than one medical condition the risk was particularly high, suggesting a need for increased screening for suicidality in general medical settings. Sleep disturbances such as insomnia and sleep apnea have been cited in various studies as risk indicators for depression and suicide. In some instances the sleep disturbance itself may be the risk factor independent of depression. A careful medical evaluation is recommended for all people presenting with psychiatric symptoms as many medical conditions present with psychiatric symptomatology. The major medical conditions presenting with psychiatric symptoms in order of frequency were infectious, pulmonary, thyroid, diabetic, hematopoietic, hepatic and CNS diseases. Conservative estimates are that 10% of all psychological symptoms may be due to undiagnosed medical conditions, with the results of one study suggesting that about 50% of individuals with a serious mental illness "have general medical conditions that are largely undiagnosed and untreated and may cause or exacerbate psychiatric symptoms".

MENTAL DISORDERS
Certain mental disorders are often present at the time of suicide. It is estimated that from 87% to 98% of suicides are committed by people with some type of mental disorder. Broken down by type: mood disorders are present in 30%, substance abuse in

18%, schizophrenia in 14%, and personality disorders in 13% of suicides. About 5% of people with schizophrenia die of suicide. Major depression and alcoholism are the specific disorders most strongly correlated with suicide risk. Risk is greatest during the early stages of illness among people with mood disorders, such as major depression or bipolar disorder. Depression is among the most commonly diagnosed psychiatric disorders; increasingly diagnosed across various segments of the worldwide population. 17.6 million Americans are affected each year; approximately 1 in 6 people. Within the next twenty years, depression is expected to become the leading cause of disability in developed nations and the second leading cause of disability worldwide. While the psychological and medical communities no longer classify acts of self-harm as suicide attempts, recent research has indicated that the presence of self-injurious behavior may be correlated to increased suicide risk. While there is a correlation between self-harm and suicide, it is not believed to be causal; both are most likely a joint effect of depression. This may also be classified as deliberate self-harm and is most common in younger people, but has been increasing in recent years in people of all ages. Most people who attempt suicide do not complete the act on their first attempt. However, a history of suicide attempts is correlated with increased risk of eventual completion of a suicide.

BIOLOGY
Some mental disorders identified as risk factors for suicide often may have an underlying biological basis. Serotonin is a vital brain neurotransmitter; in those who have attempted suicide it has been found that they have lower serotonin levels, and individuals who have completed suicide have the lowest levels. This disregulation in the serotonin pathway has been identified, in the ventromedial prefrontal cortex. This alteration in the brain has been found to be a risk factor for suicide independent of a history of a major depression "indicating that it is involved in the predisposition to suicide in many psychiatric disorders." There is evidence that there may be an underlying neurobiological basis for suicide risk independent of the inheritable genetic factors responsible for the major psychiatric disorders

associated with suicide. Genetic inheritance accounts for roughly 3050% of the variance in suicide risk between individuals. Having a parent who has committed suicide is a strong predictor of suicide attempts. Epigenetics, the study of changes in genetic expression in response to environmental factors which do not alter the underlying DNA, may also play a role in determining suicide risk.

PERCEIVED BURDENSOMENESS TO OTHERS

Several studies have found perceived burdensomeness to others to be a particularly strong risk factor. It also differentiates between attempted vs. completed suicide and predicts lethality of suicide method unlike feelings of hopelessness and emotional pain. Likely related to this, completed suicides are characterized by altruistic feelings while non-lethal self-injuries are characterized by feelings of anger or self-punishment. An evolutionary psychology explanation for this is that suicide may under some circumstances improve inclusive fitness. This may occur if the person committing suicide will not have more children (even if not committing suicide) and takes away resources from relatives by staying alive. An objection is that some suicides, such as healthy adolescents committing suicide, likely do not increase inclusive fitness. One response is that adaptations to the very different ancestral environment may be maladaptive in the current one ."

SUBSTANCE ABUSE
Substance abuse is the second most common risk factor for suicide after major depression and bipolar disorder. Both chronic substance misuse as well as acute substance abuse are associated with suicide. This is attributed to the intoxicating, disinhibiting, and dissociative effects of many psychoactive substances. When combined with personal grief, such as bereavement, the risk of suicide is greatly increased. More than 50% of suicides have some relation to alcohol or drug use and up to 25% of suicides are committed by drug addicts and alcoholics. This figure is even higher with alcohol or drug use among adolescents, playing a role

in up to 70% of suicides. It has been recommended that all drug addicts or alcoholics undergo investigation for suicidal thoughts due to their high risk of suicide. An investigation in the New York Prison Service found that 90% of inmates who committed suicide had a history of substance abuse.

POINT OF VIEW
Suicide cuts across all sex, age, and economic barriers. People of all ages complete suicide, men and women as well as young children, the rich as well as the poor. No one is immune to this tragedy. Why would anyone willingly hasten or cause his or her own death? Mental health professionals who have been searching for years for an answer to that question generally agree that people who took their own lives felt trapped by what they saw as a hopeless situation. Whatever the reality, whatever the emotional support provided, they felt isolated and cut off from life, friendships, etc. Even if no physical illness was present suicide victims felt intense pain, anguish, and hopelessness. John Newer, author of After Suicide, says, "He or she probably wasn't choosing death as much as choosing to end this unbearable pain." Were there financial burdens that couldn't be met? ...marriage or family problems? ...divorce? ...scholastic goals that weren't achieved? ...loss of a special friendship? ...the death of a close friend or spouse? A combination of these or other circumstances could have precipitated suicide, or it could have been a response to a physiological depression. Although many people face similar problems and overcome them, your loved one could find no solution other than death. But sometimes there are no apparent causes. No matter how long and hard you search for a reason, you won't be able to answer the "WHY" that haunts you. Each suicide is individual, regardless of the generalizations about the "whys", and there may be no way you will completely understand the suicide victim's thought process. As you look for answers and understanding, you also need to deal with your feelings of shock, anger and guilt. The intensity of your feelings will depend on how close you were to the deceased and the degree of involvement you had with his or her life. As each suicide is individual, so will your reaction, healing, and coping process be unique. The general observations that follow may help you deal with your grief.

BIBLIOGRAPHY/ REFERENCES:
http://en.wikipedia.org/wiki/Suicide http://www.samritans.org/your_emotional_health/about_suicide.aspx Smith, Edward; Atkinson & Hilgards Introduction to Psychology; Wardsworth Publishing, 2003.