In this article we take a look at risk factors and warning signs for suicide. How to help a person with suicidal thoughts and how assess suicide risk?
Has the behavior of someone you know been troubling you? Are you afraid to ask them what’s really going on? Suicide is on the rise and lack of social connection plays a large role in this phenomenon.
“It’s just a stage,” “She’s been depressed before,” “She’s just trying to get attention,” “Time will heal all” and “He was just joking, wasn’t he?” are examples of things we say to ourselves to soothe our troubled minds.
More troubling is that 50%-75% of suicides do make some effort to tip off a friend or loved one or show imminent warning signs.
Your concern might be the very thing that makes the difference between life and death.
Psychiatrist Jerome Motter was haunted by a note left by the “successful” suicide of a patient of his: “I’m going to walk to the bridge. If one person smiles at me on the way, I will not jump.” 1
Risk Factors for suicide
Risk Factors for suicide are mostly related to loss:2 & 3
- Loss of health
- Loss of a loved one or a break-up
- Loss of a job, money, status, home
- Loss of feelings of personal security or self-esteem
- Loss of a social network: friends, family or acquaintances due to moves, job changes, illness or death
Other factors that increase the risk of suicide include:
- Access to firearms
- Alcohol and/or drug use
- Emotional trauma
- Excess or prolonged adversity
- Exposure to family members or friends who have committed suicide or overt media exposure
- History of aggressive and/or disruptive behavior
- History of risky behavior
- History of neglect or abuse
- History of self-harm
- Mental illness
- Social isolation
Depression is a strong risk factor for depression. That’s not to say that all depressed people are suicidal, but two-thirds of those who die from suicide were depressed and 30% of those hospitalized for depression attempt suicide. 3
No one gets used to depression. Even if someone you know suffers from it on and off, that doesn’t mean it isn’t cause for concern. Having a severe bout of depression makes people 70% more likely to suffer another severe episode. The good news is that cognitive behavioral therapy and medication can help people overcome depression. 4 It’s just that they might need your help to get the impetus to seek treatment.
Depression isn’t just feeling blue once in awhile or even reacting strongly to an adverse event or mourning a loss. Clinical depression is diagnosed if 5 or more of the following symptoms are present during a two-week period and 1 of them must include loss of interest or pleasure in usual activities or depressed mood.4
- Change in appetite or weight
- Change in sleeping patterns
- Decreased sex drive
- Depressed mood
- Diminished ability to think or concentrate, indecisiveness
- Fatigue or loss of energy
- Feelings of worthlessness or guilt
- Loss of interest in usually pleasurable activities
- Speaking or moving with unusual speed or unusual slowness
- Thoughts of death or suicide
Symptoms of depression and suicide can overlap. The following are some symptoms that, unchecked, can lead to suicide. 5
- A sense of hopelessness
- Alterations in eating and sleeping habits
- Declining performance at work or school or increased and fervent activity
- Fears of losing control, harming oneself or others
- Feelings of worthlessness, unlovability, shame, guilt or self-hatred
- Neglect of personal welfare and physical appearance
- Personality changes: acting out, anger, anxiety, apathy, irritability, hyperactivity, loss of interest in normal activities, sadness, withdrawal
- Social isolation
Imminent Risk of Suicide Warning Signs 3 & 5
- Ambiguous statements such as “You won’t be seeing me then” or “You won’t have to worry about me anymore.”
- Depression suddenly disappears
- Development of a suicide plan
- Explicit statements of suicidal thoughts and feelings
- Extreme agitation, anxiety or rage
- Feelings of desperation
- Increase in alcohol and drug use
- Making inappropriate jokes about death or suicide, fascination with morbid stories
- Making of a will or giving away possessions
- Precipitating event that exacerbates psychic pain: holidays, job loss, break-up etc.
- Reckless behavior
- Saying good-byes inappropriately
- Self-starvation, dietary mismanagement, mismanaging medication
- Sudden isolation
- Wondering aloud about death,suicide or heaven
What to Do 5, 6 & 7
So what do you do if someone tells you they’re thinking of suicide?
1)Take it seriously
There’s a few myths about suicide that don’t pan out. Among them:
“The people who talk about it don’t do it.”
Remember, 50%-75% of all suicides do attempt to give some warning of their intention.
“Anyone who tries to kill themselves is seriously nuts (and that’s not my friend.)”
Only 10% of suicides are psychotic or severely mentally ill. Most people still function in their daily lives.
“Those problems aren’t serious enough for him to kill himself over.”
It’s not what the events are, but what the person is feeling inside, and that’s not something readily evident.
“If someone really wanted to kill themselves, they wouldn’t say anything and nothing would stop them.”
The truth is, suicide is a cry for help. Suicidal people are ambivalent: they wrestle with an extreme desire for escape from their pain and yet may still have some hope lying buried in their hopelessness. When someone tips you off, with words or behaviors, that small part of them is reaching out.
Make the time to give the person your full attention and be willing to help immediately. The person may have waited to talk to someone until they are at a critical point.
- Don’t assume you know what they’re feeling until they’ve had a chance to tell you.
Be patient and accepting. Voice your care and concern. Share examples of things you’ve noticed.
Resist the temptation to argue with someone about their feelings. You can’t use logic to argue someone out of something they feel.
Many suicidal people are fearful about sharing their thoughts for fear of seeming foolish or manipulative. Do everything you can to make them feel as if they’ve done the right thing by confiding in you.
Just venting and sharing their load will bring the person relief.
3) Ask the question
If they haven’t offered up the information freely, don’t be afraid to ask them if they are contemplating suicide and whether or not they have a specific plan. You won’t make someone commit suicide that hasn’t already been considering it.
If they have been considering it, ask them if they have set a time and date and whether or not they have the means or method in place.
Do not argue with them! Avoid making them feel guilty for your incipient sadness or that of their family. Don’t try to convince them that they have so much to live for. Don’t belittle their feelings or try to solve their problems.
Do acknowledge their feelings. Do tell them that in many cases, suicidal feelings do pass. Do tell them that you care, that they are not alone and that depression can be treated.
4) Get Help
Find out if they are seeing a therapist or taking medication. If the person has ingested drugs, do your best to find out what and how much, how long ago and what they’ve eaten. Do they take other medications for other health conditions?
Call the Poison Control Center if you can. Call an ambulance if necessary or take them to the hospital. Call the therapist if there is one.
If the person is not with you, find out where they are and make sure they are not left alone.
A suicidal person may initially refuse medical care or refuse to cooperate with your efforts to help. Stay sympathetic and non-judgmental.
5) After the crisis
If the person hasn’t yet attempted suicide, it’s up to you to make sure they aren’t left alone and you do contact someone for help. Not just for them, but for you.
Get the Poison Control Center number and keep the number for a suicide hotline nearby.
Make sure that means of suicide aren’t available in their home.
Your friend or loved one will need to see a mental health professional. Suicide can’t wait. The hopelessness and other overwhelming feelings they are experiencing makes it hard for them to push themselves. Help them get help immediately, no matter how reluctant they are. Be patient and persistent.
Take them there. Make sure they continue getting treatment. Talk to someone to manage your own trauma over the situation.
A Helpful Link
1) Thomas E. (2005) Why People die by Suicide. The President and Fellow of Harvard University.
2) All About Depression Staff (2009).Suicide and Depression. All About Depression [online]. Retrieved from http://www.allaboutdepression.com/tre_10.html
3) American Foundation for Suicide Prevention Staff Writer (2009) Risk Factors for Suicide. American Foundation for Suicide Prevention [online]. Retrieved from http://www.afsp.org/index.cfm?fuseaction=home.viewPage&page_id=05147440-E24E-E376-BDF4BF8BA6444E76
4)American Foundation for Suicide Prevention Staff Writer (2009) Depression and Suicide Prevention. American Foundation for Suicide Prevention [online]. Retrieved from
5) Conroy, David L. (2009). Nine ways to help a suicidal person; and Suicide Warning Signs. Metanoia [online]. Retrieved from http://www.metanoia.org/suicide/whattodo.htm
6) Conroy, David L. (2009) Handling a call from a suicidal person. Metanoia [online]. Retrieved from http://www.metanoia.org/suicide/sphone.htm
7) American Foundation for Suicide Prevention Staff Writer (2009) When You Fear Someone May Take Their Life. American Foundation for Suicide Prevention [online]. Retrieved from http://www.afsp.org/index.cfm?fuseaction=home.viewPage&page_id=F2F25092-7E90-9BD4-C4658F1D2B5D19A0