Suicide rates are high and have only been increasing over the years. Over 800,000 people die all over the world by suicide each year. A proportion of the suicides are murder suicides resulting in additional loss of life. Attempts at suicide occur more frequently and we have about one million suicide attempts occurring each year.
Suicide is a heart-breaking problem that is growing and needs to be addressed in as many ways as is possible. Understanding the risk factors, knowing the warning signs and what to do about them, is a crucial step. The more the awareness the greater the impact on suicide prevention.
Risk Factors for Suicide
Psychiatric illnesses have been diagnosed in 90% or more of individuals who die by suicide. Among the mental health conditions depression is the most potent in elevating risk for suicide. Suicidal ideation becomes more active when the severity of the depression is higher and compounded when the individual experiences a major stressful life event. The presence of other risk factors also operates to increase risk for suicide. Other mental health conditions that are associated with suicide in hierarchical order include drug abuse, bipolar disorder, schizophrenia and personality disorders like borderline personality disorder.
Serious or chronic health conditions such as cancer, Alzheimer’s, traumatic brain injuries, HIV/AIDS and chronic pain are associated with suicide risk. Individuals with such illnesses often have co-morbid depression as well.
Childhood physical and sexual abuse have been found it to be associated with suicidal attempts and deaths.
History of suicide attempts is a potent predictor of suicide especially in the first year following discharge from hospital for an attempt. Individuals who have multiple suicide attempts, are at greater risk for subsequent suicidal behavior.
Prolonged Stress, which can manifest in the form of bullying, harassment or relationship problems can also be a precursor for suicidal behavior.
Psychological risk factors include:
- Hopelessness has been found to be very closely linked to suicidal behavior. In some people hopelessness, can occur as a trait which manifests as a stable, negative expectancy for the future. In such individuals, it will not take much adversity to trigger an emotional state of hopelessness which usually precedes a suicidal act. Higher levels of hopelessness are associated with increasingly acute suicide ideation.
- Suicidal ideation has been found to be closely associated with suicidal behavior, especially as they become more intentional and involve thinking about ways in which to end their lives.
- Impulsivity operates in some individuals and increases suicide risk indirectly. In such instances, their impulsive behaviors exacerbate their distress levels and triggers the suicide related risk factors, like excessive drug or alcohol use.
- Problem-solving deficits have been reported by suicide survivors. They report that they made the suicide attempt because they could not see a way out of their life situation. Research has also demonstrated that suicide survivors experience an inability to generate solutions and a negative attitude towards the ability to solve problems.
- Socially prescribed perfectionism which manifests as perfectionist behaviors that are driven by the fear of rejection or judgment has been identified as a factor that has been closely associated with hopelessness and suicidal ideation.
- Lack of social connectedness and subjective perception of not belonging has been associated with suicide and attempts.
- A person’s perceptions that he or she is a burden to others has also been identified as being predictive of suicide, especially in older adults and people with chronic pain.
Access to lethal means including fire arms and drugs is a major risk factor.
Stressful and negative life events such as divorce, conflict, death of a loved one, financial problems, job loss or being diagnosed with a troubling illness. When the risk factors fuse with the triggering negative life event a suicidal crisis or act is triggered.
There are certain factors that can act to counteract the risk factors and deter suicidal behavior.
A supportive social network or family is one such protective factor. Having a support system that is accepting and supportive helps to buffer the impact of stressors
Being married and a mother causes individuals to not take the route of escape that suicide offers. As a partner and a parent, they hesitate to do something that could traumatize their loved ones. Their sense of responsibility towards their children also acts as a deterrent.
Participation in religious activities has been found to be associated with low suicidal rates. Religious activities are usually carried out in the context of a religious community which fosters a sense of community and belonging which has a stress cushioning impact. In addition, religious activities usually reinforce beliefs that it is morally wrong to take one’s life.
Fear of pain and death, operates more in women and prevents them from taking their own lives.
Being actively engaged in treatment is a very important protective factor and it is crucial that individuals who suffer from mental illnesses receive treatment and are regular with their appointments.
If you or someone you know demonstrates the warning signs listed below do make sure that mental health treatment is sought. If already in treatment the information needs to be shared with the mental health provider.
Below are some warning signs that indicate that mental health treatment is required, but not necessarily immediate, to prevent a suicidal act:
- Individual experiences and expresses feelings of hopelessness
- Person experiences and expresses excessive anger and rage and talks about seeking revenge
- Person acts recklessly or engages in risky activities without much thought.
- Person increases alcohol or drug use
- Person withdraws from friends and family and isolates more.
- Person is in a difficult situation and feels trapped which may be expressed to close friends and family.
- Person is anxious and agitated and unable to sleep or uses sleeping pills all the time.
- Person experiences dramatic changes in mood which may be apparent to family and /or friends.
- Person sees no reason for living or no purpose in life and says as much to family and/or friends.
The three warning signs that signal the need for immediate intervention are:
- The person threatens to hurt or kill self
- You come to know that the person is looking for ways to kill self, such as seeking access to pills, weapons or other means.
- The person is talking or writing about death, dying or suicide.
How can you help someone who is at risk for suicide?
Talking about suicide to someone who you think may be at risk for suicide can be uncomfortable. Sometimes people are afraid that talking about it may trigger the act. This is far from true. Talking and gently asking a loved one who is depressed if they have thoughts about suicide will allow them to talk openly about what they are going through and move them towards getting the help they need. Allow them to express their feelings and listen with interest, patience and understanding. Be supportive and non-judgmental while offering hope that there are options available that could be helpful. Safety is of prime importance so remove access to any lethal means of self-harm such as firearms, pills, alcohol, drugs or rope. Individuals who are in suicidal crisis need to get professional help at the earliest so it is important that the suicidal individual is actively encouraged to see a mental health professional as soon as possible.
People who are in a suicidal crisis are in a state of mind where they feel hopeless and stuck with no solution except for suicide. Their thinking tends to become narrowed with thoughts that are negative and distorted dominating. Their problems solving abilities are impacted. In the case of individuals who are in a suicidal crisis the first step would be to make sure that they get professional help so that they are helped to move towards emotional stability and out of the suicide ‘mode’ even as they stay safe. This may require hospitalization. The underlying disorder would need to be treated while the event that acted as the precipitant is also addressed. It is useful to involve significant others in the individual’s life such as partner/spouse, family and friends to gather information and in the treatment as needed. The goals of treatment are to help the patient to move towards an emotional state of stability where he can then work on building healthy coping skills. Treatment would involve medical treatment as well as psychotherapy.
Cognitive behavior therapy for suicide prevention is a form of psychotherapy that has been found to be particularly helpful for suicidal individuals. It helps them to understand their suicidal mind-set and develop skills that will allow them to cope more effectively with suicide triggering situations and prevent the recurrence of a suicidal crises.
For immediate help if you are in a crisis, call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), which is available 24 hours a day, 7 days a week. All calls are confidential.