Suicide terminology

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Historically, suicide terminology has been rife with issues of nomenclature, connotation, and outcomes, [1] [2] and terminology describing suicide has often been defined differently depending on the purpose of the definition (e.g., medical, legal, administrative). A lack of agreed-upon nomenclature and operational definitions has complicated understanding. In 2007, attempts were made to reach some consensus. [2] [3] [4] [5] There is controversy regarding the phrase "to commit suicide" as some view it as implying negative moral judgment and having an association with criminal or sinful activity.

Contents

In 2020, a meta-analysis of studies on the effects of media coverage of suicide found that "Reporting of deaths of celebrities by suicide appears to increase the number of suicides by 8-18% in the next 1-2 months, and information on method of suicide was associated with an increase of 18-44% in the risk of suicide by the same method." [6]

Terminology

Ideations

Suicidal ideation is any self-reported thoughts of engaging in suicide-related behavior. [2] Subtypes of suicide-related ideations depend on the presence or absence of suicidal intent.

To have suicidal intent is to have suicide or deliberate self-killing as one's purpose. [7] Intent refers to the aim, purpose, or goal of the behavior rather than the behavior itself. [3] The term connotes a conscious desire or wish to leave or escape from life, and also connotes a resolve to act. This is contrasted with suicidal motivation, or the driving force behind ideation or intent, which need not be conscious.

Suicide-related ideation with no suicidal intention is when an individual has thoughts of engaging in suicide-related behavior but has no intention to do so. When an individual is unable to clarify whether suicidal intent was present or not, the term undetermined degree of suicidal intent is used. Suicide-related ideation with some suicidal intent is when an individual has thoughts of engaging in suicide-related behavior and possesses suicidal intent. [4]

Communications

Suicide-related communications are any interpersonal act of imparting, conveying, or transmitting thoughts, wishes, desires, or intent for which there is evidence that the act of communication is not itself a self-inflicted behavior or self-injurious. This broad definition includes two subsets: [4]

A suicide threat is any interpersonal action, verbal or nonverbal, without a direct self-injurious component, that a reasonable person would interpret as communicating or suggesting that suicidal behavior might occur in the near future. Type I is a passive or active threat with no associated suicidal intent; Type II is a passive or covert threat with an undetermined level of intent; and Type III is a passive or covert threat with some degree of suicidal intent. [4]

A suicide plan is a proposed method of carrying out a design that will lead to a potentially self-injurious outcome; a systematic formulation of a program of action that has the potential for resulting in self-injury. Type I is the expression of a definite plan with no suicidal intent; Type II is a proposed method with an undetermined level of intent; Type III is a proposed method with some suicidal intent. [4]

Behaviors

Suicide related behavior is a self-inflicted, potentially injurious behavior for which there is evidence either that: (a) the person wished to use the appearance of intending to kill themselves in order to attain some other end; or (b) the person intended at some undetermined or some known degree to kill themselves. [4] Suicide-related behaviors can result in no injuries, injuries, or death. Suicide-related behaviors comprise self-harm, self-inflicted unintentional death, undetermined suicide-related behaviors, self-inflicted death with undetermined intent, suicide attempt, and suicide.

Self-harm is self-inflicted, potentially injurious behavior for which there is evidence that the person had no intent to die. Persons engage in self-harm behaviors for its own sake (e.g., to use pain as a focusing stimulant, or due to a condition like trichotillomania), or when they wish to use the appearance of intending to kill themselves in order to attain some other end (e.g., to seek help, to punish themselves or others, to receive attention, or to regulate negative moods). [4] Suicidal gestures are suicide-related behaviors that are carried out without suicidal intent. It is considered a controversial term. [8]

Self-harm type I and Type II result in no injury and nonfatal injury respectively, while Self-Inflicted Unintentional Death, often called accidental suicide, is self-harm that has resulted in death. It is defined as from self-inflicted injury, poisoning, or suffocation where there is evidence that there was no intent to die. This category includes those injuries or poisonings described as unintended or accidental. Undetermined Suicide-Related Behavior is self-injurious behavior for which the person is unable or reluctant to admit positively to the intent to die, which have resulted in no injuries, for Type I, and injuries, for Type II. [4]

A suicide attempt is defined as a self-inflicted, potentially injurious behavior with a nonfatal outcome for which there is evidence of intent to die. Type I has no resultant injuries, regardless of the degree of injury or lethality of method, while Type II has resultant injuries. Self-Inflicted Death with Undetermined Intent is self-injurious behavior that has resulted in fatal injury and for which intent is either equivocal or unknown A suicide is a self-inflicted death with evidence of intent to die. [4]

"Committing" suicide

According to Fairbairn in his philosophical study of suicide published in 1995, "The most common way of speaking about suicide is to talk of its being 'committed'." [9] An article published in 2011 stated that, although committed suicide or similar descriptions continued to be the norm in the English language, the term committed associates death by suicide, or more accurately, death by mental illness, with criminal or sinful actions. [10] Research has pointed out that this phrasing has become so entrenched in English vocabulary that it has gained "a naturalness which implies a deceptive harmlessness." [10] Per reportingonsuicide.org, [11]

Certain phrases and words can further stigmatize suicide, spread myths, and undermine suicide prevention objectives such as "committed suicide" or referring to suicide as "successful," "unsuccessful" or a "failed attempt." Instead use, "died by suicide" or "killed him/herself."

While common, Lebacqz & Englehardt argue that referring to suicide as an act "committed" is hazardous to ethical clarity. [12] Others have also argued in favour of alternative language regarding suicide, both in the interest of moral and ethical precision, [13] as well as scientific and clinical clarity. [2] [4] A United States Navy report urges against the use of the term committed suicide on similar grounds, asserting that "suicide is better understood when framed objectively within the context of behavioral health." [14]

The lack of clarity in English suicide terminology has been attributed to the connotations of crime, dishonour, and sin that suicide may carry. [15] [16] Common language has been described as "[portraying] suicide as a 'crime' to be 'committed' as is, for example, murder." [12] This is despite the fact that suicide is largely no longer a crime, [13] [17] and that, as noted suicidologist Samuel Wallace wrote, "all suicide is neither abhorrent nor not; insane or not; selfish or not; rational or not; justifiable or not." [18]

Canadian suicide prevention activist, P. Bonny Ball, commented that the alleged criminal implications of suicide are a carryover from the Middle Ages when suicide was considered "both illegal and sinful by the laws and religions of the time." [19]

Since "committing suicide" was akin to committing murder or rape, it has been argued that they continue to be linked in some languages. [10]

Various alternatives have been proposed to alter the language regarding the act of suicide from a variety of sectors – including government, journalism, community mental health advocates, and the scientific community. Terms such as death by suicide have been suggested to be more objective. [14] The World Health Organization has agreed that these terms "are more accurate and less open to misinterpretation." [20]

As it applies to a direct clinical context, the widely cited Beck Classification of Suicidal Behaviour exclusively uses the terminology of complete suicide. [21] This classification was revisited in a number of notable documents (such as the Operational Classification for Determination of Suicide, the 'Tower of Babel' nomenclature, the WHO/EURO definitions, the Columbia University suicidality classification, the Centers for Disease Control and Prevention self-directed violence surveillance system, and the Denver VA VISN 19 MIRECC self-directed violence classification system). [22]

Advocacy groups have suggested a variety of guidelines for suicide terminology. [23] [24] [25] [26] [27] [28] As it concerns media reporting of suicide, a key indicator of guideline influence on language as it is practiced in that context reports including one by the Annenberg School for Communication's Public Policy Center at the University of Pennsylvania suggests that there is "evidence of a change in reporting practices following the release of the new media guidelines". [29]

Related Research Articles

<span class="mw-page-title-main">Self-harm</span> Intentional injury to ones body

Self-harm is intentional conduct that is considered harmful to oneself. This is most commonly regarded as direct injury of one's own skin tissues usually without a suicidal intention. Other terms such as cutting, self-injury, and self-mutilation have been used for any self-harming behavior regardless of suicidal intent. Common forms of self-harm include damaging the skin with a sharp object or by scratching, hitting, or burning. The exact bounds of self-harm are imprecise, but generally exclude tissue damage that occurs as an unintended side-effect of eating disorders or substance abuse, as well as societally acceptable body modification such as tattoos and piercings.

Suicide is the second leading cause of death for people in the United States from the ages of 9 to 56.

<span class="mw-page-title-main">Suicide prevention</span> Collective efforts to reduce the incidence of suicide

Suicide prevention is a collection of efforts to reduce the risk of suicide. Suicide is often preventable, and the efforts to prevent it may occur at the individual, relationship, community, and society level. 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.

Suicide intervention is a direct effort to prevent a person or persons from attempting to take their own life or lives intentionally.

<span class="mw-page-title-main">Suicidal ideation</span> Thoughts, ideas, or ruminations about the possibility of ending ones life

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.

<span class="mw-page-title-main">Suicidology</span> Scientific study of suicide and self-destructive behaviors

Suicidology is the scientific study of suicidal behaviour, the causes of suicidalness and suicide prevention. Every year, about one million people die by suicide, which is a mortality rate of sixteen per 100,000 or one death every forty seconds. Suicidologists believe that suicide is largely preventable with the right actions, knowledge about suicide, and a change in society's view of suicide to make it more acceptable to talk about suicide. There are many different fields and disciplines involved with suicidology, the two primary ones being psychology and sociology.

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.

<span class="mw-page-title-main">Suicide</span> Intentional act of causing ones own death

Suicide is the act of intentionally causing one's own death. Mental disorders, physical disorders, and substance abuse are risk factors.

Self-embedding is the insertion of foreign objects either into soft tissues under the skin or into muscle. Self-embedding is typically considered deliberate self-harm, also known as nonsuicidal self-injury, which is defined as "deliberate, direct destruction of tissues without suicidal intent."

<span class="mw-page-title-main">Suicide in South Korea</span> Statistics and causes of suicide

South Korea records the world's fourth highest suicide rate, and the highest suicide rate in the OECD. The elderly are at the highest risk of suicide, but teen suicide deaths have been rising since 2010: Suicide caused more than half of all deaths among South Koreans in their 20s in 2022, and it is the leading cause of death among those in their teens, 20s, and 30s.

<span class="mw-page-title-main">IS PATH WARM?</span>

IS PATH WARM? is an acronym utilized as a mnemonic device. It was created by the American Association of Suicidology to help counselors and the general public "remember the warning signs of suicide."

A suicide attempt is an act in which an individual tries to kill themselves but survives. Mental health professionals discourage describing suicide attempts as "failed" or "unsuccessful", as doing so may imply that a suicide resulting in death is a successful or desirable outcome.

<span class="mw-page-title-main">Vehicular suicide</span> Suicide method

Vehicular suicide is the use of a motor vehicle to intentionally cause one's own death.

Researchers study Social media and suicide to find if a correlation exists between the two. Some research has shown that there may be a correlation.

The Columbia Suicide Severity Rating Scale, or C-SSRS, is a suicidal ideation and behavior rating scale created by researchers at Columbia University, University of Pennsylvania, University of Pittsburgh and New York University to evaluate suicide risk. It rates an individual's degree of suicidal ideation on a scale, ranging from "wish to be dead" to "active suicidal ideation with specific plan and intent and behaviors." Questions are phrased for use in an interview format, but the C-SSRS may be completed as a self-report measure if necessary. The scale identifies specific behaviors which may be indicative of an individual's intent to kill oneself. An individual exhibiting even a single behavior identified by the scale was 8 to 10 times more likely to die by suicide.

The interpersonal theory of suicide attempts to explain why individuals engage in suicidal behavior and to identify individuals who are at risk. It was developed by Thomas Joiner and is outlined in Why People Die By Suicide. The theory consists of three components that together lead to suicide attempts. According to the theory, the simultaneous presence of thwarted belongingness and perceived burdensomeness produce the desire for suicide. While the desire for suicide is necessary, it alone will not result in death by suicide. Rather, Joiner asserts that one must also have acquired capability to overcome one's natural fear of death.

The Suicide Behaviors Questionnaire-Revised (SBQ-R) is a psychological self-report questionnaire designed to identify risk factors for suicide in children and adolescents between ages 13 and 18. The four-question test is filled out by the child and takes approximately five minutes to complete. The questionnaire has been found to be reliable and valid in recent studies. One study demonstrated that the SBQ-R had high internal consistency with a sample of university students. However, another body of research, which evaluated some of the most commonly used tools for assessing suicidal thoughts and behaviors in college-aged students, found that the SBQ-R and suicide assessment tools in general have very little overlap between them. One of the greatest strengths of the SBQ-R is that, unlike some other tools commonly used for suicidality assessment, it asks about future anticipation of suicidal thoughts or behaviors as well as past and present ones and includes a question about lifetime suicidal ideation, plans to commit suicide, and actual attempts.

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.

References

  1. ↑ Archives of Suicide Research, 1997, vol. 3, pp. 139–151
  2. 1 2 3 4 O'Carroll et al. (1996). Beyond the Tower of Babel: A nomenclature for suicidology. Suicide and Life-Threatening Behavior, 26(3), 237–252.
  3. 1 2 Silverman MM, Berman AL, Sanddal ND, et al. Rebuilding the Tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. Part 1: background, rationale, and methodology. Suicide Life Threat Behav 2007; 37:248–63.
  4. 1 2 3 4 5 6 7 8 9 10 Silverman MM, Berman AL, Sanddal ND, et al. Rebuilding the Tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. Part 2: suicide-related ideations, communications, and behaviors. Suicide Life Threat Behav 2007; 37:264–77.
  5. ↑ Posner K, Oquendo MA, Gould M, et al. Columbia Classification Algorithm of Suicide Assessment (C-CASA): classification of suicidal events in the FDA's pediatric suicidal risk analysis of antidepressants" Am J Psychiatry 2007; 164:1035–43.
  6. ↑ Thomas Niederkrotenthaler; Marlies Braun; Jane Pirkis; Benedikt Till; Steven Stack; Mark Sinyor; Ulrich S Tran; Martin Voracek; Qijin Cheng; Florian Arendt; Sebastian Scherr; Paul S F Yip; Matthew J Spittal (18 March 2020). "Association between suicide reporting in the media and suicide: systematic review and meta-analysis". BMJ. 368: m575. doi:10.1136/bmj.m575. PMC   7190013 . PMID   32188637.
  7. ↑ Leenars, A. A. (2004). Psychotherapy with suicidal people. West Sussex, UK: John Wiley & Sons.
  8. ↑ Heilbron, Nicole; Compton, Jill S.; Daniel, Stephanie S.; Goldston, David B. (2010-06-01). "The Problematic Label of Suicide Gesture: Alternatives for Clinical Research and Practice". Professional Psychology: Research and Practice. 41 (3): 221–227. doi:10.1037/a0018712. ISSN   0735-7028. PMC   2904564 . PMID   20640243.
  9. ↑ Fairbairn, Gavin J (1995). Contemplating Suicide: The Language and Ethics of Self-Harm. London: Routledge. p. 34. ISBN   978-0415106061.
  10. 1 2 3 Olson, Robert (2011). "Suicide and Language" (PDF). Centre for Suicide Prevention. InfoExchange (3): 4. Retrieved 15 May 2013.
  11. ↑ "Best Practices and Recommendations for Reporting on Suicide" (PDF). reportingonsuicide.org.
  12. 1 2 Lebacqz, K. & Englehardt, H.T. (1980). "Suicide and covenant" . In Battin, M.P. & Mayo, D.J. (eds.). Suicide: the philosophical issues. New York: St. Martin's. p.  672. ISBN   978-0312775315.
  13. 1 2 Beaton, Susan; Forster, Peter; Maple, Myfanwy (February 2013). "Suicide and Language: Why we Shouldn't Use the 'C' Word". In Psych. 35 (1): 30–31.
  14. 1 2 "What's in a word? How we talk about Suicide" (PDF). Navy Suicide Prevention. United States Navy: Navy Personnel Command. Retrieved 16 May 2013.
  15. ↑ Silverman, M.M. (October 2006). "The Language of Suicidology". Suicide and Life-Threatening Behavior. 36 (5): 519–532. doi:10.1521/suli.2006.36.5.519. PMID   17087631.
  16. ↑ "Reporting on Suicide: Recommendations for the Media" (PDF). Suicide Prevention Resource Center. 2001. Archived from the original (PDF) on 2013-05-30. Retrieved 16 May 2013.
  17. ↑ "What's in a word? The Language of Suicide" (PDF). Alberta Health Services. 2009. Retrieved 15 May 2013.
  18. ↑ Wallace, S.E. (1999). "The Moral Imperative to Suicide". In Werth, J.L. Jr. (ed.). Contemporary Perspectives on Rational Suicide. Philadelphia: Taylor & Francis. pp.  48–53. ISBN   978-0876309377.
  19. ↑ Ball, P. Bonny (2005). "The Power of words". Canadian Association of Suicide Prevention. Archived from the original on 13 May 2013. Retrieved 16 May 2013.
  20. ↑ Preventing suicide : a resource for media professionals (PDF). Geneva: World Health Organization. 2008. p. 8. ISBN   978-92-4-159707-4.
  21. ↑ Beck, A.T.; Resnik, H.L.P. & Lettieri, D.J, eds. (1974). "Development of suicidal intent scales". The prediction of suicide. Bowie, MD: Charles Press. p. 41. ISBN   978-0913486139.
  22. ↑ O'Connor, R.C.; Platt, S. & Gordon, J., eds. (2011). "Challenges to Classifying Suicidal Ideations, Communications, and Behaviours". International Handbook of Suicide Prevention: Research, Policy & Practice . Oxford: John Wiley & Sons. pp.  18–21. ISBN   978-0470683842.
  23. ↑ Brenner, L.A.; Silverman, M.M.; Betthauser, L.M.; Breshears, R.E.; Bellon, K.K.; Nagamoto, H.T. (2010). "Suicide Nomenclature – 2010 Suicide Prevention Conference" (PDF). Denver: Department of Defense; Defense Centres of Excellence for Psychological Health and Traumatic Brain Injury. Retrieved 17 May 2013.
  24. ↑ Brenner, L.A.; Breshears, R.E.; Betthauser, L.M.; Bellon, K.K.; Holman, E.; Harwood, J.E.; Silverman, M.M.; Huggins, J.; Nagamoto, H.T. (June 2011). "Implementation of a suicide nomenclature within two VA healthcare settings". Journal of Clinical Psychology in Medical Settings. 18 (2): 116–28. doi:10.1007/s10880-011-9240-9. PMID   21626353. S2CID   22877623.
  25. ↑ Centre for Suicide Research (September 2012). "Media and Suicidal Behaviour: Guidelines and other information". University of Oxford. Retrieved 18 May 2013.
  26. ↑ Media Guidelines for the Reporting of Suicide: 2009 Media Guidelines for Ireland (PDF). Samaritans Ireland. 2009.
  27. ↑ IASP Task Force – Suicide and the Media. "Media Guidelines & Other Resources". International Association for Suicide Prevention. Retrieved 15 May 2013.
  28. ↑ Suicide Prevention: Guidelines for Public Awareness and Education Activities (PDF). Government of Manitoba. 2011.
  29. ↑ "New Guidelines Developed to Promote Responsible Media Coverage of Suicides". Robert Wood Johnson Foundation. March 2007. Retrieved 15 May 2013.
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