A winter night. In cold and darkness,
she steals her way through the
woods, her feet tracing the moon-silvered path dully, mechanically,
like the wheels of a train. She follows for a mile or more, glancing
occasionally at the moon, its sick white face, glimpsed through dark
branches, staring full and hopelessly back like one of those kids on a
cancer ward. Then, suddenly, a break in the trees, a deep cutting
opening its arms to catch her, the trains thumping through... every few
seconds... sudden endless carriages rushing through the windy
cutting... and she's high on the giddy footbridge. And she's leaning
her elbows on the criss-cross rails. And she's watching the carriages
rushing, pushing under her feet. And she's wondering if she has the
nerve. And she's feeling sick and bleak as the trains keep cutting
through. And she stands there for an hour, wobbling between life and
death, that night—the night she finally killed herself.
"Global figures for suicide in [adolescents] show that it is the
second most common cause of death after road-traffic
accidents—it is the third most common cause of death
in male adolescents (after road-traffic accidents and violence).
Globally, suicide is the most common cause of
death in female adolescents aged 15–19 years."
"Self-harm and suicide in adolescents," Keith Hawton, Kate Saunders, Rory O'Connor.
In the forty seconds or so that it took you to read those words...
...someone somewhere in the world has taken their own life. Read them
again and someone else will die too. Quietly and hopelessly perhaps, crying
themselves to sleep for the final time after punching pill after pill
through the foil in the packet. Noisily and angrily, perhaps, jumping
off a roof, hurling themselves under a train...
Waiting at London's Waterloo Station one afternoon a few weeks ago,
I found myself wondering why the concourse was so packed with people
looking angrily at their anxious watches, when a voice came over the
station PA: "Due to an 'incident' on the line, all services this
afternoon are subject to severe delay and disruption." And, like anyone
else who's ever heard the word 'incident' spoken by a train announcer,
I thought to myself: suicide. Someone who was alive this morning has
become an "incident", a mess to be cleared up, an inconvenience to
commuters, a "why-oh-why" story in the local paper.
And I thought to myself: why is suicide so taboo? Why does no-one
ever really talk about it? It's like when rabbits die in Watership
Down and the others disappear into their burrows without even
mentioning it, pretending nothing has even happened. It seemed so
bizarre, this conspiracy of silence. And I wondered if it was part of
the problem. I wondered if, instead of telling me about the delays to
the 15.47 to Portsmouth and the 16.08 to Poole, the announcer could
have calmly told me a few facts about suicide instead: "We
apologize for the delay to your journey this afternoon. This is due to
suicide being the second biggest killer of 15–29-year-olds
in the world today. Officially, over 160,000 people under the age of 25 will kill
themselves this year—that's over 50 times more than died in the September 11
terrorist attacks (unofficially, that's described as a "gross underestimate").
Anyway, thank you for listening. We apologize for the delay to
your journey and any inconvenience this may cause."
I pause, reflect, try to get my head round those numbers. There's a killer in our midst, stalking the youngest and most vulnerable. A new black death. I think of Wilfred Owen's Anthem for Doomed Youth: "What passing bells for these
who die as cattle?" I try to picture 160,000 dead young people—the population of
a large town or small city—piled high in a field somewhere like foot and mouth carcasses. I try to
imagine the tabloid outrage if the world's entire, annual toll of young suicides
happened on the same day—the death toll 50 times higher than that of
September 11. I find myself growing angry; I wonder how the station
announcer stays so calm.
What can we learn from suicide statistics?
"Lies, damned lies, and statistics..." applies just as much to suicide as it does to anything else.
Using statistics to understand suicide is fraught with difficulty: different countries define
"suicide" differently, many suicides are misclassified as accidents or covered up because of social,
cultural, or religious taboos. Bearing that in mind, what sorts of things do the numbers tell us?
The death toll
According to the World Health Organization, something like 800,000
people take their own lives every year (roughly
one every 40 seconds) ;
about 47,000 of them are in the United States. 
These bald numbers tell us little, though they certainly become much
more chilling when we consider the WHO's belief that they represent a
"gross underestimate": for every person who takes their own life, 10–20
more attempt it. If suicides were accurately reported, and everyone who attempted suicide pulled it off,
we might be looking at 20 million deaths worldwide each
year. Even working with the official figure of 800,000 and only one
in 20 suicide attempts proving successful, we still have the
population of the Netherlands (17 million) or Australia (23
million)—in effect, an entire country's worth of people—attempting suicide every year.
So why don't we sit up and take more notice?
Causes of death
Suicide is the 10th leading cause of death (counting all age groups together) in
the United States; homicide, which garners so much more media coverage, ranks a mere 16th. 
Both pale in comparison with the big boys of death: heart disease
(7.4 million deaths worldwide each year) and strokes (6.7 million).
HIV/AIDS notches up 1.5 million and road accidents 1.3 million.
But if suicide is as underreported as the WHO suggests, 800,000 a year
might be 1.6 million or 2.4 million in reality, so it could easily
be one of the world's top five killers.
If you're the kind of newspaper reader who frets over
violent crime, bear in mind that suicide accounts for 50
percent of all violent deaths in men worldwide and a staggering 71
percent of violent deaths in women. 
Table: You'll often read (indeed you read just now) that suicide is the tenth leading cause of death—but that's very misleading, because it kills a disproportionate number of young people. This table shows the ten leading causes of death for different age ranges from <1 (left) to >65 (right) in the United States for the year 2018.
Suicide is shown by green squares. For ages 10–34, suicide is the second most common cause of death—something
I never cease to find astonishing. From 35–54, it's fourth most common. The blue squares represent unintentional injury; the red squares show death by homicide. Table from
Wisqars: Ten Leading Causes of Death and Injury, US Centers for Disease Control and Prevention, dated March 30, 2020, retrieved June 8, 2020.
Suicide is more common in older people: in most parts of the world, the over 70s (particularly
the widowed and divorced) are most likely to kill themselves. There
are important variations, however. In the United States, the peak
rate is currently for middle-aged adults, 
while in the UK, the highest rate is for males and females aged
Suicide rates are very low in
children under 15. Infants at different stages of development can
have some unusual ideas about death (for example, that it's
reversible), but many psychologists believe children between 6 and 10
can take their own life in the same way as adults (in other words,
kill themselves with awareness of what that means).
While high suicide rates in the old and low rates in the young are
easy enough to understand, the more surprising statistics are for age
groups in between. If childhood suicide is very low, and elderly
suicide relatively high, we might suppose that the rate of suicide
would increase steadily the older people get—and that's broadly
what happens. Yet there are interesting anomalies. What, for example,
do we make of the sudden, spectacular leap in suicide rates that
begins after puberty, during adolescence and early adulthood, making
suicide the second biggest cause of death for ages 15–29 and the
biggest single killer of girls aged 15–19? What about the observation
that younger people think more about suicide and plan
for it more than older people—even though they don't successfully
kill themselves anything like as much? According to the US
Center for Disease Control and Prevention (CDC), suicidal thoughts
and planning and actual suicide attempts are "significantly higher"
in young adults (18–29) than in people over the age of 30 :
20 percent of all adolescents now consider suicide and 5–8
percent of them actually attempt it, so the number of young lives
touched by suicide, one way or another, is enormous. (Again, there
are fascinating differences between boys and girls, with just over 10
percent of female students attempting suicide compared to just over 5
percent of males.) Or how about the fact that the rate of youth
suicide has roughly tripled in the last half century? 
Most of these statistics are based on research carried out in the
United States; in some countries, suicide rates are significantly
higher in young people than in any other age group. 
One of the most worrying findings is that older schoolchildren can be highly suicidal. Research in the United
States has found that older teens (grade levels 9–12, ages 14–18)
show a worrying fascination with suicide. About one in six (17
percent) say they've considered suicide, one in seven (13.6 per cent)
have made a suicide plan, and one in twelve (8 percent) have made an
actual suicide attempt. These are relatively small numbers but still
frighteningly high percentages. Only one in thirty or so (one person
in every classroom) has actually injured, poisoned, or overdosed to
the extent that they've needed medical attention. 
In short, these young people are suicidal but, for the most part, lack
what suicidologists call "lethality" (the ability to actually kill themselves).
Chart: Suicidal intentions in students. This chart shows the percentage of adolescent boys and girls (grades 9–12) who have considered, planned, attempted, or made a harmful attempt at suicide requiring medical attention in the United States. Drawn using data quoted in Suicide: Facts at a Glance, 2015 [PDF] from research by Kann L, Kinchen S, Shanklin SL, et al. Youth Risk Behavior
Surveillance—United States, 2013. MMWR 2014; 63(ss04): 1–168.
Since the 19th century, researchers have consistently found significant
differences between men and women: the rate at which they attempt
suicide, the rate at which they succeed, and the methods they choose.
In 1838, Jean-Étienne Esquirol, one of the world's first proper
psychiatrists, based at France's pioneering mental hospital, the
in Mental Maladies: A Treatise on Insanity, that "the
proportion of suicides among men and women, is as three of the
former, to one of the latter." 
In France (and countries such as the UK, Australia, and Germany)
that's still true today. In eastern Europe and the former Soviet countries, the
disparity is wider, with male suicides outnumbering females by
anything from 5:1 (Belarus) to 8:1 (Poland). In low and middle-income
countries, the gap closes, with just 1.5 men taking their own life for
each woman. 
According to the CDC, men represent almost 80 percent of all suicides
in the United States. Tellingly, however, women are more likely to
have suicidal thoughts and to attempt suicide.
Chart: Men tend to pick more violent suicide methods than women, which is one reason why more men
kill themselves: violent suicide attempts are more likely to be successful. Data from US Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, quoted in NIMH: Suicide in the U.S.: Statistics and Prevention.
One simple explanation for the discrepancy is that men pick more
violent methods of suicide and therefore succeed much more often than
women, even though they make far fewer attempts: death by gunshot is
the most common suicide method for men, while poisoning is the (much
less effective) method chosen by most women. 
(Having a gun in the home carries a "significantly greater risk" of
someone using it to kill themself, no matter what type of gun or how
safely it's stored. )
The gender difference appliances equally to girls and older women:
in the United States, 84 percent of youth suicides are boys and only
16 percent girls. In the study of suicidal tendencies in school
children, girls score significantly higher than boys on all
categories (considered, planned, attempted, or harmed by suicide).
Emile Durkheim was one of the first people to argue that broad
social conditions play a major factor in suicide. On the face of it,
that might offer a possible explanation for the huge disparity in
suicide rates that we see worldwide. But even a glance at the World
Health Organization's striking
interactive world suicide atlas suggests there
is likely to be no single, simple explanation for the huge variation
in suicide rates across the world.
This fascinating map shows very high suicide rates in rapidly
developing countries such as India. Indeed, a recent paper
titled The changing global face of suicide, by Michael Phillips and Hui Cheng, published in The Lancet in 2012, revealed that low- and
middle-income countries account for an astonishing 84 percent of the
world's suicides (India and China make up almost half of all suicides
alone). Why the differences? Why does Canada have a conspicuously
lower rate of suicide than the United States? Why is the French
rate of suicide twice the rate in nearby Britain? How do we explain the
very low rates of suicide in North Africa and the Middle East
compared to the very high rates in East Africa? Why does
Australia—surely a happy, go-lucky, sunny kind of a place?—have a far
higher suicide rate than its Pacific island neighbors?
Chart: There are wide variations in the suicide rate around the world. This chart shows (blue bars, left y-axis) the number of suicides per 100,000 people in 15 typical countries. The orange diamonds (right y-axis) show the ratio of male to female suicides in those countries; the orange line shows the mean value of just over three to one. Drawn using 2016 data from WHO's Global Health Observatory (GHO)
(labeled as last updated July 17, 2018; the latest available data as of June 2020).
As Durkheim argued, the differences turn out to be due to complex
interactions of social, religious, and cultural factors. For example,
Muslim countries tend to have officially low rates because
suicide is still treated as a criminal offense (so may be
misclassified or under-reported); China has particularly high suicide
rates in rural areas where agricultural workers have ready access to
poisonous pesticides; the United States has high rates of male
suicide correlated with high levels of gun ownership; and rapidly
industrializing nations are in a period of huge social upheaval.
Australia has high rates of aboriginal suicide—and it's a country
to which people migrate, and therefore, perhaps, lack a sense of
belonging and social connection (critically important factors that
help to prevent against suicide).
Even within a country, there can be startling variations in the
suicide rate, for example, due to ethnic variations. In the United
States, Latinos kill themselves more than white people, while blacks
(until recently) had a much lower rate. Young Native Americans and
Alaskans have an extremely high suicide rate (1.5 times the national
average) largely, it's been argued, because of their difficulty in
integrating into modern America, high rates of substance abuse and
child abuse, and high levels of gun ownership. Mixed-race adults
report the highest levels of suicidal thoughts. Among students,
Hispanics show significantly higher rates of contemplating, planning,
attempting, or harming themselves in a nonfatal suicide attempt than
either white or black students. 
Every study of suicide is a snapshot of the problem; suicide rates
are fluctuating from year to year. Even so, it's possible to chart
changes in the suicide rate over time. In the United States, broadly
speaking, the rate increased from the 1960s to the late-1980s,
declined until 2000, and has since risen again to its 1980s peak. The
rate of youth suicide tripled in the second half of the 20th
Since 2000, the youth suicide rate has held roughly steady, suicides
in the elderly have declined somewhat, but there have been very
significant increases in the mid-age brackets 25–44 and 45–64.
The biggest increases have been among white people and Native Americans;
blacks, Asians/Pacific islands, and Hispanics have held steady.
Why can't society discuss and address the epidemic of suicide in young people?
"The pain of severe depression is quite unimaginable to
those who have not suffered it, and it kills in many instances
because its anguish can no longer be borne. The prevention of
many suicides will continue to be hindered until there is a general
awareness of the nature of this pain."
William Styron, Darkness Visible
Trying to understand why so many young people take their own lives is
hard. But then trying to understand why anyone kills themself isn't
easy. There are a whole variety of reasons why people end their lives
prematurely and often very violently. Certain people are much more
likely to kill themselves than others; doctors, dentists, vets, and
farmers—with ready access to the tools of "self-murder"—top the
list. Not surprisingly, mental illness is the most significant factor
of all: many people who take their own life suffer from an untreated
illness, perhaps a mood disorder such as depression or bipolar disorder
(the illness formerly known as manic depression, a roller-coaster ride
of epic highs and crushing lows) or an eating disorder such as anorexia
or bulimia. Brain biology plays a major role in mood disorders: cursed
with badly wired brains, some people need chemical help to sort
themselves out. "Negative life events" as the psychologists call them
(things like lost jobs, bereavements, and the end of relationships)
play a key role too; psychotherapy proves especially effective there.
Together, medication and psychotherapy make a great team. Mental
illnesses are often as treatable as physical problems like gallstones
or broken bones.
But most people with broken bones don't die. Thousands of young people
are not dying of broken bones every year. So what makes mental
illnesses and suicide so different?
If the media are to be believed, there's always been something
distinctly hip about dying before your time. And I don't just mean Kurt
Cobain. Take a trip to the Tate and study the romantic, oil-painted
portrayals of Thomas Chatterton, the self-poisoned poet, draped
suggestively over a sofa, or Ophelia, Hamlet's unrequited love,
floating glassy eyed between the weeds, and you'll see what I mean:
romanticizing suicide is nothing new. But it's a long, long way from
wallowing in the melancholy of a Tindersticks lyric to being wheeled
into A&E with a blanket pulled over your head. If young people
killed themselves simply because it was cool, they'd be dying in their
millions. Studies have estimated that only five per cent of suicides in
young people are copycat deaths. That's five per cent too many, of
course, and it shows that insensitive and sensational media coverage
can do more harm than good. But it also shows we have to look elsewhere
for an explanation.
Photo: Suicide romanticized? Thomas Chatterton, poet and forger, is believed to have taken his own life at the age of just 17. This famous portrait painted by Henry Wallis in 1856 heightened his credibility as a romantic figure, but it's highly misleading and disingenuous: we see nothing of the pain or despair that drove him to take his own life.
If it's not a matter of copycat killing, why are so many young
people ending their lives so prematurely? There seem to be a whole raft
of things that can make one young person more likely to attempt suicide
than another. Alcohol and drug use are thought to play an important
role; both affect your ability to reason, both can act as depressants,
both can make you less inhibited and more likely to actually kill
yourself if you're feeling suicidal in the first place. Young men are
ten times more likely to use drugs to relieve stress. And drugs, in
particular stimulants like cocaine and speed, can tip the balance in
people who are already genetically hard-wired for mental illnesses such
as bipolar disorder. But drugs are far from the only reason for the
surge in young deaths. Puberty is also happening earlier now, bringing
adolescence and depression to a younger age group ill-equipped to cope.
No man—or woman—is an island. And people don't always kill
themselves purely because of the things going on inside their heads. Ever
since French sociologist Emile Durkheim wrote his groundbreaking book
Suicide in 1897, psychiatrists and psychologists have recognized the
importance of wider social factors, both in causing suicide and in
helping to prevent it. It comes as no surprise that high suicide rates
often go hand-in-hand with high unemployment rates, for example. And
young people from broken homes or families in which there's a high
level of stress (due to parental unemployment, mental illness, or
alcohol abuse, for example) are also more likely to attempt suicide, as
are young people who have suffered physical or sexual abuse. Those at
particular risk include young gay and bisexual men (estimated to be two
to six times more likely to take their own lives than straight men) and
people in prison or young offenders' institutions. Sometimes social
factors can have a surprising effect. For example, suicides went up by
nearly 20 per cent in the month following Princess Diana's funeral,
while episodes of self-harm increased by 44 per cent. Equally, though,
social factors can protect against suicide. People strongly integrated
into social groups, such as devout church-goers, are much less likely
to kill themselves.
So why do more young men kill themselves than young women? Again,
the picture is complex. In the United States, women are two to three
times more likely to attempt suicide than men, but men are four times
more likely to actually kill themselves. The reason is partly due to
the different types of mental illness that women and men typically
suffer from and partly because men choose more violent methods of
suicide that are more likely to succeed. Another crucial problem
identified by researchers is that men and boys—because of social
pressures to be "strong", "macho" or whatever—seem to find it much
harder to ask for help when they're having a bad time.
Photo: Alcohol abuse (and a history of alcohol or substance abuse in your family) puts you at greater risk from suicide. Alcohol abuse is also strongly connected with violence, itself one of the leading causes of death among young people. According to the World Health Organization: "Harmful drinking among adolescents is an increasing concern in many countries."
So what do we do about all this?
According to The Samaritans (a British charity that provides a
sympathetic ear at the end of the phone to anyone who needs it): "There
are no quick and easy solutions to the complex problems of suicide in
our society today. Perhaps a starting point is to consider our response
to the emotional distress that we see in the people around us." Our
response means all of us. It means the World Health Organization, who
have declared that it's essential for the world "to break the taboo
surrounding suicide"—a major global problem that is currently
slaughtering far more young people than war and AIDS. It means governments
providing health care that kids and young people can actually relate
to; member countries of the World Health Organization have set
themselves the target of reducing the global suicide tally by 10 percent by
the year 2020. It means bridging the gap between the
health care that's available and the people who need it (a 1999 study
by the Mental Health Foundation in London found that half the people
surveyed had no idea who to contact if someone they knew needed
psychiatric help). And it means us too—you and me.
Because ending the taboo of suicide means not mumbling
apologetically about "incidents" on rail lines or going quiet or changing the
subject, but talking openly about mental illness as easily and
comfortably as we talk about the common cold. A third of us will suffer
from some sort of mental illness at some point in our lives. That means
us, our friends, and our families. Most of us will go on to lead normal
lives, because in most cases mental illness is no big deal: it is as
normal, common and treatable as physical illness provided people get
the help and support they need, when they need it.
I come back to the question that's been haunting me since I started
working on this article: why are so many young people killing
themselves? Not because "suicide is painless", as the Manics once
sang—how painless is it having your stomach pumped in A&E because
you screwed up an overdose?—but because for some people, sometimes, life
becomes acutely and unbearably painful. Not because killing themselves
was a quick and easy solution to a simple problem, but because, in most
cases, they had a history of personal or family problems and untreated
depression or another mental illness. People kill themselves because,
at the moment when they decide to take their own life, they can see no
alternative. They may or may not be ill, but they're not in their right
mind either. And no-one sees it and no-one helps them in time. No-one
asks them the right questions, so no-one gives them the right answers.
On average, in England, one person dies from suicide every hour.
Maybe one of your friends, maybe one of mine. Maybe there's not much
you or I can do to stop people dying of TB (the world's biggest
killer). Maybe we can't stop people killing one another in wars. But
where suicide—the black death—is concerned we can all make a
difference, just by being there.
Getting help – call a suicide hotline
Every year, 800,000 people die from suicide (World Health Organization).
Are you thinking of joining them? If you're feeling suicidal, please get help. Now.
If you think a friend is contemplating suicide, the best thing you
can do is talk to them about it, rather than skirt round the issue. You may have spotted the warning signs
already. These can include dramatic personality changes, withdrawal
from pleasant activities, strange sleep or eating patterns, taking
unnecessary risks or giving away personal possessions. Never be tempted
to play psychiatrist; you may make things worse. But mental health
professionals agree on one thing: asking suicidal people directly about
their plans is one of the most helpful things you can do. You won't
make matters worse; you may save someone's life. Try to find out how
serious the situation is. For example: Do they really think they'd be
better off dead? Have they made suicide attempts in the past? Have they
drawn up a definite plan to kill themself? How will they do it? When?
What, if anything, would hold them back? If you think they're at
serious and imminent risk of suicide, get help immediately.
If the threat is less serious, help your friend find a qualified
counselor (their GP/physician is probably the place to start) or suggest
they talk about their problems with someone they trust.
In my opinion, these are the best four books for general readers:
November of the Soul: The Enigma of Suicide by George Howe Colt. Scribner, 2006. A compassionate review of the entire topic, from adolescent suicide to mercy killings by well-meaning physicians and the complex question of whether euthanasia should be legal. Written in a compelling journalistic
Why People Die by Suicide by Thomas Joiner. Harvard University Press, 2005. In this fairly accessible academic book, Joiner reviews evidence for his theory that suicide can be explained by three factors: "burdensomeness" (feeling a burden to friends and family), "belongingness" (proper integration into family or society), and "acquired lethality" (systematically building up the ability to defeat our instinct for self-preservation). He doesn't really offer much evidence to challenge his own theory, however.
The Suicidal Mind by Edwin Shneiderman. Oxford University Press, 1996. A short and very readable account by the founding father of modern suicidology.
Also worth a look...
Suicide: a study in sociology by Émile Durkheim. Routledge, 2002. The classic and highly influential sociological account, written in 1897, is still worth a look, though our ideas about suicide have moved on somewhat since then.
Suicide by Hal Marcovitz. Abdo, 2010. A comprehensive review of suicide, its history, causes, and prevention. Includes contentious issues such as euthanasia and suicide bombers.
At Risk Youth by J. Jeffries McWhirter et al. Brooks Cole, 2013. This covers a variety of social problems, not just suicide, and is mainly intended for teachers, counselors, and professionals. See particularly Chapter 11 "Youth suicide, pp253–280.
Self-harm and suicide in adolescents by Keith Hawton, Kate Saunders, and Rory O'Connor. The Lancet, Vol 379, June 23, 2012, pp.2373–2382. An excellent recent review by three leading British researchers.
World Health Organization: Suicide: How do suicide rates vary around the world? You'll find country-by-country reports and charts, plus lots of other statistical information about his huge world problem.
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