Suicide Research Paper

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1. Definition

The term suicide was mentioned for the first time in medieval times in 1177 (van Hooff 1990) according to the Latin sui cidium (self-killing) and sui caedere (to kill himself/herself). Now, this term is used in the international scientific literature. It avoids judgment, as do terms like ‘self murder’ and ‘voluntary death.’

In the realm of the term suicide, there are other terms that have to be defined. Suicide ideas include: thinking about death either of one’s own or someone else’s or death in general; the wish to die; suicide ideas in a more narrow sense. It is not easy to define the term suicide attempt. The definition most commonly accepted is the following: ‘An act with nonfatal outcome, in which an individual deliberately indicates a nonhabitual behavior that, without the intervention of others, will cause self-harm, or deliberately ingests a substance in excess of the prescribed or generally recognized therapeutic dosage, and which is aimed at realizing changes which the subject desired via the actual or expected physical consequences’ (WHO 1989, Platt et al. 1992). This definition includes an active intention for self-harm but not necessarily self-killing. Suicide and suicide attempt are also considered as suicidal behavior.

2. Importance Of Suicide

Suicide belongs to the 10 most frequent causes of death among adults in industrialized European and North American countries. In these countries, suicide is considered the second most frequent cause of death among adolescents and young adults (15–35 years). Suicide in young male adults has increased constantly during the last 20 years. Table 1 shows the frequencies of causes of death worldwide (WHO 1990) disregarding the most frequent causes of death such as cardiovascular diseases, stroke, cancer, infectious diseases, and malnutrition. These figures have to be taken cum grano salis because of a dearth of or inaccurate statistics on death in developing countries. As shown in Table 1, only fatal car accidents had a similar frequency of death as compared with suicide rates. War activities, crime, or even AIDS at the beginning of the 1990s had a considerably lower death rate.

Suicide Research Paper Table 1

3. Epidemiology

The most recent available suicide rates from all over the world are depicted in Fig. 1. This shows that a high variability of suicide rates exists across cultures and countries. Looking at the rank order of the frequency of suicide rates, a relatively stable pattern can be described—at least for European countries. There exist a North–South down gradient and a East–West down gradient of suicide rates: eastern and northern countries have higher suicide rates than western and southern countries. Hereby, sociological factors seem to play an important role in terms of secularization and industrialization with the collapse of the family group as a consequence as well as climate factors, which cannot be disentangled sufficiently.

Suicide Research Paper Figure 1

There exist distinct sex differences with a preponderance of males in suicide and preponderance of females in suicide attempt. This distribution is stable across all countries and cultures. Only China reports a prevalance of suicide among women in selected areas.

The highest rate of suicide is found in people of older age and that of suicide attempt in younger people. Suicidal behavior has been found very rarely in children but, without doubt, there is clinical evidence that children from 4 years of age have suicide ideas and make a suicide attempt or kill themselves. However, suicide occurring in children before prepuberty is very rare. Furthermore, it has to be taken into consideration, that until prepuberty (8–10 years) children normally do not experience death as something irreversible (Pfeffer 1986). Cultural differences exist in terms of using different suicide methods. Socalled weak suicide methods (ingestion of drugs, wrist cutting) and hard suicide methods (shooting, hanging, jumping, drowning, etc.) will be distinguished. Weak suicide methods prevail in suicide attempts, hard methods in successful suicide. In general, females more often prefer weak methods than males. The most frequent method for suicide in females and males in North America is shooting, in Europe hanging.

Suicide rates in several European countries such as Germany, England and Wales, France, Hungary, and the Nordic countries show an astonishing stability over decades and even a century. The same holds true for counties such as Saxonia, Brandenburg, and Thuringia, where suicide rates have been stable over a century. Figure 2 depicts suicide rates over one century in Germany (Deutsches Reich and Federal Republic of Germany) (Wedler 1992). Such stability can be traced also (in other countries) back to the nineteenth century such as in Prussia, France, and the Nordic countries. On the other hand, there have been dramatic changes in suicide rates as during the nineteenth century, where secularization, industrialization, and individualization have taken place in western and northern European societies. During World War I and II further dramatic changes occurred not only affecting both males and females but also countries which have not been involved in these wars, such as Switzerland. Finally, the last changes have occurred after the fall of the Iron Curtain in Eastern Europe between 1985 and 1995 with a dramatic decrease in suicide rates by up to 40 percent (Diekstra 1996).

Suicide Research Paper Figure 2

4. Differing And Common Aspects Between Suicide And Suicide Attempts

There are considerable differences between suicide attempters and suicide victims (Stengel 1964). The group of suicide victims is rather small in comparison with the group of suicide attempters. The sociodemographic characteristics are quite different: suicide victims are older and predominantly male, suicide attempters are younger age and predominantly female. The tendency of a transition from the group of suicide attempters to the group of suicide victims is rather small with a 10 percent chance. Whereas the life of the victim is terminated by suicide, a nonfatal suicide attempt becomes a very important event in the life of this person, often with a change in the further life trajectory.

Nevertheless, there are also some common aspects between these two groups: the probability of suicide is higher, the more often suicide attempts happen. Despite the fact that more males are committing suicide and more females make a suicide attempt, there is a considerable overlap between both groups. The same holds true for age distribution: a considerable proportion of young males and females commit suicide, while older males and females make suicide attempts. Most of the risk factors are equally valid for both suicide victims and suicide attempters (see below).

5. Risk Factors For Suicide And Suicide Attempts

Risk factors for suicide and suicide attempts are as follows: increased age; marital status like being separated, divorced, widowed; single; unemployment; gender and economical status (suicide occurs more often in males, suicide attempts occur more often in females and the lowest social class). The most important risk factors for suicide and suicide attempts, however, are a previous suicide attempt and a psychiatric disorder (Kreitman 1977).

Psychiatric hospitals bear a great risk of losing a patient to suicide. It has been estimated that 15 percent of depressed patients, 15 percent of patients with a drug or alcohol addiction, and 10 percent of patients with schizophrenia, who have been treated in a psychiatric hospital, finally die by committing suicide. Patients with anxiety disorders or personality disorders also have a considerable risk of committing suicide. From an epidemiological point of view, subjects with a depression or an addiction have a 15fold to 60-fold higher risk of committing suicide as compared with the general population (Bronisch 1999).

There are differences between urban and rural areas with respect to suicide rates. The highest suicide rates are seen in urban areas, whereas the lower rates are seen in rural areas. An exception are the states of the former USSR, where a preponderance of suicide rates in rural areas is found.

Climate seems also to play an important role in the distribution of suicide rates. The highest suicide rates are found during late spring and summer time. This distribution can be found across the northern as well as the southern hemispheres. Countries in southern parts of Europe show a lower suicide rate than countries in the northern parts of Europe.

Religious affiliation also plays in important role in the frequency of suicides. Especially in those countries with a predominance of Catholics, suicide rates are lower, whereas in countries with a predominance of Protestants, suicide rates are higher. However, if the degree of urbanization and the distribution of social classes are taken into consideration, the differences between catholic and protestant countries are fading (Kreitman 1977).

6. Origins Of Suicidal Behavior

6.1 Suicide As A Basic Human Existential Problem

Ever since the written history of mankind, suicide has been considered a basic human existential phenomenon that has been reflected in many philosophical and religious contributions as well as in all kinds of arts. The attitude towards suicide did not only depend on the Zeitgeist of the respective historical period, but also on the individual stance of different philosophical schools such as of Stoa and Epikur in antiquity and different religions such as Christianity and Buddhism. The sociological theories are a consequence of the enlightment of the seventeenth and eighteenth centuries. During the second half of the nineteenth century, psychological theories developed upon the influence of psychological thinking and emerging psychoanalysis. During the second half of the twentieth century, biological theories were finally stimulated by the natural sciences focusing on the brain.

Suicide requires self-reflecting properties of an individual, i.e., an individual who can differentiate between an observing and experiencing ego. Suicide does not exist in animals. Even nonhuman primates do not show suicidal behavior, neither in natural settings nor in preservations. However, suicide has been found in Neolithic societies.

6.2 Sociological Aspects

6.2.1 Durkheim´s theory. Sociological theories are influenced by the theory of Durkheim (1897) based upon the evaluation of suicide statistics of western European countries (France and Prussia) during the second half of the nineteenth century. Durkheim proposed four different types of suicide depending on the degree of successful adaptation of the individual to different types of societies. A prerequisite to adaptation of the individual to society is that individualization is neither too weak nor too strong. If the individualization is too strong, the individual will be isolated from society and the danger of an egoistic suicide increases. If the individualization is too weak, the danger of an altruistic suicide increases.

On the other hand, a prerequisite to the equilibrium between the individual and society is that social norms are neither too strong nor too unspecific. Norms that are too strong facilitate fatalistic suicide such as an expiatory death. Norms that are too unspecific favor anomic suicide. With the help of the existing suicide statistics, Durkheim tried to verify three of the four types (he did not discuss the fatalistic suicide). He tried to prove that Protestant countries have a higher suicide rate than Catholic countries, since Protestantism allows the individual a higher degree of freedom than does Catholicism: it is called egoistic suicide. He explained the increase in suicide rates during political crises (Dreyfuss affair in France) in terms of an egoistic suicide. During times of flourishing economic growth, implying a derestriction of social norms, suicide rates should lead to an anomic suicide, whereas during times of war, stronger norms lead to a stronger coherence of society resulting in a decrease in suicide rates.

6.2.2 General Sociological Trends. During the nineteenth century, only parts of Durkheim s theories could be confirmed such as the differences between Catholic and Protestant countries in western Europe and the decrease of suicide rates during both world wars. Generally speaking, Durkheim s data and statistical data from the twentieth centuries could demonstrate an increase in suicide in Europe during the nineteenth and twentieth centuries depending on the development of industrialization, secularization, and individualization of the respective countries, i.e., the more pronounced these developments were the more frequent suicide and suicide attempts occurred (Retterstol 1992). However, through the fall of the Iron Curtain in Eastern Europe between 1985 and 1995, the theory of anomic suicide has been opposed. Also, a remarkably stable sex difference with male preponderance in suicide and female preponderance in suicide attempts has been shown in nearly all cultures and societies. Another quite remarkable trend of the last decades has been the increase in suicide rate of 15–35-year-old adolescents and young adults. In most western societies, this development has been correlated with an increasing rate of depression and addiction potential. An increasing urbanization, loss of social structures and familial bonds, as well as changes in sex roles may play an important role in this development (Klerman 1987).

6.3 Psychological Aspects

Psychological models include psychodynamic, attachment, and cognitive-behavioral theories that are only partially substantiated by empirical research. The main theories are concerning aggression directed inward instead of outward, the loss of a symbiotic relationship, and a severe personal insult resulting in severe loss of self-esteem. Finally, classical conditioning, operant conditioning, and model learning are, in terms of the behavioral point of view, also of great importance.

6.3.1 Aggression Directed Against The Ego. Freud (1917) conceptualized one of the first psychological theories about the development of suicidal behavior in ‘mourning and melancholia.’ To him, the psychodynamics of suicidal behavior and depression were indistinguishable, i.e., suicidal behavior and depression were seen as a turn of aggression against the ego and an ambivalent attitude towards other people. Aggression directed against other people will be followed by loss of a desperately needed person. Turn of the aggression against the ego is expressed by feelings of guilt, self-devaluation, and finally self-killing.

6.3.2 Distorted Cognitive Schemes. Beck (1967) also emphasized a strong connection between suicidal behavior and depression. The depressive sees himself, the world, and the future (so called cognitive triade) negatively because of their distorted cognitive schemes. Catastrophization, minimizing, maximizing, and overgeneralization belong to typically distorted cognitive schemes. As a consequence of such a cognitive triade, helpnessless, hopelessness, and powerlessness result. In this case, the only solution for an individual may be to end their miserable life by committing suicide.

6.3.3 Narcissistic Crisis. Henseler (1974 1984) formulated the first narcissistic theory of suicidal behavior. Individuals with narcissistic personality traits are people who can be hurt easily by significant others through criticism or lack of special attention. They are lacking a stable self-esteem and their self-perception is distorted: they oscillate between overestimation and underestimation of their own abilities. This is not restricted to one’s own character but also extends onto a corresponding distorted view of other people. Insults through criticism or lack of special attention lead to aggressive outbursts that can be directed either towards others or their own character in terms of a suicide or suicide attempt.

6.3.4 Appeal To Human Bonding. Attachment of the newborn to the mother is a characteristic common to all mammals. In all mammals, the newborn is very dependent and the reproductivity rate at least in the nonhuman and human primates is rather small. Therefore, the strong attachment is a life-preserving measure of the evolution to protect the dependent newborn until it is grown up. The emotional bonding in primates is very intense, a separation of the mother will be experienced as very painful (Bowlby 1977a, 1977b).

As has been known from many empirical studies, most suicides and suicide attempts are consequences of imminent separation, separation, or divorce of males and females. The intention to die is ambivalent in most suicide attempts, i.e., besides a true tendency to end life in nearly all suicide attempts there are tendencies to survive. That can be seen easily in the choice of suicide methods, which often are not so dangerous, i.e., ingestion of small amounts of pills, or in the arrangement of suicide attempt that leaves a rescue open, i.e., by attempting suicide in the presence of a significant other.

The painfully expected or experienced separation from a significant other and the appeal of the significant others not to be left behind both seem to play an important role in the meaning of a suicide attempt (Bronisch 1995).

6.3.5 Classical And Operant Conditioning. Basic principles of behavioral theory and therapy can be described using the Stimulus Organism Reaction Kontingency Consequence Scheme (SORKC scheme) of Kanfer (Schmidtke 1988) (see Fig. 3). The SORKC scheme tries to describe each behavior in a broader context of conditions, which can be placed linearly in a chain or circle. The constituents of the SORKC scheme for suicidal behavior are the following:

(a) life events and social situations as Stimuli variables (S), which may trigger suicidal behavior;

(b) behavioral repertoire based upon organic conditions of the individual such as psychiatric disorders and the personality (e.g., cognitive styles and stances) as Organism variable (O), which may predispose to suicidal behavior;

(c) suicidal behavior as a reaction (R) to the S and O variables;

(d) Kontingency (K), i.e., the reinforcement conditions, which support or suppress suicidal behavior; and behavior according to a regular or irregular order of the consequences;

(e) Consequences (C) in the sense of negative reinforcement (e.g., death) or positive reinforcement (attention of the environment) of suicidal behavior.

The process hereby is rather circular, i.e., consequences can again influence further suicidal behavior. This might be possible by changing the individual (O variable) and the surroundings (S variable).

Suicide Research Paper Figure 3

6.3.6 Model Learning. Imitation of suicidal behavior is a new area in suicide research. The observation that suicidal behavior is running in certain families, cultures, and countries could be explained by genetic transmission, psychological conflicts, or by model learning. In regard to model learning, three hypotheses have been proposed: the imitation hypothesis, the contagion hypothesis, and the suggestion hypothesis. All three hypotheses have in common that suicidal behavior of a model will be imitated, whereby predisposition of the individual (so-called ‘presuicidal personality’), lack of social support in coping with life crises and enduring social burden are the contributing factors. Furthermore, a high degree of social suggestibility of predisposed individuals plays an important role.

During the 1980s and 1990s the influence of different media, such as books, newspapers, journals, television, and movies, on increasing suicide rates can be demonstrated (Phillips and Lesyna 1995). Suicide victims have resembled the person portrayed by the respective media: there have been similarities between this person and the suicide victim in terms of age, gender, motives for the suicide, and the methods used for suicide. The increase of suicide rate was in temporal relationship to the reported suicide cases and was not compensated by a decrease in later time, i.e., these suicides were committed earlier than planned. Also very impressive are studies that demonstrate a decrease in suicide rates not only by changing the information towards being more informative and being less sensational, but also by reducing information about suicide (Phillips and Lesyna 1995). One example is a study of railway suicides reported in newspapers, which could be reduced by cooperation with local newspapers in reducing and confining to nonsensational reports on this matter (Sonneck et al. 1994).

In a broader sense, traditions in different cultures and countries concerning either permissive or restrictive attitudes towards suicide can also be regarded as a form of model learning. These attitudes may be transferred over generations such as in Hungary where an extremely high suicide rate can be observed throughout an entire century.

6.4 Biological Aspects

During the nineteenth century, Esquirol (1838) was the first to observe that suicidal behavior ran in families and, therefore, postulated that suicidal behavior was a kind of mental illness. Family, twin, and adoption studies gave hints about suicidal behavior having a genetic component.

There is a familial burden due to suicide and suicide attempts (of suicide victims or suicide attempters as compared with subjects without suicide or suicide attempts). Separation of nature (heritage) and nurture (rearing) is not possible within family studies, but is within twin and adoption studies. In twin studies, identical (identical genes) and fraternal twins (half of the genes are nonidentical as in sisters and brothers) are compared with regards to suicide or suicide attempts. The respective studies demonstrate a significantly higher frequency of suicide and suicide attempts in identical as compared with fraternal twins (Roy et al. 1991). In adoption studies, identical twins have been compared with each other, whereby one twin has been raised with his biological parents, while the other twin has been adopted right away after birth. Significantly fewer twins raised by their biological parents developed suicidal behavior or committed suicide than twins who had been adopted following birth. Furthermore, within biological families, a significantly higher rate of suicides or suicide attempts was shown than within adoptive families of the respective identical twin. All these studies also demonstrate that suicidal behavior has to be seen apart from a specific psychiatric diagnosis, especially apart from a depressive illness. On the other hand, the distinctive feature that might be inherited may not be suicidal behavior as such but rather personality traits such as lack of impulse control or aggressiveness (Wender et al. 1986). Postmortem studies of suicide victims and in vivo studies (investigation of cerebrospinal fluid and the platelets in the blood of suicidal persons concerning molecular genetic, biochemical and physiological parameters) support the so-called serotonin hypotheses of suicidal behavior: impulsiveness, aggression directed inwards or outwards, and violent suicidal behavior are correlated with a dysfunction of the serotonergic transmitter system in the human brain (Mann 1998).

7. Prevention

Prevention can be divided into primary, secondary, and tertiary prevention. With regard to primary prevention the main focus implies a reduction of tendencies within the society that support suicidal tendencies. A verdict of suicidal behavior by means of social ostracizing or punishment has not been successful in reducing suicide rates in medieval and modern times (Minois 1995). However, primary prevention also concerns the prevention of suicidal behavior by ameliorating life conditions in general and socioeconomical conditions in particular as well as effective treatment of psychiatric disorders. It also refers to a support of tolerance for individual life styles. Furthermore, the restricted approach to frequently used methods, such as guns for shooting, can be helpful. Primary prevention implies also an amelioration of power of resistance against suicidal tendencies in the individual. Education of lay people and professionals in detecting and treating suicidal persons could be the most effective strategies. Secondary and tertiary prevention provided by fellow citizens (e.g., Samaritans) or medical or psychological professional personnel mean prevention of relapses in suicidal behavior or rehabilitation of patients with suicidal behavior. Empirical studies proving the effect of the above mentioned preventive strategies are still lacking. There is now an emerging trend to develop national suicide prevention programs in several western and northern European countries (Silverman and Maris 1995).

8. Therapy

Therapy has to be divided into crisis intervention, with actual psychiatric-psychotherapeutic intervention, into pharmacotherapy and psychotherapy. Crisis intervention primarily means prevention of an imminent danger of suicide. Crisis intervention should provide care and protection to the individual, i.e., protection of life, since suicide attempts often require medical care such as admission to an internal intensive care unit for detoxification or a surgical intervention. Crisis intervention also includes immediate evaluation of still existing suicidal tendencies of the patient in order to make decisions for further preventive measures: admission to a closed psychiatric ward for relapse prevention or crisis intervention on an inpatient or outpatient basis. Crisis intervention also includes acute psychotherapy and pharmacotherapy of the patient. The most important determinant of the psychotherapy is hereby the development of a supportive relationship between the suicidal person and the therapist. The greater the time lapse between the suicide attempt and help offered, the more often suicidal people are inclined to disregard this help. A supportive relationship means that the therapist is accepting the patient’s ‘cry for help’ and is making a commitment trying to understand the patient, however, is not willing to accept the patient’s decision to end their life as a form of reasonable problem solving. They clarify the triggering situation that has led to the suicide attempt. Together with the patient, the therapist tries to develop other strategies to resolve seemingly insoluble conflicts in the patient’s life. Also, an important determinant of a successful intervention is the involvement of significant others of the patient as well as the social environment in general. The acute pharmacological intervention means primarily sedation of the patient in order to keep him or her from further suicidal behavior.

Psychotherapy means treatment of psychopathological states such as depression, dysfunctional behaviors like impulsiveness, or pathological personality traits such as low self-esteem (Bronisch 1999). It includes the classical types of psychotherapy, i.e., psychodynamic approaches and cognitive-behavioral approaches. So far, empirical studies could only demonstrate efficacy for some groups of patients, such as patients with Borderline Personality Disorders by cognitive-behavioral therapies (Linehan 1997).

Pharmacotherapy of suicidal behavior primarily is focused on the underlying psychiatric illness of the patient such as schizophrenia (antipsychotics), depressive disorders (antidepressants), anxiety disorders (anxiolytics), and addiction (drugs against withdrawal symptoms). However, during the 1990s drugs specifically targeting the typical characteristics of suicide attempters such as impulsiveness and aggressiveness seem to have been successful in reducing suicide and suicide attempts: lithium (Ahrens 1997) and selective serotonin reuptake inhibitors (Montgomery 1997).

9. Conclusion

Suicide and suicide attempt are a behavior confined to human beings. They are rooted fundamentally in the human existence and have as a prerequisite self-reflecting properties of the individual, i.e., conscious acting with the consequence or the attempt to extinguish the own existence.

The attempts to describe suicide and suicide attempt based on a single cause in only one dimension has been tried by Esquirol (1838) in biology, Durkheim (1897) in sociology, or Freud (1917) in psychology and seems to be inappropriate. Suicide and suicide attempt are multidetermined acts (Roy 2000). However, the weighting of different aspects of suicide and suicide attempt seems to be rather difficult to explain, so that in the following, only a synopsis of the empirical findings will be given.

Suicide is lacking in animals and even in nonhuman primates. However, it has already been found in Neolithic societies as well as later on in the old Greek and Latin societies. Precise empirical data about suicide in different countries and cultures has been lacking up to the nineteenth century so that a description of the development of suicide from the antiquity via the medieval to modern times is impossible. However, there is a considerable increase of suicides in societies with a high degree of secularization, industrialization, and individualization starting in the middle of the nineteenth century. For individual countries, there is often a stability of suicide rates on a high or low level depending at least in Europe on the degree of industrialization, religious affiliation and climate: northern countries with a high degree of industrialization, Protestant religious affiliation and rather few sunny days have considerably higher suicide rates than southern countries with a low degree of industrialization, Catholic religious affiliation, and many sunny days have lower suicide rates. The differences could best be explained by human bonding as a protective factor, whereas climate could influence biological rhythms, hence, triggering suicidal behavior.

In regard to sex differences and suicidal behavior, very stable differences exist between males and females with a male preponderance in suicide and female preponderance in suicide attempts. The reasons for these sex differences, which seem to be stable across countries, cultures, and times, have not been well investigated and need further empirical research. There is no doubt that psychological motives play not only an important role as triggers for suicidal behavior but also are important determinants for the development of suicidal behavior. The most important motive for suicidal behavior is certainly the impending loss of a human relationship, even if the wish to die outweighs the wish to survive in the suicidal act, i.e., in the seriousness of the suicide attempt. Besides that, the turning of aggressive tendencies towards the own character and narcissistic vulnerability are personality traits predisposing to suicidal behavior. From the cognitive-behavioral point of view, classical conditioning, operant conditioning, and model learning are basic learning principles, which also can be transferred to behaviors such as suicide and suicide attempt. This way, model learning is not only important for perpetuating suicidal behavior in families and peer groups but also in societies with traditional high (Hungary) suicide rates (so called imitation hypothesis).

In certain families, a genetic burden of suicidal behavior could be confirmed by twin and adoption studies. This genetic burden is often connected to psychiatric illnesses such as depressive disorder, addiction, anxiety disorder, schizophrenia, and personality disorder. Biological studies (postmortem brain and peripheral biochemical studies) could demonstrate a dysfunction of the serotonergic system in suicide victims and suicide attempters, which in psychopathological terms is correlated to a loss of impulse control, aggressiveness, affective instability, and violent suicide attempt.

As empirical studies could confirm, suicidal behavior is not a ‘normal’ behavior, but is rooted in psychological and biological abnormalities of the respondent with the corollary of prevention and therapy. However, empirical data about successful prevention of suicidal behavior is still lacking and successful therapeutic interventions only exist for subgroups of suicide attempters such as depressives with a successful treatment with lithium and serotonin reuptake inhibitors as well as cognitive behavioral therapy for patients with a borderline personality disorder. Life as a precious good, desperation, and suffering of the respondents as well as suffering of the relatives should bring the focus on suicide more into the scientific scope of view as other life threatening illnesses already have been for a long time.


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