Strange, isn't it? Each man's life touches so many other lives. When he isn't around, he leaves an awful hole, doesn't he? — Guardian angel "Clarence" to George Bailey, who is contemplating suicide on Christmas Eve in the 1947 film "It's a Wonderful Life."

An empty chair at the table. A vacant bedroom that gathers dust. Tears that slowly become invisible except to those who still cry them.
      Suicide leaves a unique kind of hole that never seems to be quite filled.
      At a time of year many associate not only with joy, but with deepened despair and pain for the suffering, there has grown up a myth that those who die by their own hand do so disproportionately during the holidays.
      The National Center for Injury Prevention and Control and the Utah Department of Health both report that suicide rates are actually lowest in the winter and highest in the spring.
      Yet the timing isn't what matters to those whose own futures have been altered by the irrevocable decision of a loved one. And there are many more of those "walking wounded" than Utahns may realize.
      Health department statistics show the state ranks seventh nationally in the proportion of residents who kill themselves. An average of 310 Utahns commit suicide each year; 890 who attempt to do so are hospitalized; and 3,240 are treated in the state's emergency rooms. Suicide is the second leading cause of death for residents ages 10-34, the third leading cause for those 35-44, and the fourth leading cause for those 45-54.
      Four times as many males as females take their own lives, but more females make the attempt to do so.
      The carnage leaves those in a family-focused culture known for its religious mores not only to deal with the guilt and loneliness that survivors say they suffer, but to wonder about the long-range spiritual implications. Every major faith teaches that life is sacred.
      Yet local mental health advocates say 90 percent of those who kill themselves have been diagnosed as mentally ill, with depression and bipolar disorder among the most common diagnoses. Few of those were in treatment at the time they ended their lives, according to Sherri Whittwer, executive director for the Utah chapter of the National Alliance on Mental Illness.
      She said the organization's continuing education campaign has reached 20,000 Utah clergy in the past four years, the majority of them local leaders for The Church of Jesus Christ of Latter-day Saints. Suicide is still something of a taboo topic, she said, particularly among many actively religious people. "It's just giving people the information so that they will understand that behaviors they may see are actually symptoms of an illness." Most people depressed to the point of taking their own lives don't arrive at that point "due to character flaws or lack of willpower," though that is one of "many myths associated with mental illness. As we raise awareness and erase the stigma, then we can encourage people to seek treatment." The stigma of being mentally ill is "the main barrier to treatment," she said.
      Those interested in clergy training or other information about mental illness may call 323-9900, or visit the Web site at www.namiut.org.
      Those in need of immediate help are urged to call one of several 24-hour crisis lines available throughout the state. In Ogden, call (801) 625-3700; in Orem, (801) 226-4433; in Provo, (801) 373-7393; and in Salt Lake City, (801) 261-1442.

Katie Aston, director of Utah County Crisis Line, said her agency receives from 4,000 to 6,000 calls per year. In the past decade, suicide-related calls account for 5 percent to 11 percent of those, while calls regarding depression, bipolar disorder or other symptoms of mental illness comprise about 35 percent of call volume.
      Volunteers are trained to understand that callers experience a broad range of feelings "from fear to sadness to even guilt for having those feelings." Training emphasizes how to help those threatening suicide because "even though they are not the largest percentage, they're the most important calls we get."
      Carolina Howard with the Utah County Health Department said suicide is "not about wanting to die, but about a powerful need to end pain." Those who seek to kill themselves "feel that they are unable to cope with feelings of pain, hopelessness, isolation or other uncertainties."
      While mental illness is a major risk factor for suicide, religious affiliation is often listed as a "preventive" factor against it, according to Cyndi Bemis with the state Department of Health's Violence and Injury Prevention Program.
      She said higher levels of religiosity appear to be associated with lower levels of suicide.
      Among 15- to 19-year-old males in Utah, less-active LDS youths and those who did not belong to the LDS Church had relative risks of suicide of 3.28 and 3.43, respectively, as compared with active LDS youth at 1.0, according to Gary Mower, injury prevention specialist with the state Department of Health. That means among those who killed themselves, the rate was 3.43 times higher for non Latter-day Saint young men and 3.28 times higher for less-active LDS young men than it was for active LDS teen males.
      The study was published in the American Journal of Epidemiology, March 2002, and was co-authored by Dr. Joseph Lyon at the University of Utah, Mower said. "Other studies outside the state have found that being a member of a religion is one of the protective factors for suicide."
      Rick Hawks, a local psychologist associated with the Mental Health Resource Foundation in Ogden, agreed religion is a preventive factor but said it may also play into the mix of emotions that figure into the decision to end one's life, particularly within faith traditions that hold their members to high standards of personal behavior.
      "It's a paradox. Increased spirituality has a tendency to prevent it — especially if it's a religion like the LDS Church, where we are against self-harm and suicide. Therefore it helps them not do it. On the other hand, because of the stress factors related to high expectations and perfectionism, it creates that stress and inability to keep up with it. The flip side is, there are folks that certainly commit suicide with that as a contributing factor."
      Hawks said there is little evidence to suggest that the rate of mental illness among religious people — including Latter-day Saints — is any lower than among the population in general.
      Based on World Health Organization figures that the current suicide rate of 16 per 100,000 people worldwide holds true across the board, Hawks said the multiplier among Latter-day Saints could mean nearly 2,000 Mormons kill themselves each year. He emphasized the extrapolation is only an illustration but used it to emphasize the need for a wider understanding within both the LDS and the wider faith community about both mental illness and suicide.
      "If it was a hurricane that killed that many Saints this year, or an earthquake or bird flu, we would be outraged if we did nothing. Yet often that's what we do — nothing. We need to educate people about mental illness and the warning signs and communicate to others there is hope."
      Hawks' nonprofit foundation has a variety of resources available to the public on both mental illness and suicide, including a book detailing the experiences of those dealing with the suicide of a loved one from an LDS perspective. "Where Is Our Hope For Peace? A Resource for Families Coping With Suicide" is available through the Web site at MentalHealthLibrary.info, or by calling 1-800-723-1760.
      In the book, one local father who is an LDS bishop shares the details about how his son grew up seeking social acceptance but feeling increasingly isolated from peers. The boy married, but alcohol and negative peer influence contributed to the end of the marriage. He returned home to live with his parents. One day after church, his father went downstairs to tell his son dinner was ready.
      "He didn't wake when I called his name. When I turned on the light, I saw him lying back on his pillows and that he had shot himself in the heart. I reached out to hold him, but his spirit had gone. Thoughts raced through my mind — with my priesthood, I could heal him, if only I was good enough. . . . I remembered how Jesus raised the dead and I wanted so much to have the faith to bring my son back to me.
      "I went to the stairs to tell my wife . . . and I literally felt my heart break. . . .
      "It has been two years now since he died and gradually I am finding ways to cope. There will never be a day or an hour that I don't think of him and miss him."