Suicide |
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Suicide prevention is a collection of efforts to reduce the risk of suicide. [1] Suicide is often preventable, [2] and the efforts to prevent it may occur at the individual, relationship, community, and society level. [1] Suicide is a serious public health problem that can have long-lasting effects on individuals, families, and communities. Preventing suicide requires strategies at all levels of society. This includes prevention and protective strategies for individuals, families, and communities. Suicide can be prevented by learning the warning signs, promoting prevention and resilience, and committing to social change. [3]
Beyond direct interventions to stop an impending suicide, methods may include:
General efforts include measures within the realms of medicine, mental health, and public health. Because protective factors [4] such as social support and social engagement—as well as environmental risk factors such as access to lethal means— play a role in suicide, suicide is not solely a medical or mental-health issue. [5]
Means reduction — reducing the odds that a person attempting suicide will use highly lethal means — is an important component of suicide prevention. [6] This practice is also called "means restriction". It has been demonstrated that restricting lethal means can help reduce suicide rates, as delaying action until the desire to die has passed. [7] In general, strong evidence supports the effectiveness of means restriction in preventing suicides. [8] [9] [10] [11] There is also strong evidence that restricted access at so-called suicide hotspots, such as bridges and cliffs, reduces suicides, whereas other interventions such as placing signs or increasing surveillance at these sites appears less effective. [12]
One of the most famous historical examples of means reduction is that of coal gas in the United Kingdom. Until the 1950s, the most common means of suicide in the UK was poisoning by gas inhalation. In 1958, natural gas (virtually free of carbon monoxide) was introduced, and over the next decade, comprised over 50% of gas used. As carbon monoxide in gas decreased, suicides also decreased. The decrease was driven entirely by dramatic decreases in the number of suicides by carbon monoxide poisoning. [13] [14] A 2020 Cochrane review on means restrictions for jumping found tentative evidence of reductions in frequency. [15]
In the United States, firearm access is associated with increased suicide completion. [16] About 85% of suicide attempts with a gun result in death, while most other widely used suicide attempt methods result in death less than 5% of the time. [16] [17] Matthew Miller, M.D., Sc.D. conducted research comparing the number of suicides in states with the highest rates of gun ownership, to the number of suicides in states with the lowest rates of gun ownership. He found that men were 3.7 times more likely to die by firearm suicide and women were 7.9 times more likely to die by firearm suicide living in states with high rates of gun ownership. There was no difference in non-firearm suicides. [18] Although restrictions on access to firearms have reduced firearm suicide rates in other countries, such restrictions are difficult in the United States because the Second Amendment to the United States Constitution limits restrictions on weapons. [19]
Crisis hotlines connect a person in distress to either a volunteer or staff member. [2] This may occur via telephone, online chat, or in person. [2] Even though crisis hotlines are common, they have not been well studied. [20] [21] One study found a decrease in psychological pain, hopelessness, and desire to die from the beginning of the call through the next few weeks; however, the desire to die did not decrease long term. [2]
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About 50% of people who die of suicide have a mood disorder such as major depression. [22] [23] Sleep and diet may play a role in depression (major depressive disorder), and interventions in these areas may be an effective add-on to conventional methods. [24] Vitamin B2, B6 and B12 deficiency may cause depression in females. [25]
Vitamin B12, for humans, is the only vitamin that must be sourced from animal-derived foods or from supplements. [26] [27] Only some archaea and bacteria can synthesize vitamin B12. [28] Foods containing vitamin B12 include meat, clams, liver, fish, poultry, eggs, and dairy products. [26] Many breakfast cereals are fortified with the vitamin. [26] Natural sources of Vitamin B2 (riboflavin) include meat, fish and fowl, eggs, dairy products, green vegetables, mushrooms, and almonds. [29] Sources of Vitamin B6 include (most values shown are rounded to nearest tenth of a milligram):
Source [30] [31] | B6 amount (mg per 100 grams) |
---|---|
Pistachio | 1.7 |
Whey protein concentrate | 1.2 |
Beef liver, pan-fried | 1.0 |
Tuna, skipjack, cooked | 1.0 |
Beef steak, grilled | 0.9 |
Salmon, Atlantic, cooked | 0.9 |
Chicken breast, grilled | 0.7 |
Pork chop, cooked | 0.6 |
Turkey, ground, cooked | 0.6 |
Banana | 0.4 |
Source [30] [31] | B6 amount (mg per 100 grams) |
---|---|
Mushroom, Shiitake, raw | 0.3 |
Potato, baked, with skin | 0.3 |
Sweet potato baked | 0.3 |
Bell pepper, red | 0.3 |
Peanuts | 0.3 |
Avocado | 0.25 |
Spinach | 0.2 |
Ginger | 0.16 |
Chickpeas | 0.1 |
Tofu, firm | 0.1 |
Source [31] | B6 amount (mg per 100 grams) |
---|---|
Corn grits | 0.1 |
Milk, whole | 0.1 (one cup) |
Yogurt | 0.1 (one cup) |
Almonds | 0.1 |
Bread, whole wheat/white | 0.2/0.1 |
Rice, cooked, brown/white | 0.15/0.02 |
Beans, baked | 0.1 |
Beans, green | 0.1 |
Chicken egg | 0.1 |
According to Healthdirect, the national health advice service in Australia, risk of depression may be reduced with a healthy diet "high in fruits, vegetables, nuts, and legumes; moderate amounts of poultry, eggs, and dairy products; and only occasional red meat". [32] Consuming oily fish (e.g., salmon, perch, tuna, mackerel, sardines and herring) may also help as they contain omega-3 fats. Consuming too much refined carbohydrates (e.g., snack foods) may increase the risk of depression symptoms. The mechanism on how diet improves or worsens mental health is still not fully understood. Blood glucose levels alterations, inflammation, or effects on the gut microbiome have been suggested. More information about food (e.g. oily fish with omega-3 fats, a class of PUFA), drink (e.g. water), healthy, balanced diet and mental health can be found on Healthdirect’s website. [32]
In the United States, the 2012 National Strategy for Suicide Prevention promotes various specific suicide prevention efforts including: [33]
Recommendations around media reporting of suicide include not sensationalizing the event or attributing it to a single cause. [2] It is also recommended that media messages include suicide prevention messages such as stories of hope and links to further resources. [2] [34] Particular care is recommended when the person who died is famous. [35] Including specific details of the method or the location is not recommended. [35]
There is little evidence, however, regarding the benefit of providing resources for those looking for help, and the evidence for media guidelines generally is mixed at best. [36]
TV shows and news media may also be able to help prevent suicide by linking suicide with negative outcomes such as pain for the person who has attempted suicide and their survivors, conveying that the majority of people choose something other than suicide to solve their problems, avoiding mentioning suicide epidemics, and avoiding presenting authorities or sympathetic, ordinary people as spokespersons for the reasonableness of suicide. [37]
Medication can be a powerful and helpful tool for those struggling with mental health conditions. It can help with depression, anxiety, and suicidal thoughts and ideations. There are many different types of medications you can take for mental health, and the variety of medications helps a diverse number of people. Common treatments may include antidepressants, antianxiety, antipsychotics, stimulants, mood stabilizers, and all kinds of SSRI medications. These can help a person tremendously in treating their mental health conditions, improving their quality of life, and reducing symptoms.
Medications can lower the risk of suicidal tendencies, ideations, and thoughts. As such, finding a matching prescription for an individual can be lifesaving. Those who struggle with deep suicidal crises can highly benefit from including medications in their suicide prevention and mental health improvement plans. Alongside medications, a health team often includes therapy and other beneficial resources to support good outcomes for individuals and their communities.
The medication lithium may be useful in certain situations to reduce the risk of suicide. [38] Specifically, it is effective at lowering the risk of suicide in those with bipolar disorder and major depressive disorder. [38] [39] Some antidepressant medications may increase suicidal ideation in some patients under certain conditions. [40] Medical professionals advise supervision and communication during the usage of these medications. [41]
There are multiple talking therapies that reduce suicidal thoughts and behaviors, including dialectical behavior therapy (DBT). [42] [43] Cognitive behavior therapy for suicide prevention (CBT-SP) is a form of DBT adapted for adolescents at high risk for repeated suicide attempts. [44] [45] The brief intervention and contact technique developed by the World Health Organization also has shown benefit. [46]
The World Health Organization recommends "specific skills should be available in the education system to prevent bullying and violence in and around the school". [47]
Coping planning is a strengths-based intervention that aims to meet the needs of people who ask for help, including those experiencing suicidal ideation. [48] By addressing why someone asks for help, the risk assessment and management stays on what the person needs, and the needs assessment focuses on the individual needs of each person. [49] [50] The coping planning approach to suicide prevention draws on the health-focused theory of coping. Coping is normalized as a normal and universal human response to unpleasant emotions, and interventions are considered a change continuum of low intensity (e.g., self-soothing) to high intensity support (e.g. professional help). By planning for coping, it supports people who are distressed and provides a sense of belongingness and resilience in treatment of illness. [51] [52] The proactive coping planning approach overcomes implications of ironic process theory. [53] The biopsychosocial [54] strategy of training people in healthy coping improves emotional regulation and decreases memories of unpleasant emotions. [55] A good coping planning strategically reduces the inattentional blindness for a person while developing resilience and regulation strengths. [51]
The traditional approach has been to identify the risk factors that increase suicide or self-harm, though meta-analysis studies suggest that suicide risk assessment might not be useful and recommend immediate hospitalization of the person with suicidal feelings as the healthy choice. [56] In 2001, the U.S. Department of Health and Human Services, published the National Strategy for Suicide Prevention, establishing a framework for suicide prevention in the U.S. The document, and its 2012 revision, calls for a public health approach to suicide prevention, focusing on identifying patterns of suicide and suicidal ideation throughout a group or population (as opposed to exploring the history and health conditions that could lead to suicide in a single individual). [57] The ability to recognize warning signs of suicide allows individuals who may be concerned about someone they know to direct them to help. [58]
Suicide gesture and suicidal desire (a vague wish for death without any actual intent to kill oneself) are potentially self-injurious behaviors that a person may use to attain some other ends, like to seek help, punish others, or to receive attention. This behavior has the potential to aid an individual's capability for suicide and can be considered as a suicide warning, when the person shows intent through verbal and behavioral signs. [59]
Suicide prevention strategies focus on reducing the risk factors and intervening strategically to reduce the level of risk. Risk and protective factors unique to the individual can be assessed by a qualified mental health professional.
Some of the specific strategies used to address are:
Psychotherapies that have shown most successful or evidence based are dialectical behavior therapy (DBT), which has shown to be helpful in reducing suicide attempts and reducing hospitalizations for suicidal ideation [61] and cognitive behavioral therapy (CBT), which has shown to improve problem-solving and coping abilities. [62]
Postvention is for people affected by an individual's suicide. This intervention facilitates grieving, guides to reduce guilt, guides to reduce anxiety and depression, and helps to decrease the effects of trauma. Bereavement is ruled out and promoted for catharsis and supporting their adaptive capacities before intervening depression and any psychiatric disorders. Postvention is also provided to minimize the risk of imitative or copycat suicides, but there is a lack of evidence based standard protocol. The general goal of the mental health practitioner is to decrease the likelihood of others identifying with the suicidal behavior of the deceased as a coping strategy in dealing with adversity. [63]
Warning signs of suicide can allow individuals to direct people who may be considering suicide to get help. [64]
Behaviors that may be warning signs include: [65]
Additionally, the National Institute for Mental Health includes feeling burdensome, and strong feelings of pain—either emotional or physical—as warning signs that someone may attempt suicide. [64]
An effective way to assess suicidal thoughts is to talk with the person directly, to ask about depression, and assess suicide plans as to how and when it might be attempted. [66] Contrary to popular misconceptions, talking with people about suicide does not plant the idea in their heads. [66] However, such discussions and questions should be asked with care, concern and compassion. [66] The tactic is to reduce sadness and provide assurance that other people care. The WHO advises to not say everything will be all right nor make the problem seem trivial, nor give false assurances about serious issues. [66] The discussions should be gradual and specifically executed when the person is comfortable about discussing their feelings. ICARE (Identify the thought, Connect with it, Assess evidence for it, Restructure the thought in positive light, Express or provide room for expressing feelings from the restructured thought) is a model of approach used here. [66]
The U.S. Surgeon General has suggested that screening to detect those at risk of suicide may be one of the most effective means of preventing suicide in children and adolescents. [67] There are various screening tools in the form of self-report questionnaires to help identify those at risk such as the Beck Hopelessness Scale and Is Path Warm?. A number of these self-report questionnaires have been tested and found to be effective for use among adolescents and young adults. [68] There is however a high rate of false-positive identification and those deemed to be at risk should ideally have a follow-up clinical interview. [69] The predictive quality of these screening questionnaires has not been conclusively validated so it is not possible to determine if those identified at risk of suicide will actually die by suicide. [70] Asking about or screening for suicide does not create or increase the risk. [71]
In approximately 75 percent of suicides, the individuals had seen a physician within the year before their death, including 45 to 66 percent within the prior month. Approximately 33 to 41 percent of those who died by suicide had contact with mental health services in the prior year, including 20 percent within the prior month. These studies suggest an increased need for effective screening. [72] [73] [74] [75] [76] Many suicide risk assessment measures are not sufficiently validated, and do not include all three core suicidality attributes (i.e., suicidal affect, behavior, and cognition). [77] A study published by the University of New South Wales has concluded that asking about suicidal thoughts cannot be used as a reliable predictor of suicide risk. [78]
The conservative estimate is that 10% of individuals with psychiatric disorders may have an undiagnosed medical condition causing their symptoms, [79] with some estimates stating that upwards of 50% may have an undiagnosed medical condition which, if not causing, is exacerbating their psychiatric symptoms. [80] [81] Illegal drugs and prescribed medications may also produce psychiatric symptoms. [82] Effective diagnosis and, if necessary, medical testing, which may include neuroimaging [83] to diagnose and treat any such medical conditions or medication side effects, may reduce the risk of suicidal ideation as a result of psychiatric symptoms. Most often including depression, which are present in up to 90–95% of cases. [84]
All people can be at risk of suicide. Risk factors that contribute to someone feeling suicidal or making a suicide attempt may include:
Suicide is a crime in some parts of the world. [88] However, while suicide has been decriminalized in many countries, the act is almost universally stigmatized and discouraged. In some contexts, suicide could be utilized as an extreme expression of liberty, as is exemplified by its usage as an expression of devout dissent towards perceived tyranny or injustice which occurred occasionally in cultures such as ancient Rome, medieval Japan, or today's Tibet Autonomous Region.
While a person who has died by suicide is beyond the reach of the law, there can still be legal consequences regarding treatment of the corpse or the fate of the person's property or family members. The associated matters of assisting a suicide and attempting suicide have also been dealt with by the laws of some jurisdictions. Some countries criminalise suicide attempts.Many non-profit organizations exist, such as the American Foundation for Suicide Prevention in the United States, which serve as crisis hotlines; it has benefited from at least one crowd-sourced campaign. [89] The first documented program aimed at preventing suicide was initiated in 1906 in both New York, the National Save-A-Life League, and in London, the Suicide Prevention Department of the Salvation Army. [90]
Suicide prevention interventions fall into two broad categories: prevention targeted at the level of the individual and prevention targeted at the level of the population. [91] To identify, review, and disseminate information about best practices to address specific objectives of the National Strategy Best Practices Registry (BPR) was initiated. The Best Practices Registry of Suicide Prevention Resource Center is a registry of various suicide intervention programs maintained by the American Association of Suicide Prevention. The programs are divided, with those in Section I listing evidence-based programs: interventions which have been subjected to in depth review and for which evidence has demonstrated positive outcomes. Section III programs have been subjected to review. [92] [93]
In the United States it is estimated that a suicide results in costs of about $1.3 million. [94] The loss of productivity from the deceased individual accounts for 97 percent of these costs. The remaining 3 percent of the costs were from medical expenses. Money spent on intervention programs is estimated to result in a decrease in economic losses that are 2.5-fold greater than the amount spent. [94]
Major depressive disorder (MDD), also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. Introduced by a group of US clinicians in the mid-1970s, the term was adopted by the American Psychiatric Association for this symptom cluster under mood disorders in the 1980 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), and has become widely used since.
Suicide is the second leading cause of death for people in the United States from the ages of 9 to 56.
Adjustment disorder is a maladaptive response to a psychosocial stressor. It is classified as a mental disorder. The maladaptive response usually involves otherwise normal emotional and behavioral reactions that manifest more intensely than usual, causing marked distress, preoccupation with the stressor and its consequences, and functional impairment.
Child psychopathology refers to the scientific study of mental disorders in children and adolescents. Oppositional defiant disorder, attention-deficit hyperactivity disorder, and autism spectrum disorder are examples of psychopathology that are typically first diagnosed during childhood. Mental health providers who work with children and adolescents are informed by research in developmental psychology, clinical child psychology, and family systems. Lists of child and adult mental disorders can be found in the International Statistical Classification of Diseases and Related Health Problems, 10th Edition (ICD-10), published by the World Health Organization (WHO) and in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association (APA). In addition, the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood is used in assessing mental health and developmental disorders in children up to age five.
Suicide intervention is a direct effort to prevent a person or persons from attempting to take their own life or lives intentionally.
Suicidal ideation, or suicidal thoughts, is the thought process of having ideas, or ruminations about the possibility of completing suicide. It is not a diagnosis but is a symptom of some mental disorders, use of certain psychoactive drugs, and can also occur in response to adverse life events without the presence of a mental disorder.
A major depressive episode (MDE) is a period characterized by symptoms of major depressive disorder. Those affected primarily exhibit a depressive mood for at least two weeks or more, and a loss of interest or pleasure in everyday activities. Other symptoms can include feelings of emptiness, hopelessness, anxiety, worthlessness, guilt, irritability, changes in appetite, difficulties in concentration, difficulties remembering details, making decisions, and thoughts of suicide. Insomnia or hypersomnia and aches, pains, or digestive problems that are resistant to treatment may also be present.
Suicide risk assessment is a process of estimating the likelihood for a person to attempt or die by suicide. The goal of a thorough risk assessment is to learn about the circumstances of an individual person with regard to suicide, including warning signs, risk factors, and protective factors. Risk for suicide is re-evaluated throughout the course of care to assess the patient's response to personal situational changes and clinical interventions. Accurate and defensible risk assessment requires a clinician to integrate a clinical judgment with the latest evidence-based practice, although accurate prediction of low base rate events, such as suicide, is inherently difficult and prone to false positives.
A suicide crisis, suicidal crisis or potential suicide is a situation in which a person is attempting to kill themselves or is seriously contemplating or planning to do so. It is considered by public safety authorities, medical practice, and emergency services to be a medical emergency, requiring immediate suicide intervention and emergency medical treatment. Suicidal presentations occur when an individual faces an emotional, physical, or social problem they feel they cannot overcome and considers suicide to be a solution. Clinicians usually attempt to re-frame suicidal crises, point out that suicide is not a solution and help the individual identify and solve or tolerate the problems.
Youth suicide is when a young person, generally categorized as someone below the legal age of majority, deliberately ends their own life. Rates of youth suicide and attempted youth suicide in Western societies and other countries are high. Youth suicide attempts are more common among girls, but adolescent males are the ones who usually carry out suicide. Suicide rates in youths have nearly tripled between the 1960s and 1980s. For example, in Australia suicide is second only to motor vehicle accidents as its leading cause of death for people aged 15 to 25.
Suicide is the act of intentionally causing one's own death. Mental disorders, physical disorders, and substance abuse are risk factors. Some suicides are impulsive acts due to stress, relationship problems, or harassment and bullying. Those who have previously attempted suicide are at a higher risk for future attempts. Effective suicide prevention efforts include limiting access to methods of suicide such as firearms, drugs, and poisons; treating mental disorders and substance abuse; careful media reporting about suicide; improving economic conditions; and dialectical behaviour therapy (DBT). Although crisis hotlines are common resources, their effectiveness has not been well studied.
Major depressive disorder, often simply referred to as depression, is a mental disorder characterized by prolonged unhappiness or irritability. It is accompanied by a constellation of somatic and cognitive signs and symptoms such as fatigue, apathy, sleep problems, loss of appetite, loss of engagement, low self-regard/worthlessness, difficulty concentrating or indecisiveness, or recurrent thoughts of death or suicide.
Depression, one of the most commonly diagnosed psychiatric disorders, is being diagnosed in increasing numbers in various segments of the population worldwide. Depression in the United States alone affects 17.6 million Americans each year or 1 in 6 people. Depressed patients are at increased risk of type 2 diabetes, cardiovascular disease and suicide. Within the next twenty years depression is expected to become the second leading cause of disability worldwide and the leading cause in high-income nations, including the United States. In approximately 75% of suicides, the individuals had seen a physician within the prior year before their death, 45–66% within the prior month. About a third of those who died by suicide had contact with mental health services in the prior year, a fifth within the preceding month.
Igor Galynker is an American psychiatrist, clinician and researcher. His research interests include bipolar disorder, suicide prevention, and the role of family dynamics in psychiatric illness. He has published on these topics both in professional journals and in the lay press. His recent research has been devoted to describing Suicide Crisis Syndrome (SCS), an acute suicidal cognitive-affective state predictive of imminent suicidal behavior.
In 2014, the WHO ranked Nepal as the 7th in the global suicide rate. The estimated annual suicides in Nepal are 6,840 or 24.9 suicides per 100,000 people. Data on suicide in Nepal are primarily based on police reports and therefore rely on mortality statistics. However, the burden of suicide in communities is likely to be higher, particularly among women, migrant workers, and populations affected by disasters.
In colleges and universities in the United States, suicide is one of the most common causes of death among students. Each year, approximately 24,000 college students attempt suicide while 1,100 students succeed in their attempt, making suicide the second-leading cause of death among U.S. college students. Roughly 12% of college students report the occurrence of suicide ideation during their first four years in college, with 2.6% percent reporting persistent suicide ideation. 65% of college students reported that they knew someone who has either attempted or died by suicide, showing that the majority of students on college campuses are exposed to suicide or suicidal attempts.
Prevention of mental disorders are measures that try to decrease the chances of a mental disorder occurring. A 2004 WHO report stated that "prevention of these disorders is obviously one of the most effective ways to reduce the disease burden." The 2011 European Psychiatric Association (EPA) guidance on prevention of mental disorders states "There is considerable evidence that various psychiatric conditions can be prevented through the implementation of effective evidence-based interventions." A 2011 UK Department of Health report on the economic case for mental health promotion and mental illness prevention found that "many interventions are outstandingly good value for money, low in cost and often become self-financing over time, saving public expenditure". In 2016, the National Institute of Mental Health re-affirmed prevention as a research priority area.
Suicide and trauma is the increased risk of suicide that is caused by psychological trauma.
Suicide cases have remained constant or decreased since the outbreak of the COVID-19 pandemic. According to a study done on twenty-one high and upper-middle-income countries in April–July 2020, the number of suicides has remained static. These results were attributed to a variety of factors, including the composition of mental health support, financial assistance, having families and communities work diligently to care for at-risk individuals, discovering new ways to connect through the use of technology, and having more time spent with family members which aided in the strengthening of their bonds. Despite this, there has been an increase in isolation, fear, stigma, abuse, and economic fallout as a result of COVID-19. Self-reported levels of depression, anxiety, and suicidal thoughts were elevated during the initial stay-at-home periods, according to empirical evidence from several countries, but this does not appear to have translated into an increase in suicides.
Youth suicide in India is when young Indian people deliberately end their own life. People aged 15 to 24 years have the highest suicide rate in India, which is consistent with international trends in youth suicide. 35% of recorded suicides in India occur in this age group. Risk factors and methods of youth suicide differ from those in other age groups.
Protective Factors are the positive conditions, personal and social resources that promote resiliency and reduce the potential for youth suicide as well as other related high-risk behaviors. Just as suicide risks rise from an interaction between familial, genetic, and environmental factors, so do protective factors.
Suicide should not be viewed solely as a medical or mental health problem, since protective factors such as social support and connectedness appear to play significant roles in the prevention of death.
About 85% of attempts with a firearm are fatal: that's a much higher case fatality rate than for nearly every other method. Many of the most widely used suicide attempt methods have case fatality rates below 5%.
Other suicide prevention strategies that have been considered are crisis centres and hotlines, method control, and media education... There is minimal research on these strategies. Even though crisis centres and hotlines are used by suicidal youth, information about their impact on suicidal behaviour is lacking.
Other approaches that need further investigation include gatekeeper training, education of physicians, and internet and helpline support.
Half of all completed suicides are related to depressive and other mood disorders
All nutritional values within this article have been sourced from the USDA's FoodData Central Database.