Suicide is a leading cause of death in the United States. It typically ranks about tenth with women attempting it about three times more often than men although men's attempts are more lethal. Firearms are involved in slightly more than half of all cases.
The risks for suicide can be divided into fixed risks and changeable risks. The fixed risks are mostly historical or environmental. They would include history of suicide attempts, history of substance abuse, history of mood disorder, family history of suicide, family history of abuse, history of losses such as deaths, loss of money, self-esteem etc., unwillingness or inability to secure mental health care, social isolation, and very severe stress. The changeable risks are the mental states a person experiences which can be modified with treatment.
What are some of the factors that can reduce or modify the above risks? First and foremost is effective treatment for psychiatric and substance abuse disorders. A close second is the support of family, close friends, and community structures such as churches or temples. In addition, development of problem solving skills to resolve interpersonal conflicts or other disputes is also important. Finally assimilating cultural values that promote life-preserving values and discourage suicide.
In 1977 Avery and Winokur published the results of their study on the prevalence of suicide in depression and estimated 15% of people with unipolar depression committed suicide. In 1990 Goodwin and Jamison published their review of the literature showing that 19% of people with bipolar disorder committed suicide. The higher rate for bipolar patients is likely related to the clinical finding that they are more likely to have co-morbid panic disorder, obsessive-compulsive disorder, social phobia and posttraumatic stress disorder than those with unipolar depression. This clinical finding has been studied, supported, and reported by Dilsaver, Akiskal and colleagues in 2006. The relationship between the amount of anxiety and probability of an attempted suicide is well established. Another factor affecting the probability of attempting or completing suicide is the amount of time that a person spends in a depressed state. In 2002 Judd, Akiskal and colleagues published the results of their study of the weekly symptomatic presentation of bipolar I patients over a period of almost 13 years. They found that the patients were depressed 31.9% of the weeks, in a cycling or mixed state 5.9% of the time, and manic or hypomanic only 8.9% of the time. In another paper by the same authors, they found that bipolar II patients spent 51.9% of the year depressed and only 1.9% hypomanic. The mixed states are the most dangerous and lethal. Mixed states are ones that have the features of depression but are contaminated by hypomania or mania.