Suicide is the tenth leading cause of American deaths, according to data from the Centers for Disease Control. In 2017, 47,173 people ended their lives, and another 1.3 million people are estimated to have attempted suicide. The actual rate of suicide is likely much higher, given that car accidents, overdoses, and drownings may fall into the category as well. Researchers are concerned that the rate of suicide is increasing over the last decade, and there is real urgency to understand what can be done to identify and support people with suicidal impulse. Here are some things you can do if you know someone in trouble.
There is no clear causality for suicide. It is one individual's response to a particular set of painful circumstances. Suicide appears like a solution when psychological pain and intense hopelessness outweigh someone's coping resources. Most suicidal people do not want to die; they want an end to their suffering. The only option that they can see to end the pain is to end their lives. The best suicide prevention measure that currently exists is to recognize that someone is in pain and intervene quickly with resources, support and coping strategies. While suicide is a unique and individual decision, there are often common signs of trouble when people are at risk.
Notice Psychological Symptoms and Behavioral Signs
People express emotional pain in different ways. They might be tearful and sad, moody and withdrawn, numb and disengaged, or hostile. While pain is expressed differently, there are often psychological symptoms and behavioral signs that signal potential suicidal impulse. Here are some important psychological indicators:
- Changes in eating and sleeping patterns
- Increasing feelings of hopelessness
- Negative moods states (sadness, anger, anxiety, irritability) or rapid shifts in mood
- Feeling worthless, undeserving or like a burden
- Increasing feelings of helplessness, ineffectiveness or brokenness
- Impulsivity, agitation, or chronic anxiety
- Harsh beliefs about oneself and rigid (black or white) thinking
Emotional distress is often signaled in behavior and interpersonal attitudes. These are additional indicators of potential suicide risk:
- Withdrawal and social isolation
- Declining or erratic performance at work or in school
- Increasing use of alcohol or other intoxicants
- Risky behaviors (speeding, going home with strangers, etc.)
- Expressing the wish to not wake up, to have everything over with, or to die
- Angry or vengeful statements ("I'll show you!")
- Unusual good-byes or expressions of appreciation
- Making a will or giving away of possessions
- Stockpiling pills
Be Aware of History
In addition to these current psychological symptoms and behavioral signs, a suicidal impulse is more likely when someone has experienced certain types of events or challenges in their past. These include:
- History of depressive episodes, bipolar disorder or substance abuse
- Previous suicide attempts or an escalation in a pattern of self-injury
- Family history of suicide
- Anniversary of significant loss or trauma, or a holiday (e.g. Mother's Day, Christmas)
- History of childhood neglect, abuse, trauma or bullying
Notice Red-Flag Risks
There are particular circumstances that may create more vulnerability to suicide. One is the presence of a gun in the home. The percentage of suicides from firearms is roughly 51 percent. Adolescents who have easy access to guns are at much higher risk for suicide. Gun safety measures, including thumbprint gun locks, have been used in some states as an anti-suicide intervention.
Another risk factor is a recent loss or experience of some significant change in the structure of someone's life. Loss can occur through death, divorce, or an end to a relationship. Other events such as job loss, relocation, financial instability, loss of housing or legal status, and retirement involve changes that can destabilize an individual's coping capacities.
Another window of suicide risk occurs after recent diagnosis of medical conditions and mental health issues. Information about conditions that may affect a person's life in dramatic ways may prove devastating to someone's sense of their physical and mental capacities and their ability to envision a hopeful future.
Higher risk for suicide may also follow when a depressed individual who was formally immobilized by their symptoms experiences increased energy. This increased energy can result from seasonal changes, such as increasing daylight as winter becomes spring, or as a result of antidepressant medication. In the first few weeks of antidepressant medication, increased energy may be experienced before the full benefits of improved mood may occur. Medication response should be monitored carefully for this reason.
Increased suicide risk can be elevated following someone's discharge from psychiatric or substance abuse facilities. The individual may feel overwhelmed by the shift from a structured and supportive environment back to the daunting task of navigating their life again. These transitions need to be managed carefully to ensure adequate supportive resources are in place.
Be Aware of Imminent Signs
The most important suicide warning sign is the presence of a clear plan. If someone has approached you to discuss their suicidal feelings, it is important to ask about any plans to end their life.
- Have they settled on a specific plan?
- If so, what is the method of that plan, and do they have the means available now?
- Have they chosen a time or date for that plan?
- Do they intend to carry out the plan?
Know Your Role and Trust Your Gut
While you might identify a variety of suicide factors and learn about others as a result of your conversation with someone who is suicidal, it is impossible to cover all possible indicators and risk factors. Pain can be expressed in many unique ways that do not invite attention. You are not obligated as a support person to perform a complete suicide assessment. These important issues can be further explored by professionals trained in suicide prevention.
The fact that you are concerned for another person's safety and well-being is enough to prompt further intervention. If you believe that someone is at risk for suicide, approach them privately for a conversation about their well-being.
Who to Call
If there are obstacles or concerns about your specific involvement, bring your concerns to other friends, family members, or trained professionals (teachers, counselors, clergy, etc.). Additional consultation, resources, and information can be obtained at any time by calling the National Suicide Prevention Lifeline at (800) 273-TALK (8255). By noticing and responding to someone's distress, you may save a life.
Carol Povenmire, Ph.D., is a licensed psychologist with a practice in Pasadena, California.