September is National Suicide Prevention Awareness Month, a time during which experts and advocates promote resources and awareness about suicide prevention, how to help others, and how to talk about suicide.
Suicidal thoughts can affect anyone regardless of age, gender, or background. Suicide is the tenth leading cause of death among adults in the U.S. and the third leading cause of death among adolescents. It is often the result of mental health conditions that affect people when they are most vulnerable.
Each year more than 34,000 individuals take their own life, leaving behind friends and family members to deal with the confusion and tragedy of their loss.
Suicide claimed 41,149 lives in 2013 in the United States alone, with someone dying by suicide every 12.8 minutes.
A suicide attempt is made every minute of every day, resulting in nearly one million attempts made annually.
In many cases individuals, friends, and families affected by suicide are left in the dark, and experience shame or stigma that prevents them from talking openly about their experiences.
Suicidal thoughts and behaviors are damaging and dangerous, and are therefore considered a psychiatric emergency. Someone experiencing these thoughts should seek immediate assistance from a health or mental health care provider.
It is important to remember that having suicidal thoughts does not mean someone is weak or flawed. It means they need professional help – as soon as possible.
Awareness is the key to preventing suicide, and knowing the warning signs and the risk factors is crucial.
Warning signs indicate an immediate risk of suicide, whereas risk factors indicate someone is at heightened risk for suicide, but indicate little or nothing about immediate risk.
Warning Signs of Suicide
Here’s an easy-to-remember warning signs mnemonic from the American Association of Suicidology:
IS PATH WARM?
Warning Signs in Detail:
- Increased substance (alcohol or drug) use
- No reason for living; no sense of purpose in life
- Anxiety, agitation, unable to sleep or sleeping all of the time
- Feeling trapped – like there’s no way out
- Withdrawal from friends, family and society
- Talking about feeling like a burden to others
- Rage, uncontrolled anger, seeking revenge
- Acting reckless or engaging in risky activities, seemingly without thinking
- Dramatic mood changes
A person in acute risk for suicidal behavior most often will show warning signs, including:
- Threatening to hurt or kill him/herself, or talking about wanting to do so
- Looking for ways to kill him/herself by seeking access to firearms, available pills, or other means
- Talking or writing about death, dying, or suicide, when these actions are out of the ordinary
- Putting their affairs in order and giving away their possessions
- Saying goodbye to friends and family
- Mood shifts from despair to calm
Anyone exhibiting the acute risk warning signs above should get medical care immediately, even if it means calling 911.
If you think someone you care about is suicidal, the National Alliance on Mental Illness (NAMI) recommends the following:
- Remove means such as guns, knives, or stockpiled pills
- Calmly ask simple and direct questions, such as “Can I help you call your psychiatrist?” rather than, “Would you rather I call your psychiatrist, your therapist or your case manager?”
- Talk openly and honestly about suicide. Don’t be afraid to ask questions such as “Are you having thoughts of suicide?” or “Do you have a plan for how you would kill yourself?”
- If there are multiple people, have one person speak at a time
- Ask what you can do to help
- Don’t argue, threaten, or raise your voice
- Don’t debate whether suicide is right or wrong
- If your loved one asks for something, provide it, as long as the request is safe and reasonable
- If you are nervous, try not to fidget or pace
- If your loved one is having hallucinations or delusions, be gentle and sympathetic, but do not get in an argument about whether the delusions or hallucinations are real
Risk Factors for Suicide
According to NAMI , the following things may put a person at risk of becoming suicidal:
- A family history of suicide.
- Substance abuse. Drugs and alcohol can result in mental highs and lows that exacerbate suicidal thoughts.
- Intoxication. More than one in three people who die from suicide are found to be currently under the influence.
- Access to firearms.
- A serious or chronic medical illness.
- Gender. Although more women than men attempt suicide, men are four times more likely to die by suicide.
- A history of trauma or abuse.
- Prolonged stress.
- Age. People under age 24 or above age 65 are at a higher risk for suicide.
- A recent tragedy or loss.
- Agitation and sleep deprivation.
Protective factors are characteristics that make it less likely that individuals will consider, attempt, or die by suicide.
- Effective mental health care (including Cognitive Behavioral Therapy and Dialectical Behavior Therapy)
- Connectedness to individuals, family, community, and social institutions
- Problem-solving skills
- Contacts with caregivers
Research has found that about 90% of individuals who die by suicide experience mental illness.
According to the American Foundation for Suicide Prevention (AFSP), several studies have shown that teaching general practitioners to recognize and treat depression decreases suicide rates among their patients. One study showed that as antidepressant use increased, rates of suicide decreased. These studies demonstrate that educating physicians to recognize and appropriately treat depression can reduce suicide rates.
However, it is important to note that some antidepressants have been linked to increased risk of suicidal thoughts and attempts in children and teens.
Studies comparing treatment as usual to manualized short-term Cognitive Behavioral Therapy for suicide attempters (CBT) or Dialectic Behavior Therapy (DBT) for repeated suicide attempters showed greatly reduced rates of suicide attempts during the 18 months following the attempt for those who received either CBT or DBT compared with those who received treatment as usual. This points to the need for increasing the very limited supply of therapists trained in these therapies.
While the month of September is recognized as Suicide Prevention Awareness Month, it is vital that we all address and discuss mental health issues year round.
For mental health screening resources and anonymous online self-assessments, please see Help Yourself, Help Others.
The National Suicide Prevention Lifeline can connect you to a local crisis line 24 hours a day, 7 days a week: 1-800-273-TALK (8255)
List of resources for assistance from ASFP: Find Help
List of resources about youth suicide prevention from the Children’s Safety Network