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A Handbook for Pastors, Chaplains and Pastoral Counselors
By Karen Mason
The Prevalence of Suicide in the Church
The phone rings at your home at 10:30 p.m. Jim is sobbing. Bit by bit he tells you that he plans to kill himself tonight because his wife has discovered his ongoing affair. He says he has disappointed God, his family and himself in an unforgivable way.
Jim is the last person in your congregation you would have expected to experience suicidal thinking. He's an involved member of your church, a committed Christian. He has never discussed any concerns about his marriage. And even if he had, he is upbeat and positive, and people describe him as "dependable" with "a winning personality." You wonder: If Jim is suicidal, are there others in your faith community who might be as well? Suicidal thinking and suicide are a lot more common than we often believe.
Is Suicide That Widespread?
The World Health Organization has found that for every death due to war in the world, there are three deaths due to homicide and five due to suicide. Closer to home in the United States, suicide was the tenth leading cause of death across all ages in 2010 (affecting 38,364people), ahead of homicide (16,259 people) and HIV (8,352 people). Even as you read this chapter, there will be one US suicide every sixteen minutes. Suicide is a serious threat and must be taken seriously, especially because these numbers are underreported. Take this example from 1899 cited by Kushner: A 34 year--old woman inhaled gas but revived. She then swallowed morphine and lost consciousness, but again she recovered and showed improvement. She died five days later of pneumonia, which is listed as the cause of death on both the coroner's report and her death certificate in 1899.
Those who actually die by suicide are just the tip of the iceberg. Based on large national surveys, it is estimated that for every fourteen suicides per hundred thousand people each year, approximately five hundred people attempt suicide and three thousand think about it. Therefore, there's a significant chance suicidal thinking occurs in your faith community. Individuals in your pews, those who request counseling and even members of your governing board may at some point have thought about suicide or even attempted it. And you may experience a suicide death in your faith community.
Jim's story ended well. He called his pastor who talked about God's forgiveness (Rom 5:20--21) and prevented his suicide. But what happens when the Jim in your church doesn't call you? Is there a way to identify him and help him anyway?
Risk and Protective Factors: Researching Suicide
You may wonder how we answer this question about factors when "the chief source of information is no longer available." One method employed is psychological autopsy, which comprises in--depth interviews with family, friends and colleagues of the person who died by suicide, as well as professionals who worked with him or her, in order to clarify intent to die.
Another method is epidemiology, which involves the study of patterns related to suicide deaths in order to identify risk factors (factors that increase the likelihood of suicide) and protective factors (factors that decrease the likelihood). Durkheim calls these factors the "coefficient of aggravation" and the "coefficient of preservation." Epidemiology can also help quantify the amount of risk a factor adds—for example, researchers have found that almost six times as many people who have a diagnosis of alcohol abuse or dependence die by suicide compared to the general population. Based on these methodologies, researcher shave identified the following risk and protective factors, which may be factors in Jim's and Joan's suicidal thinking.
Mental health factors. A prominent factor associated with suicide is the presence of a mental health problem. In a large national survey, a mental health disorder was present in 82ercent of people with suicidal thoughts, 94.5 percent of those who made a suicide plan, and88.2 percent of those who had attempted suicide in the previous twelve months. Major depression was the most common disorder. The "big five" mental health disorders are of particular concern for suicide risk: borderline personality disorder (400 times higher suicide rate than that of the general population), anorexia nervosa (which increases suicide risk 23times), major depressive disorder (20 times more risk), bipolar disorder (15 times greater risk), and schizophrenia (8.5 times greater risk). Joiner assumes that everyone who dies by suicide experiences at least some symptoms of a mental health problem. Mental health factors are important to know about because one in five Americans has a mental health problem and this may confer some suicide risk. For example, John, an unemployed contractor in his fifties, lived with depression and thoughts of suicide since his college days, experiencing a lifelong struggle with not meeting his father's expectations. One in five members of your congregation may be at some risk of suicide because of a mental health disorder.
—Excerpted from Chapter One, "Who Dies by Suicide?"