It is generally agreed that official suicide statistics understate the actual number of suicides, perhaps by as much as half. Such underrepresentation is due to social stigma against suicide, the need for unequivocal proof before classifying a death as suicide, suicides that masquerade as accidents or victim-precipitated homicides, and sensitivity to survivors' concerns, as well as to differences in the manner in which coroners’ and medical examiners' investigations of possible suicides are conducted in different jurisdictions.
The psychological autopsy is a potent investigative tool for improving suicide statistics as well as enhancing knowledge about the factors that influence suicidal behavior.
Theoretical approaches to explaining suicide are based mainly on a sociological model (focusing on the relationship between the individual and society) and a psychological model (focusing on the dynamics of an individual's mental and emotional life). A comprehensive understanding of suicide makes use of both models.
Typologically, suicidal behavior can be classified as an escape from some mental or physical pain, as due to impaired logic caused by clinical depression or psychosis, as the unconscious result of chronic or subintentional factors hastening death, and as a cry for help in alleviating some problem.
There may be two fairly distinct populations of people engaging in suicidal behaviors: attempters and completers. It must be recognized, however, that any suicide attempt can end in death.
Culture, personality, and the unique combination of circumstances affecting a particular individual's life each play a role in determining the degree to which a person may be at risk of suicide; neurobiological correlates may also be important as a risk factor in suicide.
The varying risk of suicide also corresponds to changes in outlook and circumstance that occur throughout the lifespan. Suicide among adolescents and young adults is viewed as a major public health problem.
The likelihood of a fatal outcome increases as a suicidal person plans his or her demise and acquires the means to carry out the plan; as the potential lethality of the method increases, the more likely the outcome will be death. There is an "order of lethality" among the various methods people employ when engaging in suicidal behavior.
Suicide notes reflect a range of concerns by people who kill themselves, from simple reminders directed to survivors about carrying out ordinary tasks to complex explanations about why the person chose to end his or her life. A sense of ambivalence is a hallmark of many suicide notes.
Suicide prevention, intervention, and postvention are important avenues for reducing the incidence of suicidal behavior and easing the pain of loss for people who are bereaved as a result of a loved one’s suicide.
When helping a person in suicidal crisis, one must listen carefully to what the person is communicating, both verbally and behaviorally, and offer compassion and support.
