by Emily Durbin
& Sherry Walling
Many of us experience periods of sadness, apathy and anxiety. In fact, many people have passing thoughts of causing harm to ourselves. Suicidal thoughts are not unusual, but they can become dangerous if they are persistent and pervasive. Although, it can be a difficult topic to discuss, candid conversations about suicidal thoughts can be lifesaving.
Suicidal behavior is found in individuals of every culture, and across all ages and social and economic backgrounds. In the United States, suicide is the tenth leading cause of death with nearly 35,000 Americans committing suicide each year—90% of whom use firearms, poison, or suffocation (NIMH, 2007). For every completed suicide, there are eleven attempted suicides in the United States (NIMH, 2007). American emergency rooms see more than 376,000 self-inflicted injuries each year (CDC, 2010). One third of people who attempt suicide will try again within a year (NIH, 2011). According to a study done by the Center for Disease Control and Prevention, men are four times as likely to commit suicide as women, but women are three times as likely to attempt it. Men tend to use lethal means (i.e. firearms), while women most often use less lethal means.
Somewhat contrary to depictions in popular media, the elderly have the highest rates of suicide (14.3 suicides per 100,000 people). Young adults (ages 20-24) are the second highest risk group with a rate of 12.7 suicides per 100,000.
Thoughts of suicide routinely present as a reaction to stressful life changes when individuals perceive that their dilemma is inescapable or their lives are out of their control. Suicide survivors report experiencing ‘tunnel vision’ where suicide seemed like the only way out. They were unable to identify hope in their future or the possibility of relief from their feelings of neglect, loss, or loneliness. Most suicidal individuals desperately want to live, but are unable to see beyond their present pain.
In the wake of the thousands of suicides and suicide attempts, millions of people are left to pick up the pieces of their lives. Friends and family members of those who commit suicide often blame themselves, have deep feelings of anger and guilt, and have an increased likelihood of being depressed and even committing suicide themselves.
There are a number of mental and physical illnesses that can be risk factors for suicide. A mental illness diagnosis or prolonged battle with substance abuse is found in 90% of suicide cases (NIMH, 2007).
There are six specific mental illnesses that have the highest occurrence of correlated suicide attempts and completions.
• Major Depressive Disorder This disorder is characterized by increased feelings of hopelessness, worthlessness and a marked change in energy level, eating habits and sleep patterns all of which persist and negatively impact social, work, school, and/or personal interactions. Suicidal thoughts and actions can dramatically increase with changes in social connection and impulsivity.
• Bipolar Disorder The low valleys of depression produce suicidal thoughts and the high peaks during mania provide the drive and energy to form and carry out a suicide plan.
• Anxiety Disorders Frequent anxiety is highly correlated with suicidal ideation, or thinking about suicide. Untreated anxiety can lead to suicidal actions.
• Schizophrenia Sufferers have trouble thinking logically and differentiating between what is real and not real. The consequences of suicide may not be fully understood in the midst of a delusion or the individual may wish to end the pain of their symptoms.
• Borderline Personality Disorder The unstable and turbulent emotions that these individuals experience often leave them feeling empty and suicide is seen as a way to escape.
• Post Traumatic Stress Disorder Overwhelming fear reinforced by flashbacks to the traumatic event and heightened arousal fed by a need to avoid danger can be suffocating. Suicide can be seen as a way out.
Several physical conditions, such as thyroid disease or lupus, have also been linked to an increase in suicidal thoughts and actions. The common thread that connects these diagnoses is their chronic nature and severity. Suicidal thoughts may accompany feelings of fatigue, hopelessness and a belief that the painful symptoms or painful situation will never change.
The risk for suicidal thoughts and behaviors can also increase according to an individual’s family history, personal history, community experience, and situational changes.
• Families with a history of mental illness, substance abuse, suicide, violence, child abuse and/or neglect and the presence of firearms in the home face an elevated risk for suicidal behavior.
• Individuals who have a history of harming themselves (e.g., cutting), failed suicide attempts, social isolation, or a history of physical abuse and/or sexual abuse have higher rates of suicide.
• Communities that have highly publicized cases of suicide often see a rash of attempts.
• Social or discipline problems at school or work, the end of a romantic or long-term relationship, the death of a loved one, the diagnosis of a chronic or debilitating disease, or financial or legal problems can also influence suicidality.
Signs and Symptoms
Warning signs can be placed in two categories: changes in emotions and changes in behavior.
Suicidal individuals may seem to be preoccupied with death; exhibit feelings of hopelessness, uncontrollable rage, or anger; be withdrawn or uninterested in previously enjoyed activities; feel trapped with no way out; or be unable to identify a reason to live. Strong feelings of guilt and an increase in anxiety or agitation have also been seen. Any dramatic mood change is cause for alarm especially if reckless, risky, or impulsive behavior follows.
Someone dealing with thoughts of suicide might have marked changes in their eating or sleeping habits (either seen as more or less than normal). They may also increase self-destructive behaviors such as frequent drug or alcohol use or by cutting or otherwise hurting themselves. They may also seek access to firearms, or stockpile medications. Individuals considering suicide will commonly talk about death or threaten to hurt or kill themselves.
The most alarming warning sign is if a suicidal individual suddenly appears calm after a period of deep depression or anxiety. This could indicate that they have formulated and intend to carry out a suicide plan. Saying goodbye, giving away belongings, getting their affairs in order (such as updating a will) or talking about going away should be taken very seriously.
Whether you or someone you know is having thoughts of suicide, it is important to seek help. The American Medical Association (2005) specifically cites the treatment of underlying mental illness and a strong social support system as the best ways to reduce suicide risk.
Having Thoughts of Suicide?
The best thing you can do is reach out. This can be seeking help from a close friend, family member, or spiritual leader. Or by seeking professional guidance from your doctor, a mental health professional or by calling a crisis hotline. Sometimes people are embarrassed or ashamed of how they feel, afraid to ask for help because they don’t want to be thought of as weak. Help is available to anyone and everyone can be helped—suicide is a choice, not the solution.
A doctor will want to evaluate whether you are an immediate threat to yourself. They will also ask about any previous suicide attempts and if you have a history of drug or alcohol abuse, uncontrollable changes in mood, detachment from reality, or impulsive behavior. Therapy options can be explored to understand where and why you have these thoughts, medications tailored to specific mental disorders can be used to reduce symptoms, and a system of support and accountability can be set up to ensure future safety.
It is important to go to all appointments, take medications as directed, and be aware of your own triggers and warning signs. Creating a contract with your doctor, a family member, or friend that outlines a plan for future action if suicidal thoughts and feelings return, can help you better cope if your thinking becomes clouded by the hopelessness of tunnel vision.
If you are in an urgent crisis and you don’t feel that you are safe enough to wait for an appointment with your doctor, you should go to the nearest emergency room.
Information for Friends and Family
Talking about suicide or bringing up your concerns with an individual you fear is suicidal does not cause that person to be more suicidal- especially if done in a nonjudgmental, straightforward manner. Try to communicate that they are important to you by listening with genuine concern, by offering hope, and mentioning the alternatives available to them. Reacting with shock or lecturing them on the ethics or morals involved will only create more distance between you, diminishing your ability to help.
If someone you know is actively suicidal you should seek help immediately (by calling 911), eliminate their access to tools of suicide (such as firearms or medications), and stay with them.
The greatest tool in preventing suicide is understanding the warning signs, especially dramatic changes in mood, behavior, or attitude. Major life stresses such as death, divorce, diagnosis of a chronic illness, or loss of status (e.g., loss of job, family or reputation) predict increased feelings of depression and anxiety. If you also do not have a strong support system or have not learned appropriate ways to cope with these feelings (e.g., if you turn to alcohol or drugs to numb the pain), thoughts of suicide may increase in frequency and severity.
Most suicidal individuals give definite warning signs of suicidality so being attentive is vital. If you observe drastic or severe behavior in someone you love, do not be afraid to get involved, ask questions and show that you care. Empathy, not sympathy, is key in creating and sustaining hope that things will get better. Some practical advice would be to avoid illegal drug use, limit alcohol consumption, and to lock alcohol, prescription medications, and firearms in a secure location away from troubled hands. It may also be important to limit a suicidal person’s access to an automobile.
Loss of a loved one to suicide can fill survivors with shock, fear and anger. If you or someone you know is thinking about suicide, reach out. A therapist, physician, school counselor/psychologist, church leader, family member or friend could all help pull you back in or provide support or information when moving forward. A suicide hotline can also answer questions, provide support and direct you to further help.
National Suicide Prevention Lifeline – 800-273-TALK (800-273-8255)
Reach trained counselors 24 hours a day, 7 days a week
Suicide Prevention Resource Center – sprc.org
National Institute for Mental Health – nimh.nih.gov
Substance Abuse and Mental Health Services Administration – samhsa.gov
Your local physician or a local psychologist or counselor.