women are twice as likely as men to experience episodes of major depression in the United States, they are 25 percent less likely than men to complete suicide (Murphy, 1998). There are several factors that may explain this. Men who are depressed have a higher prevalence of comorbid alcohol and substance abuse than women. Also, men’s depression in later life is more likely to go unrecognized and untreated than women’s depression (Rihmer et al., 1995). Murphy (1998) suggests that men may regard a need for help as a weakness and consequently avoid help seeking; while women may place a higher value on interdependence and consider how their actions will affect others to a greater degree than do men.

A comparison of male and female suicide victims provides additional clues as to the gender differences for completed suicide (Brent et al., 1999). First, females are more likely to engage in suicidal behavior using potentially reversible methods, such as overdose. Second, females are less likely to use alcohol during a suicide completion. Third, alcohol intoxication in the context of a suicide increases the likelihood of use of a gun for completion of suicide in males, but not females.

Youth

Although suicide rates for all age groups have been relatively stable since the 1950s, the reported rate among adolescents has increased markedly. Between 1970 and 1990, the rates for youth aged 15 through 19 nearly doubled; the rate tripled since the mid 1950s. Since 1990, the overall suicide rate for this age group has stabilized at approximately 11 deaths per 100,000. One national school-based study of youth found high one-year prevalence rates for suicide attempts (7.7 percent), ideation (20.5 percent), and making a plan (15.7 percent) (Kann et al., 1998). The increase in the suicide rate is thought to be attributable to an increase in alcohol and substance abuse and increased availability of firearms over this period of time (Brent et al., 1987). Being unemployed or out of school was associated with completed suicide in a large case-control study completed in New York (Gould et al., 1996; Shaffer et al., 1996). In other countries that experienced a dramatic increase in suicide in the past 10 years, such as New Zealand and in the province of Quebec, social change, including diminishing opportunities for employment, is thought to be a primary factor (Beautrais, 2000).

Suicide victims under the age of 30 are more likely to have problems with substance abuse, impulsive aggressive personality disorders, and precipitants such as interpersonal and legal problems (Rich et al., 1986b) than those over 30. Co-occurrences of mental illness, substance abuse, conduct disorder, or all three are significant risk factors for suicide, but



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