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American Foundation of Suicide Prevention

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.
 (http://www.afsp.org)       American Foundation of Suicide Prevention
 
Possible signs of suicide contemplation online:
 
The following list gives indicators that an person may be contemplating suicide. Many of these clues or signs could easily be expressed in material posted online. The main points are material from SAMHSA (Substance Abuse and Mental Health Services Administration). The italics show how this information may be reflected in online activity:
  • Threatening to hurt or kill oneself or talking about wanting to hurt or kill self.
  • Posting this kind of material online on a personal Web site or in a blog, or including these thoughts in electronic messages.
  •  Looking for ways to kill oneself by seeking access to firearms, pills or other means.
  • Searching for information on methods to commit suicide on Web sites or requesting information in online discussion groups.
  • Talking or writing about death, dying or suicide when these actions are out of the ordinary for the person.
  • Posting this kind of material online on a personal Web site, in a blog or including these thoughts in electronic messages.
  • Feeling hopeless.
  • Feeling rage or uncontrolled anger or seeking revenge.
  • Acting recklessly or engaging in risky activities- seemingly without thinking.
  • Feeling trapped-like there is no way out.
  • The preceding four feelings or activities could be reflected in online postings or communications.
  • Increasing use of alcohol or drugs
  • Withdrawal from friends, family and society.
  • Signs of Internet addiction could be implicated in possible suicide behavior.
  • Feeling anxious, agitated, or unable to sleep-or sleeping all the time.
  • Experiencing dramatic mood changes.
  • Seeing no reason for living or having no sense of purpose in life. 
  • The preceding three feelings could also be reflected in online postings or communications.

Enter subhead content here

Ways in which there may be a connection between online activity and suicidal behavior. The person who is contemplating suicide may:
  • Express these thoughts and intention online.
  • Search for information on suicide methods online.
  • Communicate with others in an online forum who are also contemplating harmful or suicidal behavior and thus receive reinforcement for the idea that suicide is an appropriate answer, information on suicide methods, and encouragement. Communication with others may also result in arrangements for joint participation in suicide.
  • Communicate in an online forum with others who are contemplating violent actions against others, followed by suicide.
  • Form a relationship with a very sick, dangerous stranger who takes perverse pleasure in convincing people that suicide is the answer and providing assistance and encouragement for such action.
  • Respond to intense cyberbullying by resorting to suicide or be encouraged to commit suicide by other teens in the context of cyberbullying.
  • Consider that suicide is the answer to some other online situation that has led to feelings of helplessness and hopelessness, including involvement with an online sexual predator or online gambling.  
(Cyberbullying and Cyberthreats, responding to the challenge of online social aggression, threats and distress by Nancy Willard, 2007)

Who is at risk for engaging in risky online behavior?
  • Youth who are at risk in general.
The following is a list of traits in boys and girls ages 10-17 who had formed close relationships with people they met on the Internet:
  • Girls who had high levels of conflict with parents 
  • Girls who were highly troubled
  • Boys who had low level communication with parents
  • Boys who were highly troubled 
Is it possible that these young people are looking for acceptance, caring, attention and love in the wrong place? These youth are more vulnerable to predators in general. 

Risk Factors for Suicide
 
Psychiatric Disorders
It is believed that at least 80-90 percent of people who die by suicide had a diagnosable and treatable psychiatric illnesses -- such as major depression (especially combined with alcohol or substance abuse), bipolar disorder, or some other depressive illness, including Schizophrenia, alcohol or drug abuse, particularly when combined with depression
Post-traumatic Stress Disorder, or some other anxiety disorder
Eating disorders
Personality disorders:especially borderline or antisocial personality disorder
Teens: Most common: Mood disorder, antisocial disorder, substance abuse or anxiety disorder.
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 people 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 is the 3rd leading cause of death among those ages 10-24 with the peak age 15-16.
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 or school failure. There may be an abrupt severed attachment. Sometimes the individuals own behavior precipitates the event: for example, a man's abusive behavior while drinking causes his wife to leave him. A student's disruptive behavior gets him suspended from school, or substance abuse causes his/her relationship to break up. Most teen suicides are school dropouts who drift and are not at work. Most common stressful life event for teens prior:Recent losses also include: death, divorce, separation, broken relationship, loss of work, money, status, self confidence, self-esteem, loss of religious faith.
Talking About Dying: any mention of dying, disappearing, jumping, shooting oneself or other types of self harm.
Maladaptive Coping: Isolation, Alcohol Use/Abuse, Blaming Others, Wishful thinking,
interpersonal losses, and legal/disciplinary crises. Often connected to: Conduct disorder, ADHD or Oppositional Defiant Disorder. Bullying: increased depression and severe suicide ideation among both those who were bullied and those who are bullies.
Intense Affective State in Addition to Depression
Desperation (anguish plus urgency regarding need for relief), rage, psychic pain or inner tension, extreme self hatred,  extreme dread, extreme 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, school or socially, increasing use of alcohol, other self-destructive behavior, loss of control, rage explosions. Grades suddenly dropping.
Availability of a Method/Means: weapons etc.
Change in Sleep Patterns: insomnia, often with early waking or oversleeping, nightmares.
Change in Eating Patterns:loss of appetite and weight, or overeating.
Diminished Sexual Interest
No Hope for the Future:belief that nothing will get better or ever change.
Remember the risk for suicide may be greatest as the depression lifts, because the sufferer regains enough energy to act on self destructive thoughts.

Another way to remember signs:  IS PATH WARM?
Ideation: Threatened or communicated
Substance abuse: Excessive or increased

P
urposeless: No reasons for living
Anxiety: Agitation/Insomnia
Trapped: Feeling there is no way out
Hopelessness

Withdrawing: From friends, family, society
Anger: (uncontrolled)- rage, seeking revenge
Recklessness: Risky acts, unthinking
Mood changes: dramatic

(Adapted from Suicide Prevention Lifeline and the American Foundation for Suicide Prevention, Center for Trauma Psychology, University of Michigan Depression Center)
 
If someone in the family has had a suicide attempt, please visit: www.feelingblue.org and there click preventing suicide and then click After An Attempt: The Emotional Impact of a Suicide Attempt on Families

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