Before Kurt Cobain was found dead 20 years ago in his Seattle home, there were several red flags that Nirvana's lead singer was suicidal: a family history of suicide, bipolar disorder and drug addiction.
During a 1991 tour, he admitted to using heroin to push away suicidal thoughts: "This is the only thing that's saving me from blowing my head off right now."
But was his profession as a musician also a risk factor?
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It's clear that some artistic professions are more at risk of suicide -- including writers, actors and painters.
The suicide rate of musicians is about three times the national average, according to work by Steve Stack, director of the Center for Suicide Research and a professor at Wayne State University, whose research on occupation and suicide is the most comprehensive to date, covering a period of eight years of death certificates that list occupation.
This alarming statistic measures suicide among all people who are alive, including the very young, whose risk of suicide is low.
But if you measure among the 2,000,000 people who have died each year in the United States, musicians appear to be only slightly more likely to have committed suicide. The percentage of suicides among those who have died is 1.5 percent. The number for musicians is 2.1 percent.
Either way you look at it, Stack says, it's an elevated risk for musicians.
Cobain's case, however, seems to be a classic representation of struggles that disproportionately affect artists:
"There's definitely a known connection between creativity and mental illness," said Dr. Christine Moutier, Chief Medical Officer for the American Foundation for Suicide Prevention. Over 90 percent of people who commit suicide had a mental illness, whether it be active or under-treated or undiagnosed, Moutier said.
Many artists and people who commit suicide share character traits such as perfectionism. Common pathways in the brain lead people to both be more creative and experience mood and behavior patterns outside the norm, Moutier said.
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Families of creative types should be in tune to their loved ones' changes in behavior, substance use patterns, even changes in sleep.
When real life -- with losses, unexpected events, stresses -- plays in, it can be lethal for those who have access to suicidal means: a bridge without a suicide barrier, for example, or enough medicine in easy-to-open packages, or, as in Cobain's case, a gun.
And real life for artists can be especially challenging, Stack points out.
"(I) developed a new explanation for artist suicide based on artist labor markets," he said. "As an occupational group, artists are more likely than others to experience labor market strains. These strains include unemployment, underemployment, client dependency (in a quest after gigs/contracts), multiple job holding and low incomes. Some work at menial jobs by day and do art at night."
Combined with the higher rates of mental disorders such as manic depression and bipolar disorders, lives of artists are often volatile.
"It's not to say you should squelch creativity, but I do think family support of young adults excited about artistic endeavors is important," Moutier said.