especially in adolescent males (Brent et al., 1999; Shaffer et al., 1996). In general, suicidal behavior is a more impulsive act in younger people. Younger people are less likely to complete a suicide than older people. Even within the adolescent age range, younger adolescents who complete suicide show lower suicidal intent than older ones (Brent et al., 1999; Groholt et al., 1998). Furthermore, youth are more likely to be influenced by media presentations of suicide and to die in cluster suicides1 (although even so, only about 5% of youth suicides occur in clusters; Gould and Shaffer, 1986; Gould et al., 1990; Phillips and Carstensen, 1986).

Guns are the most common mechanism of suicide among youths. In a case-control study of suicide, the availability of guns in the home conveyed the largest risk in adolescents and young adults (Kellermann et al., 1992). A comparison of the suicide rates in Seattle and Vancouver (see also Chapter 8) showed that when gun control was absent (in the United States) youth (15–24) suicide was significantly greater, with 10-fold more suicide by firearms (Sloan et al., 1990).

Moreover, guns in the home, particularly loaded guns, pose up to a 30-fold increased risk for suicide, especially among individuals without major mental disorder (Brent et al., 1993; Kellermann et al., 1992). The rate of psychopathology among younger adolescent suicide victims is much lower than among older adolescents, so that the availability of guns becomes the paramount risk factor for younger, impulsive individuals (Brent et al., 1999; Shaffer et al., 1996).

Elderly

In almost all industrialized countries, men 75 years of age and older have the highest suicide rate among all age groups (Pearson et al., 1997). Of the countries that provide suicide data, Hungary has the highest suicide rates for both elderly men and women: in 1991–1992, the suicide rate for men 75 years and older was as high as 177.5/100,000 (Sartorius, 1996). The lowest rates for both elderly men and women were in Northern Ireland and England/Wales, with rates for men of 20/100,000 and 18/ 100,000, respectively (Schweizer et al., 1988).

In 1990 the United States had a suicide rate of 24.9/100,000 for men aged 75–84. In 1998 the rate had risen to 42.0/100,000. Although older individuals comprise approximately 10% of the U.S. population, they account for 20% of the completed suicides (Hoyert et al., 2001; Hoyert et al., 1999). Men account for about four out of five completed suicides among those older than 65. This is partly explained by the fact that men are more

1  

The term cluster suicides refers to higher-than-expected numbers of suicides occurring in a small geographic area within a limited time period.



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