Editing Suicide methods

{{short description|Means by which a person dies by suicide}}
{{For|information on methods of suicide intervention|Suicide prevention}}
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{{Use dmy dates|date=June 2019}}
{{Suicide sidebar}}

A '''suicide method''' is any means by which a person may choose to [[suicide|end their life]]. [[Suicide attempts]] do not always result in death, and a non-fatal suicide attempt can leave the person with serious physical injuries, long-term health problems, or [[brain damage]].<ref name="CDC2019">{{cite web |date=11 September 2019 |title=Preventing Suicide {{!}}Violence Prevention{{!}}Injury Centerf|url=https://www.cdc.gov/violenceprevention/suicide/fastfact.html |access-date=2 October 2019 |website=[[Centers for Disease Control and Prevention]] }}</ref>

Worldwide, three suicide methods predominate, with the pattern varying in different countries: these are [[suicide by hanging|hanging]], [[Pesticide poisoning|pesticides]], and [[firearm]]s.<ref name="who2">{{cite web|date=9 September 2019|title=Suicide: one person dies every 40 seconds|url=https://www.who.int/news-room/detail/09-09-2019-suicide-one-person-dies-every-40-seconds|website=World Health Organization}}</ref> Some suicides may be [[Suicide prevention|preventable]] by removing the means.<ref name=":4"/> Making common suicide methods [[Suicide prevention#Lethal means reduction|less accessible]] leads to an overall reduction in the number of suicides.<ref name=":3" /><ref name="APA">{{cite web |title=Worrying trends in U.S. suicide rates |url=https://www.apa.org/monitor/2019/03/trends-suicide }}</ref>

Method-specific ways to do this might include restricting access to pesticides, firearms, and commonly used drugs. Other important measures are the introduction of policies that address the [[misuse of alcohol]] and the treatment of [[mental disorders]].<ref name=WHO2020>{{cite web |title=Suicide |url=https://www.who.int/en/news-room/fact-sheets/detail/suicide |website=www.who.int |access-date=5 September 2020 }}</ref> [[Gun-control]] measures in a number of countries have seen a reduction in suicides and other gun-related deaths.<ref name="Santaella-Tenorio">{{cite journal |last1=Santaella-Tenorio |first1=J |last2=Cerdá |first2=M |last3=Villaveces |first3=A |last4=Galea |first4=S |title=What Do We Know About the Association Between Firearm Legislation and Firearm-Related Injuries? |journal=Epidemiologic Reviews |date=2016 |volume=38 |issue=1 |pages=140–57 |doi=10.1093/epirev/mxv012 |pmid=26905895|pmc=6283012}}</ref>  Other preventive measures are not method-specific; these include support, access to treatment, and calling a [[crisis hotline]].<ref name="cdc.gov">{{cite web |date=25 April 2019 |title=Suicide Risk and Protective Factors{{!}}Suicide{{!}}Violence Prevention{{!}}Injury Center |url=https://www.cdc.gov/violenceprevention/suicide/riskprotectivefactors.html |access-date=29 July 2019 |website=www.cdc.gov }}</ref> There are multiple [[talk therapies]] that reduce suicidal thoughts and behaviors regardless of method, including [[dialectical behavior therapy]] (DBT).<ref>{{cite journal |author1=Canadian Agency for Drugs Technologies in Health (CADTH) |date=1 March 2010 |title=Dialectical Behaviour Therapy in Adolescents for Suicide Prevention: Systematic Review of Clinical-Effectiveness |journal=CADTH Technology Overviews |volume=1 |issue=1 |pages=e0104 |pmc=3411135 |pmid=22977392}}</ref><ref>National Institute of Mental Health: Suicide in the U.S.: Statistics and Prevention [http://www.nimh.nih.gov/health/publications/suicide-in-the-us-statistics-and-prevention/index.shtml#DB-Therapy]</ref> 
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== Purpose of study ==
The [[Suicidology|study of suicide methods]] aims to identify those commonly used, and the groups at risk of suicide; making methods less accessible may be useful in [[suicide prevention]].<ref name=":3">{{Cite journal|last1=Yip|first1=Paul S. F.|last2=Caine|first2=Eric|last3=Yousuf|first3=Saman|last4=Chang|first4=Shu-Sen|last5=Wu|first5=Kevin Chien-Chang|last6=Chen|first6=Ying-Yeh|date=2012-06-23|title=Means restriction for suicide prevention|journal=Lancet|volume=379|issue=9834|pages=2393–99|doi=10.1016/S0140-6736(12)60521-2|issn=1474-547X|pmc=6191653|pmid=22726520}}</ref><ref name=":4">{{Cite journal|last1=Turecki|first1=Gustavo|last2=Brent|first2=David A.|date=2016-03-19|title=Suicide and suicidal behaviour|journal=Lancet|volume=387|issue=10024|pages=1227–39|doi=10.1016/S0140-6736(15)00234-2|issn=0140-6736|pmc=5319859|pmid=26385066}}</ref><ref name=":2">{{Cite book|last=Berk|first=Michele|url=https://books.google.com/books?id=Nl6NDwAAQBAJ&pg=PA309|title=Evidence-Based Treatment Approaches for Suicidal Adolescents: Translating Science Into Practice|date=2019-03-12|publisher=American Psychiatric Pub|isbn=978-1-61537-163-1|pages=309}}</ref> Limiting the availability of means such as [[pesticide]]s and [[firearm]]s is recommended by a [[World Health Report]] on suicide and its prevention. The early identification of [[mental disorder]]s and [[substance abuse disorder]]s, follow-up care for those who have attempted suicide, and responsible reporting by the media are all seen to be key in reducing the number of deaths by suicide.<ref name="Report">{{cite web |title=First WHO report on suicide prevention calls for coordinated action to reduce suicides worldwide |url=https://www.who.int/violence_injury_prevention/media/news/2014/05_09/en/ |archive-url=https://web.archive.org/web/20141018084403/http://www.who.int/violence_injury_prevention/media/news/2014/05_09/en/ |url-status=dead |archive-date=18 October 2014 |website=WHO |access-date=12 September 2020}}</ref> National suicide prevention strategies are also advocated using a comprehensive and coordinated response to suicide prevention. This needs to include the registration and monitoring of suicides and attempted suicide, breaking figures down by age, [[Gender differences in suicide|sex]], and method.<ref name="Report"/>

Such information allows public health resources to focus on the problems that are relevant in a particular place, or for a given population or subpopulation.<ref name="who.int">{{cite web |title=Campaign materials – handouts |url=https://www.who.int/health-topics/suicide/campaign-materials-handouts |archive-url=https://web.archive.org/web/20191018033936/https://www.who.int/health-topics/suicide/campaign-materials-handouts |url-status=dead |archive-date=18 October 2019 |website=www.who.int |access-date=5 September 2020 }}</ref> For instance, if firearms are used in a significant number of suicides in one place, then public health policies there could focus on [[gun safety]], such as keeping guns locked away, and the key inaccessible to [[Assessment of suicide risk|at-risk family members]]. If young people are found to be at increased risk of suicide by overdosing on particular medications, then an alternative class of medication may be prescribed instead, a safety plan and monitoring of medication can be put in place, and parents can be educated about how to prevent the hoarding of medication for a future suicide attempt.<ref name=":2" />

== Media reporting ==
[[File:988 Suicide & Crisis Lifeline logo - navy - square.svg|thumb| When news organizations report on suicide-related events, media guidelines encourage them to provide information about [[List of suicide crisis lines#Crisis lines by country|local suicide crisis phone numbers]], such as this number for North America.]]
Media reporting of the methods used in any given suicide is "strongly discouraged" by the [[World Health Organization]], government health agencies, universities, and the [[Associated Press]] among others.<ref>{{cite journal |last1=Carmichael |first1=Victoria |last2=Whitley |first2=Rob |title=Media coverage of Robin Williams' suicide in the United States: A contributor to contagion? |journal=PLOS ONE |date=May 9, 2019 |volume=14 |issue=5 |pages=e0216543 |doi=10.1371/journal.pone.0216543 |pmid=31071144 |pmc=6508639 |bibcode=2019PLoSO..1416543C |url=|doi-access=free }}</ref> Detailed descriptions of suicides or the personal characteristics of the person who died contribute to copycat suicides ([[suicide contagion]]).<ref>{{cite web |title=Reporting on Suicide: Recommendations for the Media |url=https://www.afsp.org/education/recommendations/5/1.htm |website=American Foundation for Suicide Prevention |access-date=25 February 2021 |archive-url=https://web.archive.org/web/20041031080834/http://www.afsp.org/education/recommendations/5/1.htm |archive-date=October 31, 2004}}</ref><ref name=":6" /> Dramatic or inappropriate descriptions of individual suicides by [[mass media]] has been linked specifically to copycat suicides among teenagers.<ref name=":6" /> Writing for the ''New Yorker'' about celebrity suicides, [[Andrew Solomon]] wrote that "You who are reading this are at statistically increased risk of suicide right now."<ref>{{cite news |last1=Solomon |first1=Andrew |title=Anthony Bourdain, Kate Spade, and the Preventable Tragedies of Suicide |url=https://www.newyorker.com/news/daily-comment/preventable-tragedies |access-date=25 February 2021 |work=New Yorker |date=June 9, 2018}}</ref> In one study, changes in how news outlets reported suicide reduced suicides by a particular method.<ref name=":6">{{Cite book|last=Wasserman|first=Danuta|author-link=Danuta Wasserman|url=https://books.google.com/books?id=_CMZCwAAQBAJ|title=Suicide: An unnecessary death|date=2016-01-14|publisher=Oxford University Press|isbn=978-0-19-102683-6|pages=359–361}}</ref>

Media reporting guidelines also apply to "online content including citizen-generated media coverage". The Recommendations for Reporting on Suicide, created by journalists, suicide prevention groups, and [[internet safety]] non-profit organizations, encourage linking to resources such as a [[list of suicide crisis lines]] and information about [[risk factors for suicide]], and reporting on suicide as a multi-faceted, treatable health issue.<ref>{{cite web |title=Online Media |url=https://reportingonsuicide.org/onlinemedia/ |website=Reporting on Suicide |access-date=25 February 2021 |url-status=live|archive-url=https://web.archive.org/web/20210110161746/https://reportingonsuicide.org/onlinemedia/ |archive-date=January 10, 2021}}</ref>

== Method restriction ==
{{see also|Suicide prevention#Lethal means reduction}}
Method restriction, also called ''lethal means reduction'', is an effective way to reduce the number of suicide deaths in the short and medium term.<ref>{{cite journal|last1=Yip|first1=PS|last2=Caine|first2=E|last3=Yousuf|first3=S|last4=Chang|first4=SS|last5=Wu|first5=KC|last6=Chen|first6=YY|date=23 June 2012|title=Means restriction for suicide prevention.|journal=Lancet|volume=379|issue=9834|pages=2393–9|doi=10.1016/S0140-6736(12)60521-2|pmc=6191653|pmid=22726520}}</ref> Method restriction is considered a [[best practice]] supported by "compelling" [[Evidence-based medicine|evidence]].<ref name=":6" /> Some of these actions, such as installing barriers on bridges and reducing the toxicity in gas, require action by governments, industries, or [[Public utility|public utilities]]. At the individual level, method restriction can be as simple as asking a trusted friend or family member to store firearms until the crisis has passed.<ref name=":7" /><ref name=":1" /> According to [[Danuta Wasserman]], professor in [[psychiatry]] and [[suicidology]] at [[Karolinska Institute]], choosing not to restrict access to suicide methods is [[unethical]].<ref name=":6" />

Method restriction is effective and prevents suicides.<ref name=":6" /> It has the largest effect on overall suicide rates when the method being restricted is common and no direct substitution is available.''<ref name=":6" />'' If the method being restricted is uncommon, or if a substitute is readily available, then it may be effective in individual cases but not produce a large-scale reduction in the number of deaths in a country.<ref name=":6" />

''Method substitution'' is the process of choosing a different suicide method when the first-choice method is inaccessible.<ref name=":4" /> In many cases, when the first-choice method is restricted, the person does not attempt to find a substitute.<ref name=":6" /> Method substitution has been measured over the course of decades, so when a [[Suicide prevention#Lethal means reduction|common method is restricted]] (for example, by making domestic gas less toxic), overall suicide rates may be suppressed for many years.<ref name=":4" /><ref name=":6" /> If the first-choice suicide method is inaccessible, a method substitution may be made which may be less lethal, tending to result in fewer fatal suicide attempts.<ref name=":4" />

In an example of the [[curb cut effect]], changes unrelated to suicide have also functioned as suicide method restrictions.<ref name=":6" /> Examples of this include changes to align train doors with platforms, switching from [[coal gas]] to [[natural gas]] in homes, and [[gun control]] laws, all of which have reduced suicides despite being intended for a different purpose.<ref name=":6" />

==List==

=== Suffocation ===
[[Suffocation]], as a classification of suicide method, includes [[strangulation]] and [[hanging]].<ref name="Stats">{{cite journal |date=2016 |title=QuickStats: Age-Adjusted Suicide Rates for Females and Males, by Method – National Vital Statistics System, United States, 2000 and 2014 |url=https://www.cdc.gov/mmwr/volumes/65/wr/mm6519a7.htm |journal=Morbidity and Mortality Weekly Report |publisher=Centers for Disease Control and Prevention |volume=65 |issue=19 |page=503 |doi=10.15585/mmwr.mm6519a7 |pmid=27197046 |doi-access=free}}</ref><ref name="ONS">{{cite web |title=Suicides in the UK|url=https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/suicidesintheunitedkingdom/2018registrations |website=www.ons.gov.uk – Office for National Statistics }}</ref>

Suicide by suffocation involves restricting breathing or the amount of oxygen taken in, causing [[asphyxia]] and eventually [[hypoxia (medical)|hypoxia]]. It is not possible to die simply by holding the breath, since a [[reflex]] causes the [[respiratory muscles]] to contract, forcing an in-breath, and the re-establishment of a normal breathing rhythm.<ref>{{cite web|last=Kurzban|first=Robert|title=Why Can't You Hold Your Breath Until You're Dead?|url=http://www.epjournal.net/blog/2011/02/why-can%E2%80%99t-you-hold-your-breath-until-you%E2%80%99re-dead/|archive-url=https://web.archive.org/web/20110210132603/http://www.epjournal.net/blog/2011/02/why-can%E2%80%99t-you-hold-your-breath-until-you%E2%80%99re-dead/|url-status=usurped|archive-date=10 February 2011|website=Web.|access-date=23 August 2013|date=7 February 2011}}</ref> Therefore, inhaling an [[inert gas]] such as [[helium]] or [[nitrogen]], or a toxic gas such as [[Carbon monoxide poisoning|carbon monoxide]], is used to bring about [[unconsciousness]].<ref>{{cite web |url=https://www.osha.gov/dts/shib/shib042704.html | title=Deaths Involving the Inadvertent Connection of Air-line Respirators to Inert Gas Supplies }}</ref><ref>{{cite journal |author=Goldstein |first=M. |date=December 2008 |title=Carbon monoxide poisoning |url=http://www.bmj.com/cgi/content/short/3/5716/180 |journal=Journal of Emergency Nursing |volume=34 |issue=6 |pages=538–42 |doi=10.1016/j.jen.2007.11.014 |pmid=19022078|url-access=subscription }}</ref> Certain devices such as [[Suicide bag|exit bags]] are designed to be used with this method, and provide a way for the carbon dioxide to passively escape, which prevents the panic, sense of [[suffocation]] and struggling before [[unconsciousness]], known as the [[Hypercapnia|hypercapnic]] alarm response caused by the presence of high [[carbon dioxide]] concentrations in the blood.<ref name="PDH2">{{cite book |last1=Nitschke |first1=Philip |author-link=Philip Nitschke |title=The Peaceful Pill Handbook |last2=Stewart |first2=Fiona |author-link2=Fiona Stewart (author) |date=2016 |publisher=Exit International US Limited |isbn=978-0-9758339-1-9 |chapter=Hypoxic Death and the Exit bag}}</ref>  {{As of|2010}}, organizations supporting a [[right to die]] promoted death by helium inhalation, although most cases using this method in the US were people with psychiatric conditions.<ref>Howard M, Hall M, Jeffrey D et al., "[http://deepblue.lib.umich.edu/bitstream/handle/2027.42/78181/heliumsuicide.pdf;jsessionid=D092B0E3A7286434E6064E09D10618C8?sequence=1 ''Suicide by Asphyxiation due to Helium Inhalation''], Am J Forensic Med Pathol 2010; accessed 12 May 2014</ref>

====Hanging====
{{Main|Suicide by hanging}}
[[File:Giotto - Scrovegni - -47- - Desperation.jpg|thumb|right|120px|14th century [[fresco]] by [[Giotto]], depicting suicide by [[hanging]]]]

[[Hanging]] is a common method of suicide.<ref name="ONS"/><ref name="Stats" /> Hanging involves the use of a [[Ligature strangulation|ligature]] such as a rope or cord attached to an anchor point with the other end used to form a [[noose]] placed around the neck. The cause of death will either be due to strangulation or a [[cervical fracture|broken neck]]. About half of attempted [[suicide by hanging|suicides by hanging]] result in death.<ref name="AIM2019" /> People who favor this method are usually unaware that it is often a "slow, painful, and messy method that [needs] technical knowledge".<ref>{{Cite journal|last1=Park|first1=Subin|last2=Ahn|first2=Myung Hee|last3=Lee|first3=Ahrong|last4=Hong|first4=Jin Pyo|date=2014-06-04|title=Associations between changes in the pattern of suicide methods and rates in Korea, the US, and Finland|journal=International Journal of Mental Health Systems|volume=8|pages=22|doi=10.1186/1752-4458-8-22|issn=1752-4458|pmc=4062645|pmid=24949083 |doi-access=free }}</ref>

Hanging is the prevalent means of suicide in impoverished [[pre-industrial society|pre-industrial societies]], and is more common in [[rural]] areas than in [[Urban area|urban]] areas.<ref>{{cite book|url=https://books.google.com/books?id=Zi-xoFAPnPMC|title=Comprehensive Textbook of Suicidology|author1=Ronald W. Maris |author2=Alan L. Berman |author3=Morton M. Silverman |author4=Bruce Michael Bongar |isbn=978-1-57230-541-0|year=2000| publisher=Guildford Press| page=96}}</ref>

Hanging was the most common method in [[Chinese culture|traditional Chinese culture]],<ref name=pel/> as it was believed that the rage involved in such a death permitted the person's [[Chinese soul|spirit]] to haunt and torment survivors.<ref>{{citation |first=Jonathan H.X. |last=Lee |author2=Kathleen Nadeau |ref={{harvid|Lee & al.|2011}} |date=2011 |url=https://books.google.com/books?id=-0sEJ_0vV1QC |title=Encyclopedia of Asian American Folklore and Folklife |publisher=[[ABC-CLIO]] |page=[https://books.google.com/books?id=-0sEJ_0vV1QC&pg=PA11 11] |isbn=978-0-313-35067-2 }}.</ref><ref>{{citation |last=Lee |first=Evelyn |date=1997 |url=https://books.google.com/books?id=PLXmf749kmAC |title=Working with Asian Americans: A Guide for Clinicians |publisher=[[Guilford Press]] |page=[https://books.google.com/books?id=PLXmf749kmAC&o&pg=PA59 59] |isbn=978-1-57230-570-0 }}.</ref> In the Chinese culture, suicide by hanging was used as an act of revenge by women<ref>{{cite journal |last1=Bourne |first1=P G |title=Suicide among Chinese in San Francisco. |journal=American Journal of Public Health |date=August 1973 |volume=63 |issue=8 |pages=744–50 |pmid=4719540 |pmc=1775294 |doi=10.2105/AJPH.63.8.744 }}</ref> and of defiance by powerless officials, who used it as a "final, but unequivocal, way of standing still against and above oppressive authorities".<ref name=pel/> Chinese people would often [[Philosophy of suicide#Confucianism|approach the act ceremonially]], including the use of proper attire.<ref name=pel>{{citation |editor-last=Perry |editor-first=Elizabeth J. |editor2=Mark Selden |date=2003 |display-editors=0 |url=https://books.google.com/books?id=fUKqoXHqDGEC |title=Chinese Society: Change, Conflict and Resistance |location=Abingdon |publisher=[[Routledge]] |page=[https://books.google.com/books?id=fUKqoXHqDGEC&pg=PA297 297] |last=Lee |first=Sing |author2=Arthur Kleinman |contribution=Suicide as Resistance in Chinese Society <!--|pages=289–311--> |contribution-url=https://books.google.com/books?id=fUKqoXHqDGEC&pg=PA289 |ref={{harvid|Lee & al.|2003}} |isbn=978-0-415-30170-1 }}.</ref>

====Drowning====
{{main|Drowning}}
[[File:Street Girl's End.jpg|thumb|120px|1884 illustration of a [[homeless]] girl contemplating drowning herself]]
Suicide by drowning is the act of deliberately submerging oneself in water or other liquid to prevent [[breath]]ing. It accounts for less than 2% of all suicides in the United States.<ref name='WISQARS'>{{cite web
|url=http://webappa.cdc.gov/sasweb/ncipc/leadcaus10.html
| title = WISQARS Leading Causes of Death Reports
| access-date = 2009-07-06
}}</ref> People with [[dementia]] and [[schizophrenia]] have a higher risk of dying by drowning.<ref>{{Cite journal |last1=Peden |first1=Amy E. |last2=Taylor |first2=Danielle H. |last3=Franklin |first3=Richard C. |date=2022-07-21 |title=Pre-Existing Medical Conditions: A Systematic Literature Review of a Silent Contributor to Adult Drowning |journal=International Journal of Environmental Research and Public Health |volume=19 |issue=14 |pages=8863 |doi=10.3390/ijerph19148863 |issn=1660-4601 |pmc=9324568 |pmid=35886717 |quote=Drowning is a common suicide method for those with schizophrenia, psychotic disorders and dementia. |doi-access=free }}</ref> Of those who attempt suicide by drowning in the US, about half die.<ref name=AIM2019>{{cite journal |last1=Conner |first1=Andrew |last2=Azrael |first2=Deborah |last3=Miller |first3=Matthew |title=Suicide Case-Fatality Rates in the United States, 2007 to 2014 |journal=Annals of Internal Medicine |date=3 December 2019 |doi=10.7326/M19-1324|pmid=31791066 |volume=171 |issue=12 |pages=885–895 |s2cid=208611916 }}</ref>

About 2% to 3% of suicides by drowning involve [[#Road|driving a vehicle]] into a body of water.<ref name=":9">{{Cite journal |last1=O'Donovan |first1=Siobhan |last2=van den Heuvel |first2=Corinna |last3=Baldock |first3=Matthew |last4=Byard |first4=Roger W |date=April 2023 |title=An overview of suicides related to motor vehicles |url=http://journals.sagepub.com/doi/10.1177/00258024221122187 |journal=Medicine, Science and the Law |volume=63 |issue=2 |pages=151–158 |doi=10.1177/00258024221122187 |pmid=36000305 |issn=0025-8024|url-access=subscription }}</ref>

=== Poisoning ===
{{Main article|Suicide pill}}
Suicide by [[poisoning]], also called ''self-poisoning'', is usually classed as a [[drug overdose]] when drugs such as painkillers or recreational drugs are used. The use of [[pesticide poisoning|pesticides to self-poison]] is the most common method used in some countries.<ref name="who2" /> Poisoning through the means of [[toxic plants]] is usually slow and painful.<ref>{{cite web |url=http://www.ctrl-c.liu.se/~ingvar/methods/poison.html |title=Poisoning methods |publisher=Ctrl-c.liu.se |access-date=2012-01-15 |archive-date=10 May 1996 |archive-url=https://web.archive.org/web/19960510161817/http://www.ctrl-c.liu.se/~ingvar/methods/poison.html |url-status=dead }}</ref><ref>{{Cite web |title=Poison - Animal, Zootoxins, Biochemistry |url=https://www.britannica.com/science/poison-biochemistry/Animal-poisons-zootoxins |access-date=2023-10-09 |website=www.britannica.com }}</ref>

==== Pesticide ====
{{see also|Pesticide poisoning}}
[[File:Share of suicide deaths from pesticide poisoning, OWID.svg|class=skin-invert-image|thumb|upright=1.6|Share of suicide deaths from pesticide poisoning<ref name=OWID>{{cite web |title=Share of suicide deaths from pesticide poisoning |url=https://ourworldindata.org/grapher/share-suicide-pesticide-poisoning |website=Our World in Data |access-date=4 March 2020}}</ref>]]

{{As of|2006}}, worldwide, around 30% of suicides were from [[pesticide poisoning]]s.<ref name="BJP">{{cite journal |last1=Bertolote |first1=J. M. |last2=Fleischmann |first2=A. |last3=Eddleston |first3=M. |last4=Gunnell |first4=D. |title=Deaths from pesticide poisoning: a global response |journal=The British Journal of Psychiatry |pages=201–03 |doi=10.1192/bjp.bp.105.020834 |date=September 2006|volume=189 |issue=3 |pmid=16946353 |pmc=2493385 }}</ref> It was the leading suicide method in [[Developing country|developing countries]],<ref>{{Citation |last1=Harmer |first1=Bonnie |title=Suicidal Ideation |date=2024 |work=StatPearls |url=http://www.ncbi.nlm.nih.gov/books/NBK565877/ |access-date=2024-05-02 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=33351435 |last2=Lee |first2=Sarah |last3=Duong |first3=Truc vi H. |last4=Saadabadi |first4=Abdolreza}}</ref> with about half of suicide deaths in India involving poisoning, and most of those involving pesticides.<ref>{{Cite journal |last1=Varghese |first1=Prinston |last2=Erickson |first2=Timothy B. |date=2022 |title=Pesticide Poisoning Among Children in India: The Need for an Urgent Solution |journal=Global Pediatric Health |volume=9 |pages=2333794X221086577 |doi=10.1177/2333794X221086577 |issn=2333-794X |pmc=8990700 |pmid=35400019}}</ref> The use of this method varies markedly in different areas of the world, from 0.9% in Europe to about 50% in the Pacific region.<ref name=OWID/> In the US, pesticide poisoning is used in about 12 suicides per year.<ref>{{cite web |title=Underlying Cause of Death, 1999–2018 Request |url=https://wonder.cdc.gov/ucd-icd10.html |website=wonder.cdc.gov |access-date=7 March 2020}}</ref> The overall [[case fatality rate]] for suicide attempts using pesticide is about 10–20%;<ref>{{cite journal |last1= Gunnell|first1= David|author-link=David Gunnell|last2= Eddleston|first2= Michael|date=December 1, 2003 |title= Suicide by intentional ingestion of pesticides: a continuing tragedy in developing countries |journal= [[International Journal of Epidemiology]]|volume= 32|issue= 6|pages= 902–909|doi= 10.1093/ije/dyg307|pmid= 14681240|pmc= 2001280}}</ref> the risk of death increases if the person is also [[drunk]] at the time.<ref>{{Cite journal |last1=Dhanarisi |first1=Jeevan |last2=Perera |first2=Sriyani |last3=Wijerathna |first3=Thilini |last4=Gawarammana |first4=Indika |last5=Shihana |first5=Fathima |last6=Pathiraja |first6=Vindya |last7=Eddleston |first7=Michael |last8=Mohamed |first8=Fahim |date=2023-01-09 |title=Relationship Between Alcohol Co-Ingestion and Clinical Outcome in Pesticide Self-Poisoning: A Systematic Review and Meta-Analysis |url=https://pubmed.ncbi.nlm.nih.gov/36172715 |journal=Alcohol and Alcoholism (Oxford, Oxfordshire) |volume=58 |issue=1 |pages=4–12 |doi=10.1093/alcalc/agac045 |issn=1464-3502 |pmid=36172715}}</ref>

Method restriction is an effective way to reduce suicide by pesticide poisoning.<ref>{{Cite journal |last1=Lim |first1=Jessy S. |last2=Buckley |first2=Nicholas A. |last3=Chitty |first3=Kate M. |last4=Moles |first4=Rebekah Jane |last5=Cairns |first5=Rose |date=October 2021 |title=Association Between Means Restriction of Poison and Method-Specific Suicide Rates: A Systematic Review |journal=JAMA Health Forum |volume=2 |issue=10 |pages=e213042 |doi=10.1001/jamahealthforum.2021.3042 |issn=2689-0186 |pmc=8727039 |pmid=35977165}}</ref> In Finland, limiting access to [[parathion]] in the 1960s resulted in a rapid decline in both poisoning-related suicides and total suicide deaths for several years, and a slower decline in subsequent years.<ref name=":5">{{Cite journal|last1=Kim|first1=Jinyong|last2=Shin|first2=Sang Do|last3=Jeong|first3=Seungmin|last4=Suh|first4=Gil Joon|last5=Kwak|first5=Young Ho|date=2017-11-02|title=Effect of prohibiting the use of Paraquat on pesticide-associated mortality|journal=BMC Public Health|volume=17|issue=1|pages=858|doi=10.1186/s12889-017-4832-4|issn=1471-2458|pmc=5667494|pmid=29096617 |doi-access=free }}</ref> In [[Sri Lanka]], both suicide by pesticide and total suicides declined after first [[toxicity class|toxicity class I]] and later [[toxicity class|class II]] [[endosulfan]] were banned.<ref>{{Cite journal | doi = 10.1126/science.341.6147.738| title = In Rural Asia, Locking Up Poisons to Prevent Suicides| journal = Science| volume = 341| issue = 6147| pages = 738–39| year = 2013| last1 = Hvistendahl | first1 = M.| pmid=23950528| bibcode = 2013Sci...341..738H| doi-access = free}}</ref> Overall suicide deaths were cut by 70%, with 93,000 lives saved over 20 years as a result of banning these pesticides.<ref name="who2" /> In Korea, banning a single pesticide, [[paraquat]], halved the number of suicides by pesticide poisoning<ref name="who2" /> and reduced the total number of suicides in that country.<ref name=":5" />

==== Drug overdose ====
{{see also|Drug overdose}}
A [[drug overdose]] involves taking a dose of a [[drug]] that exceeds safe levels. In the UK (England and Wales) until 2013, a drug overdose was the most common suicide method in women.<ref name="ONS19">{{cite web |title=Suicides in England and Wales – Office for National Statistics |url=https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/suicidesintheunitedkingdom/2019registrations |website=www.ons.gov.uk}}</ref> In 2019 in males the percentage is 16%. Self-poisoning accounts for the highest number of non-fatal suicide attempts. In the United States about 60% of suicide attempts and 14% of suicide deaths involve drug overdoses.<ref name="AIM2019" /> The risk of death in suicide attempts involving overdose is about 2%.<ref name="AIM2019" />{{Verify source|date=June 2021|reason=Two percent, or twenty?}}

Overdose attempts using [[Analgesics|painkillers]] are among the most common, due to their easy availability over-the-counter.<ref>{{cite journal |last =Brock |first =Anita |author2=Sini Dominy |author3=Clare Griffiths |date=6 November 2003 |title = Trends in suicide by method in England and Wales, 1979 to 2001 |journal = Health Statistics Quarterly |volume = 20 |pages = 7–18 |issn = 1465-1645 |url=http://www.statistics.gov.uk/CCI/article.asp?ID=1538&Pos=4&ColRank=1&Rank=176 |access-date = 2007-06-25 }}</ref> [[Paracetamol]] (also called acetaminophen) is the most widely used analgesic worldwide and is commonly used in overdose attempts.<ref name="CDB18">{{cite journal |last1=Chiew |first1=AL |last2=Gluud |first2=C |last3=Brok |first3=J |last4=Buckley |first4=NA |title=Interventions for paracetamol (acetaminophen) overdose. |journal=The Cochrane Database of Systematic Reviews |date=23 February 2018 |volume=2018 |issue=2 |pages=CD003328 |doi=10.1002/14651858.CD003328.pub3 |pmid=29473717|pmc=6491303 }}</ref> [[Paracetamol poisoning]] is a common cause of [[acute liver failure]].<ref name="JoE">{{cite journal |last1=Aminoshariae |first1=A |last2=Khan |first2=A |title=Acetaminophen: old drug, new issues. |journal=Journal of Endodontics |date=May 2015 |volume=41 |issue=5 |pages=588–93 |doi=10.1016/j.joen.2015.01.024 |pmid=25732401}}</ref><ref name="CDB18" /> If not treated, the overdose produces a long and painful illness, with symptoms of [[nausea]], [[vomiting]], [[sweating]], and [[abdominal pain]] appearing several hours after ingestion and continuing for several days.<ref name="Heard-NEJM">{{cite journal |author=Heard KJ |date=July 2008 |title=Acetylcysteine for Acetaminophen Poisoning |journal=The New England Journal of Medicine |volume=359 |issue=3 |pages=285–92 |doi=10.1056/NEJMct0708278 |pmc=2637612 |pmid=18635433}}</ref><ref name="Rumack1975">{{cite journal |vauthors=Rumack B, Matthew H |year=1975 |title=Acetaminophen poisoning and toxicity |journal=Pediatrics |volume=55 |issue=6 |pages=871–876 |doi=10.1542/peds.55.6.871 |pmid=1134886 |s2cid=45739342}}</ref> People who take overdoses of paracetamol do not fall asleep or lose consciousness, although most people who attempt suicide with paracetamol wrongly believe that they will be rendered unconscious by the drug.<ref>{{Cite journal |last1=Simkin |first1=S. |last2=Hawton |first2=K. |last3=Kapur |first3=N. |last4=Gunnell |first4=D. |date=2012-01-01 |title=What can be done to reduce mortality from paracetamol overdoses? A patient interview study |journal=QJM |volume=105 |issue=1 |pages=41–51 |doi=10.1093/qjmed/hcr135 |pmid=21856743 |issn=1460-2725|doi-access=free }}</ref><ref name="met1">{{cite web |date=25 August 2012 |title=Metabolism of Paracetamol (Acetaminophen), Acetanilide and Phenacetin |url=https://pharmaxchange.info/2012/08/metabolism-of-paracetamol-acetaminophen-acetanilide-and-phenacetin/ |url-status=dead |archive-url=https://web.archive.org/web/20191028061441/https://pharmaxchange.info/2012/08/metabolism-of-paracetamol-acetaminophen-acetanilide-and-phenacetin/ |archive-date=28 October 2019 |access-date=27 October 2019 |website=PharmaXChange.info |vauthors=Mehta S}}</ref>  Method-specific restriction through reducing package size in the UK and Ireland has reduced suicide deaths by drug overdose.<ref>{{Cite journal |last1=Hawton |first1=K. |last2=Bergen |first2=H. |last3=Simkin |first3=S. |last4=Dodd |first4=S. |last5=Pocock |first5=P. |last6=Bernal |first6=W. |last7=Gunnell |first7=D. |last8=Kapur |first8=N. |date=2013-02-07 |title=Long term effect of reduced pack sizes of paracetamol on poisoning deaths and liver transplant activity in England and Wales: interrupted time series analyses |journal=BMJ |volume=346 |issue=feb07 1 |pages=f403 |doi=10.1136/bmj.f403 |issn=1756-1833 |pmc=3567205 |pmid=23393081}}</ref>

==== Carbon monoxide ====
{{See also|Carbon monoxide poisoning}}
A particular type of poisoning involves the inhalation of high levels of [[carbon monoxide]] (CO). Death usually occurs through [[hypoxia (medical)|hypoxia]]. A nonfatal attempt can result in memory loss and other symptoms.<ref>{{cite journal |last1=Hay |first1=Phillipa J |last2=Denson |first2=Linley A |last3=van Hoof |first3=Miranda |last4=Blumenfeld |first4=Natalia |title=The neuropsychiatry of carbon monoxide poisoning in attempted suicide |journal=Journal of Psychosomatic Research |date=August 2002 |volume=53 |issue=2 |pages=699–708 |doi=10.1016/S0022-3999(02)00424-5 |pmid=12169344 }}</ref>

Carbon monoxide is a colorless and odorless [[gas]], so its presence cannot be detected by sight or smell. It acts by binding preferentially to the [[hemoglobin]] in the bloodstream, displacing oxygen molecules and progressively deoxygenating the blood, eventually resulting in the failure of [[cellular respiration]] and death. Carbon monoxide is extremely dangerous to bystanders and people who may discover the body; right-to-die advocate [[Philip Nitschke]] has therefore recommended against this method.<ref name="Nitschke">{{cite book |last1=Nitschke |first1=Philip |title=The peaceful pill handbook |date=2007 |publisher=Exit International US |location=Waterford, MI |isbn=978-0-9788788-2-5 |edition=New rev. international}}</ref>{{Self-published inline|date=June 2021}}

Before [[air quality index|air quality]] regulations and [[catalytic converter]]s, suicide by carbon monoxide poisoning was often achieved by running a car's engine in an enclosed space such as a garage, or by redirecting a running car's exhaust back inside the cabin with a hose. [[Exhaust gas|Motor car exhaust]] may have contained up to 25% carbon monoxide. Catalytic converters found on all modern automobiles eliminate over 99% of carbon monoxide produced.<ref name="Chest1999-vossberg">{{cite journal |vauthors=Vossberg B, Skolnick J | title=The role of catalytic converters in automobile carbon monoxide poisoning: a case report | journal=Chest | year=1999 | pages=580–81 | volume=115 | issue=2 | pmid=10027464 | doi=10.1378/chest.115.2.580| s2cid=34394596 }}</ref> As a further complication, the amount of unburned gasoline in emissions can make exhaust unbearable to breathe well before a person loses consciousness.

[[Charcoal-burning suicide]] induces death from [[carbon monoxide poisoning]]. Originally used in [[Hong Kong]], it spread to [[Japan]],<ref name="SCMP">{{cite web |title=Taking the easy way out? |url=https://www.scmp.com/article/484827/taking-easy-way-out |website=[[South China Morning Post]] |access-date=6 September 2020 |date=9 January 2005}}</ref> where small charcoal-burning heaters (''[[hibachi]]'') or stoves (''[[shichirin]]'') have been used in a sealed room. By 2001, this method accounted for 25% of deaths from suicide in Japan.<ref name="BMJ">{{cite journal | doi = 10.1136/bmj.326.7387.498 | pmid = 12609951 | pmc = 1125377 | title = Media influence on suicide | year = 2003 | last1 = Howe | first1 = A. | journal = BMJ | volume = 326 | issue = 7387 | page = 498 }}</ref> Nonfatal attempts can result in severe [[brain damage]] due to [[cerebral anoxia]].

==== Other toxins ====
{{anchor|Suicide by household gas}}
Gas-oven suicide was a common method of suicide in the early to mid-20th centuries in some North American and European countries. Household gas was originally [[coal gas]], also called [[History of manufactured fuel gases|illuminating gas]], or town gas, which was composed of methane, hydrogen and carbon monoxide. Stoves of this era required one to manually ignite a [[pilot light]] with a [[match]]; without the combustion the gas cloud would spread unimpeded. [[Carbon monoxide poisoning]] was the proximate cause of death. [[Natural gas]], introduced in the 1960s, is composed of methane, ethane and an [[odorant]] added for safety.<ref>{{Cite web |title=Why have people stopped committing suicide with gas? |url=https://gizmodo.com/why-have-people-stopped-committing-suicide-with-gas-5959303/amp |access-date=2022-10-02 |website=gizmodo.com|date=9 November 2012 }}</ref> The suicide rates by domestic gas fell from 1960 to 1980, as changes were made to the formula to make it less lethal.<ref name=":4" /><ref>{{cite journal |last1=Lester |first1=D. |date=March 1990 |title=Changes in the methods used for suicide in 16 countries from 1960 to 1980 |journal=Acta Psychiatrica Scandinavica |volume=81 |issue=3 |pages=260–61 |doi=10.1111/j.1600-0447.1990.tb06492.x |pmid=2343750 |s2cid=28751662}}</ref>

=== Shooting ===
{{see also|Multiple gunshot suicide}}
{{ multiple image | total_width=450
|image1= 200012 Suicide methods in order of lethality - variable-width bar chart.svg |caption1= Though substance overdose is the most common method of attempted suicide in the U.S., guns are the most lethal (most likely to result in death).<ref name=AmJnlPublicHealth_20001200>{{cite journal |last1=Spicer |first1=Rebecca S. |last2=Miller |first2=Ted R. |title=Suicide Acts in 8 States: Incidence and Case Fatality Rates by Demographics and Method |journal=American Journal of Public Health |date=December 2000 |volume=90 |issue=12 |pages=1885–1891 |doi=10.2105/ajph.90.12.1885 |pmid=11111261 |pmc=1446422 |quote=Table 1}}</ref>
| image2= 1981- Suicide rates vs gun ownership rates, by gender.svg |caption2= For both men and women, gun suicide death rates are positively correlated with household gun ownership rates.<ref name=Siegel_AJPH_20160610>{{cite journal |last1=Siegel |first1=Michael |last2=Rothman |first2=Emily F. |title=Firearm Ownership and Suicide Rates Among US Men and Women, 1981–2013 |journal=American Journal of Public Health  |date=10 June 2016 |volume=106 |issue=7 |pages=1316–1322 |doi=10.2105/AJPH.2016.303182|pmid=27196643 |pmc=4984734 }} Table 1.</ref>
}}
[[File:2010 suicide rates - gun versus non-gun - high-income countries.png| thumb | right | upright=1.25 | Comparison of gun-related suicide rates to non-gun-related suicide rates in high-income [[OECD]] countries, 2010, countries in graph ordered by total suicides. The US was the only OECD country in which gun suicide rates exceeded non-gun suicide rates.<ref name=AJM201603>{{cite journal |last1=Grinshteyn |first1=Erin |last2=Hemenway |first2=David |title=Violent Death Rates: The US Compared with Other High-income OECD Countries, 2010 |journal=The American Journal of Medicine |date=March 2016 |volume=129 |issue=3 |pages=266–73 |doi=10.1016/j.amjmed.2015.10.025 |pmid=26551975 |doi-access=free }}</ref>]]
[[File:Suicide rate by firearm, OWID.svg|thumb|Suicide rate by firearm<ref>{{cite web |title=Suicide rate by firearm |url=https://ourworldindata.org/grapher/suicide-rate-by-firearm |website=Our World in Data |access-date=4 March 2020}}</ref>]]
[[File:Edouard Manet - Le Suicidé.jpg|thumb|''[[Le Suicidé]]'' (''The Suicide'') by [[Édouard Manet]], depicting suicide by gunshot]]

In the United States, suicide by firearm is the most lethal method of suicide, resulting in a fatality 90% of the time,<ref name=AIM2019/> and is thus the leading cause of death by [[Suicide in the United States|suicide as of 2017]].<ref name=NIMH2019>{{cite web |title=NIMH » Suicide |url=https://www.nimh.nih.gov/health/statistics/suicide.shtml |website=www.nimh.nih.gov |access-date=3 December 2019}}</ref> Worldwide, firearm prevalence in suicides varies widely, depending on the acceptance and availability of firearms in a culture. The use of firearms in suicides ranges from less than 10% in Australia<ref>{{cite web|url=http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442458840 |title=A review of suicide statistics in Australia|date=21 March 2024 |publisher=Government of Australia}}</ref> to 50.5% in the U.S., where it is the most common method of suicide.<ref>{{cite web|url=http://www.suicidology.org/c/document_library/get_file?folderId=262&name=DLFE-636.pdf |title=U.S.A. Suicide: 2010 Official Final Data |last1=McIntosh |first1=JL |last2=Drapeau |first2=CW |date=28 November 2012 |website=suicidology.org |publisher=American Association of Suicidology |access-date=25 February 2014 |url-status=dead |archive-url=https://web.archive.org/web/20140628133647/http://www.suicidology.org/c/document_library/get_file?folderId=262&name=DLFE-636.pdf |archive-date=28 June 2014 }}</ref>

Generally, the [[bullet]] will be aimed at [[point-blank range]]. Surviving a self-inflicted gunshot may result in severe [[chronic pain]] as well as reduced cognitive abilities and motor function, [[subdural hematoma]], foreign bodies in the head, [[pneumocephalus]] and [[cerebrospinal fluid leak]]s. For temporal bone directed bullets, temporal lobe abscess, meningitis, aphasia, hemianopsia, and hemiplegia are common late intracranial complications. As many as 50% of people who survive gunshot wounds directed at the temporal bone suffer facial nerve damage, usually due to a severed nerve.<ref name = "TEMPORAL_SHOT">{{cite web |url=http://www.bcm.edu/oto/grand/8593.html | title=Temporal Bone Gunshot Wounds: Evaluation and Management | publisher=Baylor College of Medicine | archive-url=https://web.archive.org/web/20080517030957/http://www.bcm.edu/oto/grand/8593.html |archive-date=17 May 2008 | first=Douglas | last=Backous |date=5 August 1993}}</ref>

==== Gun control ====
{{Further|Gun control|Overview of gun laws by nation}}
Reducing access to guns at a population level decreases the risk of suicide by firearms.<ref>{{cite journal |last1=Mann |first1=JJ |last2=Michel |first2=CA |title=Prevention of Firearm Suicide in the United States: What Works and What Is Possible. |journal=The American Journal of Psychiatry |date=1 October 2016 |volume=173 |issue=10 |pages=969–79 |doi=10.1176/appi.ajp.2016.16010069 |pmid=27444796}}</ref><ref>{{cite journal |last=Reisch |first=Thomas |title=Change in Suicide Rates in Switzerland Before and After Firearm Restriction Resulting From the 2003 "Army XXI" Reform. |journal=American Journal of Psychiatry |date=2013 |volume=170 |issue=9 |pages=977–984 |doi=10.1176/appi.ajp.2013.12091256|pmid=23897090 }}</ref><ref>{{cite journal |last=Rosenbaum |first=Janet |title=Gun utopias? Firearm access and ownership in Israel and Switzerland. |journal=Journal of Public Health Policy |date=2012 |volume=33 |issue=1 |pages=46–58 |doi=10.1057/jphp.2011.56|pmid=22089893 |pmc=3267868 }}</ref>

Fewer people die from suicide overall in places with stricter laws regulating the use, purchase, and trading of firearms.<ref>{{cite journal|last1=Anestis|first1=Michael D.|last2=Khazem|first2=Lauren R.|last3=Law|first3=Keyne C.|last4=Houtsma|first4=Claire|last5=LeTard|first5=Rachel|last6=Moberg|first6=Fallon|last7=Martin|first7=Rachel|title=The Association Between State Laws Regulating Handgun Ownership and Statewide Suicide Rates|journal=American Journal of Public Health|date=October 2015|volume=105|issue=10|pages=2059–67|doi=10.2105/AJPH.2014.302465|pmid=25880944|pmc=4566551}}</ref><ref>{{cite journal|last1=Conner|first1=Kenneth R|last2=Zhong|first2=Yueying|title=State firearm laws and rates of suicide in men and women|journal=American Journal of Preventive Medicine|date=November 2003|volume=25|issue=4|pages=320–24|doi=10.1016/S0749-3797(03)00212-5|pmid=14580634|doi-access=free}}</ref> Suicide risk goes up when firearms are more available.<ref>{{cite journal|last1=Westefeld|first1=John S.|last2=Gann|first2=Lianne C.|last3=Lustgarten|first3=Samuel D.|last4=Yeates|first4=Kevin J.|date=2016|title=Relationships between firearm availability and suicide: The role of psychology|journal=Professional Psychology: Research and Practice|volume=47|issue=4|pages=271–77|doi=10.1037/pro0000089}}</ref><ref>{{cite journal|last1=Anglemyer|first1=Andrew|last2=Horvath|first2=Tara|last3=Rutherford|first3=George|date=21 January 2014|title=The Accessibility of Firearms and Risk for Suicide and Homicide Victimization Among Household Members|journal=Annals of Internal Medicine|volume=160|issue=2|pages=101–10|doi=10.7326/M13-1301|pmid=24592495|s2cid=4509567}}</ref><ref>{{cite journal|last1=Miller|first1=M.|last2=Swanson|first2=S. A.|last3=Azrael|first3=D.|date=13 January 2016|title=Are We Missing Something Pertinent? A Bias Analysis of Unmeasured Confounding in the Firearm-Suicide Literature|journal=Epidemiologic Reviews|volume=38|issue=1|pages=62–9|doi=10.1093/epirev/mxv011|pmid=26769723|doi-access=free}}</ref>

Gun control is a primary method of reducing suicide by people who live in a home with guns. Prevention measures include simple actions such as locking all firearms in a [[gun safe]] or installing [[gun lock]]s.<ref name=":1">{{Cite news|last=Rabin|first=Roni Caryn|date=2020-11-17|title='How Did We Not Know?' Gun Owners Confront a Suicide Epidemic|work=The New York Times|url=https://www.nytimes.com/2020/11/17/health/suicide-guns-prevention.html |archive-url=https://web.archive.org/web/20201117073551/https://www.nytimes.com/2020/11/17/health/suicide-guns-prevention.html |archive-date=2020-11-17 |url-access=subscription |url-status=live|access-date=2020-11-22|issn=0362-4331}}</ref> Some people self-impose a barrier to using the keys to unlock their guns, such as by asking a friend to keep the keys in a different place, or by freezing them in an ice cube.<ref name=":13">{{Cite news |last1=Corkery |first1=Michael |last2=Irvine |first2=Tailyr |date=2024-06-10 |title=She's Fighting to Save America's 'Last Best Place' From Suicide |url=https://www.nytimes.com/2024/06/10/us/montana-suicide-guns.html |access-date=2024-06-14 |work=The New York Times |language=en-US |issn=0362-4331}}</ref>  This prevents spur-of-the-moment access to their own guns.<ref name=":13" /> Some stores that sell guns provide temporary storage as a service; in other cases, a trusted friend or family member will offer to store the guns until the crisis has passed.<ref name=":7">{{Cite journal|last1=Pierpoint|first1=Lauren A|last2=Tung|first2=Gregory J|last3=Brooks-Russell|first3=Ashley|last4=Brandspigel|first4=Sara|last5=Betz|first5=Marian|last6=Runyan|first6=Carol W|date=September 2019|title=Gun retailers as storage partners for suicide prevention: what barriers need to be overcome?|journal=Injury Prevention |volume=25|issue=Suppl 1|pages=i5–i8|doi=10.1136/injuryprev-2017-042700|issn=1353-8047|pmc=6081260|pmid=29436398}}</ref><ref name=":1" /> When a person is going through a crisis, [[red flag law]]s in some places allow family members to petition the courts to have firearms temporarily removed and stored elsewhere.

More firearms are involved in suicide than are involved in homicides in the United States. A 1999 study of [[California]] and gun mortality found that a person is more likely to die by suicide if they have purchased a firearm, with a measurable increase of suicide by firearm beginning at most a week after the purchase and continuing for six years or more.<ref>{{cite journal |last1=Lewiecki |first1=E. Michael |last2=Miller |first2=Sara A. |title=Suicide, Guns, and Public Policy |journal=American Journal of Public Health |date=January 2013 |volume=103 |issue=1 |pages=27–31 |doi=10.2105/AJPH.2012.300964 |pmid=23153127 |pmc=3518361 }}</ref>

The United States has both the highest number of suicides and firearms in circulation in a developed country, and when gun ownership rises so too does suicide involving the use of a firearm.<ref>{{cite web|date=15 May 2008|title=Guns and suicide: A fatal link|url=https://www.hsph.harvard.edu/news/magazine/guns-and-suicide/|access-date=7 May 2020|publisher=Harvard T.H. Chan School of Public Health}}</ref><ref>{{cite journal|last1=Studdert|first1=David M.|last2=Zhang|first2=Yifan|last3=Swanson|first3=Sonja A.|last4=Prince|first4=Lea|last5=Rodden|first5=Jonathan A.|last6=Holsinger|first6=Erin|last7=Spittal|first7=Matthew|last8=Wintemute|first8=Garen|last9=Miller|first9=Matthew|year=2020|title=Handgun Ownership and Suicide in California|journal=The New England Journal of Medicine|volume=382|issue=23|pages=2220–29|doi=10.1056/NEJMsa1916744|pmid=32492303|doi-access=free}}</ref> A 2004 report by the [[National Academy of Sciences]] found an association between estimated household firearm ownership and gun [[suicide]] rates,<ref name="NAS-exec">{{cite book |title=Firearms and Violence: A Critical Review |year=2004 |publisher=National Academy of Science |author=Committee on Law and Justice |chapter=Executive Summary |chapter-url=http://www.nap.edu/books/0309091241/html/1.html |isbn=978-0-309-09124-4|doi=10.17226/10881 }}</ref><ref>{{cite journal |doi=10.1056/NEJM199208133270705 |last1=Kellermann |first1=A.L. |title=Suicide in the home in relation to gun ownership |journal=New England Journal of Medicine |year=1992 |volume=327 |pages=467–72 |pmid=1308093 |issue=7 |first2=F.P. |last2=Rivara |first3=G. |last3=Somes |last4=Francisco |first4=Jerry |last5=Banton |first5=Joyce Gillentine |last6=Prodzinski |first6=Janice |last7=Fligner |first7=Corinne |last8=Hackman |first8=Bela B.|s2cid=35031090 |doi-access=free }}</ref> though a study by two Harvard researchers did not find a [[statistically significant]] association between household firearms and gun suicide rates,<ref name="Miller_Hemenway" /> except in the suicides of children aged 5–14.<ref name="Miller_Hemenway">{{cite book |author1=Miller, Matthew |author2=Hemenway, David |title=Firearm Prevalence and the Risk of Suicide: A Review |url=http://www.hcs.harvard.edu/~epihc/currentissue/Fall2001/miller.htm |publisher=Harvard Health Policy Review |year=2001 |page=2 |quote=One study found a statistically significant relationship between estimated gun ownership levels and suicide rate across 14 developed nations (e.g. where survey data on gun ownership levels were available), but the association lost its statistical significance when additional countries were included. |access-date=7 April 2009 |archive-date=14 August 2011 |archive-url=https://web.archive.org/web/20110814065037/http://www.hcs.harvard.edu/~epihc/currentissue/Fall2001/miller.htm |url-status=dead }}</ref> Another study found that gun prevalence rates were positively associated with suicide rates among people aged 15 to 24, and 65 to 84, but not among those aged 25 to 64.<ref>{{cite journal|last1=Birckmayer|first1=Johanna|last2=Hemenway|first2=David|title=Suicide and Firearm Prevalence: Are Youth Disproportionately Affected?|journal=Suicide and Life-Threatening Behavior|date=September 2001|volume=31|issue=3|pages=303–10|doi=10.1521/suli.31.3.303.24243|pmid=11577914}}</ref> Access to firearms is associated with a higher risk of suicide,<ref>{{cite journal |last1=Anglemyer |first1=A |last2=Horvath |first2=T |last3=Rutherford |first3=G |date=21 January 2014 |title=The accessibility of firearms and risk for suicide and homicide victimization among household members: a systematic review and meta-analysis |journal=Annals of Internal Medicine |volume=160 |issue=2 |pages=101–10 |doi=10.7326/M13-1301 |pmid=24592495 |s2cid=4509567}}</ref> especially for people keeping loaded guns in the home.<ref>{{cite journal|last1=Brent|first1=D. A.|last2=Bridge|first2=J.|title=Firearms Availability and Suicide: Evidence, Interventions, and Future Directions|journal=American Behavioral Scientist|date=1 May 2003|volume=46|issue=9|pages=1192–1210|doi=10.1177/0002764202250662|s2cid=72451364}}</ref> Numerous ecological and time series studies have also shown a positive association between gun ownership rates and suicide rates.<ref>{{cite journal|last1=Briggs|first1=Justin Thomas|last2=Tabarrok|first2=Alexander|title=Firearms and suicides in US states|journal=International Review of Law and Economics|date=March 2014|volume=37|pages=180–88|doi=10.1016/j.irle.2013.10.004|citeseerx=10.1.1.453.3579}}</ref><ref name="ip2015">{{cite journal|last1=Miller|first1=Matthew|last2=Warren|first2=Molly|last3=Hemenway|first3=David|last4=Azrael|first4=Deborah|title=Firearms and suicide in US cities|journal=Injury Prevention|date=April 2015|volume=21|issue=e1|pages=e116–e119|doi=10.1136/injuryprev-2013-040969|pmid=24302479|s2cid=3275417}}</ref><ref>{{cite journal|last1=Miller|first1=M.|last2=Barber|first2=C.|last3=White|first3=R. A.|last4=Azrael|first4=D.|title=Firearms and Suicide in the United States: Is Risk Independent of Underlying Suicidal Behavior?|journal=American Journal of Epidemiology|date=23 August 2013|volume=178|issue=6|pages=946–55|doi=10.1093/aje/kwt197|pmid=23975641|doi-access=free}}</ref> This association tends to only exist for firearm-related and overall suicides, not for non-firearm suicides.<ref name="ip2015" /><ref>{{cite journal|last1=Miller|first1=M|title=The association between changes in household firearm ownership and rates of suicide in the United States, 1981–2002|journal=Injury Prevention|date=1 June 2006|volume=12|issue=3|pages=178–82|doi=10.1136/ip.2005.010850|pmid=16751449|pmc=2563517}}</ref><ref>{{cite journal|last1=Miller|first1=Matthew|last2=Lippmann|first2=Steven J.|last3=Azrael|first3=Deborah|last4=Hemenway|first4=David|title=Household Firearm Ownership and Rates of Suicide Across the 50 United States|journal=The Journal of Trauma: Injury, Infection, and Critical Care|date=April 2007|volume=62|issue=4|pages=1029–35|doi=10.1097/01.ta.0000198214.24056.40|pmid=17426563|s2cid=27028514 }}</ref><ref>{{cite journal|last1=Anestis|first1=MD|last2=Houtsma|first2=C|title=The Association Between Gun Ownership and Statewide Overall Suicide Rates|journal=Suicide and Life-Threatening Behavior|volume=48|issue=2|pages=204–17|date=13 March 2017|doi=10.1111/sltb.12346|pmid=28294383|s2cid=4756779}}</ref> Studies consistently find a relationship between gun ownership and gun-related suicides, with few exceptions.<ref>{{cite journal|last1=Stroebe|first1=Wolfgang|title=Firearm possession and violent death: A critical review|journal=Aggression and Violent Behavior|date=November 2013|volume=18|issue=6|pages=709–21|doi=10.1016/j.avb.2013.07.025|hdl=10419/214553|hdl-access=free}}</ref> A 2016 study found a positive association between gun ownership and both gun-related and overall suicides among men, but not among women; gun ownership was only strongly associated with gun-related suicides among women.<ref>{{cite journal|last1=Siegel|first1=Michael|last2=Rothman|first2=Emily F.|title=Firearm Ownership and Suicide Rates Among US Men and Women, 1981–2013|journal=American Journal of Public Health|date=July 2016|volume=106|issue=7|pages=1316–22|doi=10.2105/AJPH.2016.303182|pmid=27196643|pmc=4984734}}</ref> During the 1980s and early 1990s, there was a strong upward trend in adolescent suicides with a gun,<ref name="cook2000-ch2">{{cite book |last1=Cook |first1=Philip J. |first2=Jens |last2=Ludwig |title=Gun Violence: The Real Costs |chapter-url=https://archive.org/details/gunviolencerealc0000cook |chapter-url-access=registration |publisher=Oxford University Press |year=2000 |chapter=Chapter 2 |isbn=978-0-19-513793-4 |url-access=registration |url=https://archive.org/details/gunviolencerealc0000cook }}</ref> as well as a sharp overall increase in suicides among those age 75 and over.<ref>{{cite book |last1=Ikeda |first1=Robin M. |first2=Rachel |last2=Gorwitz |first3=Stephen P. |last3=James |first4=Kenneth E. |last4=Powell |first5=James A. |last5=Mercy |title=Fatal Firearm Injuries in the United States, 1962–1994: Violence Surveillance Summary Series, No. 3 |year=1997 |publisher=National Center for Injury and Prevention Control}}</ref>

Firearm-related suicides declined in Australia after the introduction of [[National Firearms Agreement|nationwide gun control]]. The same study found no evidence of substitution to other methods.<ref>{{cite journal|last1=Chapman|first1=S|last2=Alpers|first2=P|last3=Agho|first3=K|last4=Jones|first4=M|title=Australia's 1996 gun law reforms: faster falls in firearm deaths, firearm suicides, and a decade without mass shootings|journal=Injury Prevention|date=1 December 2006|volume=12|issue=6|pages=365–372|doi=10.1136/ip.2006.013714|pmid=17170183|pmc=2704353}}</ref> In Canada, gun suicides declined after gun control, but other methods rose, leading to no change in the overall rates.<ref>{{cite journal |last1=Caron |first1=Jean |title=Gun Control and Suicide: Possible Impact of Canadian Legislation to Ensure Safe Storage of Firearms |journal=Archives of Suicide Research |date=October 2004 |volume=8 |issue=4 |pages=361–74 |doi=10.1080/13811110490476752 |pmid=16081402 |s2cid=35131214 }}</ref><ref>{{cite journal |last1=Caron |first1=Jean |last2=Julien |first2=Marie |last3=Huang |first3=Jean Hua |title=Changes in Suicide Methods in Quebec between 1987 and 2000: The Possible Impact of Bill C-17 Requiring Safe Storage of Firearms |journal=Suicide and Life-Threatening Behavior |date=April 2008 |volume=38 |issue=2 |pages=195–208 |doi=10.1521/suli.2008.38.2.195 |pmid=18444777 }}</ref><ref>{{cite journal |last1=Cheung |first1=AH |last2=Dewa |first2=CS |title=Current trends in youth suicide and firearms regulations |journal=Canadian Journal of Public Health |date=2005 |volume=96 |issue=2 |pages=131–35 |pmid=15850034 |doi=10.1007/BF03403676 |pmc=6975744 }}</ref> Similarly, in New Zealand, gun suicides declined after more legislation, but overall suicide rates did not change;<ref>{{cite journal |last1=Beautrais |first1=A. L. |last2=Fergusson |first2=D. M. |last3=Horwood |first3=L. J. |title=Firearms Legislation and Reductions in Firearm-Related Suicide Deaths in New Zealand |journal=Australian & New Zealand Journal of Psychiatry |date=26 June 2016 |volume=40 |issue=3 |pages=253–59 |doi=10.1080/j.1440-1614.2006.01782.x |pmid=16476153 |s2cid=208623661 }}</ref> this might be due to the highly stringent firearm storage laws and very low prevalence of handgun ownership in New Zealand.<ref>{{cite journal |last1=Beautrais |first1=Annette L. |last2=Joyce |first2=Peter R. |last3=Mulder |first3=Roger T. |title=Access to Firearms and the Risk of Suicide: A Case Control Study |journal=Australian & New Zealand Journal of Psychiatry |date=26 June 2016 |volume=30 |issue=6 |pages=741–748 |doi=10.3109/00048679609065040 |pmid=9034462 |s2cid=9805679 }}</ref> A study about Canada found no significant correlations between provincial firearm ownership and overall provincial suicide rates.<ref>{{Cite journal|pmid = 32555647|year = 2020|last1 = Langmann|first1 = C.|title = Effect of firearms legislation on suicide and homicide in Canada from 1981 to 2016|journal = PLOS ONE|volume = 15|issue = 6|pages = e0234457|doi = 10.1371/journal.pone.0234457|pmc = 7302582|bibcode = 2020PLoSO..1534457L|doi-access = free}}</ref>

=== Jumping ===
{{Main|Suicide by jumping from height}}
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<!-- Prevalence -->Jumping is the most common method of suicide in [[Hong Kong]], accounting for 52.1% of all reported suicide cases in 2006 and similar rates for the years before that.<ref name="HKJC">{{cite web |year=2006 |title=Method Used in Completed Suicide |url=http://csrp.hku.hk/WEB/eng/statistics.asp#3 |url-status=dead |archive-url=https://web.archive.org/web/20090910011320/http://csrp.hku.hk/web/eng/statistics.asp |archive-date=10 September 2009 |access-date=2009-09-10 |publisher=HKJC Centre for Suicide Research and Prevention, University of Hong Kong}}</ref> The Centre for Suicide Research and Prevention of the [[University of Hong Kong]] believes that it may be due to the abundance of easily accessible [[high-rise building]]s in Hong Kong.<ref>{{Cite news |date=9 August 2009 |title=遭家人責罵：掛住上網媾女唔讀書 成績跌出三甲 中四生跳樓亡 |newspaper=[[Apple Daily]] |url=http://hk.apple.nextmedia.com/template/apple/art_main.php?iss_id=20090809&sec_id=4104&subsec=12731&art_id=13078710 |access-date=2009-09-10}}</ref> In the United States, jumping is among the least common methods of suicide (less than 2% of all reported suicides in 2005).<ref name="WISQARS"/> Between 1937 and 2012, there were around 2,000 [[suicides at the Golden Gate Bridge]].<ref name=":11">{{Cite news |last=Anderson |first=Scott |date=6 July 2008 |title=The Urge to End It |work=[[The New York Times]] |url=https://www.nytimes.com/2008/07/06/magazine/06suicide-t.html}}</ref> Jumping deaths are often impulsive, and one study of the Golden Gate Bridge demonstrated that more than 90% of people interrupted in a suicide attempt ultimately died by natural or accidental causes, with only 6% dying in a subsequent suicide attempt.<ref name=":11" />

<!-- Method-specific prevention -->Many jumping deaths could be prevented through the construction of fencing or other safety equipment. For example, suicide by jumping into a [[volcanic crater]] is a rare method of suicide. [[Mount Mihara]] in [[Japan]] briefly became a notorious suicide site during the [[Great Depression]] following media reports of a suicide there. [[Copycat suicide]]s in the ensuing years prompted the erection of a protective fence surrounding the crater.<ref>{{cite book |author=Cedric A. Mims |title=When we die |publisher=Robinson |year=1998 |isbn=978-1-85487-529-7 |page=40}}</ref><ref>{{cite book |author1=Edward Robb Ellis |title=Traitor within: our suicide problem |author2=George N. Allen |publisher=Doubleday |year=1961 |page=98}}</ref>  Similarly, in New Zealand, secure fencing at the [[Grafton Bridge]] substantially reduced the rate of suicides.<ref name="Havârneanu">{{cite journal |last1=Havârneanu |first1=GM |last2=Burkhardt |first2=JM |last3=Paran |first3=F |title=A systematic review of the literature on safety measures to prevent railway suicides and trespassing accidents. |journal=Accident Analysis and Prevention |date=August 2015 |volume=81 |pages=30–50 |doi=10.1016/j.aap.2015.04.012 |pmid=25939134}}</ref>  Chest-high barriers are more effective than waist-high barriers because they require more time and effort to climb over.<ref name=":11" />

Constructing barriers is not the only option, and it can be expensive.<ref name=":10">{{Citation |last=International Parking & Mobility Institute |title=Suicide in Parking Facilities: Prevention, Response, and Recovery |url=https://www.parking-mobility.org/wp-content/uploads/2019/01/0416_IPMI-Suicide-in-Garages_2019_Final.pdf |year=2019}}</ref>  Other method-specific prevention actions include making staff members visible in high-risk areas, using [[closed-circuit television]] cameras to identify people in inappropriate places or behaving abnormally (e.g., lingering in a place that people normally spend little time in), and installing awnings and soft-looking landscaping, which deters suicide attempts by making the place look ineffective.<ref name=":10" />

Another factor in reducing jumping deaths is to avoid suggesting in news articles, signs, or other communication that a high-risk place is a common, appropriate, or effective place for dying by jumping from.<ref name=":10" /> The efficacy of signage is uncertain, and may depend on whether the wording is simple and appropriate.<ref name=":10" />

=== Cutting and stabbing ===
{{Main|Cutting|Stabbing}}
{{See also|Self-harm}}
{{Redirect|Hesitation wounds|the 2010s punk band|Hesitation Wounds}}
{{Distinguish |Hesitation Marks}}

A fatal self-inflicted wound to the [[wrist]] is termed a ''deep wrist injury'', and is often preceded by several tentative surface-breaking attempts known as ''hesitation wounds'', indicating indecision or a [[self-harm]] tactic.<ref name="Kisch">{{cite journal |last1=Kisch |first1=T |last2=Matzkeit |first2=N |last3=Waldmann |title=The Reason Matters: Deep Wrist Injury Patterns Differ with Intentionality (Accident versus Suicide Attempt). |journal=Plastic and Reconstructive Surgery. Global Open |date=May 2019 |volume=7 |issue=5 |pages=e2139 |doi=10.1097/GOX.0000000000002139 |pmid=31333923|pmc=6571333 }}</ref> For every suicide by wrist cutting, there are many more nonfatal attempts, so that the number of actual deaths using this method is very low.<ref name=OUP1991>{{cite book |last1=Baker |first1=Susan P. |last2=O'Neill |first2=Brian |last3=Ginsburg |first3=Marvin J. |last4=Li |first4=Guohua |title=The Injury Fact Book |date=1991 |publisher=Oxford University Press |isbn=978-0-19-974870-9 |page=65 |url=https://books.google.com/books?id=YeNe2vBFdzIC&pg=PA65 }}</ref>

Wounds from suicide attempts involve the non-dominant hand, with damage often done to the [[median nerve]], [[ulnar nerve]], [[radial artery]], [[palmaris longus muscle]], and [[flexor carpi radialis muscle]].<ref>{{cite journal |last1=Bukhari |first1=AJ |last2=Saleem |first2=M |last3=Bhutta |first3=AR |last4=Khan |first4=AZ |last5=Abid |first5=KJ |title=Spaghetti wrist: management and outcome |journal=Journal of the College of Physicians and Surgeons Pakistan |date=October 2004 |volume=14 |issue=10 |pages=608–11 |pmid=15456551 |doi= <!-- 10.2004 is deactivated --> }}</ref><ref name="Kisch"/> Such injuries can severely affect the function of the hand, and the inability caused to carry out work or interests increases the risk of further attempts.<ref name="Kisch"/>

[[Seppuku]] is a form of Japanese ritual [[suicide]] by [[disembowelment]]. While reserved for [[samurai]] in their [[Bushido|code of honour]], a feminine counterpart of female ritual suicide also exists (sometimes incorrectly referred to in western understanding as jigai), which involves cutting the [[jugular vein]]. While seppuku requires the assistance of another samurai, jigai can be performed on the self. Seppuku is painful and slow - neither method is common in the modern day.<ref>{{Cite news |last=Wudunn |first=Sheryl |date=1999-03-24 |title=Manager Commits Hara-Kiri to Fight Corporate Restructuring |work=The New York Times |url=https://www.nytimes.com/1999/03/24/world/manager-commits-hara-kiri-to-fight-corporate-restructuring.html |access-date=2022-08-02 |issn=0362-4331}}</ref><ref>{{Cite magazine |title=The Gory Way Japanese Generals Ended Their Battle on Okinawa |url=https://time.com/3918248/okinawa-ended-1945-history/ |access-date=2022-08-02 |magazine=Time }}</ref><ref name=":14">{{Cite journal |last1=Maiese |first1=Aniello |last2=Gitto |first2=Lorenzo |last3=dell'Aquila |first3=Massimiliano |last4=Bolino |first4=Giorgio |date=Mar 2014 |title=A peculiar case of suicide enacted through the ancient Japanese ritual of Jigai |url=https://pubmed.ncbi.nlm.nih.gov/24457577/ |journal=  The American Journal of Forensic Medicine and Pathology|volume=35 |issue=1 |pages=8–10 |doi=10.1097/PAF.0000000000000070|pmid=24457577 }}</ref>

=== Starvation and dehydration ===
A classification has been made of ''Voluntarily Stopping Eating and Drinking'' (VSED) which is often resorted to by those with a terminal illness.<ref name="Grunewald">{{cite journal |last1=Gruenewald |first1=DA |title=Voluntarily Stopping Eating and Drinking: A Practical Approach for Long-Term Care Facilities. |journal=Journal of Palliative Medicine |date=September 2018 |volume=21 |issue=9 |pages=1214–20 |doi=10.1089/jpm.2018.0100 |pmid=29870302|s2cid=46943176 }}</ref><ref name="Pope"/> This includes [[fasting]] and [[dehydration]], and has also been referred to as ''autoeuthanasia''.<ref name="Sheldon">{{cite journal |last1=Sheldon |first1=T |title=Dutch doctors publish guide to "careful suicide". |journal=BMJ (Clinical Research Ed.) |date=21 June 2008 |volume=336 |issue=7658 |pages=1394–95 |doi=10.1136/bmj.a362 |pmid=18566058|pmc=2432148 }}</ref> It has been used by [[Euthanasia|assisted dying]] activists, such as [[Wendy Mitchell (activist)|Wendy Mitchell]], as an means of death in places where assisted suicide is not available.

Fasting to death has been used by [[Hindu]], [[Buddhist]], and [[Jain]] ascetics and householders, as a ritual method of suicide known as "[[prayopavesa]]" in [[Hinduism]]; "[[sokushinbutsu]]" historically in [[Buddhism]]; and as "[[sallekhana]]" in [[Jainism]].<ref>Docker C, ''The Art and Science of Fasting'' in: Smith C, Docker C, Hofsess J, Dunn B, Beyond Final Exit 1995</ref><ref name=":0">{{Cite web|title=Nishidhi Stones and the ritual of Sallekhana|url=https://isjs.in/sites/isjs.in/files/docs/Nishidhi%20Stones%20by%20A.%20Sundara.pdf|last=Sundara|first=A.|website=International School for Jain Studies|archive-url=https://web.archive.org/web/20180228111226/https://www.isjs.in/sites/isjs.in/files/docs/Nishidhi%20Stones%20by%20A.%20Sundara.pdf|archive-date=28 February 2018|access-date=21 April 2017}}</ref><ref name="bbc">{{cite web|title=Hinduism – Euthanasia and Suicide|url=http://www.bbc.co.uk/religion/religions/hinduism/hinduethics/euthanasia.shtml|date=2009-08-25|publisher=[[BBC]]}}</ref> [[Catharism|Cathars]] also fasted to death after receiving the [[consolamentum]] sacrament, in order to die while in a morally perfect state.<ref>{{cite book|url=https://books.google.com/books?id=xAmMNnJlfnoC&q=cathars+starvation&pg=PA90 |title=The New Encyclopedia of the Occult |via=Google Books |access-date=2014-02-04|isbn=978-1-56718-336-8 |last1=Greer |first1=John Michael |year=2003 |publisher=Llewellyn Publications }}</ref> The method is also used in passive [[senicide]] and associated with the political protest of the [[hunger strike]] such as the [[1981 Irish hunger strike]] in which ten prisoners died.

Death from dehydration can take from several days to a few weeks. This means that unlike many other suicide methods, it cannot be accomplished impulsively. Those who die by terminal dehydration typically lapse into unconsciousness before death, and may also experience [[delirium]] and deranged [[serum sodium]].<ref>{{cite journal |last1=Baumrucker |first1=Steven |title=Science, hospice, and terminal dehydration |journal=American Journal of Hospice and Palliative Medicine |date=5 September 2016 |volume=16 |issue=3 |pages=502–03 |doi=10.1177/104990919901600302 |pmid=10661057 |s2cid=44883936 }}</ref>

[[Terminal dehydration]] has been described as having substantial advantages over physician-assisted suicide with respect to [[self-determination]], access, professional integrity, and social implications. Specifically, a patient has a right to refuse treatment and it would be a personal assault for someone to force water on a patient, but such is not the case if a doctor merely refuses to provide lethal medication.<ref>{{cite journal |last1=Bernat |first1=James L. |title=Patient Refusal of Hydration and Nutrition |journal=Archives of Internal Medicine |date=27 December 1993 |volume=153 |issue=24 |pages=2723–28 |pmid=8257247 |doi=10.1001/archinte.1993.00410240021003 |s2cid=36848946 }}</ref> But it also has distinctive drawbacks as a humane means of voluntary death.<ref>{{Cite journal|title=Voluntary Death: A Comparison of Terminal Dehydration and Physician-Assisted Suicide|author1=Miller, Franklin G. |author2=Meier, Diane E.|year=2004|pmid=9518401|volume=128|issue=7|pages=559–62|journal=Annals of Internal Medicine|doi=10.7326/0003-4819-128-7-199804010-00007|s2cid=34734585}}</ref> One survey of hospice nurses found that nearly twice as many had cared for patients who chose voluntary refusal of food and fluids to hasten death as had cared for patients who chose physician-assisted suicide.<ref>{{cite journal |last1=Jacobs |first1=Sandra |title=Death by Voluntary Dehydration – What the Caregivers Say |journal=New England Journal of Medicine |date=24 July 2003 |volume=349 |issue=4 |pages=325–26 |doi=10.1056/NEJMp038115 |pmid=12878738}}</ref> They also rated fasting and dehydration as causing less suffering and pain and being more peaceful than physician-assisted suicide.<ref>{{Cite journal|title=Terminally Ill Choose Fasting Over M.D.-Assisted Suicide |author=Arehart-Treichel, Joan |journal=Psychiatric News |date=16 January 2004 |volume=39 |pages=15–51 |issue=2 |doi=10.1176/pn.39.2.0015}}</ref><ref name="Pope">{{citation |last1=Pope |first1=Thaddeus Mason |last2=Anderson |first2=Lindsey E. |title=Voluntarily Stopping Eating and Drinking: A Legal Treatment Option at the End of Life |date=7 October 2010|ssrn=1689049}}</ref> Other sources note very painful side effects of dehydration, including seizures, skin cracking and bleeding, blindness, nausea, vomiting, cramping and severe headaches.<ref>{{cite web |first1=Wesley J. |last1=Smith |title=A 'Painless' Death? |url=https://www.weeklystandard.com/wesley-j-smith/a-painless-death |archive-url=https://web.archive.org/web/20180704210137/https://www.weeklystandard.com/wesley-j-smith/a-painless-death |url-status=dead |archive-date=4 July 2018 |website=The Weekly Standard |date=12 November 2003}}</ref>

=== Collision with or of a vehicle ===
Another suicide method is to lie down, or throw oneself, in the path of a fast-moving vehicle, either on the road or onto railway tracks. Nonfatal attempts may result in profound injuries, such as [[bone fracture|multiple bone fractures]], [[amputations]], [[concussion]] and severe [[brain damage|mental]] and [[physical disability|physical handicapping]].<ref>{{Cite news|title=Suicide by Train Is a Growing Concern|author=Ricardo Alonso-Zaldivar|work=Los Angeles Times|date=26 January 2005|url=http://thetransitcoalition.us/news/lat20050126c.htm|access-date=9 July 2010|archive-date=11 October 2016|archive-url=https://web.archive.org/web/20161011203054/http://thetransitcoalition.us/News/LAT20050126c.htm|url-status=dead}}</ref>

==== Road ====
{{main|Vehicular suicide}}
Some people use intentional car crashes as a suicide method. This especially applies to single-occupant, single-vehicle wrecks,<ref name=":9" /> although some suicidal drivers cause [[head-on collision]]s.<ref name=":12">{{Cite journal |last1=Radun |first1=Igor |last2=Radun |first2=Jenni |last3=Kaistinen |first3=Jyrki |last4=Olivier |first4=Jake |last5=Parkkari |first5=Inkeri |last6=Kecklund |first6=Göran |last7=Theorell |first7=Töres |date=2019-11-17 |title=Suicide by crashing into a heavy vehicle: Professional drivers' views |url=https://www.tandfonline.com/doi/full/10.1080/15389588.2019.1679796 |journal=Traffic Injury Prevention |volume=20 |issue=8 |pages=826–831 |doi=10.1080/15389588.2019.1679796 |pmid=31738579 |issn=1538-9588|url-access=subscription }}</ref>  Even single-vehicle collisions may harm other road users; for example, a driver who brakes abruptly or swerves to avoid a suicidal person may collide with something else on the road, resulting in harm to the driver or others. Both the innocent driver and bystanders may be [[traumatized]] by the experience, even if everyone survives.  Being victimized by a suicidal [[pedestrian]] is recognized as an [[occupational hazard]] for professional drivers, especially if they operate heavy vehicles.<ref name=":9" /><ref name=":12" />

The real percentage of suicides among motor vehicle fatalities is not reliably known and likely varies by the ease of accessing a car and the ease of accessing other methods. Suicidal intent is often inferred from the circumstances, such as the driver being alone in the vehicle, driving at a high speed, without normal use of a [[seat belt]], under circumstances that do not normally result in fatal wrecks (e.g., a straight road and good weather conditions).<ref name=":9" />  Somewhere between 1% and 10% of all crashes (fatal and non-fatal combined) likely result from suicidal intent.<ref name="Pompili">{{cite journal |last1=Pompili |first1=M |last2=Serafini |first2=G |last3=Innamorati |first3=M |display-authors=etal |date=30 November 2012 |title=Car accidents as a method of suicide: a comprehensive overview. |journal=Forensic Science International |volume=223 |issue=1–3 |pages=1–9 |doi=10.1016/j.forsciint.2012.04.012 |pmid=22576104 |hdl-access=free |hdl=11567/503698}}</ref><ref name=":9" />  In addition a vehicle being used as a method (e.g., deliberately causing a wreck), a vehicle may be the location of a suicide attempt using another method (e.g., while the suicidal person is inside a parked car).<ref name=":9" />

People who attempt vehicular suicide or murder–suicides tend to be adult men who recently experienced a stressful event.<ref name=":9" />  They tend to be [[Impulsivity|impulsive]], to have previously attempted suicide, and to have a history of [[reckless driving]].<ref name=":9" />  Suicidal drivers are unlikely to be drunk at the time, though in the case of [[Road collision types#Collisions involving pedestrians|vehicle–pedestrian collisions]], it may be difficult to determine whether an intoxicated pedestrian had suicidal intent or was non-suicidal but was so drunk as to be unable to recognize and respond to a dangerous situation.<ref name=":9" />

==== Rail ====
{{main|Rail suicide}}
[[File:Suizidpr%C3%A4vention_Graz_Don_Bosco.jpg|thumb|A sign near a railway telling people not to kill themselves]]
{{excerpt|:Rail suicide}}

==== Air ====
{{See also|Suicide by pilot}}
Toward the end of the 20th century, one or two pilots in the US [[pilot suicide|died by suicide by aircraft]] each year.<ref name=":8">{{cite journal|last1=Bills|first1=Corey B.|last2=Grabowski|first2=Jurek George|last3=Li|first3=Guohua|date=2005|title=Suicide by Aircraft: A Comparative Analysis|url=https://www.ingentaconnect.com/content/asma/asem/2005/00000076/00000008/art00001|journal=Aviation, Space, and Environmental Medicine|volume=76|issue=8|pages=715–19|pmid=16110685}}</ref> The pilot was usually flying alone at the time, and was using alcohol or drugs about half the time.<ref name=":8" /><ref>{{Cite journal|last1=Kenedi|first1=Christopher|last2=Friedman|first2=Susan Hatters|last3=Watson|first3=Dougal|last4=Preitner|first4=Claude|date=2016-04-01|title=Suicide and Murder-Suicide Involving Aircraft|url=https://www.ingentaconnect.com/content/10.3357/AMHP.4474.2016|journal=Aerospace Medicine and Human Performance|volume=87|issue=4|pages=388–396|doi=10.3357/AMHP.4474.2016|pmid=27026123|issn=2375-6314|url-access=subscription}}</ref> In the rare case of a pilot engaging in murder–suicide, the number of innocent people is sometimes very high. On 24 March 2015, a Germanwings co-pilot deliberately crashed [[Germanwings Flight 9525]] into the [[French Alps]] to kill himself, killing 150 people with him.<ref name="nytimes2">{{cite news |last1=Clark |first1=Nicola |last2=Bilefsky |first2=Dan |title=Germanwings Co-Pilot Deliberately Crashed Airbus Jet, French Prosecutor Says |url=http://nyti.ms/1yb7Zcu |access-date=26 March 2015 |work=The New York Times |date=26 March 2015}}</ref><ref name="CBC2">{{cite news |url=http://www.cbc.ca/news/world/germanwings-flight-4u9525-co-pilot-andreas-lubitz-deliberately-crashed-jet-prosecutor-1.3010045 |title=Germanwings Flight 4U9525: Co-pilot put plane into descent, prosecutor says |date=26 March 2015 |publisher=[[CBC News]] |access-date=26 March 2015}}</ref> Suicide by pilot has also been proposed as a potential cause for the disappearance and following destruction of [[Malaysian Airlines Flight 370]] in 2014,<ref name="BBC News">{{cite news|last1=Wescott|first1=Richard|title=Flight MH370: Could it have been suicide?|url=https://www.bbc.co.uk/news/magazine-31736835|website=[[BBC News]]|publisher=BBC News|access-date=20 June 2017|ref=BBC|date=16 April 2015}}</ref> with supporting evidence being found in a [[flight simulator]] application used by the flight's pilot.<ref>{{cite web|last1=Pells|first1=Rachael|title=MH370 pilot flew 'suicide route' on a simulator 'closely matching' his final flight|url=https://www.independent.co.uk/news/world/australasia/mh370-pilot-flew-suicide-route-simulator-final-flight-missing-malaysian-airlines-a7152581.html |archive-url=https://ghostarchive.org/archive/20220525/https://www.independent.co.uk/news/world/australasia/mh370-pilot-flew-suicide-route-simulator-final-flight-missing-malaysian-airlines-a7152581.html |archive-date=25 May 2022 |url-access=subscription |url-status=live|website=[[The Independent]]|publisher=The Independent|access-date=20 June 2017|date=23 July 2016}}</ref>

=== Disease ===
{{see also|Bugchasing}}
There have been documented cases of [[gay men]] deliberately trying to contract a disease such as [[HIV/AIDS]] as a means of suicide.<ref>{{cite journal|title=Contracting AIDS as a means of committing suicide|author1=Frances, Richard J. |author2=Wikstrom, Thomas |author3=Alcena, Valiere |journal=The American Journal of Psychiatry|year=1985|volume=142|issue=5|page=656 |doi=10.1176/ajp.142.5.656b|pmid=3985206}}</ref><ref>{{cite journal|author1=Flavin, Daniel K. |author2=Franklin, John E. |author3=Frances, Richard J. |journal=The American Journal of Psychiatry|year=1986|volume=143|issue=11|pages=1440–42|doi=10.1176/ajp.143.11.1440|title=The acquired immune deficiency syndrome (AIDS) and suicidal behavior in alcohol-dependent homosexual men |pmid=3777237|s2cid=21218263 }}</ref><ref>{{cite book|author1=Ronald W. Maris |author2=Alan L. Berman |author3=Morton M. Silverman |author4=Bruce M. Bongar |title=Comprehensive textbook of suicidology|publisher=Guilford Press|year=2000|page=161|isbn=978-1-57230-541-0}}</ref>

=== Electrocution ===
{{See also|Electrocution}}
Suicide by electrocution involves using a lethal [[electric shock]], and is a rarely used method.<ref name="Marc">{{cite journal |last1=Marc |first1=B |last2=Baudry |first2=F |last3=Douceron |first3=H |last4=Ghaith |first4=A |last5=Wepierre |first5=JL |last6=Garnier |first6=M |title=Suicide by electrocution with low-voltage current. |journal=Journal of Forensic Sciences |date=January 2000 |volume=45 |issue=1 |pages=216–22 |doi=10.1520/JFS14665J |pmid=10641944}}</ref> This causes arrhythmias of the heart, meaning that the heart does not contract in synchrony between the different chambers, essentially causing elimination of blood flow. Furthermore, depending on the [[Electric current|current]], burns may also occur.

=== Fire ===
{{Further|Self-immolation}}
[[Self-immolation]] is suicide usually by [[fire]]. This method of suicide is rare due to it being long and painful. If the attempt is intervened, severe burns and scar tissue will prevail with subsequent emotional impact.

It has been used as a protest tactic, by [[Thích Quảng Đức]] in 1963 to protest the [[South Vietnam]]'s anti-Buddhist policies; by [[Malachi Ritscher]] in 2006 to protest the [[United States of America|United States]]' involvement in the [[Iraq War]]; by [[Mohamed Bouazizi]] in 2011 in [[Tunisia]] which gave rise to the [[Tunisian Revolution]];<ref name="nytimes1">{{cite news|url=https://www.nytimes.com/2011/01/22/world/africa/22sidi.html?_r=1&pagewanted=2&src=twrhp|author=Fahim, Kareem|title=Slap to a Man's Pride Set Off Tumult in Tunisia|work=The New York Times|date=21 January 2011|page=2|access-date=23 January 2011}}</ref> by [[Aaron Bushnell]] in 2024 to protest the United States' support for Israel in the Israel–Hamas war;<ref name="nyt">{{cite news |last=Kavi |first=Aishvarya |date=February 25, 2024 |title=A man set himself on fire outside the Israeli Embassy in Washington, the police said. |url=https://www.nytimes.com/2024/02/25/world/middleeast/israel-embassy-man-on-fire.html |access-date=February 26, 2024 |work=[[The New York Times]] |issn=0362-4331 |archive-date=February 25, 2024 |archive-url=https://web.archive.org/web/20240225234815/https://www.nytimes.com/2024/02/25/world/middleeast/israel-embassy-man-on-fire.html |url-status=live}}</ref> and historically as a ritual known as [[Sati (practice)|sati]] where a [[Hindu]] widow would immolate herself in her husband's [[funeral pyre]].<ref>Sophie Gilmartin (1997), [https://www.jstor.org/stable/25058378 ''The Sati, the Bride, and the Widow: Sacrificial Woman in the Nineteenth Century''], Victorian Literature and Culture, Cambridge University Press, Vol. 25, No. 1, p. 141, Quote: "Suttee, or sati, is the obsolete Hindu practice in which a widow burns herself upon her husband's funeral pyre..."</ref>

=== Hypothermia ===
[[Hypothermia]] is a rare method of suicide. Between 1991 and 2014 in the United States, there were eight cases in the scientific literature, and they usually involved some other factor like drugs.<ref name="Sagepub.com">{{cite journal|last1=Wilcoxon|first1=Rebecca|last2=Jackson|first2=Lorren|last3=Baker|first3=Andrew|title=Suicide by Hypothermia: A Report of Two Cases and 23-Year Retrospective Review|journal=Academic Forensic Pathology|date=1 September 2015|volume=5|issue=3|pages=462–475|doi=10.23907/2015.051|s2cid=79722611|url=https://journals.sagepub.com/doi/abs/10.23907/2015.051?journalCode=afpa|access-date=25 December 2021|url-access=subscription}}</ref>

=== Assisted suicide ===
{{Main|Assisted suicide}}

=== Indirect ===
Indirect suicide is the act of setting out on an obviously fatal course without directly carrying out the act upon oneself. Indirect suicide is differentiated from legally defined suicide by the fact that the person does not directly cause the action meant to kill them, but rather expects and allows the action to happen to them.{{citation needed|date=April 2024}} Examples of indirect suicide include a soldier enlisting in the [[army]] with the intention and expectation of being killed in combat, or provoking an armed law enforcement officer into using lethal force against them. The latter is generally called "[[suicide by cop]]".

Evidence exists for suicide by [[Capital punishment|capital crime]] in [[colonial Australia]]. Convicts seeking to escape their brutal treatment would murder another individual. This was felt necessary due to a religious taboo against direct suicide. A person [[Suicidal ideation|committing suicide]] was believed to be destined for [[hell]], whereas a person committing murder could be [[Absolution|absolved of their sins]] before execution. In its most extreme form, groups of prisoners on the extremely brutal penal colony of [[Norfolk Island]] would form suicide lotteries. Prisoners would [[Drawing lots (decision making)|draw straws]] with one prisoner murdering another. The remaining participants would witness the crime, and would be sent away to [[Sydney]], as capital trials could not be held on Norfolk Island, thus earning a break from the Island. There is uncertainty as to the extent of suicide lotteries. While surviving contemporary accounts claim that the practice was common, such claims are probably exaggerated.<ref>{{cite book | last = Hughes | first = Robert | author-link = Robert Hughes (critic) | title = The Fatal Shore, The Epic Story of Australia's Founding | publisher =Vintage Books | edition = first | date = 1988}}</ref>

=== Rituals{{anchor|Ritual_suicide}} ===

[[Ritual]] suicide is performed in a specifically prescribed way, often as part of a cultural or religious practice. [[Suicide by hanging]] was traditionally practiced in [[ancient China|China]] and the [[Sinosphere]] as a means of ensuring that one's [[ghost]] would be able to haunt and torment the powerful but unjust. [[Self-immolation]] was practiced similarly in [[ancient India|India]] and spread with [[Dharmic religions]]. Some forms of suicide involve or are understood as [[martyrdom]] and are undertaken ritualistically. [[Sallekhana]] is the practice of ritualized starvation following [[Jainism|Jain]] practices.<ref>{{Cite book |last=Kleine |first=Christoph |title=Asceticism and Its Critics |publisher=[[Oxford University Press]] |year=2006 |isbn=9780195307917 |editor-last=Freiberger |editor-first=Oliver |edition=1st |pages=154 |chapter="The Epitome of the Ascetic Life": The Controversy over Self-Mortification and Ritual Suicide as Ascetic Practices in East Asian Buddhism}}</ref> [[Ancient Rome|Romans]] who considered themselves dishonored would "fall on their sword", ritualistically transfixing themselves on their [[Roman sword|swords]]; the similar [[medieval Japan]]ese practice became known as [[seppuku]] or [[harakiri]] for samurai. Female ritual suicide (incorrectly referred to in some English sources as ''jigai'')<ref>{{Cite journal |last=Pierre |first=Joseph M. |date=2015-03-22 |title=Culturally sanctioned suicide: Euthanasia, seppuku, and terrorist martyrdom |journal=World Journal of Psychiatry |language=en |volume=5 |issue=1 |page=9 |doi=10.5498/wjp.v5.i1.4 |doi-access=free |pmc=4369548 |pmid=25815251 |quote=While such cases suggest that the acts have been inspired by the Japanese tradition of seppuku, the absence of any such cultural sanctioning in other countries and the omnipresence of mental illness suggest that they should be described simply as suicide or suicide attempts by self-stabbing[68] rather than seppuku, harakiri, or jigai. Indeed, it has been arguedthat equating mere acts of self-stabbing with seppukuis “misleading at best, just as a casual benediction offered among friends while serving wine and crackers as refreshments ought not to be equated with the rite of Catholic Eucharist”}}</ref> was carried out in Japan by wives of samurai who had committed seppuku or otherwise brought dishonour.<ref name=":14" />

==See also==
* [[Advocacy of suicide]]
* [[List of suicides]] from antiquity to the present
* [[List of suicides in the 21st century]]
* [[Sarco device]]
* [[Suicide bag]]
* [[Suicide legislation]]

==References==
{{Reflist|30em}}

==Further reading==
{{Sister project links|display=Suicide}}
* {{cite book |author-link= Derek Humphry |last= Humphry |first= Derek |title= Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying |publisher= Dell |date= 1997 |page= 240 |title-link= Final Exit }}
* {{cite book |author-link= Philip Nitschke |first= Philip |last= Nitschke |title= The Peaceful Pill Handbook |publisher= Exit International |location= US |date= 2007 |isbn= 978-0-9788788-2-5 |page= 211 |title-link= The Peaceful Pill Handbook }}
* {{cite book |last= Docker |first= C. |title= Five Last Acts - The Exit Path |location= Scotland |publisher= Createspace |date= 2015 }}
* {{cite book |last= Stone |first= G. |title= Suicide and Attempted Suicide: Methods and Consequences |location= New York |publisher= Carroll & Graf |date= 2001 |isbn= 978-0-7867-0940-3 }}

{{Suicide navbox}}

{{DEFAULTSORT:Suicide Methods}}
[[Category:Suicide methods| ]]
[[Category:Killings by type|Suicide]]