In the United States, suicide is the tenth leading cause of death, responsible for tens of thousands of deaths each year, according to the Centers for Disease Control and Prevention. Each year, millions of people attempt suicide. Yet the reasons for suicide still feel mysterious and even unimaginable to many of us.
There’s no simple answer for why some people seek to die by suicide. “Often, people engage in suicidal thinking or suicidal behaviors because they feel like they can no longer withstand the psychological and emotional pain that they’re currently in,” Anthony P. DeMaria, PhD, a clinical psychologist and psychotherapist and associate director of adult ambulatory psychiatry at Mount Sinai St. Luke's and Mount Sinai West Hospitals in New York City, tells Health.
Having a better sense of the factors linked with suicide is a meaningful step toward prevention. Get insight into these risk factors—along with suicide warning signs to watch for and simple ways to help when your loved ones appear at risk.
Suicide risk factors
It can be helpful to think of the factors associated with suicide as belonging to three different groups, says DeMaria. First, there are biological factors—this includes illnesses, both mental and physical. Suffering from an illness that results in chronic pain, for instance, is a biological risk factor, says DeMaria.
Then there are psychological factors, such as a person's resiliency and coping skills, along with feelings of hopelessness. The last category is what DeMaria calls "social determinants of health." Think of these as environmental triggers like a person's financial health, the strength and quality of their relationships, housing situation, and work experiences.
Here are the most common reasons for suicide from those three categories.
Depression and other mental illnesses
People who are depressed, bipolar, or have post-traumatic stress, are more vulnerable to suicidal thoughts or action, Michael Genovese, MD, clinical psychiatrist, addiction specialist, and chief medical officer of Acadia Healthcare, tells Health. “That said, a lot of people who have not been diagnosed with anything die by suicide,” he notes. While many people may have clinical depression, however, few attempt suicide.
A feeling of total despair—a sense that there’s no escape from an ongoing intolerable situation—is another big risk factor. “Often people engage in suicidal thinking or suicidal behaviors because they feel like they can no longer withstand the psychological emotional pain that they’re currently in,” says DeMaria.
Feeling like a burden
“Another common precipitating event is a perceived sense of burdensomeness,” says DeMaria. This leads to a sense of inappropriate guilt and can give a person the idea of not going on living, he notes.
Stressful situations can lead to suicidality, says Dr. Genovese. What counts as stressful covers a wide range of experiences, such as a relationship crisis, financial problems, academic or work pressures, bullying, health problems, loss of a loved one, and so on.
Having family support and social structure is a protective factor against suicide, says Dr. Genovese. Conversely, people who lack support and community are at a heightened risk for suicide.
Additional risk factors for suicide include previous suicide attempts, a family member who has died of suicide, alcohol or substance abuse, or a history of abuse or trauma. Not having mental health resources available (or feeling a stigma against seeking them out) is another risk factor, as is ready access to drugs, alcohol, and weapons.
Warning signs of suicide
Suicide can be a surprise to loved ones. But often, suicidal people send up flares beforehand—little warning signs to friends and family that they are feeling unwell.
Take it very seriously, for instance, if someone frequently talks about death or mentions suicide. Statements can be direct (“I’m thinking about killing myself”) but frequently are more subtle (“Things are never going to get better”), notes Dr. Genovese.
Being sad occasionally or due to specific circumstances is normal. Yet prolonged, pervasive sadness is another signal that a person might be contemplating ending their life, says Dr. Genovese. Watch too for changes in behavior—for instance, if a normally outgoing person opts out of all activities, or a studious person skips class, he says.
Be mindful if somone you know seems to be making a plan—this could range from settling their affairs (giving away items, creating a will, writing goodbye letters) or even procuring a means for suicide, such as obtaining a gun. “Those are really red flags,” says Dr. Genovese.
What you can do to help
If you observe any of these warning signs, don’t brush them off. Instead, express your concerns. “A lot of people are afraid to engage people in a conversation about suicide because they think they’re going to plant the seed, giving a person the ideas. That’s not going to happen,” says Dr. Genovese.
Be thoughtful and considerate when it comes to the language you use while talking to a friend in distress, advises DeMaria, but don’t shy away from checking in. “If I want to find out how someone is feeling emotionally, the best way isn’t a sophisticated brain scan or psychologically validated measure—it’s asking," he says. Try saying, “I’m concerned about what you just said” or “I’m feeling worried about you because of XYZ.”
Then, look for practical ways to lend a hand. “If someone is so depressed that they're thinking of taking their life, even the most minor tasks becomes daunting,” says Dr. Genovese. Something as simple as offering to find a doctor, make an appointment, and drive the person there can be hugely helpful.
In general with friends and family, reinforce that it’s OK to struggle, says DeMaria. That will create an environment where people feel comfortable reaching out for help and support and sharing what’s on their minds—even if it’s sad, scary, or unpleasant.
Talking about mental health and suicide is important, says Dr. Genovese. The brain is complex, and we don’t fully understand it, he says, but that’s no reason to limit discussion, he says. “The more communication, the better,” he adds.
If you or someone you know is in crisis, there's help available. Call 911, or reach out the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255)
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