considered when assessing risk factors, particularly in the elderly, although only 2–4 percent of terminally ill elderly complete suicide. Suicidal ideation is rare without depression even in the terminally ill. Untreated or under-treated pain, anticipatory anxiety regarding the progression of medical illness, fear of dependence, and fear of burdening the family are the major contributing factors in the suicidality of elderly with medical illness. Adequate management of chronic pain decreases the request to die among cancer patients (Foley, 1991). When pain and depression are adequately treated, most previously suicidal elderly express a wish to live (Hendin, 1999). In one study, two-thirds of the patients who requested euthanasia changed their minds during a 2-week follow-up period (Hendin, 1999).
Suicide, like many health outcomes, varies widely across different racial and ethnic groups in the United States (IOM, 2002). Over the last twenty years, when considering all age groups and both sexes, whites and Native Americans have the highest suicide rates, varying from approximately 11 to 14 per 100,000 (NCIPC, 2000). Asian-Pacific Islanders and African-Americans and Hispanics2 have rates at approximately half— averaging 6.14 to 6.53 per 100,000 across this same time-span (NCIPC, 2000). These differences are even more complex when examined by gender (Figure 2-6), as well as age group. Mining the reasons underlying such differences may hold important information for reducing suicide (Chapter 6). Below we discuss the differences in suicide rates for African Americans and Native Americans in greater detail.
The rate of suicide among African Americans has historically been lower than that of whites, but in young black males the gap has been gradually closing (see Table 2-2; Griffith and Bell, 1989). In fact, the rate of increase in young black males has been a cause for concern. From 1980 to 1995, the suicide rates for black youth ages 10–19 increased from 2.1 to 4.5 per 100,000—an increase of 114 percent. For comparison over the same time, the rates in white males of the same ages increased from 5.4 to 6.4 per 100,000. The suicide rate increased the most for blacks ages 10–14 years (233 percent; CDC, 1998). The convergence of black and white rates was more dramatic with different age groups. For example in 1986 in