Figure 1. Having protective factors like social support is crucial to coping with emotional pain.

For some people with mood disorders, the extreme emotional pain they experience becomes unendurable. Overwhelmed by hopelessness, devastated by incapacitating feelings of worthlessness, and burdened with the inability to adequately cope with such feelings, they may consider suicide to be a reasonable way out. Suicide, defined by the CDC as “death caused by self-directed injurious behavior with any intent to die as the result of the behavior” (CDC, 2013a), in a sense represents an outcome of several things going wrong all at the same time (Crosby, Ortega, & Melanson, 2011). Not only must the person be biologically or psychologically vulnerable, but they must also have the means to perform the suicidal act, and must lack the necessary protective factors (e.g., social support from friends and family, religion, coping skills, and problem-solving skills) that provide comfort and enable one to cope during times of crisis or great psychological pain (Berman, 2009).

Suicide is not listed as a disorder in the DSM-5; however, suffering from a mental disorder—especially a mood disorder—poses the greatest risk for suicide. Around 90% of those who complete suicides have a diagnosis of at least one mental disorder, with mood disorders being the most frequent (Fleischman, Bertolote, Belfer, & Beautrais, 2005). In fact, the association between major depressive disorder and suicide is so strong that one of the criteria for the disorder is thoughts of suicide, as discussed above (APA, 2013). Suicide rates can be difficult to interpret because some deaths that appear to be accidental may in fact be acts of suicide (e.g., automobile crash).

• Suicide was the 10th leading cause of death for all ages in 2010 (Centers for Disease Control and Prevention [CDC], 2012).
• There were 38,364 suicides in 2010 in the United States—an average of 105 each day (CDC, 2012).
• Suicide among males is four times higher than among females and accounts for 79% of all suicides; firearms are the most commonly used method of suicide for males, whereas poisoning is the most commonly used method for females (CDC, 2012).
• From 1991 to 2003, suicide rates were consistently higher among those 65 years and older. Since 2001, however, suicide rates among those ages 25–64 have risen consistently, and, since 2006, suicide rates have been greater for those ages 65 and older (CDC, 2013b). This increase in suicide rates among middle-aged Americans has prompted concern in some quarters that baby boomers (individuals born between 1946–1964) who face economic worry and easy access to prescription medication may be particularly vulnerable to suicide (Parker-Pope, 2013).
• The highest rates of suicide within the United States are among American Indians/Alaskan natives and non-Hispanic Whites (CDC, 2013b).
• Suicide rates vary across the United States, with the highest rates consistently found in the mountain states of the west (Alaska, Montana, Nevada, Wyoming, Colorado, and Idaho) (Berman, 2009).

Contrary to popular belief, suicide rates peak during the springtime (April and May), not during the holiday season or winter. In fact, suicide rates are generally lowest during the winter months (Postolache et al., 2010).

Celebrity Suicides

Figure 2. Celebrity chef Anthony Bourdain.

In early June 2018, celebrity chef Anthony Bourdain was working on an episode of Parts Unknown in Strasbourg, with his frequent collaborator and friend Éric Ripert. On June 8, Ripert became worried when Bourdain had missed dinner and breakfast. He subsequently found Bourdain dead of an apparent suicide by hanging in his room at Le Chambard hotel in Kaysersberg near Colmar. Bourdain was 61 years old.

Christian de Rocquigny du Fayel, the public prosecutor for Colmar, said Bourdain’s body bore no signs of violence and the suicide appeared to be an impulsive act. Rocquigny du Fayel disclosed that Bourdain’s toxicology results were negative for narcotics, showing only a trace of a therapeutic non-narcotic medication. Bourdain’s body was cremated in France on June 13, 2018, and his ashes were returned to the United States two days later.
Bourdain’s mother, Gladys Bourdain, told The New York Times, “He is absolutely the last person in the world I would have ever dreamed would do something like this.”

Following the news of Bourdain’s death, various celebrity chefs and other public figures expressed sentiments of condolence. Among them were fellow chefs Andrew Zimmern and Gordon Ramsay and former astronaut Scott Kelly. CNN issued a statement, saying that Bourdain’s “talents never ceased to amaze us and we will miss him very much.” Former U.S. President Barack Obama, who dined with Bourdain in Vietnam on an episode of Parts Unknown, wrote on Twitter, “He taught us about food—but more importantly, about its ability to bring us together. To make us a little less afraid of the unknown.” On June 8, 2018, CNN aired Remembering Anthony Bourdain, a tribute program.

In the days following Bourdain’s death, fans paid tribute to him outside his now-closed former place of employment, Brasserie Les Halles. Cooks and restaurant owners gathered together and held tribute dinners and memorials and donated net sales to the National Suicide Prevention Lifeline.

Bourdain’s death came just days after the suicide of designer Kate Spade.

Watch this video from CBS in the aftermath of Bourdain’s death as it discusses some of the risk factors for suicide.

You can view the transcript for “Anthony Bourdain’s death: Dr. LaPook on suicide risk factors” here (opens in new window).

Risk Factors for Suicide

Figure 3. Alcoholism is a significant risk factor for suicide.

Suicidal risk is especially high among people with substance abuse problems. Individuals with alcohol dependence are at 10 times greater risk for suicide than the general population (Wilcox, Conner, & Caine, 2004). The risk of suicidal behavior is especially high among those who have made a prior suicide attempt. Among those who attempt suicide, 16% make another attempt within a year and over 21% make another attempt within four years (Owens, Horrocks, & House, 2002). Suicidal individuals may be at high risk for terminating their life if they have a lethal means in which to act, such as a firearm in the home (Brent & Bridge, 2003). Withdrawal from social relationships, feeling as though one is a burden to others, and engaging in reckless and risk-taking behaviors may be precursors to suicidal behavior (Berman, 2009). A sense of entrapment or feeling unable to escape one’s miserable feelings or external circumstances (e.g., an abusive relationship with no perceived way out) predicts suicidal behavior (O’Connor, Smyth, Ferguson, Ryan, & Williams, 2013). Tragically, reports of suicides among adolescents following instances of cyberbullying have emerged in recent years. In one widely publicized case, Phoebe Prince, a 15-year-old high school student in Massachusetts, committed suicide following incessant harassment and taunting from her classmates via texting and Facebook (McCabe, 2010).

Suicides can have a contagious effect on people. For example, another’s suicide, especially that of a family member, heightens one’s risk of suicide (Agerbo, Nordentoft, & Mortensen, 2002). Additionally, widely publicized suicides tend to trigger copycat suicides in some individuals. One study examining suicide statistics in the United States from 1947 to 1967 found that the rates of suicide skyrocketed for the first month after a suicide story was printed on the front page of the New York Times (Phillips, 1974). Austrian researchers found a significant increase in the number of suicides by firearms in the three weeks following extensive reports in Austria’s largest newspaper of a celebrity suicide by gun (Etzersdorfer, Voracek, & Sonneck, 2004). A review of 42 studies concluded that media coverage of celebrity suicides is more than 14 times more likely to trigger copycat suicides than is coverage of non-celebrity suicides (Stack, 2000). This review also demonstrated that the medium of coverage is important: televised stories are considerably less likely to prompt a surge in suicides than are newspaper stories. Research suggests that a trend appears to be emerging whereby people use online social media to leave suicide notes, although it is not clear to what extent suicide notes on such media might induce copycat suicides (Ruder, Hatch, Ampanozi, Thali, & Fischer, 2011). Nevertheless, it is reasonable to conjecture that suicide notes left by individuals on social media may influence the decisions of other vulnerable people who encounter them (Luxton, June, & Fairall, 2012).

One possible contributing factor in suicide is brain chemistry. Contemporary neurological research shows that disturbances in the functioning of serotonin are linked to suicidal behavior (Pompili et al., 2010). Low levels of serotonin predict future suicide attempts and suicide completions, and low levels have been observed post-mortem among suicide victims (Mann, 2003). Serotonin dysfunction, as noted earlier, is also known to play an important role in depression; low levels of serotonin have also been linked to aggression and impulsivity (Stanley et al., 2000). The combination of these three characteristics constitutes a potential formula for suicide—especially violent suicide. A classic study conducted during the 1970s found that patients with major depressive disorder who had very low levels of serotonin attempted suicide more frequently and more violently than did patients with higher levels (Asberg, Thorén, Träskman, Bertilsson, & Ringberger, 1976; Mann, 2003).

Suicidal thoughts, plans, and even off-hand remarks (“I might kill myself this afternoon”) should always be taken extremely seriously. People who contemplate terminating their life need immediate help. Below are links to two excellent websites that contain resources (including hotlines) for people who are struggling with suicidal ideation, have loved ones who may be suicidal, or who have lost loved ones to suicide: American Foundation for Suicide Prevention and American Association of Suicidology.