• There are around 4000 recorded suicides per year in the UK, but it is estimated that it is under-reported by 30 to 50 per cent.
• It is among the 10 commonest causes of death, and the fourth commonest for young adults.
• Since the 1960s the rates have been increasing.

More women than men take overdoses, although the difference between the sexes is decreasing. Men are more likely to use violent means (hanging, shooting, jumping, cutting) or car exhaust fumes than women. One in six people who kill themselves leave a note.

Risk factors

• Men are more likely to kill themselves than women.
• Rates increase with age and are highest at 60 to 75 years old. However, in recent years there has been a large and steady increase in the incidence of suicide in younger age groups and some decline in the elderly.
• The risk is higher in those who are divorced, widows and widowers. The lowest risk is in those who are married.
• Rates are higher in the unemployed than the employed.
• Some employment groups have high rates, including university students, doctors, dentists, vets, lawyers, farmers, policemen and insurance agents.
• Being an immigrant.
• Social isolation.
• Previous episodes of deliberate self-harm.
• Recent loss, e.g. bereavement (this includes pets), separation, redundancy.
• Long-term physical illness.
• Psychiatric illness. Up to 90 per cent of people who commit suicide have a psychiatric illness Around 70 per cent of people who commit suicide have some depressive symptoms, if not a clear depressive illness. Overall, 15 per cent of people with depression, schizophrenia or alcohol problems will commit suicide.

Only in a small minority is suicide a 'rational' choice.

There is an 'urban myth' that people who are seriously considering suicide do not talk about their feelings or intentions. Nothing could be further from the truth. Suicidal ideas are expressed by 68 per cent of people before they act.

Deliberate self-harm

Deliberate self-harm (DSH) patients are a mixed group, made up of those who have 'failed' to complete suicide, those who are uncertain about whether they want to die, and those whose intention is not to die.

There are extremely high rates of DSH, with up to 1 in 100 young women being admitted to hospital at least once with DSH. It is the commonest single cause of acute medical admission to hospital for women, and second only to heart disease in men.

Around 90 per cent of DSH acts are drug overdoses. Of non-overdose DSH, cutting oneself is the most common.

Self-cutting

This can be of three forms:

• deep and dangerous wound with high suicidal intent.
• self-mutilation, ie deliberately causing oneself damage, perhaps due to a psychiatric illness.
• superficial wounds. This is the largest group. Most commonly, young women with low self-esteem, poor control of their impulses, unstable moods, difficulty with relationships, and a tendency to misuse alcohol and drugs are affected.

DSH is more common in:

• The young than the old.
• Divorced, and single people.
• The unemployed.

People who have a psychiatric illness account for 15-20 per cent of DSH cases.

The majority of those who self-harm have experienced major life events, problems with relationships, broken homes, criminal records, child abuse, social isolation, anxiety over job or housing, etc.

Most commonly, DSH is unplanned following a crisis in the person's life. Serious suicidal intent is present in up to 15 per cent of those who self-harm.

Reasons given for acts of self-harm include:

• 'cry for help'
• 'escape from intolerable situation'
• 'relief from state of mind'
• 'attempt to influence others'
• 'testing the benevolence of fate'.

There is a considerable overlap between those people who deliberately harm themselves and those who kill themselves. In addition, there are significant rates of psychiatric illness in DSH patients. The seriousness of DSH should never be underestimated. One to two per cent of people who deliberately self-harm kill themselves within one to two years.

Things that raise concern in those that deliberately self-harm:

• the person expressing a clear intention to die, and remorse for having failed.
• planning the episode in advance.
• having taken steps to avoid being discovered.
• not attempting to obtain help afterwards.
• using violent methods.
• undertaking 'final acts' such as paying off bills, or writing a will.

What to do if you feel suicidal

• Speak to those around you about the reasons for feeling like this.
• Go to see your family doctor (GP).

What to do if someone you know talks of a wish to die (or you suspect they feel that way)

• Take the risk seriously (see above).
• Speak to them about it.
• Involve family and friends.
• Contact any of the services listed above.