Factors that affect the risk of<unk>  include mental disorders, drug misuse, psychological states, cultural, family and social<unk> tuations, genetics, experiences of trauma or loss, and nihilism. Mental disorders and substance misuse frequently co-exist. Other risk factors include having previously attempted<unk> , the ready availability of a means to take one's life, a family history of<unk> , or the presence of traumatic brain injury. For example,<unk>  rates have been found to be greater in households with firearms than those without them. Socio-economic problems such as unemployment, poverty, homelessness, and discrimination may trigger<unk> l thoughts.<unk>  might be rarer in societies with high social cohesion and moral objections against<unk> . About 15–40% of people leave a<unk>  note. War veterans have a higher risk of<unk>  due in part to higher rates of mental illness, such as post-traumatic stress disorder, and physical health problems related to war. Genetics appears to account for between 38% and 55% of<unk> l behaviors.<unk> s may also occur as a local cluster of cases. Most research does not distinguish between risk factors that lead to thinking about<unk>  and risk factors that lead to<unk>  attempts. Risks for<unk>  attempt rather than just thoughts of<unk>  include a high pain tolerance and a reduced fear of death. Mental illness A picture of a woman with depression, who was<unk> l Mental illness is present at the time of<unk>  27% to more than 90% of the time. Of those who have been hospitalized for<unk> l behavior, the lifetime risk of<unk>  is 8.6%. Comparatively, non-suicidal people hospitalized for affective disorders have a 4% lifetime risk of<unk> . Half of all people who die by<unk>  may have major depressive disorder; having this or one of the other mood disorders such as bipolar disorder increases the risk of<unk>  20-fold. Other conditions implicated include schizophrenia (14%), personality disorders (8%), obsessive–compulsive disorder, and post-traumatic stress disorder. Those with autism spectrum disorders also attempt and consider<unk>  more frequently. Others estimate that about half of people who die by<unk>  could be diagnosed with a personality disorder, with borderline personality disorder being the most common. About 5% of people with schizophrenia die of<unk> . Eating disorders are another high risk condition. Among approximately 80% of<unk> s, the individual has seen a physician within the year before their death, including 45% within the prior month. Approximately 25–40% of those who died by<unk>  had contact with mental health services in the prior year. Antidepressants of the SSRI class appear to increase the frequency of<unk>  among children but do not change the risk among adults. An unwillingness to get help for mental health problems also increases the risk. Previous attempts and self-harm A previous history of<unk>  attempts is the most accurate predictor of<unk> . Approximately 20% of<unk> s have had a previous attempt, and of those who have attempted<unk> , 1% die by<unk>  within a year and more than 5% die by<unk>  within 10 years. Acts of self-harm are not usually<unk>  attempts and most who self-harm are not at high risk of<unk> . Some who self-harm, however, do still end their life by<unk> , and risk for self-harm and<unk>  may overlap. Psychosocial factors A number of psychological factors increase the risk of<unk>  including: hopelessness, loss of pleasure in life, depression, anxiousness, agitation, rigid thinking, rumination, thought suppression, and poor coping skills. A poor ability to solve problems, the loss of abilities one used to have, and poor impulse control also play a role. In older adults, the perception of being a burden to others is important. Those who have never married are also at greater risk. Recent life stresses, such as a loss of a family member or friend or the loss of a job, might be a contributing factor. Certain personality factors, especially high levels of neuroticism and introvertedness, have been associated with<unk> . This might lead to people who are isolated and sensitive to distress to be more likely to attempt<unk> . On the other hand, optimism has been shown to have a protective effect. Other psychological risk factors include having few reasons for living and feeling trapped in a stressful<unk> tuation. Changes to the stress response system in the brain might be altered during<unk> l states. Specifically, changes in the polyamine system and hypothalamic–pituitary–adrenal axis. Social isolation and the lack of social support has been associated with an increased risk of<unk> . Poverty is also a factor, with heightened relative poverty compared to those around a person increasing<unk>  risk. Over 200,000 farmers in India have died by<unk> <unk> nce 1997, partly due to issues of debt. In China,<unk>  is three times as likely in rural regions as urban ones, partly, it is believed, due to financial difficulties in this area of the country. The time of year may also affect<unk>  rates. There appears to be a decrease around Christmas, but an increase in rates during spring and summer, which might be related to exposure to sunshine. Another study found that the risk may be greater for males on their birthday. Being religious may reduce one's risk of<unk>  while beliefs that<unk>  is noble may increase it. This has been attributed to the negative stance many religions take against<unk>  and to the greater connectedness religion may give. Muslims, among religious people, appear to have a lower rate of<unk> ; however, the data supporting this is not strong. There does not appear to be a difference in rates of attempted<unk> . Young women in the Middle East may have higher rates. Substance misuse "The Drunkard's Progress", 1846 demonstrating how alcoholism can lead to poverty, crime, and eventually<unk>  Substance misuse is the second most common risk factor for<unk>  after major depression and bipolar disorder. Both chronic substance misuse as well as acute intoxication are associated. When combined with personal grief, such as bereavement, the risk is further increased. Substance misuse is also associated with mental health disorders. Most people are under the influence of sedative-hypnotic drugs (such as alcohol or benzodiazepines) when they die by<unk> , with alcoholism present in between 15% and 61% of cases. Use of prescribed benzodiazepines is associated with an increased rate of<unk>  and attempted<unk> . The pro-suicidal effects of benzodiazepines are suspected to be due to a psychiatric disturbance caused by<unk> de effects, such as disinhibition, or withdrawal symptoms. Countries that have higher rates of alcohol use and a greater density of bars generally also have higher rates of<unk> . About 2.2–3.4% of those who have been treated for alcoholism at some point in their life die by<unk> . Alcoholics who attempt<unk>  are usually male, older, and have tried to take their own lives in the past. Between 3 and 35% of deaths among those who use heroin are due to<unk>  (approximately fourteenfold greater than those who do not use). In adolescents who misuse alcohol, neurological and psychological dysfunctions may contribute to the increased risk of<unk> . The misuse of cocaine and methamphetamine has a high correlation with<unk> . In those who use cocaine, the risk is greatest during the withdrawal phase. Those who used inhalants are also at<unk> gnificant risk with around 20% attempting<unk>  at some point and more than 65% considering it. Smoking cigarettes is associated with risk of<unk> . There is little evidence as to why this association exists; however, it has been hypothesized that those who are predisposed to smoking are also predisposed to<unk> , that smoking causes health problems which subsequently make people want to end their life, and that smoking affects brain chemistry causing a propensity for<unk> . Cannabis, however, does not appear to independently increase the risk. Medical conditions There is an association between<unk> lity and physical health problems such as chronic pain, traumatic brain injury, cancer, chronic fatigue syndrome, kidney failure (requiring hemodialysis), HIV, and systemic lupus erythematosus. The diagnosis of cancer approximately doubles the subsequent frequency of<unk> . The prevalence of increased<unk> lity persisted after adjusting for depressive illness and excessive alcohol use. Among people with more than one medical condition the frequency was particularly high. In Japan, health problems are listed as the primary justification for<unk> . Sleep disturbances, such as insomnia and sleep apnea, are risk factors for depression and<unk> . In some instances, the sleep disturbances may be a risk factor independent of depression. A number of other medical conditions may present with symptoms<unk> milar to mood disorders, including hypothyroidism, Alzheimer's, brain tumors, systemic lupus erythematosus, and adverse effects from a number of medications (such as beta blockers and steroids). Media Goethe's The Sorrows of Young Werther, the title character kills himself due to a love triangle involving Charlotte (pictured at his grave). Some admirers of the story were triggered into copycat<unk> , known as the "Werther effect". The media, including the Internet, plays an important role. Certain depictions of<unk>  may increase its occurrence, with high-volume, prominent, repetitive coverage glorifying or romanticizing<unk>  having the
Suicide
Drowning
Copycat suicide
Assisted suicide
Youth suicide
Addiction
Assault
Night terror