Risk Factors for Suicide

• Psychiatric Disorders
  At least 90 percent of people who kill themselves have a diagnosable and treatable psychiatric illnesses -- such as major depression, bipolar depression, or some other depressive illness, including:
  Schizophrenia
  Alcohol or drug abuse, particularly when combined with depression
  Posttraumatic Stress Disorder, or some other anxiety disorder
  Bulimia or anorexia nervousa
  Personality disorders especially borderline or antisocial
• Past History of Attempted Suicide
  Between 20 and 50 percent of people who kill themselves had previously attempted suicide. Those who have made serious suicide attempts are at a much higher risk for actually taking their lives.
• Genetic Predisposition
  Family history of suicide, suicide attempts, depression or other psychiatric illness.
• Neurotransmitters
  A clear relationship has been demonstrated between low concentrations of the serotonin metabolite 5-hydroxyindoleactic acid (5-HIAA) in cerebrospinal fluid and an increased incidence of attempted and completed suicide in psychiatric patients.
• Impulsivity
  Impulsive individuals are more apt to act on suicidal impulses.
• Demographics
  Sex: Males are three to five times more likely to commit suicide than females.
  Age: Elderly Caucasian males have the highest suicide rates.

Suicide Crisis

A suicide crisis is a time-limited occurrence signaling immediate danger of suicide. Suicide risk, by contrast, is a broader term that includes the above factors such as age and sex, psychiatric diagnosis, past suicide attempts, and traits like impulsivity. The signs of crisis are:

• Precipitating Event
  A recent event that is particularly distressing such as loss of loved one or career failure. Sometimes the individuals own behavior precipitates the event: for example, a man's abusive behavior while drinking causes his wife to leave him.
• Intense Affective State in Addition to Depression
  Desperation (anguish plus urgency regarding need for relief), rage, psychic pain or inner tension, anxiety, guilt, hopelessness, acute sense of abandonment.
• Changes in Behavior
  Speech suggesting the individual is close to suicide. Such speech may be indirect. Be alert to such statements as, "My family would be better off without me." Sometimes those contemplating suicide talk as if they are saying goodbye or going away.
  Actions ranging from buying a gun to suddenly putting one's affairs in order.
  Deterioration in functioning at work or socially, increasing use of alcohol, other self-destructive behavior, loss of control, rage explosions.

Warning Signs of Suicide

Suicide can be prevented. While some suicides occur without any outward warning, most people who are suicidal do give warnings. Prevent the suicide of loved ones by learning to recognize the signs of someone at risk, taking those signs seriously and knowing how to respond to them.

Warning signs of suicide include:

• Observable signs of serious depression:
  Unrelenting low mood
  Pessimism
  Hopelessness
  Desperation
  Anxiety, psychic pain and inner tension
  Withdrawal
  Sleep problems
• Increased alcohol and/or other drug use
• Recent impulsiveness and taking unnecessary risks
• Threatening suicide or expressing a strong wish to die
• Making a plan:
  Giving away prized possessions
  Sudden or impulsive purchase of a firearm
  Obtaining other means of killing oneself such as poisons or medications
• Unexpected rage or anger

The emotional crises that usually precede suicide are often recognizable and treatable. Although most depressed people are not suicidal, most suicidal people are depressed. Serious depression can be manifested in obvious sadness, but often it is rather expressed as a loss of pleasure or withdrawal from activities that had been enjoyable. One can help prevent suicide through early recognition and treatment of depression and other psychiatric illnesses.

When You Fear Someone May Take Their Life

Most suicidal individuals give some warning of their intentions. The most effective way to prevent a friend or loved one from taking his or her life is to recognize the factors that put people at risk for suicide, take warning signs seriously and know how to respond.

Know the Facts

PSYCHIATRIC DISORDERS

More than 90 percent of people who kill themselves are suffering from one or more psychiatric disorders, in particular:

• Major depression (especially when combined with alcohol and/or drug abuse)
• Bipolar depression
• Alcohol abuse and dependence
• Drug abuse and dependence
• Schizophrenia
• Post Traumatic Stress Disorder (PTSD)
• Eating disorders
• Personality disorders

Depression and the other mental disorders that may lead to suicide are -- in most cases -- both recognizable and treatable. Remember, depression can be lethal.

The core symptoms of major depression are a "down" or depressed mood most of the day or a loss of interest or pleasure in activities that were previously enjoyed for at least two weeks, as well as:

• Changes in sleeping patterns
• Change in appetite or weight
• Intense anxiety, agitation, restlessness or being slowed down
• Fatigue or loss of energy
• Decreased concentration, indecisiveness or poorer memory
• Feelings of hopelessness, worthlessness, self-reproach or excessive or inappropriate guilt
• Recurrent thoughts of death or suicide

PAST SUICIDE ATTEMPTS

Between 25 and 50 percent of people who kill themselves had previously attempted suicide. Those who have made suicide attempts are at higher risk for actually taking their own lives.

Availability of means

• In the presence of depression and other risk factors, ready access to guns and other weapons, medications or other methods of self-harm increases suicide risk.

Recognize the Imminent Dangers

The signs that most directly warn of suicide include:

• Threatening to hurt or kill oneself
• Looking for ways to kill oneself (weapons, pills or other means)
• Talking or writing about death, dying or suicide
• Has made plans or preparations for a potentially serious attempt

Other warning signs include expressions or other indications of certain intense feelings in addition to depression, in particular:

• Insomnia
• Intense anxiety, usually exhibited as psychic
• pain or internal tension, as well as panic attacks
• Feeling desperate or trapped -- like there's no way out
• Feeling hopeless
• Feeling there's no reason or purpose to live
• Rage or anger

Certain behaviors can also serve as warning signs, particularly when they are not characteristic of the person's normal behavior. These include:

• Acting reckless or engaging in risky activities
• Engaging in violent or self-destructive behavior
• Increasing alcohol or drug use
• Withdrawing from friends or family

Take it Seriously

• Fifty to 75 percent of all suicides give some warning of their intentions to a friend or family member.
• Imminent signs must be taken seriously.

Be Willing to Listen

• Start by telling the person you are concerned and give him/her examples.
• If he/she is depressed, don't be afraid to ask whether he/she is considering suicide, or if he/she has a particular plan or method in mind.
• Ask if they have a therapist and are taking medication.
• Do not attempt to argue someone out of suicide. Rather, let the person know you care, that he/she is not alone, that suicidal feelings are temporary and that depression can be treated. Avoid the temptation to say, "You have so much to live for," or "Your suicide will hurt your family."

Seek Professional Help

• Be actively involved in encouraging the person to see a physician or mental health professional immediately.
• Individuals contemplating suicide often don't believe they can be helped, so you may have to do more.
• Help the person find a knowledgeable mental health professional or a reputable treatment facility, and take them to the treatment.

In an Acute Crisis

• If a friend or loved one is threatening, talking about or making plans for suicide, these are signs of an acute crisis.
• Do not leave the person alone.
• Remove from the vicinity any firearms, drugs or sharp objects that could be used for suicide.
• Take the person to an emergency room or walk-in clinic at a psychiatric hospital.
• If a psychiatric facility is unavailable, go to your nearest hospital or clinic.
• If the above options are unavailable, call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

Follow-up on Treatment

• Suicidal individuals are often hesitant to seek help and may need your continuing support to pursue treatment after an initial contact.
• If medication is prescribed, make sure your friend or loved one is taking it exactly as prescribed. Be aware of possible side effects and be sure to notify the physician if the person seems to be getting worse. Usually, alternative medications can be prescribed.
• Frequently the first medication doesn't work. It takes time and persistence to find the right medication(s) and therapist for the individual person.