Occasional passing thoughts about death or suicide usually are harmless, particularly in people who otherwise seem healthy and happy, with no signs of depression, mental illness, drug or alcohol abuse or crises in their lives. However, any persistent thoughts of or conversations about wanting to die or committing suicide should be taken seriously. While predicting whether someone is serious about committing suicide is often difficult, certain groups are more vulnerable. For example, white men have the highest rates of suicide, although women and teens attempt suicide more often.
Risk factors for suicide include:
- A prior suicide attempt.
- Alcohol or drug abuse problems.
- Mental illness (such as depression or bi-polar disorder).
- A family history of substance abuse or mental disorder.
- Family violence, including physical or sexual abuse.
- Firearms in the home.
- Arrest or incarceration.
- Recent release from a psychiatric hospital (an often overwhelming time of transition).
- The recent suicide of a relative, friend, co-worker or classmate.
- Unrelenting long-term pain, or a disabling or terminal illness.
- People in occupations involving high stress or high burnout rates, such as law enforcement or hospice care.
Warning signs of suicide include:
- Feeling depressed, or excessively sad.
- Feelings of hopelessness, worthlessness or having no purpose in life.
- A preoccupation with death, dying or violence, or talking about wanting to die.
- Seeking access to weapons, medications or other means of killing oneself.
- Wide mood swings (feeling extremely "up" one day and terribly "down" the next).
- Feelings of great agitation, rage or uncontrolled anger, or wanting to get revenge.
- Changes in eating and sleeping habits (including sleeping too much or too little).
- Changes in appearance, behavior or personality, including withdrawing from family members and friends or suddenly becoming outgoing when the person is typically shy.
- Risky or self-destructive behavior, such as taking illegal drugs or driving recklessly.
- Sudden calmness (when the person had made the decision to end his or her life).
- Life crises, traumas or setbacks (including difficulties at school, work or in relationships; job loss; divorce; death of a loved one; financial difficulties; diagnosis of a terminal illness).
- Putting one's affairs in order - including giving away belongings, visiting family members and friends, drawing up a will or writing a suicide note.
In some cases, the person will not reveal any suicidal behaviors; in others, the person will consider or attempt suicide at a point in which it is assumed he or she is feeling better.
In any event, if you have suicidal thoughts or you suspect someone you know has them, it's important not to ignore the situation. However, keep in mind that most people who attempt suicide do not really intend to kill themselves, and that in many cases the attempt is a cry for help.
The good news is that medications and therapy usually can help people with suicidal impulses. In addition, treating underlying causes such as mental illness and substance abuse can reduce the risk of suicide. Finally, oftentimes just talking with a friend or a counselor can bring some relief and can help the suicidal person regain hope.
If you are in crisis and feeling suicidal, you are not alone and there is help:
- Immediate assistance is available by calling the Suicide Prevention Hotline toll-free at 1-800-SUICIDE (1-800-784-2433), 1-800-273-TALK (1-800-273-8255). Deaf persons should call 1-800-799-4889; for assistance in Spanish (en Español), call 1-888-628-9454.
- When you call, you will be connected to the nearest available suicide prevention and mental health service provider. (To learn more, see www.suicidepreventionlifeline.org.)
If someone you know is threatening to commit suicide, take it seriously. Remain calm and take the following steps to help manage the crisis:
- Do not leave the person alone, and eliminate access to firearms, knives, medications or any other tool the person could use to try to commit suicide.
- Don't try to handle a suicide threat or attempt alone. Involve other people. You don't want to risk your own health and safety.
- Call 911 or the local emergency response number, if necessary. Contact the person's doctor, the police, a crisis intervention team, or others who are trained to help.
- While waiting for help to arrive, listen closely to the person. Let the person know you are listening by maintaining eye contact, moving close to the person or holding his or her hand, if appropriate.
- Ask the person questions. Find out if the person has a specific plan for suicide. Try to determine what method of suicide the person is considering.
- Acknowledge the person's feelings. Be understanding, not judgmental or argumentative.
- Remind the person that help is available, change is inevitable and things will get better. Stress that suicide is a permanent solution to a temporary problem.
- Don't promise the person threatening suicide that you will keep his or her suicidal thoughts confidential. You may need to speak to a physician or mental health professional in order to protect the person from injury.
- Stay with the suicidal person until you are sure they are in the hands of competent professionals. If you have to leave, make sure another friend or family member can stay with the person until they can receive professional help.
- If a person attempts suicide, immediately call for emergency medical assistance. Administer first aid, if necessary. If you know the person has swallowed poison or drugs, call the Poison Control Center at 1-800-222-1222. Be prepared with the name of the poison or drug used.