By Kristen Rogers, CNN
suicide is a leading cause of death in children and adults, but spotting risk factors and warning signs is not easy.
This is National Suicide Prevention Week September 4-10 part of Suicide Prevention Awareness Month. Nearly 46,000 people in the United States died by suicide in 2020, or about one death every 11 minutes, according to the US Centers for Disease Control and Prevention.
Researchers still haven’t figured out how to better predict who is at risk of attempting suicide, and if or when vulnerable people will, said Justin Baker, clinical director of The Suicide and Trauma Reduction Initiative for Veterans at The Ohio. State University Wexner Medical Center.
“It’s extremely, extremely difficult,” he said. “You can look back in time, when someone tried or died, and say, ‘Oh, look at all these things that happened in their life.’ The difficulty is that many people deal with or experience these types of stressors as well, but never (attempt suicide).”
Also, there isn’t always a long period of time someone is contemplating suicide and showing signs – and it can be as little as 5-15 minutes between someone deciding to attempt suicide. and does, Baker added.
“What we collectively understand is that it’s an emotional dysregulation and a cognitive error that’s happening,” Baker said. “They can’t resolve the situation, or they can’t think about the situation, so suicide becomes a viable option as a way to deal with the pain they’re feeling. So they can act on it. Short, brief window.
But there are some situations in which someone who is suicidal and planning for a longer time frame will exhibit behavioral changes, Baker added.
“If you’re noticing those kinds of things, obviously it’s someone who’s really about to be an imminent risk – someone who’s really about to make a decision to end their life,” did he declare. “But I would say most people don’t get that kind of warning.”
If you think you or someone you know is at risk, trained counselors with the National 24/7 Suicide Prevention Lifeline could help you overcome any signs you feel or see. To increase its accessibility, every state started rolling out 988 as a new lifeline on July 16. The current number is 1-800-273-8255 (TALK), and it will always remain available for those in emotional distress or in a suicidal crisis, according to the Addiction and Mental Health Services Administration.
Here are some of the most common behavioral, verbal, and emotional signs and risk factors you should watch out for, according to experts.
Behaviors to watch out for
Some people may appear to be their usual selves in the weeks or days leading up to a suicide attempt, while others may show behavioral changes that don’t match what you know about them, said psychologist Michael Roeske. clinician and senior director of the Newport Healthcare Center for Research and Innovation.
These can include practicing or preparing for suicide, which could look like unusual behavior with guns, pills or other life-threatening objects, according to SAMHSA.
According to Roeske, Baker, and SAMHSA, other potential behavioral red flags include giving away valuable possessions, sleeping too much or too little, withdrawing or isolating oneself, showing rage or a desire for revenge. and acting anxious or agitated. Getting really drunk one night or driving recklessly could also be signs to look out for, Roeske said.
Such behavior could be that they are “testing themselves to see if they can actually do it,” Baker said. “A lot of times people have to work up to that actual attempt because it’s a biological thing that you have to oppose, your own survival.”
Talking about wanting to die — by suicide or otherwise — is another warning sign that should always be taken seriously, Roeske said. Such comments are sometimes just expressions of discomfort, pain, annoyance, or a desire for closeness rather than a reflection of actually wanting to die, but that doesn’t mean you don’t watch the person making them. he added.
Some people might say they feel like they have no reason to live. “If someone is having trouble finding a reason for living, they’re a much higher risk person than someone who is even able to identify a (reason) for it,” Baker said.
Others say they feel like a burden on their loved ones, Roeske said, or like they don’t belong or belong to anyone. These comments can include “you don’t need me for that anymore” or “I feel like it would be better if I just wasn’t there.” Teenagers contemplating suicide might not want their guardians to use their money for college, he added.
Mood and other risk factors
Psychological factors, distressing situations or genetic factors can increase the likelihood that a person will consider, attempt or die by suicide, according to SAMHSA. These risk factors cannot cause or predict a suicide attempt, but it is important to be aware of them, according to SAMHSA:
- Despair. “They don’t feel like the future is getting better, or they really feel like they can’t imagine not being in the pain they’re in,” Roeske said.
- Extreme mood swings. This includes if someone who is usually very stressed or depressed suddenly seems calm or happy, according to Roeske and Johns Hopkins Medicine. This person may have decided to attempt suicide without telling anyone, and they feel relieved. The good mood after a depressive episode is also revealing.
- Obsession with death or lethal means. Some people have more sinister artistic or musical interests than others, but if their engagement with those things goes beyond what’s normal for them, that would be concerning, Roeske said.
- Experiences of abuse, neglect, or other trauma
- Substance abuse issues
- Mental disorders such as schizophrenia, depression or anxiety, and personality disorders, especially coupled with the absence of treatment
- Serious physical illnesses, including chronic pain. “Especially if it’s a bit recalcitrant and very difficult to deal with, people can get very desperate,” Roeske said. “It’s really just, ‘I don’t want to feel this anymore and I can’t find any other way. I feel trapped.
- Family or personal history of suicide. “The biggest predictor of successful suicide is past suicide attempts — the reason for that is you’ll see an escalation in lethality, or the ways in which someone does it,” Roeske said.
- Job loss or financial loss
- Relationship problems or loss
- Loss of interest in activities or school
- Prolonged stress from other causes, such as harassment or bullying
- Easy access to potentially lethal means
- Exposure to suicide or graphic or sensational accounts of suicide. “On the one hand, we don’t want people to avoid the subject of suicide. We want people to approach and even use the word with others and have discussions about it,” Roeske said. But if a depiction or story romanticizes or gratuitously justifies the sense of relief that might come from a suicide, that’s problematic.
- Insufficient social support or feelings of isolation
What to do
If any of these signs resonate with you, seek professional help and talk to someone you can trust who will support you, Baker said. Psychotherapy and certain psychiatric medications, such as antidepressants, can help, Roeske said.
If a loved one shows signs they might be at risk for suicide, “it’s not really your job to be able to predict the future,” Baker said. But you can be supportive and intentional by asking them what’s going on, Roeske and Baker said.
“You’re not going to trick someone into being suicidal by directly asking questions about suicide,” Baker said. “The worst they will say is ‘no’ and not take offense. If they are, ask them anyway. I’d rather have someone offended against me than dead.
When verifying someone, use what experts call a person-centered storytelling approach, Baker recommended. It might sound like an open-ended question: “Hey, I noticed that life has gotten overwhelming these past few days. Do you want to tell me about it?”
As the person responds, you can, to some degree, listen, express your appreciation for them to share their story, and offer to help them figure it out together, without giving advice on how to handle it. , Baker said. But if your loved one seems more at risk or trying to kill themselves, “you no longer have the time or the luxury to have their opinion,” he added. Get medical attention or call 911.
When Roeske started working as a clinician, he had a young patient who was a very accomplished equestrian, attended a prestigious school and had plenty of family resources, he said – but she had been chronically suicidal for 10 to 15 years. , since she was a teenager.
“Every time she would go to her mother and say that to her, her mother (says things like) ‘Oh, you’re so beautiful. Look how you are with horses,'” Roeske said. said: “What I felt was that mum was scared of what I was saying and needed to get away from it.
She said therapists would do the same thing — you know, “create a positive gratitude list or fix your cognitive distortions.” Finally, there was a psychiatrist who looked at her and said, “I think I’m going to kill myself. And the psychiatrist said, ‘I think you could too.’ And she said that was the first time anyone agreed to be there with her.
When talking with someone who is suicidal, you might want to tell them all the wonderful reasons why they should stay alive, Roeske said — but it can actually make them feel more alone.
If you are worried about someone in your household, reduce the chances of a suicide attempt by restrict access to or remove potentially deadly items such as guns or pills, Roeske said. Hiding a weapon is not a sufficient precaution, the experts said.
Unfortunately, “we are no better able to predict who will die by suicide than who will be in a car crash,” Baker said. “It doesn’t help to lessen the grief or pain of those who have lost loved ones to suicide, but hopefully it helps take away some of the guilt and responsibility.”
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CNN’s Jacqueline Howard contributed to this story.