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What should you do if someone tells you they are thinking about suicide?

Suicide is preventable. Any statements about suicide should be taken seriously; 50 to 60 percent of all people who died by suicide gave some warning of their intentions to a friend or family member. Most people considering suicide need help getting through their moment of crisis. Often they have tried to find solutions but may begin to feel hopeless and unable to see alternative solutions to problems. If someone tells you they are thinking about suicide listen non-judgmentally, and help them get to a professional for evaluation and treatment. If someone is in imminent danger of harming himself or herself, do not leave the person alone. You may need to take emergency steps to get help, such as calling 911. When someone is in a suicidal crisis, it is important to limit access to firearms or other lethal means of committing suicide.

Is it possible to predict suicide?

At the current time there is no definitive measure to predict suicide or suicidal behavior. Researchers have identified factors that place individuals at higher risk for suicide, including mental illness, substance abuse, previous suicide attempts, family history of suicide, history of being sexually abused, and impulsive or aggressive tendencies. While many people may think about suicide, attempts and death by suicide are relatively rare events and it is therefore difficult to predict which persons with these risk factors will ultimately complete suicide. What is important is that people considering suicide usually do seek help; for example, in one study, nearly three-fourths of those who died by suicide visited a doctor in the four months before their deaths, and half in the month before. Being aware of risk factors and warning signs can help detect someone that may be at risk for attempting suicide.

Why do people attempt suicide?

Unfortunately, there is no simple answer to this question. People die by suicide for a number of reasons. A suicide attempt is a clear indication that something is gravely wrong in a person’s life. The majority of people who take their lives (estimated at 90 percent) were suffering with an underlying mental illness and substance abuse problem at the time of their death. No matter the race or age of the person, how rich or poor they are, it is true that most people who die by suicide have a mental illness, emotional disorder and/or chemical dependency. The most common underlying disorder is depression, with an estimated 60 percent of suicides were by people suffering from depression. However, it is very important to remember that the vast majority of people living with depression do not attempt or die by suicide.

What are the most common methods of suicide?

Firearms are the most commonly used method of completing suicide, accounting for more than 50 percent of all suicides. The majority of all firearm suicides are completed by white males. For women, the most common method of suicide was self-poisoning. The presence of a firearm in the home has been found to be an independent, additional risk factor for suicide. Thus, when a family member or health care provider is faced with an individual at risk for suicide, they should make sure that firearms are removed from the home.

Why do men complete suicide more often than women do?

More than four times as many men as women die by suicide; but women attempt suicide three times more often during their lives than do men. A probable reason for higher suicide rates in males is that males tend to use more lethal methods (e.g., firearms) and women are more likely to use less lethal means, such as self-poisoning. In countries where the poisons are highly lethal or where treatment resources scarce, rescue is rare and female suicides outnumber males. Additionally, males are more involved than females in all forms of aggressive and violent behavior.

Who is at highest risk for suicide in the United States?

In the United States, Caucasian ethnic groups have the highest suicide rate compared to all other ethnic groups. People with diagnosed mental illnesses and chemical use have a higher risk for suicide than the general population. While suicide rates among youth have increased, suicide rates are higher among middle aged and older adults. Risk goes up with age and the elderly, white men in particular who are 85 and older, divorced, widowed or separated have a suicide rate that is six times that of the overall national rate. Some older persons are less likely to survive attempts because they are less likely to recuperate. More than 70 percent of older suicide victims have been to their primary care physician within the month of their death, many did not tell their doctors they were depressed nor did the doctor detect it.

Is suicide related to impulsiveness?

Impulsiveness is the tendency to act without thinking through a plan or its consequences. It is a symptom of a number of mental disorders, and therefore, it has been linked to suicidal behavior because of its association with mental disorders and/or substance abuse. The mental disorders with impulsiveness most linked to suicide include: borderline personality disorder among young females, conduct disorder among young males, antisocial behavior in adult males, and alcohol and substance abuse among young and middle-aged males. Impulsiveness appears to have a lesser role in older adult suicides. Attention deficit disorder with hyperactivity and impulsivity is not a strong risk factor for suicide by itself. Impulsiveness has been linked with aggressive and violent behaviors including homicide and suicide. However, impulsiveness without aggression or violence present has also been found to contribute to risk for suicide.

What biological factors increase risk for suicide?

Researchers believe that both depression and suicidal behavior can be linked to decreased serotonin in the brain. Low levels of a serotonin metabolite, 5-HIAA, have been detected in cerebral spinal fluid in persons who have attempted suicide, as well as by postmortem studies examining certain brain regions of suicide victims. One of the goals of understanding the biology of suicidal behavior is to improve treatments. Scientists have learned that serotonin receptors in the brain increase their activity in persons with major depression and suicidality, which explains why medications that desensitize or down-regulate these receptors (such as the serotonin reuptake inhibitors, or SSRIs) have been found effective in treating depression. Currently, studies are underway to examine to what extent medications like SSRIs can reduce suicidal behavior.

Can the risk for suicide be inherited?

While suicidal behavior is not genetically inherited, it can be socially learned from significant others and many risk factors for suicide can be inherited. A healthy person talking about a suicide or being aware of a suicide among family or friends does not put them at greater risk for attempting suicide. And mere exposure to suicide does not alone put someone at greater risk for suicide. However, when combined with a number of other risk factors, exposure to suicide can increase someone’s likelihood of an attempt. Major psychiatric illnesses, including: Bipolar Disorder, Major Depression, Schizophrenia, alcoholism and substance abuse, and certain personality disorders, which run in families, increase the risk for suicidal behavior. This does not mean that suicidal behavior is inevitable for individuals with this family history; it simply means that such persons may be more vulnerable and should take steps to reduce their risk, such as getting evaluation and treatment at the first sign of mental illness.

Does alcohol and other drug abuse increase the risk for suicide?

A number of recent national surveys have helped shed light on the relationship between alcohol and other drug use and suicidal behavior. A review of minimum-age drinking laws and suicides among youths age 18 to 20 found that lower minimum-age drinking laws were associated with higher youth suicide rates. In a large study following adults who drink alcohol, suicide ideation was reported among persons with depression (Grant & Hasin, 1999). In another survey, persons who reported that they had made a suicide attempt during their lifetime were more likely to have had a depressive disorder, and many also had an alcohol or substance abuse disorder. In a study of all non-traffic injury deaths associated with alcohol intoxication, over 20 percent were suicides.

In studies that examine risk factors among people who have completed suicide, substance use and abuse occurs more frequently among youth and adults, compared to older persons. For particular groups at risk, such as American Indians and Alaskan Natives, depression and alcohol use and abuse are the most common risk factors for completed suicide. Alcohol and substance abuse problems contribute to suicidal behavior in several ways. Persons who are dependent on substances often have a number of other risk factors for suicide. They may be experiencing depression, social problems and/or financial issues. Substance use and abuse can be common among persons prone to being impulsive and among persons who engage in many types of high risk behaviors that result in self-harm. Fortunately, there are a number of effective prevention efforts that reduce risk for substance abuse in youth and there are effective treatments for alcohol and substance use problems. Researchers are currently testing treatments specifically for persons with substance abuse problems who are also suicidal or have attempted suicide in the past.

Do people attempt suicide to prove something or to get sympathy?

No. A suicide attempt should never be ignored and is a warning that something is terribly wrong. Most people who attempt suicide are not 100% certain they want to die—they just want their pain and suffering to end. It isn’t to try and get someone to feel bad for them, that's usually the last thing they would want.

Apart from talking to a suicidal person and encouraging him or her to go for counseling, what else can we do to prevent this?

Going with someone to the counselor often helps. If the person won't listen to you, you may need to talk to someone who might influence him or her. Saving a life is more important than violating a confidence. For a person determined to attempt suicide the desire to live is overshadowed by the seeming hopelessness of the disease. The decision to attempt suicide is really a desire to stop suffering. Never give up on someone just because they say they’ve made up their mind.

Why do people attempt suicide when they appear to feel better?

Sometimes a severely depressed person contemplating suicide doesn't have enough energy to attempt it. As the depression lifts, they may regain some energy but feelings of hopelessness remain and the increased energy levels may contribute to acting on suicidal feelings. Another theory proposes that a person may "give in" to depression because they can't fight it anymore. Resolving to die relieves some anxiety, which makes them appear calmer in the period preceding a suicide attempt.

Why don't people talk about mental illnesses like depression, bipolar disorder and suicide?

Stigma and lack of understanding are the main reasons mental illness and suicide remain topics we avoid. People suffering from a mental illness fear others will think they’re crazy or weak, or somehow a lesser person. Cultural norms are slowly changing, and people are becoming more aware of the nature of mental illnesses and their impact on a person’s well being. Education will help reduce stigma and save lives.

Alcoholism, drug addiction, HIV and AIDS are examples of medical conditions previously attributed to a weakness or character problems. Today, they are widely recognized as medical diseases and people feel comfortable openly discussing the impact of the disease and seeking help through a variety of treatments. The dangers of alcohol and substance abuse have been the subject of major national public health campaigns in the United States, leading to a general public more aware of the value of prevention. Breast cancer is another medical illness that for many years went unspoken, but today receives millions of dollars in research funding, supportive programming and awareness.

What does 'suicide contagion' mean, and what can be done to prevent it?

Suicide contagion is the exposure to suicide or suicidal behaviors within one's family, peer group, or through media reports of suicide and can result in an increase in suicide and suicidal behaviors. Direct and indirect exposure to suicidal behavior has been shown to precede an increase in suicidal behavior in persons at risk for suicide, especially in adolescents and young adults. The risk for suicide contagion as a result of media reporting can be minimized by factual and concise media reports of suicide. Reports of suicide should not be repetitive, as prolonged exposure can increase the likelihood of suicide contagion. Suicide is the result of many complex factors; therefore media coverage should not report oversimplified explanations such as recent negative life events or acute stressors. Reports should not divulge detailed descriptions of the method used to avoid possible duplication. Reports should not glorify the victim and should not imply that suicide was effective in achieving a personal goal such as gaining media attention. In addition, information such as hotlines or emergency contacts should be provided for those at risk for suicide. Following exposure to suicide or suicidal behaviors within one's family or peer group, suicide risk can be minimized by having family members, friends, peers, and colleagues of the victim evaluated by a mental health professional. Persons deemed at risk for suicide should then be referred for additional mental health services.

Is there such a thing as 'rational' suicide?

Some right-to-die advocacy groups promote the idea that suicide, including assisted suicide, can be a rational decision. Others have argued that suicide is never a rational decision and that it is the result of depression, anxiety, and fear of being dependent or a burden. Surveys of terminally ill persons indicate that very few consider taking their own life, and when they do, it is in the context of depression. Attitude surveys suggest that assisted suicide is more acceptable by the public and health providers for the old who are ill or disabled, compared to the young who are ill or disabled. At this time, there is limited research on the frequency with which persons with terminal illness have depression and suicidal ideation, whether they would consider assisted suicide, the characteristics of such persons, and the context of their depression and suicidal thoughts, such as family stress, or availability of palliative care. Neither is it yet clear what effect other factors such as the availability of social support, access to care, and pain relief may have on end-of-life preferences. This public debate will be better informed after such research is conducted.