What drives people to take their own lives?

MY friend committed suicide recently. It was a shock to all of us. We didn't know he was in such a state. He was extremely worried about his grades and how he would fare in an upcoming major exam. But we didn't know it affected him that deeply. Is suicide very common?

Suicide is the eighth leading cause of death in the US. Approximately 30,000 Americans commit suicide every year. It is something to be taken very seriously indeed and anyone exhibiting thoughts of suicide must always be taken seriously.

As for people who try to commit suicide but fail, the number is 10 times that of a completed suicide.

Some facts about suicide:

• About 30 - 40% of people who successfully commit suicide have had a previous attempt.
• Suicide rates are not, as believed, confined to mostly emotional teenagers. They are highest actually in older people. 40% of suicide victims are over age 60. After you reach age 75, you have three times the risk of committing suicide than the average population.
• Poor quality sleep and insomnia are associated with suicide among college undergraduates.
• Suicidal thoughts are involuntary. You don't choose to think or have them. They come into your mind on their own. They push and compel and drive you towards suicide. Some people who have attempted suicide say these thoughts are like a malignant entity taking over their lives.
• About 20% of suicides have abused alcohol.

Do you have to be depressed before you attempt suicide?

It depends on what you mean by the term "depressed". If it's taken in the layman's term (sadness, hopelessness), in the majority of suicide cases, there is some element of that.

People who are suicidal are often suffering from some sort of undiagnosed and untreated depression.

However, if you take depression by its actual psychiatric definition of "major depression" and/or "bipolar disorder" (those manifesting swings of both mania and depression), then an estimated 2% to 15% of patients die by suicide, especially when they exhibit hopelessness about their future, have attempted suicide in the past and have just been discharged from hospital.

Mental disorders like schizophrenia are also highly associated with suicide, as 6% to 15% of schizophrenics die this way, especially men. Patients suffering from personality disorders have also a high risk of suicide.

Why are alcoholics at greater risk of committing suicide? Is it something in alcohol itself?

A recent study of suicide in alcoholics suggest that it is not just alcohol that increases your risk of suicide - it is everything else that goes with alcoholism: mood disorders (because of the emotional upswings alcohol tends to give you), financial problems (due to excessive drinking, taking up expenses and inability to work and maintain a proper job), problems with your relationships such as with your wife or children.

Alcoholics who are suicides tend to be male, older and have marital problems.

By the way, it is not just alcoholics that have a greater risk of suicide - it is people who abuse substances per se - drugs in all forms. Even cigarettes have been suggested in some studies to have an association with suicide.

Why do people commit suicide at all? I'm still trying to grasp my friend's situation - couldn't he just quit school instead of having to take his life because school was giving him so many problems?

People commit suicide in response to extreme emotional pain, and there is a suggestion that brain chemistry may be involved in invoking these thoughts as well.

Usually these people have been through a very prolonged situation that has caused them extreme duress - emotional upset, death of a loved one, abuse, terrible living conditions, abject poverty, drastic change in life circumstances (such as losing your entire savings), poor health (many cancer victims commit suicide rather than live through the slow pain), disability (paralysis, loss of limbs, loss of eyesight).

When these people see no way out of their situation and the thought of having to live through the rest of their lives in such circumstances becomes too hard to bear, this precipitates depression and suicidal thoughts.

How do I know someone is harbouring suicidal thoughts?

There are some warning signs you can look out for in your friends or loved ones:

• If they talk or write about hurting or wanting to kill themselves, and this is out of the ordinary for their character
• If they start looking for ways to kill themselves, like seeking access to pills and weapons
• If they feel hopeless or trapped
• If they start acting reckless and engage in risky activities
• If they start increasing their alcohol or drug intake
• If they start withdrawing themselves from family, friends and society
• If they feel anxious, agitated, and have difficulty sleeping all the time
• If they have dramatic mood changes

Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health advice, computers and entertainment. The information contained in this column is for general educational purposes only. Neither The Star, the author nor AsiaOne gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star, the author and AsiaOne disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

This story was first published in The Star on June 22, 2008.