Suicide

What is suicide and suicidal behaviour?

Suicide is the act of taking one’s own life.

Suicidal behaviour refers to talking about or taking actions related to ending one’s own life. Suicidal thoughts and behaviours should be considered a psychiatric emergency.

If you or someone you know is exhibiting either, you should seek immediate assistance from a healthcare provider.

Warning signs that someone may attempt suicide

You can’t see what a person is feeling on the inside, so it isn’t always easy to identify when someone is having suicidal thoughts. However, some outward warning signs that a person may be contemplating suicide include:

• Talking about feeling hopeless, trapped, or alone
• Saying they have no reason to go on living
• Making a will or giving away personal possessions
• Searching for a means of doing personal harm, such as buying a gun
• Sleeping too much or too little
• Eating too little or eating too much, resulting in significant weight gain or loss
• Engaging in reckless behaviours, including excessive alcohol or drug consumption
• Avoiding social interactions with others
• Expressing rage or intentions to seek revenge
• Showing signs of extreme anxiousness or agitation
• Having dramatic mood swings
• Talking about suicide as a way out

It can feel scary, but taking action and getting someone the help they need may help prevent a suicide attempt or death.

How to talk to someone who is feeling suicidal

If you suspect that a family member or friend may be considering suicide, talk to them about your concerns. You can begin the conversation by asking questions in a non-judgmental and non-confrontational way.

Talk openly and don’t be afraid to ask direct questions, such as “Are you thinking about suicide?”

During the conversation, make sure you:

• Stay calm and speak in a reassuring tone
• Acknowledge that their feelings are legitimate
• Offer support and encouragement
• Tell them that help is available and that they can feel better with treatment
• Make sure not to minimize their problems or attempts at shaming them into changing their mind. Listening and showing your support is the best way to help them. You can also encourage them to seek help from a professional.
• Offer to help them find a healthcare provider, make a phone call, or go with them to their first appointment.

It can be frightening when someone you care about shows suicidal signs. But it’s critical to take action if you’re in a position to help. Starting a conversation to try to help save a life is a risk worth taking.

If you notice someone doing any of the following, they should get care immediately:

• Putting their affairs in order or giving away their possessions
• Saying goodbyes to friends and family
• Having a mood shift from despair to calm
• Planning, looking to buy, steal, or borrow the tools to complete a suicide, such as a firearm or medication

If you think someone is at immediate risk of self-harm:

• Call 999 or your local emergency number.
• Stay with the person until help arrives.
• Remove any guns, knives, medications, or other things that may cause harm.
• Listen, but don’t judge, argue, threaten, or yell.

What increases the risk of suicide?

There’s usually no single reason someone decides to take their own life. Several factors can increase the risk of suicide, such as having a mental health disorder.

But more than half (Trusted Source) of all people who die by suicide don’t have a known mental illness at the time of their death.

Depression is the top mental health risk factor, but others include bipolar disorder, schizophrenia, anxiety disorders, and personality disorders.

Aside from mental health conditions, other factors that increase the risk of suicide include:

• Incarceration
• Poor job security or low levels of job satisfaction
• History of being abused or witnessing continuous abuse
• Being diagnosed with a serious medical condition, such as cancer or HIV
• Being socially isolated or a victim of bullying or harassment
• Substance use disorder
• Childhood abuse or trauma
• Family history of suicide
• Previous suicide attempts
• Having a chronic disease
• Social loss, such as the loss of a significant relationship
• Loss of a job
• Access to lethal means, including firearms and drugs
• Being exposed to suicide
• Difficulty seeking help or support
• Lack of access to mental health or substance use treatment
• Following belief systems that accept suicide as a solution to personal problems

Those who have been shown to be at a higher risk for suicide are:

• Men
• People over age 45
• Caucasians, American Indians, or Alaskan Natives

Assessing people who are at risk for suicide

A healthcare provider may be able to determine whether someone is at high risk for suicide based on their symptoms, personal history, and family history.

They will want to know when symptoms started and how often the person experiences them. They’ll also ask about any past or current medical problems and about certain conditions that may run in the family.

This can help them determine possible explanations for symptoms and which tests or other professionals might be needed to make a diagnosis. They will likely make assessments of the person’s:

Mental health – In many cases, thoughts of suicide are caused by an underlying mental health disorder, such as depression, schizophrenia, or bipolar disorder. If a mental health issue is suspected, the person will likely be referred to a mental health professional.

Substance use – Mis-using alcohol or drugs often contributes to suicidal thoughts and behaviour. If substance use is an underlying problem, an alcohol or drug addiction rehabilitation program may be the first step.

Medications – The use of certain prescription drugs — including antidepressants — may also increase the risk of suicide. A healthcare provider can review any medications the person is currently taking to see if they could be contributing factors.

Treatment for people who are at risk for suicide

Treatment will depend on the underlying cause of someone’s suicidal thoughts and behaviour. In many cases, though, treatment consists of talk therapy and medication.

Talk therapy

Talk therapy, also known as psychotherapy, is one possible treatment method for lowering your risk of attempting suicide. Cognitive behavioural therapy (CBT) is a form of talk therapy that’s often used for people who are having thoughts of suicide.

Its purpose is to teach you how to work through stressful life events and emotions that may be contributing to your suicidal thoughts and behaviour. CBT can also help you replace negative beliefs with positive ones and regain a sense of satisfaction and control in your life.

A similar technique, called dialectical behavioural therapy (DBT), may also be used.

Medication

If talk therapy isn’t enough to successfully lower risk, medication may be prescribed to ease symptoms, such as depression and anxiety. Treating these symptoms can help reduce or eliminate suicidal thoughts.

One or more of the following types of medication could be prescribed:

• Antidepressants
• Antipsychotic medications
• Anti-anxiety medications

Lifestyle changes

In addition to talk therapy and medication, suicide risk can sometimes be reduced by simply adopting certain healthy habits. These include:

Avoiding alcohol and drugs – Staying away from alcohol and drugs is critical, as these substances can lower inhibitions and may increase the risk for suicide.

Exercising regularly – Exercising at least three times per week, especially outdoors and in moderate sunlight, can also help. Physical activity stimulates the production of certain brain chemicals that make you feel happier and more relaxed.

Sleeping well – It’s also important to get enough quality sleep. Poor sleep can make many mental health symptoms much worse. Talk to your healthcare provider if you’re having trouble sleeping.

How to prevent suicidal thoughts

If you’ve had suicidal thoughts or feelings, don’t be ashamed and don’t keep it to yourself. While some people have suicidal thoughts without any intention of ever acting on them, it’s still important to take some action.

To help prevent these thoughts from recurring, there are several things you can do.

Talk to someone

You should never try to manage suicidal feelings entirely on your own. Getting professional help and support from loved ones can make it easier to overcome any challenges that are causing these feelings.

Many organizations and support groups can help you cope with suicidal thoughts and recognize that suicide isn’t the best way to deal with stressful life events. The National Suicide Prevention Lifeline is a great resource.

Take medications as directed

You should never change your dosage or stop taking your medications unless your healthcare provider tells you to do so. Suicidal feelings may recur and you may experience withdrawal symptoms if you suddenly stop taking your medications.

If you’re having unwanted side effects from the medication you’re currently taking, speak with your provider about switching to another one.

Never skip an appointment

It’s important to keep all your therapy sessions and other appointments. Sticking with your treatment plan is the best way to deal with suicidal thoughts and behavior.

Pay attention to warning signs

Work with your healthcare provider or therapist to learn about the possible triggers for your suicidal feelings. This will help you recognize the signs of danger early on and decide what steps to take ahead of time.

It can also help to tell family members and friends about the warning signs so they can know when you may need help.

Eliminate access to lethal methods of suicide

Get rid of any guns, knives, or serious medications if you worry that you might act on suicidal thoughts.

Suicide in Teenagers

Why Do Teens Try to Kill Themselves?

Most teenagers after making a suicide attempt say that they did it because they were trying to escape from a situation that seemed impossible to deal with or to get relief from really bad thoughts or feelings. They state they didn’t want to die as much as they wanted to escape from what was going on. And at that particular moment dying seemed like the only way out.

Some people who end their lives or attempt suicide might be trying to escape feelings of rejection, hurt, or loss. Others might feel angry, ashamed, or guilty about something. Some people may be worried about disappointing friends or family members. And some may feel unwanted, unloved, victimized, or like they’re a burden to others.

We all feel overwhelmed by difficult emotions or situations sometimes. But most people get through it or can put their problems in perspective and find a way to carry on with determination and hope. So why does one person try suicide when another person in the same tough situation does not? What makes some people more resilient (better able to deal with life’s setbacks and difficulties) than others? What makes a person unable to see another way out of a bad situation besides ending his or her life?

The answer to those questions lies in the fact that most people who commit suicide have depression.

Depression

Depression leads people to focus mostly on failures and disappointments, to emphasize the negative side of their situations, and to downplay their own capabilities or worth. Someone with severe depression is unable to see the possibility of a good outcome and may believe they will never be happy or things will never go right for them again.

Depression affects a person’s thoughts in such a way that the person doesn’t see when a problem can be overcome. It’s as if the depression puts a filter on the person’s thinking that distorts things. That’s why depressed people don’t realize that suicide is a permanent solution to a temporary problem in the same way that other people do. A teenager with depression may feel like there’s no other way out of problems, no other escape from emotional pain, or no other way to communicate a desperate unhappiness.

Sometimes people who feel suicidal may not even realize they are depressed. They’re unaware that it is the depression — not the situation — that’s influencing them to see things in a “there’s no way out,” “it will never get better,” “there’s nothing I can do” kind of way.

When depression lifts because someone gets the proper therapy or treatment, the distorted thinking is cleared. The person can find pleasure, energy, and hope again. But while someone is seriously depressed, suicidal thinking is a real concern.

People with a condition called bipolar disorder are also more at risk for suicide because their condition can cause them to go through times when they are extremely depressed as well as times when they have abnormally high or frantic energy (called mania or manic). Both of these extreme phases of bipolar disorder affect and distort a person’s mood, outlook, and judgment. For people with this condition, it can be a challenge to keep problems in perspective and act with good judgment.

Alcohol and Drug Abuse

Teens with alcohol and drug problems are also more at risk for suicidal thinking and behaviour. Alcohol and some drugs have depressive effects on the brain. Misuse of these substances can bring on serious depression. That’s especially true for some teens that already have a tendency to depression because of their biology, family history, or other life stressors.

The problem can be made worse because many people who are depressed turn to alcohol or drugs as an escape. But they may not realise that the depressive effects alcohol and drugs have on the brain can actually intensify depression in the long run.

In addition to their depressive effects, alcohol and drugs alter a person’s judgment. They interfere with the ability to assess risk, make good choices, and think of solutions to problems. Many suicide attempts occur when someone is under the influence of alcohol or drugs.

This doesn’t mean that everyone who is depressed or who has an alcohol or drug problem will try to kill themselves, of course. But these conditions — especially both together — increase a person’s risk for suicide.

Suicide Is Not Always Planned

Sometimes a depressed person plans a suicide in advance. Many times, though, suicide attempts happen impulsively, in a moment of feeling desperately upset. A situation like a breakup, a big fight with a parent, an unintended pregnancy, being ousted by someone else, or being victimized in any way can cause someone to feel desperately upset. Often, a situation like this, on top of an existing depression, acts like the final straw.

Some people who attempt suicide mean to die and some aren’t completely sure they want to die. For some, a suicide attempt is a way to express deep emotional pain. They can’t say how they feel, so, for them, attempting suicide feels like the only way to get their message across. Sadly, many people who really didn’t mean to kill themselves end up dead or critically ill.

Warning Signs

There are often signs that someone may be thinking about or planning a suicide attempt. Here are some of them:

• Talking about suicide or death in general
• Talking about “going away”
• Referring to things they “won’t be needing,” and giving away possessions
• Talking about feeling hopeless or feeling guilty
• Pulling away from friends or family and losing the desire to go out
• Having no desire to take part in favourite things or activities
• Having trouble concentrating or thinking clearly
• Experiencing changes in eating or sleeping habits
• Engaging in self-destructive behaviour (drinking alcohol, taking drugs, or cutting, for example)

What if This Is You?

If you have been thinking about suicide, get help now. Depression is powerful. You can’t wait and hope that your mood might improve. When a person has been feeling down for a long time, it’s hard to step back and be objective.

Talk to someone you trust as soon as you can. If you can’t talk to a parent, talk to a coach, a relative, a school counsellor, a religious leader, or a teacher. Call a suicide crisis line (such as 1-800-SUICIDE) or your local emergency number (911).

These toll-free lines are staffed 24 hours a day, 7 days a week by trained professionals who can help you without ever knowing your name or seeing your face. All calls are confidential — no one you know will find out that you’ve called. They are there to help you figure out how to work through tough situations.

What if It’s Someone You Know?

It is always a good thing to start a conversation with someone you think may be considering suicide. It allows you to get help for the person, and just talking about it may help the person to feel less alone and more cared about and understood.

Talking things through also may give the person an opportunity to consider other solutions to problems. Most of the time, people who are considering suicide are willing to talk if someone asks them out of concern and care. Because people who are depressed are not as able to see answers as well as others, it can help to have someone work with them in coming up with at least one other way out of a bad situation.

Even if a friend or classmate swears you to secrecy, you must get help as soon as possible — your friend’s life could depend on it. Someone who is seriously thinking about suicide may have sunk so deeply into an emotional hole that the person could be unable to recognize that he or she needs help. Tell an adult you trust as soon as possible.

If necessary, you can also call a suicide crisis line or your local emergency number (999). These are confidential resources and the people at any of these places are happy to talk to you to help you figure out what to do.

Sometimes, teens who make a suicide attempt — or who die as a result of suicide — seem to give no clue beforehand. This can leave loved ones feeling not only grief stricken but guilty and wondering if they missed something. It is important for family members and friends of those who die by suicide to know that sometimes there is no warning and they should not blame themselves.

When someone dies by suicide, the people left behind can wrestle with a terrible emotional pain. Teens who have had a recent loss or crisis or who had a family member or classmate who committed suicide may be especially vulnerable to suicidal thinking and behaviour themselves.

If you’ve been close to someone who has attempted or committed suicide, it can help to talk with a therapist or counsellor — someone who is trained in dealing with this complex issue. Or, you could join a group for survivors where you can share your feelings and get the support of people who have been in the same situation as you.

Coping With Problems

Being a teen is not easy. There are many new social, academic, and personal pressures. And for teens that have additional problems to deal with, such as living in violent or abusive environments, life can feel even more difficult.

Some teens worry about sexuality and relationships, wondering if their feelings and attractions are normal, or if they will be loved and accepted. Others struggle with body image and eating problems; trying to reach an impossible ideal leaves them feeling bad about themselves.

Some teens have learning problems or attention problems that make it hard for them to succeed in school. They may feel disappointed in themselves or feel they are a disappointment to others.

These problems can be difficult and draining — and can lead to depression if they go on too long without relief or support. We all struggle with painful problems and events at times. How do people get through it without becoming depressed? Part of it is staying connected to family, friends, school, faith, and other support networks.

People are better able to deal with tough circumstances when they have at least one person who believes in them, wants the best for them, and in whom they can confide. People also cope better when they keep in mind that most problems are temporary and can be overcome.

When struggling with problems, it helps to:

• Tell someone you trust what’s going on with you.
• Be around people who are caring and positive.
• Ask someone to help you figure out what to do about a problem you’re facing.
• Work with a therapist or counsellor if problems are getting you down and depressed — or if you don’t have a strong support network or feel you can’t cope.

Counsellors and therapists can provide emotional support and can help teens build their own coping skills for dealing with problems. It can also help to join a support network for people who are going through the same problems — for example, anorexia and body image issues, living with an alcoholic family member, or sexuality and sexual health concerns. These groups can help provide a caring environment where you can talk through problems with people who share your concerns.