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Suicidal ideation
Suicidal ideation
Other names	Suicidal thoughts, Suicidal ideas
	Sappho, an 1897 portrait by Ernst Stückelberg
Specialty	Psychiatry, psychology

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Suicidal ideation, or suicidal thoughts, is the thought process of having ideas, or ruminations about the possibility of ending one's own life.^[1] It is not a diagnosis but is a symptom of some mental disorders, use of certain psychoactive drugs, and can also occur in response to adverse life events without the presence of a mental disorder.^[2]

On suicide risk scales, the range of suicidal ideation varies from fleeting thoughts to detailed planning. Passive suicidal ideation is thinking about not wanting to live or imagining being dead.^[3]^[4] Active suicidal ideation involves preparation to commit suicide or forming a plan to do so.^[3]^[4]

Most people who have suicidal thoughts do not go on to make suicide attempts, but suicidal thoughts are considered a risk factor.^[5] During 2008–09, an estimated 8.3 million adults aged 18 and over in the United States, or 3.7% of the adult U.S. population, reported having suicidal thoughts in the previous year, while an estimated 2.2 million reported having made suicide plans in the previous year.^[6] In 2019, 12 million U.S. adults seriously thought about suicide, 3.5 million planned a suicide attempt, 1.4 million attempted suicide, and more than 47,500 died by suicide.^[7]^[8] Suicidal thoughts are also common among teenagers.^[9]

Suicidal ideation is associated with depression and other mood disorders; however, many other mental disorders, life events and family events can increase the risk of suicidal ideation. Mental health researchers indicate that healthcare systems should provide treatment for individuals with suicidal ideation, regardless of diagnosis, because of the risk for suicidal acts and repeated problems associated with suicidal thoughts.^[10]^[11] There are a number of treatment options for people who experience suicidal ideation.

Definitions

The ICD-11 describes suicidal ideation as "thoughts, ideas, or ruminations about the possibility of ending one's life, ranging from thinking that one would be better off dead to formulation of elaborate plans".^[1]

The DSM-5 defines it as "thoughts about self-harm, with deliberate consideration or planning of possible techniques of causing one's own death".^[12]

The U.S. Centers for Disease Control and Prevention defines suicidal ideation "as thinking about, considering, or planning suicide".^[13]

Terminology

Another term for suicidal ideation is suicidal thoughts.^[5]

When someone who has not shown a history of suicidal ideation experiences a sudden and pronounced thought of performing an act which would necessarily lead to their own death, psychologists call this an intrusive thought. A commonly experienced example of this is the high place phenomenon,^[14] also referred to as the call of the void, the sudden urge to jump when in a high place.^[15]

Euphemisms related to mortal contemplation include internal struggle,^[16] voluntary death,^[17] and eating one's gun.^[18]

Risk factors

The risk factors for suicidal ideation can be divided into three categories: psychiatric disorders, life events, and family history.

Psychiatric disorders

Suicidal ideation is a symptom of many mental disorders and can occur in response to adverse life events without the presence of a mental disorder.^[2]

There are several psychiatric disorders that appear to be comorbid with suicidal ideation or considerably increase the risk of suicidal ideation.^[19] For example, many individuals with borderline personality disorder exhibit recurrent suicidal behavior and suicidal thoughts. One study found that 73% of patients with borderline personality disorder have attempted suicide, with the average patient having 3.4 attempts.^[20] The following list includes the disorders that have been shown to be the strongest predictors of suicidal ideation. These are not the only disorders that can increase the risk of suicidal ideation. The disorders in which risk is increased the greatest include:^[21]

Anxiety disorders
Autism spectrum disorder^[22]
Major depressive disorder^[23]^: 162
Dysthymia
Bipolar disorder
Attention deficit hyperactivity disorder (ADHD)
Premenstrual dysphoric disorder (PMDD)
Post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (C-PTSD)^[23]^: 278
Personality disorders
Psychosis (detachment from reality)
Paranoia
Schizophrenia^[23]^: 104
Substance use disorders,^[24]^[25] inhalant use disorder^[23]^: 538
Body dysmorphic disorder^[23]^: 245
Nightmare disorder^[23]^: 405
Gender dysphoria^[23]^: 454
Conduct disorder^[23]^: 473
Specific learning disorder^[23]^: 70

Medication side effects

Antidepressant medications are commonly used to decrease the symptoms in patients with moderate to severe clinical depression, and some studies indicate a connection between suicidal thoughts and tendencies and taking antidepressants,^[26] increasing the risk of suicidal thoughts in some patients.^[27]

Some medications, such as selective serotonin reuptake inhibitors (SSRIs), can have suicidal ideation as a side effect. Moreover, these drugs' intended effects, can themselves have the unintended consequence of increased individual risk and collective rate of suicidal behavior: Among the set of persons taking the medication, a subset feel bad enough to want to attempt suicide (or to desire the perceived results of suicide) but are inhibited by depression-induced symptoms, such as lack of energy and motivation, from following through with an attempt. Among this subset, a "sub-subset" may find that the medication alleviates their physiological symptoms (such as lack of energy) and secondary psychological symptoms (e.g., lack of motivation) before or at lower doses than it alleviates their primary psychological symptom of depressed mood. Among this group of persons, the desire for suicide or its effects persists even as major obstacles to suicidal action are removed, with the effect that the incidences of suicide and suicide attempts increase.^[28]

In 2003, the U.S. Food and Drug Administration (FDA) issued the agency's strictest warning for manufacturers of all antidepressants (including tricyclic antidepressants [TCAs] and monoamine oxidase inhibitors)^[29] due to their association with suicidal thoughts and behaviors.^[30] Further studies disagree with the warning, especially when prescribed for adults, claiming more recent studies are inconclusive in the connection between the drugs and suicidal ideation.^[30]

Individuals with anxiety disorders who self-medicate with drugs or alcohol may also have an increased likelihood of suicidal ideation.^[31]

Life events

Life events are strong predictors of increased risk for suicidal ideation. Furthermore, life events can also lead to or be comorbid with the previously listed psychiatric disorders and predict suicidal ideation through those means. Life events that adults and children face can be dissimilar and for this reason, the list of events that increase risk can vary in adults and children. The life events that have been shown to increase risk most significantly are:^[32]

Alcohol use disorder
- Studies have shown that individuals who binge drink, rather than drink socially, tend to have higher rates of suicidal ideation^[33]
- Certain studies associate those who experience suicidal ideation with higher alcohol consumption^[34]
- Not only do some studies show that solitary binge drinking can increase suicidal ideation, but there is a positive feedback relationship causing those who have more suicidal ideation to have more drinks per day in a solitary environment^[33]
Minoritized gender expression and/or sexuality^[35]
Unemployment^[34]
Chronic illness or pain^[36]
Death of family members or friends
End of a relationship or being rejected by a romantic interest
Major change in life standard (e.g. relocation abroad)
Other studies have found that tobacco use is correlated with depression and suicidal ideation^[37]
Social isolation
Unplanned pregnancy
Bullying, including cyberbullying^[38]^[39] and workplace bullying^[40]
Previous suicide attempts
- Having previously attempted suicide is one of the strongest indicators of future suicidal ideation or suicide attempts^[33]
Military experience
- Military personnel who show symptoms of PTSD, major depressive disorder, alcohol use disorder, and generalized anxiety disorder show higher levels of suicidal ideation^[41]
Community violence^[42]
Undesired changes in body weight^[43]
- Women: increased BMI increases chance of suicidal ideation
- Men: severe decrease in BMI increases chance of suicidal ideation
  - In general, the obese population has increased odds of suicidal ideation in relation to individuals that are of average-weight
Exposure and attention to suicide related images or words^[44]

Family history

Parents with a history of depression
- Valenstein et al. studied 340 adults whose parents had experienced depression. They found that 7% of the offspring had suicidal ideation in the previous month alone^[45]
Abuse^[42]
- Childhood: physical, emotional and sexual abuse^[46]
- Adolescence: physical, emotional and sexual abuse
Family violence
Childhood residential instability
- Certain studies associate those who experience suicidal ideation with family disruption.^[34]

Relationships with parents

According to a study conducted by Ruth X. Liu of San Diego State University, a significant connection was found between the parent–child relationships of adolescents in early, middle and late adolescence and their likelihood of suicidal ideation. The study consisted of measuring relationships between mothers and daughters, fathers and sons, mothers and sons, and fathers and daughters. The relationships between fathers and sons during early and middle adolescence show an inverse relationship to suicidal ideation. Closeness with the father in late adolescence is "significantly related to suicidal ideation".^[47] Liu goes on to explain the relationship found between closeness with the opposite sex parent and the child's risk of suicidal thoughts. It was found that boys are better protected from suicidal ideation if they are close to their mothers through early and late adolescence; whereas girls are better protected by having a close relationship with their father during middle adolescence.

An article published in 2010 by Zappulla and Pace found that suicidal ideation in adolescent boys is exacerbated by detachment from the parents when depression is already present in the child. Lifetime prevalence estimates of suicidal ideation among nonclinical populations of adolescents generally range from 60% to 75% and in many cases its severity increases the risk of suicide.^[48]

Prevention

As a suicide prevention initiative, these signs on the Golden Gate Bridge promote a special telephone that connects to a crisis hotline, as well as a 24/7 crisis text line.

Early detection and treatment are the best ways to prevent suicidal ideation and suicide attempts.^{[citation needed]} If signs, symptoms, or risk factors are detected early then the individual might seek treatment and help before attempting to take their own life. In a study of individuals who did die by suicide, 91% of them likely had one or more mental illnesses. However, only 35% of those individuals were treated or being treated for a mental illness.^[49] This emphasizes the importance of early detection; if a mental illness is detected, it can be treated and controlled to help prevent suicide attempts. Another study investigated strictly suicidal ideation in adolescents. This study found that depression symptoms in adolescents early as 9th grade is a predictor of suicidal ideation. Most people with long-term suicidal ideation do not seek professional help.^{[citation needed]}

The previously mentioned studies point out the difficulty that mental health professionals have in motivating individuals to seek and continue treatment. Ways to increase the number of individuals who seek treatment may include:

Increasing the availability of therapy treatment in early stage
Increasing the public's knowledge of when psychiatric help may be beneficial to them
- Those who have adverse life conditions seem to have just as much risk of suicide as those with mental illness^[49]

A study conducted by researchers in Australia set out to determine a course of early detection for suicidal ideation in teens stating that "risks associated with suicidality require an immediate focus on diminishing self-harming cognitions so as to ensure safety before attending to the underlying etiology of the behavior". A Psychological Distress scale known as the K10 was administered monthly to a random sample of individuals. According to the results among the 9.9% of individuals who reported "psychological distress (all categories)" 5.1% of the same participants reported suicidal ideation. Participants who scored "very high" on the Psychological Distress scale "were 77 times more likely to report suicidal ideation than those in the low category".^[50]

In a one-year study conducted in Finland, 41% of the patients who later died by suicide saw a healthcare professional, most seeing a psychiatrist. Of those, only 22% discussed suicidal intent on their last office visit. In most of the cases, the office visit took place within a week of the suicide, and most of the victims had a diagnosed depressive disorder.^[51]

There are many centers where one can receive aid in the fight against suicidal ideation and suicide. Hemelrijk et al. (2012) found evidence that assisting people with suicidal ideation via the internet versus more direct forms such as phone conversations has a greater effect. In a 2021 research study, Nguyen et al. (2021) propose that maybe the premise that suicidal ideation is a kind of illness has been an obstacle to dealing with suicidal ideation.^[52] They use a Bayesian statistical investigation, in conjunction with the mindsponge theory,^[53] to explore the processes where mental disorders have played a very minor role and conclude that there are many cases where the suicidal ideation represents a type of cost-benefit analysis for a life/death consideration, and these people may not be called "patients".

Assessment

Assessment seeks to understand an individual by integrating information from multiple sources such as clinical interviews; medical exams and physiological measures; standardized psychometric tests and questionnaires; structured diagnostic interviews; review of records; and collateral interviews.^[54]

Interviews

Psychologists, psychiatrists, and other mental health professionals conduct clinical interviews to ascertain the nature of a patient or client's difficulties, including any signs or symptoms of illness the person might exhibit. Clinical interviews are "unstructured" in the sense that each clinician develops a particular approach to asking questions, without necessarily following a predefined format. Structured (or semi-structured) interviews prescribe the questions, their order of presentation, "probes" (queries) if a patient's response is not clear or specific enough, and a method to rate the frequency and intensity of symptoms.^[55]

Standardized psychometric measures

Beck Scale for Suicide Ideation
Nurses' Global Assessment of Suicide Risk
Suicidal Affect–Behavior–Cognition Scale (SABCS)^[56]
Columbia Suicide Severity Rating Scale

Treatment

Treatment of suicidal ideation can be problematic due to the fact that several medications have actually been linked to increasing or causing suicidal ideation in patients. Therefore, several alternative means of treating suicidal ideation are often used. The main treatments include: therapy, hospitalization, outpatient treatment, and medication or other modalities.^[5]

Therapy

In psychotherapy a person explores the issues that make them feel suicidal and learns skills to help manage emotions more effectively.^[5]^[57]

Psychotherapy has many types in which cognition behavioral therapy(CBT) and Dialectical behavior therapy (DBT) are most effective therapies for treatment of Suicidal ideation^[58]

Hospitalization

Hospitalization allows the patient to be in a secure, supervised environment to prevent suicidal ideation from turning into suicide attempts. In most cases, individuals have the freedom to choose which treatment they see fit for themselves. However, there are several circumstances in which individuals can be hospitalized involuntarily. These circumstances are:

If an individual poses a danger to self or others
If an individual is unable to care for oneself

Hospitalization may also be a treatment option if an individual:

Has access to lethal means (e.g., a firearm or a stockpile of pills)
Does not have social support or people to supervise them
Has a suicide plan
Has symptoms of a psychiatric disorder (e.g., psychosis, mania, etc.)

Outpatient treatment

Outpatient treatment allows individuals to remain at their place of residence and receive treatment when needed or on a scheduled basis. Being at home may improve quality of life for some patients, because they will have access to their personal belongings, and be able to come and go freely. Before allowing patients the freedom that comes with outpatient treatment, physicians evaluate several factors of the patient. These factors include the patient's level of social support, impulse control and quality of judgment. After the patient passes the evaluation, they are often asked to consent to a "no-harm contract". This is a contract formulated by the physician and the family of the patient. Within the contract, the patient agrees not to harm themself, to continue their visits with the physician, and to contact the physician in times of need.^[5] There is some debate as to whether "no-harm" contracts are effective. These patients are then checked on routinely to assure they are maintaining their contract and avoiding dangerous activities (drinking alcohol, driving fast and not wearing a seat belt, etc.).

Medication

Prescribing medication to treat suicidal ideation can be difficult. One reason for this is that many medications lift patients' energy levels before lifting their moods. This puts them at greater risk of following through with attempting suicide. Additionally, if a person has a comorbid psychiatric disorder, it may be difficult to find a medication that addresses both the psychiatric disorder and suicidal ideation.

Antidepressants may be effective.^[5] Often, SSRIs are used instead of TCAs as the latter typically have greater harm in overdose.^[5]

Antidepressants have been shown to be a very effective means of treating suicidal ideation. One correlational study compared mortality rates due to suicide to the use of SSRI antidepressants in certain counties. The counties which had higher SSRI use had a significantly lower number of deaths caused by suicide.^[59] Additionally, an experimental study followed depressed patients for one year. During the first six months of that year, the patients were examined for suicidal behavior including suicidal ideation. The patients were then prescribed antidepressants for the six months following the first six observatory months. During the six months of treatment, experimenters found suicide ideation reduced from 47% of patients down to 14% of patients.^[60] Thus, it appears from current research that antidepressants have a helpful effect on the reduction of suicidal ideation.

Although research is largely in favor of the use of antidepressants for the treatment of suicidal ideation, in some cases antidepressants are claimed to be the cause of suicidal ideation. Upon the start of using antidepressants, many clinicians will note that sometimes the sudden onset of suicidal ideation may accompany treatment. This has caused the Food and Drug Administration (FDA) to issue a warning stating that sometimes the use of antidepressants may actually increase suicidal ideation.^[59] Medical studies have found antidepressants help treat cases of suicidal ideation and work especially well with psychological therapy.^[61] Lithium reduces the risk of suicide in people with mood disorders.^[62] Tentative evidence finds clozapine in people with schizophrenia reduces the risk of suicide.^[63]

LGBT youth

Suicidal ideation rates among lesbian, gay, bisexual, transgender (LGBT) youth are significantly higher than among the general population.^[64] Suicide ideation has a higher prevalence among gay teenagers compared to their heterosexual peers has been attributed to minority stress, bullying, and parental disapproval.^[65]^[66]

South Korea

South Korea has the 10th highest rate of suicide in the world and the second in the OECD. Within these rates, suicide is the primary cause of death for South Korean youth, ages 10–19.^[67] While these rates are elevated, suicide ideation additionally increases with the introduction of LGBT identity.^[68]

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^ Zappulla, Carla (2010). "Relations between suicidal ideation, depression, and emotional autonomy from parents in adolescence". Journal of Child and Family Studies. 19 (6). Springer Science + Business Media LLC: 747–756. doi:10.1007/s10826-010-9364-9. Retrieved 10 April 2012.^{[permanent dead link‍]}
^ ^a ^b Cavanagh, JO; Owens, DC; Johnstone, EC (1999). "Life events in suicide and undetermined death in south-east Scotland: a case-control study using the method of psychological autopsy". Social Psychiatry and Psychiatric Epidemiology. 34 (12): 645–650. doi:10.1007/s001270050187. PMID 10703274. S2CID 31350280.
^ Chamberlain, P; Goldney, R; Delfabbro, P; Gill, T; Dal Grande, L (2009). "Suicidal Ideation: The Clinical Utility of the K10". Crisis. 30 (1): 39–42. doi:10.1027/0227-5910.30.1.39. PMID 19261567.
^ Halgin, Richard P.; Susan Whitbourne (2006). Abnormal psychology: clinical perspectives on psychological disorders. Boston: McGraw-Hill. pp. 267–272. ISBN 978-0-07-322872-3.
^ Nguyen, MH; Le, TT; Nguyen, HKT; Ho, MT; Nguyen, TTH; Vuong, QH (2021). "Alice in Suicideland: Exploring the Suicidal Ideation Mechanism through the Sense of Connectedness and Help-Seeking Behaviors". Int. J. Environ. Res. Public Health. 7. 18 (7): 3681. doi:10.3390/ijerph18073681. PMC 8037954. PMID 33916123.
^ Vuong, QH; Napier, Nancy K. (2015). "Acculturation and global mindsponge: an emerging market perspective". International Journal of Intercultural Relations. 49: 354–367. doi:10.1016/j.ijintrel.2015.06.003.
^ Coaley, Keith, "Introduction: Individual Differences and Psychometrics", chap. 1 in An Introduction to Psychological Assessment and Psychometrics, 2nd ed. (London: Sage, 2014), 1–34. ISBN 978-1-4462-6714-1
^ Rogers, Richard. Handbook of Diagnostic and Structured Interviewing. New York: Guilford, 2001.
^ Harris, K. M.; Syu, J. J.; Lello, O. D.; Chew, Y. L. E.; Willcox, C. H.; Ho, R. H. M. (2015). "The ABC's of suicide risk assessment: Applying a tripartite approach to individual evaluations". PLOS ONE. 10 (6): 6. Bibcode:2015PLoSO..1027442H. doi:10.1371/journal.pone.0127442. PMC 4452484. PMID 26030590.
^ "Suicide and suicidal thoughts - Diagnosis and treatment - Mayo Clinic". Mayo Clinic. Archived from the original on 2016-06-05. Retrieved 2016-06-03.
^ shanzy, joseph (2023-12-08). "Suicide and suicidal ideation: treatment -". psychiatrymagazine.com/. Retrieved 2024-01-08.{{cite web}}: CS1 maint: url-status (link)
^ ^a ^b Simon, GE (2006). "How can we know whether antidepressants increase suicide risk?". American Journal of Psychiatry. 163 (11): 1861–1863. doi:10.1176/APPI.AJP.163.11.1861. PMID 17074930.
^ Mulder, RT; Joyce, P. R.; Frampton, C. M. A.; Luty, S. E. (2008). "Antidepressant treatment is associated with a reduction in suicidal ideation and suicide attempts". Acta Psychiatrica Scandinavica. 118 (12): 116–122. doi:10.1111/j.1600-0447.2008.01179.x. PMID 18384467. S2CID 34987889.
^ Zisook, S; Lesser, IM; Lebowitz, B; Rush, AJ; Kallenberg, G; Wisniewski, SR; et al. (2011). "Effect of antidepressant medication treatment on suicidal ideation and behavior in a randomized trial: An exploratory report from the Combining Medications to Enhance Depression Outcomes Study". Journal of Clinical Psychiatry. 72 (10): 1322–1332. doi:10.4088/JCP.10m06724. PMID 22075098. S2CID 20222046.
^ Cipriani A, Hawgon K, Stockton S, et al. (27 June 2013). "Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis". BMJ. 346 (jun27 4): f3646. doi:10.1136/bmj.f3646. PMID 23814104.
^ Wagstaff, A; Perry, C (2003). "Clozapine: in prevention of suicide in patients with schizophrenia or schizoaffective disorder". CNS Drugs. 17 (4): 273–80, discussion 281–3. doi:10.2165/00023210-200317040-00004. PMID 12665398.
^ Haas, Ann P.; Eliason, Mickey; Mays, Vickie M.; Mathy, Robin M.; Cochran, Susan D.; D'Augelli, Anthony R.; Silverman, Morton M.; Fisher, Prudence W.; Hughes, Tonda; Rosario, Margaret; Russell, Stephen T.; Malley, Effie; Reed, Jerry; Litts, David A.; Haller, Ellen; Sell, Randall L.; Remafedi, Gary; Bradford, Judith; Beautrais, Annette L.; Brown, Gregory K.; Diamond, Gary M.; Friedman, Mark S.; Garofalo, Robert; Turner, Mason S.; Hollibaugh, Amber; Clayton, Paula J. (30 December 2010). "Suicide and Suicide Risk in Lesbian, Gay, Bisexual, and Transgender Populations: Review and Recommendations". Journal of Homosexuality. 58 (1): 10–51. doi:10.1080/00918369.2011.534038. PMC 3662085. PMID 21213174.
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Remafedi, Gary; Farrow, James A.; Deisher, Robert W. (1991). "Risk Factors for Attempted Suicide in Gay and Bisexual Youth". Pediatrics. 87 (6): 869–875. doi:10.1542/peds.87.6.869. PMID 2034492. S2CID 42547461.
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Hammelman, Tracie L. (1993). "Gay and Lesbian Youth". Journal of Gay & Lesbian Psychotherapy. 2 (1): 77–89. doi:10.1300/J236v02n01_06.
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^ "New Research on LGBTQ Teen Suicide Rates". Newport Academy. 27 February 2023. Retrieved 26 May 2023.
^ "Definition of Bisexual suicide risk". Medterms.com. October 27, 1999. Archived from the original on December 8, 2011. Retrieved August 21, 2011.
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^ Kim, SungYeon; Yang, Eunjoo (February 2015). "Suicidal Ideation in Gay Men and Lesbians in South Korea: A Test of the Interpersonal-Psychological Model". Suicide and Life-Threatening Behavior. 45 (1): 98–110. doi:10.1111/sltb.12119. PMID 25220014.

External links

Evaluation and Treatment of Patients with Suicidal Ideation Archived 2006-09-25 at the Wayback Machine
Suicidal Thought Archived 2014-07-02 at the Wayback Machine
National Suicide Prevention Lifeline: Warning signs Archived 2016-04-08 at the Wayback Machine

[ICD-1] World Health Organization, ICD-11 for Mortality and Morbidity Statistics, ver. 09/2020, MB26.A Suicidal ideation

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[Falcone-3] Falcone, Tatiana; Timmons-Mitchell, Jane (2018-05-18). "Mood Disorders and Suicide". Suicide Prevention: A Practical Guide for the Practitioner. Springer. p. 38. ISBN 978-3-319-74391-2.

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[46] Briere, John (1986). "Suicidal thoughts and behaviours in former sexual abuse victims". Canadian Journal of Behavioural Science. 18 (4): 413–423. doi:10.1037/h0079962.

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[48] Zappulla, Carla (2010). "Relations between suicidal ideation, depression, and emotional autonomy from parents in adolescence". Journal of Child and Family Studies. 19 (6). Springer Science + Business Media LLC: 747–756. doi:10.1007/s10826-010-9364-9. Retrieved 10 April 2012.^{[permanent dead link‍]}

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[51] Halgin, Richard P.; Susan Whitbourne (2006). Abnormal psychology: clinical perspectives on psychological disorders. Boston: McGraw-Hill. pp. 267–272. ISBN 978-0-07-322872-3.

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[54] Coaley, Keith, "Introduction: Individual Differences and Psychometrics", chap. 1 in An Introduction to Psychological Assessment and Psychometrics, 2nd ed. (London: Sage, 2014), 1–34. ISBN 978-1-4462-6714-1

[55] Rogers, Richard. Handbook of Diagnostic and Structured Interviewing. New York: Guilford, 2001.

[56] Harris, K. M.; Syu, J. J.; Lello, O. D.; Chew, Y. L. E.; Willcox, C. H.; Ho, R. H. M. (2015). "The ABC's of suicide risk assessment: Applying a tripartite approach to individual evaluations". PLOS ONE. 10 (6): 6. Bibcode:2015PLoSO..1027442H. doi:10.1371/journal.pone.0127442. PMC 4452484. PMID 26030590.

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[58] shanzy, joseph (2023-12-08). "Suicide and suicidal ideation: treatment -". psychiatrymagazine.com/. Retrieved 2024-01-08.{{cite web}}: CS1 maint: url-status (link)

[Simon-59] Simon, GE (2006). "How can we know whether antidepressants increase suicide risk?". American Journal of Psychiatry. 163 (11): 1861–1863. doi:10.1176/APPI.AJP.163.11.1861. PMID 17074930.

[Mulder-60] Mulder, RT; Joyce, P. R.; Frampton, C. M. A.; Luty, S. E. (2008). "Antidepressant treatment is associated with a reduction in suicidal ideation and suicide attempts". Acta Psychiatrica Scandinavica. 118 (12): 116–122. doi:10.1111/j.1600-0447.2008.01179.x. PMID 18384467. S2CID 34987889.

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[62] Cipriani A, Hawgon K, Stockton S, et al. (27 June 2013). "Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis". BMJ. 346 (jun27 4): f3646. doi:10.1136/bmj.f3646. PMID 23814104.

[63] Wagstaff, A; Perry, C (2003). "Clozapine: in prevention of suicide in patients with schizophrenia or schizoaffective disorder". CNS Drugs. 17 (4): 273–80, discussion 281–3. doi:10.2165/00023210-200317040-00004. PMID 12665398.

[Haas2011-64] Haas, Ann P.; Eliason, Mickey; Mays, Vickie M.; Mathy, Robin M.; Cochran, Susan D.; D'Augelli, Anthony R.; Silverman, Morton M.; Fisher, Prudence W.; Hughes, Tonda; Rosario, Margaret; Russell, Stephen T.; Malley, Effie; Reed, Jerry; Litts, David A.; Haller, Ellen; Sell, Randall L.; Remafedi, Gary; Bradford, Judith; Beautrais, Annette L.; Brown, Gregory K.; Diamond, Gary M.; Friedman, Mark S.; Garofalo, Robert; Turner, Mason S.; Hollibaugh, Amber; Clayton, Paula J. (30 December 2010). "Suicide and Suicide Risk in Lesbian, Gay, Bisexual, and Transgender Populations: Review and Recommendations". Journal of Homosexuality. 58 (1): 10–51. doi:10.1080/00918369.2011.534038. PMC 3662085. PMID 21213174.
Proctor, Curtis D.; Groze, Victor K. (1994). "Risk Factors for Suicide among Gay, Lesbian, and Bisexual Youths". Social Work. 39 (5): 504–513. doi:10.1093/sw/39.5.504. PMID 7939864.
Remafedi, Gary; Farrow, James A.; Deisher, Robert W. (1991). "Risk Factors for Attempted Suicide in Gay and Bisexual Youth". Pediatrics. 87 (6): 869–875. doi:10.1542/peds.87.6.869. PMID 2034492. S2CID 42547461.
Russell, Stephen T.; Joyner, Kara (2001). "Adolescent Sexual Orientation and Suicide Risk: Evidence From a National Study". American Journal of Public Health. 91 (8): 1276–1281. doi:10.2105/AJPH.91.8.1276. PMC 1446760. PMID 11499118.
Hammelman, Tracie L. (1993). "Gay and Lesbian Youth". Journal of Gay & Lesbian Psychotherapy. 2 (1): 77–89. doi:10.1300/J236v02n01_06.
Johnson, R. B.; Oxendine, S.; Taub, D. J.; Robertson, J. (2013). "Suicide Prevention for LGBT Students" (PDF). New Directions for Student Services. 2013 (141): 55–69. doi:10.1002/ss.20040.

[Newport_Academy_2023-65] "New Research on LGBTQ Teen Suicide Rates". Newport Academy. 27 February 2023. Retrieved 26 May 2023.

[66] "Definition of Bisexual suicide risk". Medterms.com. October 27, 1999. Archived from the original on December 8, 2011. Retrieved August 21, 2011.

[:0-67] Sohn, Min; Oh, Heymin; Lee, Sang-Kyu; Potenza, Marc N. (2017-10-09). "Suicidal Ideation and Related Factors Among Korean High School Students". The Journal of School Nursing. 34 (4): 310–318. doi:10.1177/1059840517734290. ISSN 1059-8405. PMID 28992754. S2CID 1207678.

[:2-68] Kim, SungYeon; Yang, Eunjoo (February 2015). "Suicidal Ideation in Gay Men and Lesbians in South Korea: A Test of the Interpersonal-Psychological Model". Suicide and Life-Threatening Behavior. 45 (1): 98–110. doi:10.1111/sltb.12119. PMID 25220014.

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@@ Line 26: / Line 26: @@
 }}
-'''Suicidal ideation''', or '''suicidal thoughts''', is the [[thought process]] of having ideas, or ruminations about the possibility of [[suicide|ending one's own life]].<ref name=ICD>World Health Organization, ''ICD-11 for Mortality and Morbidity Statistics'', ver. 09/2020, [https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/778734771 MB26.A Suicidal ideation]</ref> It is not a diagnosis but is a symptom of some [[mental disorder]]s, use of certain [[Psychoactive drug|psychoactive drugs]], and can also occur in response to adverse life events without the presence of a mental disorder.<ref name="Barry">Barry, Lisa C. [[doi:10.1016/j.jagp.2019.08.003|Passive Suicidal Ideation in Older Adults: Implications for Suicide Prevention]], ''American Journal of Geriatric Psychiatry'' 27, no. 12 (December 2019): 1411 ("... growing evidence points toward a subgroup of individuals who endorse passive SI [suicidal ideation] in later life outside the context of clinical depression.")</ref>
+'''Suicidal ideation''', or '''suicidal thoughts''', is the [[thought process]] of having ideas, or ruminations about the possibility of [[suicide|ending one's own life]].<ref name=ICD>World Health Organization, ''ICD-11 for Mortality and Morbidity Statistics'', ver. 09/2020, [https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/778734771 MB26.A Suicidal ideation]</ref> It is not a diagnosis but is a symptom of some [[mental disorder]]s, use of certain [[psychoactive drug]]s, and can also occur in response to adverse life events without the presence of a mental disorder.<ref name="Barry">Barry, Lisa C. [[doi:10.1016/j.jagp.2019.08.003|Passive Suicidal Ideation in Older Adults: Implications for Suicide Prevention]], ''American Journal of Geriatric Psychiatry'' 27, no. 12 (December 2019): 1411 ("... growing evidence points toward a subgroup of individuals who endorse passive SI [suicidal ideation] in later life outside the context of clinical depression.")</ref>
 On suicide risk scales, the range of suicidal ideation varies from fleeting thoughts to detailed planning. '''Passive suicidal ideation''' is thinking about not wanting to live or imagining being dead.<ref name="Falcone">{{Cite book|last1=Falcone|first1=Tatiana|url=https://books.google.com/books?id=-j9bDwAAQBAJ|title=Suicide Prevention: A Practical Guide for the Practitioner|last2=Timmons-Mitchell|first2=Jane|date=2018-05-18|publisher=Springer |isbn=978-3-319-74391-2 |pages=38|language=en|chapter=Mood Disorders and Suicide}}</ref><ref name=":1">{{Cite book|last=Kumar|first=Updesh|chapter-url=https://books.google.com/books?id=qaI7DwAAQBAJ&q=%22passive+suicidal+ideation%22&pg=PA269|title=Handbook of Suicidal Behaviour|date=2017-10-26|publisher=Springer|isbn=978-981-10-4816-6|pages=269|language=en|chapter=Suicidal Ideation in Adolescents–A Transcultural Analysis}}</ref> '''Active suicidal ideation''' involves preparation to commit suicide or forming a plan to do so.<ref name="Falcone"/><ref name=":1"/>
@@ Line 183: / Line 183: @@
 In [[psychotherapy]] a person explores the issues that make them feel suicidal and learns skills to help manage emotions more effectively.<ref name=Gliatto1999/><ref>{{Cite web | url=http://www.mayoclinic.org/diseases-conditions/suicide/basics/treatment/con-20033954 | title=Suicide and suicidal thoughts - Diagnosis and treatment - Mayo Clinic | website=[[Mayo Clinic]] | access-date=2016-06-03 | archive-url=https://web.archive.org/web/20160605091131/http://www.mayoclinic.org/diseases-conditions/suicide/basics/treatment/con-20033954 | archive-date=2016-06-05 | url-status=live }}</ref>
-Psychotherapy has many types in which cognition behavioral therapy(CBT) and Dialectical behavior therapy (DBT) are most effective therapies for treatment of [https://psychiatrymagazine.com/index.php/2023/12/08/suicide-and-suicidal-ideation-treatment/ Suicidal ideation]<ref>{{Cite web |last=shanzy |first=joseph |date=2023-12-08 |title=Suicide and suicidal ideation: treatment - |url=https://psychiatrymagazine.com/index.php/2023/12/08/suicide-and-suicidal-ideation-treatment/ |url-status=live |access-date=2024-01-08 |website=https://psychiatrymagazine.com/ |language=en-US}}</ref>
+Psychotherapy has many types in which cognition behavioral therapy(CBT) and Dialectical behavior therapy (DBT) are most effective therapies for treatment of [https://psychiatrymagazine.com/index.php/2023/12/08/suicide-and-suicidal-ideation-treatment/ Suicidal ideation]<ref>{{Cite web |last=shanzy |first=joseph |date=2023-12-08 |title=Suicide and suicidal ideation: treatment - |url=https://psychiatrymagazine.com/index.php/2023/12/08/suicide-and-suicidal-ideation-treatment/ |url-status=live |access-date=2024-01-08 |website=psychiatrymagazine.com/ |language=en-US}}</ref>
 ===Hospitalization===
@@ Line 215: / Line 215: @@
 == LGBT youth ==
 {{See also|Suicide among LGBT youth}}
-[[Suicidal ideation]] rates among [[lesbian]], [[Gay men#Youth|gay]], [[bisexual]], [[transgender]] ([[LGBT]]) [[youth]] are significantly higher than among the general population.<ref name="Haas2011">{{cite journal |last1=Haas |first1=Ann P. |last2=Eliason |first2=Mickey |last3=Mays |first3=Vickie M. |last4=Mathy |first4=Robin M. |last5=Cochran |first5=Susan D. |last6=D'Augelli |first6=Anthony R. |last7=Silverman |first7=Morton M. |last8=Fisher |first8=Prudence W. |last9=Hughes |first9=Tonda |last10=Rosario |first10=Margaret |last11=Russell |first11=Stephen T. |last12=Malley |first12=Effie |last13=Reed |first13=Jerry |last14=Litts |first14=David A. |last15=Haller |first15=Ellen |date=30 December 2010 |title=Suicide and Suicide Risk in Lesbian, Gay, Bisexual, and Transgender Populations: Review and Recommendations |journal=Journal of Homosexuality |volume=58 |issue=1 |pages=10–51 |doi=10.1080/00918369.2011.534038 |pmc=3662085 |pmid=21213174 |last16=Sell |first16=Randall L. |last17=Remafedi |first17=Gary |last18=Bradford |first18=Judith |last19=Beautrais |first19=Annette L. |last20=Brown |first20=Gregory K. |last21=Diamond |first21=Gary M. |last22=Friedman |first22=Mark S. |last23=Garofalo |first23=Robert |last24=Turner |first24=Mason S. |last25=Hollibaugh |first25=Amber |author26-link=Paula Clayton |last26=Clayton |first26=Paula J.}}{{indent}}{{cite journal |last1=Proctor |first1=Curtis D. |last2=Groze |first2=Victor K. |year=1994 |title=Risk Factors for Suicide among Gay, Lesbian, and Bisexual Youths |journal=Social Work |volume=39 |issue=5 |pages=504–513 |doi=10.1093/sw/39.5.504 |pmid=7939864}}{{indent}}{{cite journal |last1=Remafedi |first1=Gary |last2=Farrow |first2=James A. |last3=Deisher |first3=Robert W. |year=1991 |title=Risk Factors for Attempted Suicide in Gay and Bisexual Youth |journal=Pediatrics |volume=87 |issue=6 |pages=869–875 |doi=10.1542/peds.87.6.869 |pmid=2034492 |s2cid=42547461}}{{indent}}{{cite journal |last1=Russell |first1=Stephen T. |last2=Joyner |first2=Kara |year=2001 |title=Adolescent Sexual Orientation and Suicide Risk: Evidence From a National Study |journal=American Journal of Public Health |volume=91 |issue=8 |pages=1276–1281 |doi=10.2105/AJPH.91.8.1276 |pmc=1446760 |pmid=11499118}}{{indent}}{{cite journal |last1=Hammelman |first1=Tracie L. |year=1993 |title=Gay and Lesbian Youth |journal=Journal of Gay & Lesbian Psychotherapy |volume=2 |issue=1 |pages=77–89 |doi=10.1300/J236v02n01_06}}{{indent}}{{cite journal |last1=Johnson |first1=R. B. |last2=Oxendine |first2=S. |last3=Taub |first3=D. J. |last4=Robertson |first4=J. |year=2013 |title=Suicide Prevention for LGBT Students |url=http://libres.uncg.edu/ir/uncg/f/B_Johnson_Suicide_2013.pdf |journal=New Directions for Student Services |volume=2013 |issue=141 |pages=55–69 |doi=10.1002/ss.20040}}</ref> Suicide ideation has a higher prevalence among gay teenagers compared to their heterosexual peers has been attributed to [[minority stress]], bullying, and parental disapproval.<ref name="Newport Academy 2023">{{cite web |date=27 February 2023 |title=New Research on LGBTQ Teen Suicide Rates |url=https://www.newportacademy.com/resources/mental-health/lgbt-suicide-rates/ |access-date=26 May 2023 |website=Newport Academy}}</ref><ref>{{cite web |date=1999-10-27 |title=Definition of Bisexual suicide risk |url=http://www.medterms.com/script/main/art.asp?articlekey=10851 |url-status=dead |archive-url=https://web.archive.org/web/20111208215013/http://www.medterms.com/script/main/art.asp?articlekey=10851 |archive-date=December 8, 2011 |access-date=2011-08-21 |publisher=Medterms.com |df=mdy-all}}</ref>
+Suicidal ideation rates among [[lesbian]], [[Gay men#Youth|gay]], [[bisexual]], [[transgender]] ([[LGBT]]) [[youth]] are significantly higher than among the general population.<ref name="Haas2011">{{cite journal |last1=Haas |first1=Ann P. |last2=Eliason |first2=Mickey |last3=Mays |first3=Vickie M. |last4=Mathy |first4=Robin M. |last5=Cochran |first5=Susan D. |last6=D'Augelli |first6=Anthony R. |last7=Silverman |first7=Morton M. |last8=Fisher |first8=Prudence W. |last9=Hughes |first9=Tonda |last10=Rosario |first10=Margaret |last11=Russell |first11=Stephen T. |last12=Malley |first12=Effie |last13=Reed |first13=Jerry |last14=Litts |first14=David A. |last15=Haller |first15=Ellen |date=30 December 2010 |title=Suicide and Suicide Risk in Lesbian, Gay, Bisexual, and Transgender Populations: Review and Recommendations |journal=Journal of Homosexuality |volume=58 |issue=1 |pages=10–51 |doi=10.1080/00918369.2011.534038 |pmc=3662085 |pmid=21213174 |last16=Sell |first16=Randall L. |last17=Remafedi |first17=Gary |last18=Bradford |first18=Judith |last19=Beautrais |first19=Annette L. |last20=Brown |first20=Gregory K. |last21=Diamond |first21=Gary M. |last22=Friedman |first22=Mark S. |last23=Garofalo |first23=Robert |last24=Turner |first24=Mason S. |last25=Hollibaugh |first25=Amber |author26-link=Paula Clayton |last26=Clayton |first26=Paula J.}}{{indent}}{{cite journal |last1=Proctor |first1=Curtis D. |last2=Groze |first2=Victor K. |year=1994 |title=Risk Factors for Suicide among Gay, Lesbian, and Bisexual Youths |journal=Social Work |volume=39 |issue=5 |pages=504–513 |doi=10.1093/sw/39.5.504 |pmid=7939864}}{{indent}}{{cite journal |last1=Remafedi |first1=Gary |last2=Farrow |first2=James A. |last3=Deisher |first3=Robert W. |year=1991 |title=Risk Factors for Attempted Suicide in Gay and Bisexual Youth |journal=Pediatrics |volume=87 |issue=6 |pages=869–875 |doi=10.1542/peds.87.6.869 |pmid=2034492 |s2cid=42547461}}{{indent}}{{cite journal |last1=Russell |first1=Stephen T. |last2=Joyner |first2=Kara |year=2001 |title=Adolescent Sexual Orientation and Suicide Risk: Evidence From a National Study |journal=American Journal of Public Health |volume=91 |issue=8 |pages=1276–1281 |doi=10.2105/AJPH.91.8.1276 |pmc=1446760 |pmid=11499118}}{{indent}}{{cite journal |last1=Hammelman |first1=Tracie L. |year=1993 |title=Gay and Lesbian Youth |journal=Journal of Gay & Lesbian Psychotherapy |volume=2 |issue=1 |pages=77–89 |doi=10.1300/J236v02n01_06}}{{indent}}{{cite journal |last1=Johnson |first1=R. B. |last2=Oxendine |first2=S. |last3=Taub |first3=D. J. |last4=Robertson |first4=J. |year=2013 |title=Suicide Prevention for LGBT Students |url=http://libres.uncg.edu/ir/uncg/f/B_Johnson_Suicide_2013.pdf |journal=New Directions for Student Services |volume=2013 |issue=141 |pages=55–69 |doi=10.1002/ss.20040}}</ref> Suicide ideation has a higher prevalence among gay teenagers compared to their heterosexual peers has been attributed to [[minority stress]], bullying, and parental disapproval.<ref name="Newport Academy 2023">{{cite web |date=27 February 2023 |title=New Research on LGBTQ Teen Suicide Rates |url=https://www.newportacademy.com/resources/mental-health/lgbt-suicide-rates/ |access-date=26 May 2023 |website=Newport Academy}}</ref><ref>{{cite web |date=1999-10-27 |title=Definition of Bisexual suicide risk |url=http://www.medterms.com/script/main/art.asp?articlekey=10851 |url-status=dead |archive-url=https://web.archive.org/web/20111208215013/http://www.medterms.com/script/main/art.asp?articlekey=10851 |archive-date=December 8, 2011 |access-date=2011-08-21 |publisher=Medterms.com |df=mdy-all}}</ref>
 === South Korea ===
-{{Main articles|Suicidal ideation in South Korean LGBT youth}}
+{{Main|Suicidal ideation in South Korean LGBT youth}}
-[[South Korea]] has the [[Suicide in South Korea|10th highest rate of suicide]] in the world and the second in the [[OECD]]. Within these rates, suicide is the primary cause of [[death]] for [[South Korea|South Korean]] [[Youth suicide|youth]], ages 10–19.<ref name=":0">{{Cite journal |last1=Sohn |first1=Min |last2=Oh |first2=Heymin |last3=Lee |first3=Sang-Kyu |last4=Potenza |first4=Marc N. |date=2017-10-09 |title=Suicidal Ideation and Related Factors Among Korean High School Students |journal=The Journal of School Nursing |volume=34 |issue=4 |pages=310–318 |doi=10.1177/1059840517734290 |issn=1059-8405 |pmid=28992754 |s2cid=1207678}}</ref> While these rates are elevated, suicide ideation additionally increases with the introduction of LGBT identity.<ref name=":2">{{Cite journal |last1=Kim |first1=SungYeon |last2=Yang |first2=Eunjoo |date=February 2015 |title=Suicidal Ideation in Gay Men and Lesbians in South Korea: A Test of the Interpersonal-Psychological Model |journal=Suicide and Life-Threatening Behavior |volume=45 |issue=1 |pages=98–110 |doi=10.1111/sltb.12119 |pmid=25220014}}</ref>
+[[South Korea]] has the [[Suicide in South Korea|10th highest rate of suicide]] in the world and the second in the [[OECD]]. Within these rates, suicide is the primary cause of [[death]] for [[South Korea]]n [[Youth suicide|youth]], ages 10–19.<ref name=":0">{{Cite journal |last1=Sohn |first1=Min |last2=Oh |first2=Heymin |last3=Lee |first3=Sang-Kyu |last4=Potenza |first4=Marc N. |date=2017-10-09 |title=Suicidal Ideation and Related Factors Among Korean High School Students |journal=The Journal of School Nursing |volume=34 |issue=4 |pages=310–318 |doi=10.1177/1059840517734290 |issn=1059-8405 |pmid=28992754 |s2cid=1207678}}</ref> While these rates are elevated, suicide ideation additionally increases with the introduction of LGBT identity.<ref name=":2">{{Cite journal |last1=Kim |first1=SungYeon |last2=Yang |first2=Eunjoo |date=February 2015 |title=Suicidal Ideation in Gay Men and Lesbians in South Korea: A Test of the Interpersonal-Psychological Model |journal=Suicide and Life-Threatening Behavior |volume=45 |issue=1 |pages=98–110 |doi=10.1111/sltb.12119 |pmid=25220014}}</ref>
 ==See also==
@@ Line 273: / Line 273: @@
 [[Category:Post-traumatic stress disorder]]
 [[Category:Psychosis]]
-[[Category:symptoms of schizophrenia]]
+[[Category:Symptoms of schizophrenia]]
 [[Category:Substance dependence]]
 [[Category:Substance-related disorders]]

v t e Signs and symptoms relating to perception, emotion and behaviour
Cognition	Confusion Delirium Psychosis Delusion Amnesia Anterograde amnesia Retrograde amnesia Convulsion Dizziness Disequilibrium Presyncope/Lightheadedness Vertigo
Emotion	Anger Anxiety Depression Fear Paranoia Hostility Irritability Suicidal ideation
Behavior	Verbosity Russell's sign
Perception	Sensory processing disorder Hallucination (Auditory hallucination) Smell Anosmia Hyposmia Dysosmia Parosmia Phantosmia Hyperosmia Synesthesia Taste Ageusia Hypogeusia Dysgeusia Hypergeusia

v t e Borderline personality disorder
General	Dimensional models of personality disorders Impulse-control disorders Trauma model of mental disorders Misdiagnosis of borderline personality disorder
Symptoms and behaviors	Dissociation Eating disorders Emotional dysregulation Feelings of emptiness Episodic memory Hypersexuality Idealization and devaluation Impulsivity Mood swings Projection Self-harm Splitting Suicidal ideation
Management	Dialectical behavior therapy Dynamic deconstructive psychotherapy McLean Hospital Mentalization-based treatment Schema therapy Social psychiatry Transference focused psychotherapy
Family challenges	BPDFamily (support group) Codependency Complex PTSD Emotional blackmail Family estrangement Sibling estrangement Personal boundaries

v t e Suicide
Suicide crisis	Assessment of suicide risk Crisis hotline list Suicidal ideation Suicide intervention Suicidology Suicide prevention Suicide watch Warning signs
Social aspects	Advocacy Altruistic Awareness Interpersonal theory Legislation Philosophy of suicide Religious views Euthanasia Right to die Social media and suicide Suicide survivor bereavement Literature Terminology Suicide and the Internet
Suicide types	Assisted suicide list Bullying and suicide list Charcoal-burning Copycat Epidemic Familicide Forced Gunshot Hanging Honor Immolation Jumping from height locations Mass Murder–suicide Vatakkiruttal Seppuku Sokushinbutsu Sallekhana Sati Prayopavesa By train London Underground Self-sacrifice Banzai charge Kamikaze Senicide Suicide attack By cop By pilot Pact Suicide pill Vehicular
Epidemiology	Sex differences List of countries by suicide rate Antidepressants and suicide risk
History	Suicide in antiquity List of suicides heads of state and government in the 21st century
Related	Animal suicide Caring letters Suicide attempt Consensual homicide Self-harm Suicide methods Suicide note Last words Tourism Suicide prevention contract
By subculture	Doctors LGBTQ youth list Mormon Military Music subcultures Prisoners Youth
By country	Afghanistan Australia Bangladesh Belarus Bhutan Cameroon Canada China France Denmark Greenland Greece Guyana Hong Kong student India youth farmers Iran Ireland Japan Kazakhstan Lithuania Mexico Mozambique Nepal Nigeria Pakistan Romania Russia Saudi Arabia Singapore South Korea LGBT youth Spain Sri Lanka Sweden Switzerland Ukraine United Kingdom Assisted suicide United States Assisted suicide college farmers military veteran Native American teenage Uruguay