Suicide and suicidal ideation have recently been brought to the fore of the public consciousness by way of a popular teen show called “13 Reasons Why”. Although I view this show as an absolute trainwreck due to the nature of the subject matter and how it is portrayed by the producers of the show, it has opened up a bit of a dialogue by touching on a subject that is extremely sensitive, often misunderstood, and difficult to broach as a topic of conversation. While suicide is complicated and tragic, it is also often preventable when the signs that signal its impending occurrence are recognized and help is sought. Over 40,000 people die by suicide in the US each year, making it a serious public health concern as the 10th leading cause of death overall.
The signs of suicidal ideation aren’t difficult to recognize, as there is a particular list of behaviors that tend to be early warning signals that someone is contemplating the taking of their own life in a serious way. Someone who is contemplating seriously contemplating suicide may talk openly about feeling hopeless, having no reason to live, or wanting to die or kill themselves. They may confide that they are in unbearable emotional or physical pain, dealing with tremendous guilt or shame, or feeling trapped in a hopeless situation or circumstance with no solution or way out other than death. Many times they will even reveal that they are working on a plan or looking for a way to commit suicide. They may begin using alcohol or drugs as a coping mechanism, or increase the use of same if they are already users. People with suicidal ideations often talk of being a burden on others, such as loved ones, friends, or coworkers, and may act anxious/agitated while slowly withdrawing from friends and family. Noticeable changes in eating or sleeping habits, showing rage, talk of “seeking revenge”, or taking unnecessary risks that could be fatal, such as driving recklessly, are often indicators of suicidal ideation, and may or may not be accompanied by displays of extreme mood swings. Someone who is contemplating the taking of their own life may be talking or thinking about death constantly, and they may prepare for the final act by saying goodbye to family and friends, giving away important possessions, or by getting their affairs in order and making a will or some other legal document as to the final disposition of their estate. While these criteria may not necessarily be indicators of suicidal ideation in and of themselves singularly, you should seek help as soon as possible if these warning signs apply to you or someone you know plurally, especially if the behavior(s) are new or have recently increased in frequency.
There are several risk factors and indicators that may signal if someone is contemplating suicide, and it is important to realize that suicide is non-discriminatory. Anyone of any gender, age, or ethnicity can be a suicide risk. The behaviors associated with suicide are complex, with no single cause; many different contributing factors are present for someone who attempts to take their own life. However, those most at risk do tend to share certain risk factors for suicide:
- Certain medical conditions
- Chronic pain
- Family history of suicide, mental disorder/substance abuse, or violence (including physical or sexual abuse)
- Depression or other mental disorders or substance abuse disorder
- Guns or other firearms in the home
- Prior suicide attempt
- Recent release or parole from prison or jail
- Exposure to the suicidal ideations/behaviors of others, such as peers, family members, or celebrities
Many people often have some of these risk factors, but do not attempt suicide or display suicidal ideations. This is because suicide is not considered to be a normal response to stress; thoughts or actions of a suicidal nature are a sign that someone is in extreme distress requiring immediate intervention and assistance. When suicidal ideations or actions are displayed by someone, it should not be ignored, or written off as a harmless bid for attention. Friends and family are usually the first to recognize the warning signs of suicide, and are usually in the best position to assist with helping someone who is at-risk find the specialized treatment that will be required to address the diagnosis and treatment of the mental health conditions that are the root of the problem.
The demographics of suicide with regard to race/ethnicity, age, and gender as related to risk are interesting. Women are more likely than men to attempt suicide, but men are more likely to actually be successful in the attempt due to a predilection for choosing deadlier methods such as firearms or suffocation, where women show a preference for suicide by poisoning. Women are most likely to attempt suicide between the ages of 45 and 64, while men peak at ages 75 and up. In younger people, suicide is the second leading cause of death in the 15 to 34 age range. Native American Indians, as well as Alaskan Natives, tend to have the highest rate of suicides among ethnic groups, just ahead of non-Hispanic whites, while African Americans trend toward the lowest rate of suicide, with Hispanics at the second lowest rate.
If you recognize the signs of suicidal ideation/contemplation and want to offer assistance, there are 5 steps you can take to assist someone who is at a suicidal level of distress. The first thing to do is to ask “Are you thinking of killing yourself?” A tough question, yes, but asking it hasn’t been shown to increase suicides or suicidal thoughts. Secondly, keep them safe by reducing or preventing their access to lethal items or places. This is an important aspect of suicide prevention, along with asking if they have a plan for their suicide and then removing or disabling the lethal means to complete their plan. The third step involves listening carefully to ascertain what the person is thinking and feeling. Talking about and acknowledging suicide may actually decrease suicidal thoughts and ideations. Next, assist them with reaching out and making a connection. The National Suicide Prevention Lifeline at 1-800-273-8255 (TALK), or a trusted family member, friend, or mental health professional can help make all the difference in assisting them with getting the help they so desperately need to overcome their crisis. Finally, stay in touch after the crisis. Studies have proven that someone following up with an at-risk individual after they’ve been discharged from care reduces their risk of recurrence.
The ability to get immediate help for someone who is contemplating suicide is critical; instant access to emergency numbers can mean the difference between saving a life and losing one. The non-emergency number to the local police department, the number of a trusted friend or relative, the Crisis Text Line at 741741, and the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) should be saved for quick retrieval in your cell phone, along with any other local emergency numbers. Being able to summon immediate help can make a difference.
It should also be noted that social media can and does play a large and ever-increasing role in people’s day to day lives, and occupies an important niche in many people’s social interactions with others. If you recognize the signs and indicators of suicide or suicidal ideations in the posts of someone on social media, reach out to them, or contact the social media site directly if you notice concerning updates.
SOURCES
Suicide Prevention. (2017, March). Retrieved June 9, 2017, from
https://www.nimh.nih.gov/health/topics/suicide-prevention/index.shtml
Teresa King
PMHC Intern