Our World in Data: Suicide

Maybe the argument that suicide hurts the people around the person who killed themself can be helpful by reminding people that there's others who care about them who would want to help if they could. Either way, it seems to be enough for some people, and I think if it helps people through a crisis then it's an argument worth repeating.

You're right that ketamine seems like a magic switch for at least some people, but please be careful if you have any history of psychosis.

I almost ended up as the murdered half of a murder-suicide due to that. Which is damnable because I've never seen any other treatment have the same effect as esketamine.

I really hope they find some way to solve that, maybe they also need to administer anti-psychotics in that case, I truly don't know. Because the treatment itself is just about as close to turning off depression as anything I've ever seen. Though I understand it may not be that way for everyone, for some, it really helps.

See also: https://slatestarcodex.com/2019/03/11/ketamine-now-by-prescr...

Is there any chance you're in the Bay Area and would be willing to share which org you got ketamine therapy through? I have a friend in SF who's antidepressants have stopped working over the years - she's hoping to do ketamine therapy but can't find a legit organization to go through.

It's a tragedy your best friend's father was a walking ball of abuse and negativity. I get your argument and it's good, but the underlying issues behind suicides are no good either.

> Every suicide is a tragedy.

People often have very reasonable reasons they want to kill themselves. Doesn't mean they should necessarily do it, but such statements are invalidating or unhelpful to the suicidal.

I think ultimately people just want to be understood.

It's also a little bit cultural isn't it. For instance Euthanasia is a form of suicide that can be entirely reasonable and made in the absence of mental illness.

"My dad was abusive and killed himself and I'm happier now."

If the child is better off with their dad killing themselves, that's a failure of society to protect the child who was being abused, or possibly the child has inherited some sociopathic tendencies.

For most people, the suicide of a parent is traumatic, regardless of whether there was abuse.

Suicide and euthanasia should be treated as separate causes of death

>A grim thought is that in an ideal world there would be a large number of deaths by suicide.

But most deaths by suicide aren't self-inflicted euthanasia to avoid a dicease, but escapes from depression, the impact of far from ideal social/family/economical circumstances, and so on.

I doubt the number would change much is euthanasia was legal everywhere, and even if it did, it would just be toward the end of the battle (with e.g. cancer), where those people would have died soon anyway.

Personally, my fear is wasting away due to some form of degenerative brain disease. I think I could put up with all sorts of other disabilities due to age, but at the moment that I realize some pathogen is attacking the core of my being and I'm going to slowly lose who I am, I don't want to be forced to continue. I especially don't want the rest of my friends and family to watch me waste away in front of them while I forget who they are, lose control of my bodily functions... what a horrible way to go. I'd much rather bow out peacefully, while I can still do so with dignity. When my time is up it's no tragedy for me to move on, it's simply the next generation's turn.

It's a touchy subject for sure, but this is where I draw my personal line in the sand. Many others have a different set of opinions, and I'm not convinced there's one right answer. Just food for thought.

> breaking the data out by age is most welcome. Suicide at 80 has a very different meaning than suicide at 18.

I find it frustrating they cluster suicides ages 14 to 59, why!?

> will go straight to hell. This belief probably explains some

That's the negative side, yes. But don't discount the equally if not more powerful positive side: Things like believing there is a greater purpose to your existence, are incredibly powerful and helpful. (i.e. "I'm in pain, but there's a reason I'm here, let me try to accomplish it.")

And that's not even touching on the far greater community support among religious people. Having a horrible day and need someone to xyz. You can talk to someone you have never met before, but who shares your beliefs, and they will most likely go out of their way to help you with it (or at least they'll help you find someone else who can do it).

Given the taboo, how likely is the suicide to be reported as such?

Could it perhaps also be that because suicide is such a taboo subject, suicides are widely underreported?

That's a pretty convincing hypothesis. If I may postulate an alternative one, it is that alternative ways of 'suicide' exist for someone who wishes to end their life, perhaps 'accidents'.

The reason for my scepticism is that India has a bunch of "cooking fire accidents" that coincide with dowry non-payment. Of course, retaliation for dowry non-payment is illegal in India. It is mere accident that kills people whose family has not paid a dowry.

Indonesia is not India, true. It is culturally very different, but my general prior if something is culturally taboo and is therefore rare is not high that it is truly rare but high that it has been renamed. For instance, Iranian homosexuality. There aren't any homosexuals there.

My hypothesis is that religion satisfies (albeit with lies) some basic human needs that leads to a more content life. They don’t say religion is the opium of the masses for no reason.

Qatar is listed with the second-highest rate of suicides, so it isn't quite as easy as that. Islam also isn't the only difference between Indonesia and Papua New Guinea: GDP is five times as much in the former, with $15,000 p.a. vs. $3,000.

Just scanning the map, I can't help but think of alcoholism: Greenland, Russia, Eastern Europe, and Australia have relatively high rates, and enjoying a bit too much is the common theme I can think of. It would even include any correlation with adherence to islam, since alcohol consumption is one of the largest differences in lifestyle setting muslims apart from all others.

Yeah but abrahamic religion believe mankind is a some chosen life form, children of God, that the earth was made for us, etc.

I think this view has something to do with how humans are absolutely dominating the earth and collectively killing ourselves. collective suicide.

The page does address the issues you speak of [0]. Having said that, I do agree that the disclaimer is critically important and should probably be placed at the beginning rather than the end of the document.

[0] https://ourworldindata.org/suicide#data-quality

Yup, this is a big issue in US data where a leading cause of death for otherwise-healthy age groups is "accidental poisoning" which is CDC-NCHS code for drug overdoses.

This misses the possibbility of common cause in some or many cases. Also, mental illness can cause immense suffering and choosing to escape that can be entirely rational depending on the circumstances especially considering acccess to health care. The reaction to mental illness socially and economically should also be considered because it can make life even worse for sufferers. If escaping a life of gauranteed pain is irrational then we're going to have to disagree on our conception of rationality here.

I thought one of the problems with that figure was that many of those cases were diagnosed after the fact and, in many cases, based on the fact that they committed suicide.

A depression diagnosis may mean that your suffering is a clear defect and unreasonable given the circumstances, or it may mean that someone thought access to a therapist could help you cope better with your shitty life.

Yup. Switched advisors about a year ago. I'm much happier with my research situation, but switching wasn't easy. I was lucky, I was able to transition my research program over pretty smoothly.

our population is only able to balloon to the current numbers because we are basically hacking nature with our technology.

before modern tech people death was rampant.

I don't see how a suicidal population control could have developed, evolutionary.

I'm not sure if all survivors would identify with suicide being a choice. I'm willing to be corrected, but I feel like a lot of people who attempt suicide feel like they have expended all of their choices. I'm also not sure if addiction is a choice either, maybe you could expand on your thoughts?

It's kind of like saying "at least people aren't dying in childbirth" lol. Still bad!

I am curious too. These data are critical to policymakers today. Without knowing what excess deaths from suicide and overdose look like stratified by age, they can't understand the risk and reward of covid-19 lockdowns. And even if they suspect as I do that the number of life years lost to suicide and overdose caused by lockdowns bmay outweigh the number 'saved' by lockdowns, it will be difficult to persuade anyone of this without data.

Not forcing HHS and CDC to prioritize collection of these statistics was a serious mistake.

I saw a recent writeup by journalists on suicide among black people in Chicago. So far we're halfway through the year and already have matched 2019.

https://chicago.suntimes.com/politics/2020/7/25/21336409/sui...

Since suicides can often be impulsive and not premeditated, if you can reduce the access to the method, you can reduce the number suicides.

Motivation is harder to categorize and collect. It also assumes someone in investigating the root cause and recording it.

Is it of questionable utility?

I don't think it's a waste to look at the data and see if certain methods of suicide really stand out. It doesn't seem unreasonable to see if (this is a gross way to phrase it but here we go) easy and efficient methods of suicide are associated with more suicides. My gut instinct would say that having easy access to handguns would be associated with more suicides, as it's (relatively) more reliable than an intentional drug overdose.

Does the data here reflect that? I am not a statistician, but what's shown actually makes me question my priors. The US has a huge difference in suicide by gun rates, but the overall suicide rate isn't all that different from European countries. And, this actually surprised me, the male-to-female suicide ratio in the US isn't much different than other countries, which really makes me question my prior that "guys have handguns and thus have an easier way to commit suicide".

There is the hypotheses that rush suicides can happen when your home has a gun or some quick way of ending your life.

There will be hard to study this theories as long as an industry is involved and politics.

I have no idea how can you use statistics from other countries and get the correct conclusions, we probably need the data from people that canceled their suicide and compare the number of gun owners and non gun owners.

It has huge policy implications. Some people push gun controls because of it, or install fences at bridges and subway stations that can cost in the billion dollar range.

In practice, this makes a noticeable difference; it's why you can't buy paracetamol in significant quantities in the UK, why the suicide rate fell when the UK switched from toxic coal gas to natural gas, and so on.

Suicide motivation is usually understood as "depression", but antidepressants aren't entirely reliable in this case. It's very hard to reach inside someone's head unless they're willing to tell you. Neither of the two people I knew who killed themselves left notes. Both were on antidepressants.

For example, men were more likely to shot themselves and women were more likely to poison themselves. Also, women were less likely to die from suicide, but more likely to attempt it.

The means matter.

Well the pie chart with possible mental illnesses had some stuff in that direction.

Suicide prevention focuses on a package of measures. These include kinder fairer societies as a long term measure. I don't know anyone working in suicide prevention in England who isn't deeply aware of the wider determinants of mental ill health. (And I know a lot of people working in suicide prevention).

But the package of measures also includes "preventing access to means and methods". This is because we know it makes a difference. We have some natural experiments to show this: changing the domestic supply of gas from coal gas to natural gas caused a substantial decline in deaths: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC478945/

Changing cars to have catalytic convertors also caused a decline in deaths.

People get caught up on this. They say "merely making it harder to buy paracetamol isn't addressing the root causes, you need to do that". They're right, but they're missing the point that this is supposed to be a package of measures that also looks at why people attempt suicide.

Well, saying that without knowing the impact on outcomes doesn't make sense.

Anyway, the focus usually reflects org structure. Solutions match org structure. If you make a Suicide Reduction Squad, they will not be able to "ensure that all children have education" to reduce suicide, they can only chase methods. After all, it's the Education Increase Squad that makes sure children have education.

May be a spurious correlation.

Pure speculation but likely reasons could include bad data, traditional societies with lesser pressure to "succeed" and actually developing countries that give opportunities.

However the correlation is not strong enough as evidenced by Egypt and Pakistan.

Stoicism would be my guess. Remember emotions are relative - having something bad happen won't necessarily cause as large an emotional response if you are used to bad things happening to you.

The more secular countries tend to be both more equal and having people not worried about eternal damnation if they kill themselves.

Cause beeing poor can force you to stick together, and with relative richness, we are alone and divided with our choices.

Suicide mortality might be correlated with geographic location (roughly speaking: latitude) rather than (or in addition to) income inequality.

Perhaps correct for the wealth effect? i.e. are wealthier countries generally more unequal? Just a blind hypothesis.

I don't know specifics re South Korea and Greece but I wouldn't be surprised if what counts as suicide in one country might count as accident or unknown cause of death in another which makes comparisons a bit tricky.

I can ensure you that Greek culture sucks too, probably way more than South Korea.

While this is maybe a bit too bluntly worded and one-sided, I still think that the general issue - prioritising GDP growth over happiness - is important, so I'm unhappy with the downvotes.

You're going to need a way less hot take than "some cultures suck".

Maybe "religion and family formation is associated with less suicide", or "inequality is associated with suicide", or "cultural norms play a role in suicide". Not to get too social justice warrior, but saying "some cultures suck" is such a thought-terminating cliche that it gets you nowhere.

When looking at the numbers, you may want to take consideration the cultural acceptability of suicide. There are cultures where suicide is not viewed the same way, and therefore it may be elevated. Certain philosophies view it as an acceptable decision if someone has suffered greatly and doesn’t wish to anymore (off the top of my head, some stoic philosophers have spoken about it). I haven’t done my research on the topic, but isn’t it somewhat acceptable to kill yourself in Japan in certain circumstances? The taboo factor in other countries likely drives the numbers down as many people won’t entertain the idea because it is “bad”.

The point is, I’m not sure “some cultures suck” is the only part of the equation. We also need to consider how that culture educated their society about suicide.

If you live in a society that has stopped you from experiencing most things that suck. Think boredom, Hunger, insecurity. Is it any surprise that when something that sucks that we can't prevent - rejection, death, loss - happens it hits these people worse than it would people who haven't had the preventable sucks taken away?

Interesting broad look but what if Greeks die from lack of hospital care more ? (non biased question, I have no agenda)

> comparaison of suicide rates between countries is,

Go careful, a lot of them count deaths in very different ways. Some of them even change the way they count death, and so you need to be careful if you're comparing rates across time for one country.

In the UK:

> The previous National Statistics definition of suicide includes deaths from intentional self-harm (where a coroner has given a suicide conclusion or made it clear in the narrative conclusion that the deceased intended to kill themselves) and events of undetermined intent (mainly deaths where a coroner has given an open conclusion) in people aged 15 and over.

[...]

> In 2016, the suicide definition was revised to include deaths from intentional self-harm in children aged 10 to 14. Previously we did not include suicides in young children due to the very small numbers involved (see Table 3). However, after discussions with Public Health England and the constituent countries of the UK, it was decided that it was appropriate to include them. Deaths from an event of undetermined intent in 10- to- 14-year-olds are not included in these suicide statistics, because although for older teenagers and adults we assume that in these deaths the harm was self-inflicted, for younger children it is not clear whether this assumption is appropriate.

So, death after self harm, even if there's no evidence of intent to die.

In the US: https://www.cdc.gov/violenceprevention/pdf/Self-Directed-Vio...

> Suicide

> Death caused by self-directed injurious behavior with any intent to die as a result of the behavior.

But it's a bit more complicated:

> Despite the large volume of data on certain types of SDV, the utility and reproducibility of the resulting information is sometimes questionable. Mortality data are problematic for several reasons: geographical differences in the definition of suicide and how equivocal cases are classified; jurisdictional differences in the requirements for the office of coroner or medical examiner affecting the standard of proof required to classify a death as a suicide; and differences in terms of the extent to which potential suicides are investigated to accurately determine cause of death.18

https://www.cdc.gov/violenceprevention/pdf/suicideTechnicalP...

> Gathering ongoing and systematic data is important for prevention efforts. However, it is also important to gather data that are uniform and consistent across systems. Consistent data allow public health and other entities to better gauge the scope of the problem, identify high-risk groups, and monitor the effects of prevention programs and policies. Currently, it is common for different sectors, agencies, and organizations to employ varying definitions of suicidal ideation, behavior, and death that can make it difficult to consistently monitor specific outcomes across sectors and over time. For example, the manner in which deaths are classified can change from one jurisdiction to another, and can change based on local medical and/or medico-legal standards.4 CDC’s uniform definitions and recommended data elements for self-directed violence provide a useful framework to help ensure that data are collected in a consistent manner across surveillance systems.

[...]

I wonder if there is a correspondence with patriarchal culture. Where there are strong expectations on men to play a certain role in society, and failure to do so is a big unrecoverable hit to status.

I was quite sad to hear of the Mayor of Seoul's death. It was interesting the difference in approach to reporting about it in the english language Korean media. I am used to reports not even mentioning that the death was by suicide anymore.

From the graphs there it doesn't seem like there's a correlation between national gun ownership and suicide rates.

>Our long-standing epidemic of firearm-induced suicide could be tempered by better gun regulation.

Are you implying that a significant number of firearm suicides are done with illegal firearms? I'm skeptical of that, being from Canada. If not, what would more regulation do?