The predominant view of modern medicine is that suicide is a mental health concern, associated with psychological factors such as the difficulty of coping with depression, inescapable pain or fear, or other mental disorders and pressures. Suicide attempts can be many times interpreted as a "cry for help" and attention, or to express despair and the wish to escape, rather than a genuine intent to die. Most suicides (for various reasons) do not succeed on a first attempt; those who later gain a history of repetitions are significantly more at risk of eventual completion. Nearly a million people worldwide die by suicide annually. While completed suicides are higher in men, women have higher rates for suicide attempts. Elderly males have the highest suicide rate, although rates for young adults have been increasing in recent years.