Warning Signs of Suicide

Throughout history, the very idea of self-murder or suicide has called forth such emotions as anger, admiration, patriotic pride, disgust, sympathy, curiosity and fear.  Many of these responses are determined by social factors and norms operating in the specific culture in which the suicide is accomplished.  A society, such as twentieth-first century United States, places high value on wellness and life and tends to view suicide with horror, shame and antagonism.  On the other hand, the Japanese culture has historically viewed some suicides as honor-saving acts or patriotic feats.

Even within the health care systems, personnel have had a difficult time viewing and discussing suicide.  The very act of self-destruction is antithetical to the health-care mission to save lives and promote health.  Suicide is a broad term that is often used to describe the ideation, attempt and completion of self-inflicted cessation.  In essence, suicide can be viewed as aggression directed inward.

Suicide is the tenth leading cause of death in the United States.  It is believed by many suicidologists that the number of reported suicides is only the tip of the iceberg.  It is theorized that for every reported suicide attempt or completion there are ten that go unreported.  Males are three times more likely to commit suicide that females.  However, females attempt suicide more than males at a rate of 3:1.  Men tend to use more lethal means to commit suicide, such as firearms or hanging, whereas women tend to attempt suicide by overdosing, poisoning or cutting.  This means that there is little or no chance of men being rescued.

Approximately for every completed suicide there are eight to ten attempts.  Of the people who complete suicide, 80% have had at least one suicide attempt.  Of those individuals, who attempt suicide, 12% will have succeeded in killing themselves within two years.  Most suicides and attempts occur during the winter months.  The least number of suicides are attempted and completed in the summer and fall.

Suicidal ideation may be passing thoughts or repetitive and intense serious considerations of suicide.  Research has indicated that any given time, 10%-15% of the general population has suicidal wishes whereas at least 75% of depressed people consider suicide.

Persons at high risk for suicide include the elderly, white, Protestant males; adolescents; college students; alcoholics; drug abusers; depressed individuals; those downwardly mobile in the socioeconomic status; and people who have experienced interpersonal loss.  Suicide generally increases with age; however the number of suicides in the 15 to 24-year-old age-group has been steadily increasing.

Variables such as marriage, religion, and race influence suicide.  Married people over the age of 23 have a lower suicide rate than nonmarried people.  However, below age 23, married individuals have a higher suicide rate.  Jews have a low rate of suicide, usually attributed to cultural and religious emphasis on family.  Protestants have a high rate of suicide whereas Catholics exhibit low rates.  American whites have a much higher suicide rate than African-Americans, although African-American suicide is increasing.  White suicides are more pronounced in the older age-groups, whereas African-Americans have a higher suicide rate between ages of 20 and 35.  Native Americans exhibit a very high rate of suicide.  Methods of suicide used by these three groups varies.  American whites utilize self-inflicted means whereas African-Americans employ methods where someone else (i.e. law enforcement officers) is forced to kill them.  Native Americans commit suicide through “accidents,” where only the individual is involved.  Suicide rates tend to much higher in industrialized, urban setting contrasted to rural areas, which tend to be nurturing and family oriented.

Behavioral Manifestations:

Suicidal individuals display a variety of behaviors that are indicative of potential suicidal risk.  Frequently, a family member or friend will notice a recent change in the individual’s behavior.  An outgoing person may suddenly become reclusive.  A spendthrift may go on a shopping spree or donate large sums of money to a local charity.  This can signal the individual’s relief for having made a decision to commit suicide and resolve the inner torment.  People who are taking antidepressant medications are particularly prone to suicidal risk when medications have begun to improve their outward behavior and energy levels but have not altered their suicidal thoughts or feelings of hopelessness.

Individuals considering suicide often attend to final business and personal affairs.  Finances may be put in order and a will composed.  The person may give away possessions such as sentimental mementos or other valuable items they normally would not have parted with like a favorite car.

Alcohol abuse is closely associated with suicide.  Alcohol impairs the senses and clouds judgment, predisposing the individual to impulsive suicide.  Impairment from alcohol also masks inhibitions and allows people who have planned suicide the opportunity to initiate the act.  Depressed individuals, who have higher suicide rates, consume alcohol in an attempt to soothe inner turmoil.  Additionally, people, who normally do not drink, use alcohol just before attempting suicide.

Suicidal individuals are often anxious and fearful.  They are frightened by overwhelming feelings of isolation and hopelessness.  They are anxious about their inner pain and the plans they are making to resolve it.  The feeling of ambivalence—wanting desperately to die yet hoping just as desperately to live—creates panic and anxiety.  Suicide is seen as a means for escaping intensively frightening situations or as relief from constant, overwhelming anxiety.  Anger is frequently expressed by suicidal individuals.  The anger may be directed inward or onto other individuals or situations.  Excessive guilt, self-blame and severe frustration may be evident.  People who have severe physical pain are high risks for suicide if they desire relief from the pain and deduce that suicide is the most attractive alternative.

The legacy of suicide is that it affects every family member, friend and everyone who knew the victim.  Family members, who are left to deal with the aftermath of suicide, have great difficulty dealing with the guilt and shame that occurs with suicide.  Questioning themselves about what they missed; how could they have stopped the suicide; and, they should have watched the suicide victim more closely to prevent the suicide, and so forth.  Others hold the family accountable for the suicide.  They believe that the family pushed the victim into suicide or were not watchful enough to prevent the suicide, which tends to isolate family members from their own friends.  The other sad reality is that children of parents, who have committed suicide, tend to commit suicide, also

The suicidal plan provides important information about the person’s suicidal risk potential.  If a family member or friend suspects the individual is suicidal, he should question the individual to see if the person is thinking about suicide and if he has a plan on how to carry out the suicide.  There is a belief that by mentioning suicide to a person that this will make him suicidal.  This is not true.  You cannot plant these thoughts.  Suicidal individuals have the thoughts all ready in mind.   Questioning them only reveals how serious they are, and how much thought they have put into carrying their suicidal plans.  Any suicidal ideation should be taken seriously.  Even if the person has threatened several times in the past and never completed the act, it is imperative that family members or friends never tease the suicidal individual or encourage him to carry out his plan.  If the person states that he/she is suicidal, help should be sought immediately by contacting the suicidal hotline in your community or a professional counselor.   There is a National Suicidal Hotline that is available 24 hours/day, 7 days/week at 1-800-SUICIDE (784-2433).