Dr. John Mann is the chairman of the scientific counsel of the American Foundation for Suicide Prevention. He is also the head of Columbia University's Clinical Research Center for the Study of Suicidal Behavior and the Department of Neuroscience at New York State Psychiatric Institute. He is the author of 277 papers and the editor of nine books on suicide and psychiatric disorders.

NYC24: When does a person become suicidal?

Dr. Mann: Suicide itself is a combination of psychiatric illnesses. In over 90 percent of these cases, there is a diagnosable psychiatric illness. The question that arises is, what is different about these individuals that lead them to kill themselves when most people who have a psychiatric illness never even attempt suicide. In addition to stressors, people need to have a predisposition. The ones who survive serious suicide attempts are distinguished from those with the same level of illness but have never made a suicide attempt by reporting more suicidal thoughts. And they feel more hopeless. Individuals prone to serious suicide attempts' lives are characterized by a lifetime of more impulsive and aggressive behavior.

NYC24: How is suicide affected by an urban setting versus a rural setting?

Dr. Mann: Traditionally, there are higher suicide rates in the city than in the country. But that depends on other factors as well. For example in countries like Sri Lanka and China, in the rural districts the suicide rate is astronomical. There are parts of Sri Lanka where the suicide rate is 200 to every 100,000, which is approximately 20 times higher than the United States. The reason it's so high is that the favored method of suicide is to take pesticides, which they all have available on their shelves. The pesticides are amazingly lethal, so every suicide attempt becomes a suicide. We have an average of about 10 suicides attempts for every suicide. So if you suddenly increase the lethality of the method, you convert more attempts into completions.