People contemplating suicide or experiencing the depths of a severe depression need to know they are not alone. From teenagers to college students, LGBT to the elderly, people struggling with depression and suicidal thoughts need options, reassurance, hope and help.
Steve Schlozman, MD is associate director of The Clay Center for Young Healthy Minds at Massachusetts General Hospital and an assistant professor of psychiatry at Harvard Medical School. He practices child and adult psychiatry at Mass General and serves as the primary consultant to the pediatric transplant service. Dr. Schlozman received BAs in English and biology from Stanford University and his MD from the Dartmouth-Brown Program in Medicine. He serves as supervisor for both general psychiatry residents and child psychiatry fellows. He has been involved in national efforts to increase recruitment in psychiatry and decrease stigma with regard to psychiatric illness. To learn more about Dr. Schlozman, follow him on Twitter (@SSchlozman), or visit his page at the Clay Center.
A. Michele Tedder holds an MS in Nursing Education. She is the founder & CEO of Joy for Life, a life purpose, personal and professional development coaching organization, and the author of “Don’t Let Grief Steal Your Joy.” She was employed for 18 years at Western Psychiatric Institute and Clinic in Pittsburgh, PA., one of the largest behavioral health care providers in the country and affiliated with the University of Pittsburgh Medical Center. During her tenure, Michele held positions as a nurse clinician in the emergency room, a clinical nurse specialist for Services for Teens at Risk (STAR), an outpatient clinic specializing in the treatment of adolescents suffering from depression and suicide, and the Project Coordinator for an outreach program called Reaching out to Adolescents with Depression (ROAD), specializing in the identification, assessment and treatment of depressed adolescents in primary care settings.
Depression and suicidal thoughts are two of the most frightening things a person can face in their lifetime. Unfortunately, acting on those suicidal thoughts is a far too common scenario for many across the world, including students. In fact, suicide is the second-leading cause of death for those between the ages of 15 and 24.
This guide is dedicated to helping those who are suffering or have suffered from depression, suicidal thoughts or suicide attempts. It is also designed for concerned friends and family members who might be worried that someone they love will experience death by suicide. Finally, it is meant for students, so that they might spot the warning signs of suicide in others – or in themselves – and find the proper resources.
If a suicide attempt seems immediate, call 911. If the threat is urgent, you can also call the National Suicide Hotline at 1-800-273-TALK, 1-800-SUICIDE, your local crisis center, dial 911, or take the person to an emergency room. Remove guns, drugs, knives, and other potentially lethal objects from the vicinity but do not, under any circumstances, leave a suicidal person alone. In search of possible means for attempting suicide, don’t forget cars, glove compartments, trunks, and other places within the car as a possible location for weapons.
An overwhelming surge of emotions that never seems to end – that’s what some who have attempted suicide try to describe to those who ask to understand why they feel the way they do. Those who are contemplating suicide might literally feel as though there is no way out of their situation. They are bombarded with feelings of hopelessness, fear, isolation, hatred toward themselves and so much more. The pain they feel is often immeasurable, to a point where they see no other option than to end their lives.
But many people who have attempted suicide will say that they wanted to live. They really didn’t want to die; the desire to remain with loved ones remained very strong. They simply didn’t see any other options.
What causes such a strong conflict in a person? What leads to that feeling of a dead-end, no-way-out scenario?
There are many reasons that someone might choose suicide or contemplate suicidal thoughts. Those reasons are often so complex and complicated that the person suffering from those feelings might not be able to articulate exactly what is going on in their head and heart. However, long and difficult research has found that the basic motivation for suicide is the feeling of utter despair and hopelessness. How a person reaches that point is what varies from one to another.
There are a number of central components that are effective for combatting stigma with regard to mental health. Most importantly, we need to avoid an us/them split. Mental Health diagnoses affect about 20% of the population at any given time. Still, the stories we hear most often are the ones that stress most starkly the differences between people without a psychiatric diagnosis and the ones with one. We hear most often about suicides, homicides, and a host of other potentially frightening and off-putting behaviors. This of course is not an accurate representation of mental illness. 20% of the population isn’t murderous, for example. The best means by which these issues can be addressed is to have people be willing to tell their own stories. Even more powerful, there exists all sorts of data showing that well known figures – actors, professional athletes, political leaders and so forth – who are willing to discuss their psychiatric challenges go a long ways towards gaining acceptance among everyone for the same challenges. Finally, we all need, as a culture, to be more open and more vigilant for stigmatizing views. Comments like “What, are you off your medications?” never help and make others less likely to come forward when they’re having problems.
If it’s a good fit, you can expect to be treated respectfully and with confidentiality. Remember that mental health clinicians don’t really have diagnostic tests. We don’t have chest x-rays or blood tests or anything like that. What we have is the story. That means that a good mental health professional will take the time to get to know you in order to help understand what brought you to the appointment. Tell your clinician why you’re there. Understand that you might not be able to get the whole story in after just one visit. Be prepared to be asked questions that might be uncomfortable – questions about suicidal thoughts, for example. But also remember that these clinicians ask these questions every day. They aren’t being nosy! They’re just getting the information they need to help.
From a psychological standpoint, there are many of the typical culprits that seem to be accentuated in the spring. Relationships dissolve, new friends are made and others perhaps move on. These are stressful events that can lead to increased suicidal feelings. From a more biological perspective, there is mounting evidence that the increased inflammation consistent with springtime allergies is associated with worsening depression and suicidal thoughts. To this end, better control of seasonal allergies is likely to be protective. This is especially the case if you move as a young adult to a new location and encounter new allergens.
Talk to the friend. Find out why the friend is feeling this way. Sometimes even the opportunity to discuss what’s going on is protective. But none of this can take the place of getting help, even against your friend’s will if need be. Ask if you can bring the concern to a responsible adult, but even if the answer is no, you still need to tell someone. Tell your parents, or your friend’s parents, or the guidance counselor at school. If you feel that your friend has already taken steps towards harming him or herself (by overdose, for example) call 911. Always take the concerns of someone expressing suicidal thoughts seriously. You’d much rather over-react than under-react.
If the person making the transition is already in treatment, that person should work with the clinician to ensure that there are ample clinicians available and even met before college starts. If there hasn’t been a need for treatment, then you should still make sure that the student understands the signs of depression and anxiety. These feelings creep into freshman year and are often made worse by the isolation of a new school and a new peer group. Add to this the natural epidemiological onset of many psychiatric syndromes at around the time kids start college, and there is a much higher risk. Telling kids about these risks and making them aware of how to get help goes a long way towards ensuring that they’ll get the help when they need it. Finally, discussions of healthy living are super-important. You don’t have to study all the time. You don’t want to get caught in the cycle of unabated and excessive substance use. Exercise is easy to go to the wayside but is hugely neuroprotective. All of these tidbits will be heard and internalized by students as they prepare to head to school.
Don’t worry alone! We’re pack animals. We do better if we let others know we’re suffering. Talk to friends, to parents, to mentors, to clergy…to the people who are designated to listen. These syndromes are immensely treatable, but the irony is that a key symptom of these syndromes is the belief that nothing can be done. Overcoming that misconception is most of the battle.
Depression has long been linked to suicidal thoughts and suicide attempts. Learning how to recognize depression, spotting when it gets worse, and finding the right resources can literally mean the difference between life and death.
There was a time when depression was seen as something people just had to “get over.” There was a stigma attached that said those with depression simply needed to “toughen up.” But in recent years, that erroneous attitude has been replaced with much more understanding.
“I think the biggest change I’ve seen over the years is more public information about depression and suicide and more treatment options,” Tedder said. “Though medication is not the only treatment option for depression, there are a lot more choices of antidepressants that produce effective results with fewer side effects.”
Here is what you need to know about depression, and how to prevent it from turning into a suicidal situation.
Depression is quite common – in fact, between 30 and 70 percent of suicide victims suffer from major depression or a related disorder. Signs of depression include a feeling of helplessness, no longer finding joy in activities you used to enjoy, sleep changes, loss of energy, anger or irritability, reckless behavior, self-loathing, and more.
Sometimes, what seems to be depression is actually pointing to something else. For instance, you might feel extremely depressed at one point, but suddenly the mood lifts, and you are happier than you have ever been – then the cycle begins again. This might be bipolar disorder, or manic-depressive disorder, or a host of other mental health issues. Evaluation by a mental health professional is the key to figuring out what is wrong.
Everyone gets depressed at some point in their lives. How long it lasts is one of the key factors to determining how severe the problem is. If depression has lasted for more than two weeks and it is affecting your day-to-day life, it’s time to get treatment. If depression seems to only get deeper and you feel as though things will never get better, immediate treatment is necessary.
In 2013, 41,149 people died by suicide in the United States. That’s one suicide every
13 minutes. (CDC)
Suicide is responsible for more than double the number of deaths each year than homicide. (NIMH)
Men are 4 times more likely than women to die by suicide. (CDC)
It is estimated that depression costs the United States $80 billion in medical costs and loss of work. (CDC)
In addition to youth and young adults, other high risk groups for suicide include military personnel, rural populations,LGBTQ and American Indian or Alaskan Natives. (CDC)
30%of college students reported feeling depressed in 2013
16 million U.S. adults had at least one major depressive episode in 2012.(NIMH)
From 2000 to 2013, the suicide rate in the United States has grown from 10.43 deaths per 100,000 to 13.02 per 100,000. (SPRC)
It can be very difficult to understand suicide. Sometimes there is no way to understand – the person who dies by suicide has a very deep pain that defies explanation, even to themselves. However, trying to understand what drives someone to such a desperate act might lead to help for others.
The following resources offer a very good overview of the things that might drive someone to suicidal thoughts, and how friends and family can step in and possibly stop a tragedy from occurring.
The National Suicide Prevention Lifeline is an organization that provides emotional support to those contemplating suicide. The service is free, confidential and available 24/7. The website provides additional resources on how to help, including explaining mental health issues and how to prevent suicide.
In addition to providing free, confidential and readily available help for those contemplating suicide or individuals who know someone who is, it also provides veteran specific information for suicide risk factors and reasons why a veteran might be thinking or talking about suicide, such as post-traumatic stress disorder.
This is an agency within the US Department of Health and Human Services that promotes awareness of substance abuse problems and mental illness in the United States, as well as initiatives to help reduce their impact. As drug or alcohol use and/or mental illness is often involved in a suicide or suicide attempt, information about these two issues can provide a broad understanding to motivations and thought processes around suicide.
This is a federally supported organization that promotes the National Strategy for Suicide Prevention, developed by the US Surgeon General and the US Department of Health and Human Services. They provide a tremendous amount of suicide information, from a best practices registry to training to publications to the basics of suicide prevention.
In many cases, a person who is suffering from suicidal thoughts will show signs of what they are contemplating. These signs might be very clear – clear enough to make friends and family very uneasy. But often they are subtle, or attributed to “just joking around.” The fact is that any mention of suicide, whether it is in a joking manner or a serious one, requires attention.
Someone who is thinking about death by suicide might not show as many signs of depression or distress as they did in the past. This often leads friends and family members to believe that that person has “gotten better” or is no longer contemplating killing themselves. Sadly, many families and friends learn too late that this kind of behavior means a person has simply made their decision, and now they are busy tying up loose ends.
The following chart offers signs of suicide that might be present. Keep in mind that some of these are clear, but most of them might be subtle. Pay attention not only to the overall behavior of the person, but to the “little things” that might be tell-tale signs of suicidal thoughts.
Whether it’s explicit “I’m going to go kill myself,” implicit “I don’t deserve to live,” or more subtle “I’m constantly in pain,” any discussion about suicide is a warning sign.
Increased aggression, irritability, anxiety or feelings of sadness that are out of the ordinary for the person.
An attempt to acquire items that could be used to end one’s life (without an alternate explanation), such as poison, firearms or knives.
An abnormal level of indifference to the future, whether it be failing to plan ahead or lack of excitement for a pleasurable or positive future event.
Giving away, destroying or selling (for an unreasonably low price) objects that were once highly prized by the individual.
A significant rise in the consumption of alcohol or drugs, or the use of such substances when the individual never took them before.
No longer engaging or participating in things once enjoyed. This can include ceasing long-term hobbies or other important causes.
An abnormal level of peace when one was usually or recently uptight, depressed, anxious or upset.
Spending less time with friends, family, coworkers or other people whose company was previously enjoyed. New or increased desire to be left alone.
A sudden and unusual level of preparation of tasks such as writing a will, selling substantial assets or making arrangements for one’s absence can be a signal of a potential suicide.
Taking risks that put themselves or others in danger, either at a higher frequency or in an uncharacteristic manner.
A substantial increase or decrease in sleeping patterns without a medical reason.
Telling friends, family and acquaintances goodbye for no apparent reason.
Depending on the reason and whether that reason still exists, a prior suicide attempt can be a strong indication that that the individual will try again.
An unusual or increased level of fascination or respect for death or suicide. Can also include artistic expression of death, suicide or similar themes.
Unusual or unjustified feelings of low self-esteem, worthlessness, shame or guilt.
Sources: AFSP, American Association of Suicidology
There could be other warning signs from those who are contemplating suicide. The links below lead to resources that can give you even further information on the more subtle ways someone might try to ask for help.
This site offers helpful information not only on the signs of suicide, but statistics that can help understand who might be a great risk, as well as information on how to get help for a person contemplating suicide.
Just as it is important to understand what might lead to suicide, it is important to understand what does not. There are a few common misconceptions that can actually hinder the ability to help when someone needs it most.
Truth: There is often a belief that someone who truly wants to die by suicide will do so, no matter what kind of intervention friends and family take on their behalf. It’s important to remember that those who die by suicide may be conflicted about the act, and if they saw any other way out, they would take it. Their desire to live is not gone; their desire to live without pain has simply become the stronger force.
Truth: This is definitely not true, as evidenced by the many individuals who have died by suicide after trying to find help through counselors, therapists, doctors and more. In fact, studies show that more than half of all suicide victims sought help within six months before they died.
Truth: This is a dangerous misconception, as it seeks to sweep suicide under the rug – “If we don’t talk about it, then it won’t happen – don’t give them any ideas!” But by staying silent about suicide, there is the risk of making the suicidal person feel even more alone and isolated, which doesn’t bode well for their state of mind. Discussing suicide can make someone open up about their own suicidal thoughts, and that can lead to then getting the help they need.
Truth: Those who die by suicide do so for a wide variety of reasons. What might seem like a terrible situation to one person could look like an easily-surmountable situation to someone else. For instance, a woman who has just suffered the breakup of a relationship might hear friends and family say, “You’ll get over this with time…he wasn’t good for you anyway.” But she might not believe those things at all, and seeing her loss as something trivial could drive her into even more isolation.
Truth: Suicide is the most serious symptom of major depression, which is an illness. One of the leading risk factors for having suicidal thoughts and behavior is having major depressive disorder or other mental illness, according to expert A. Michele Tedder. Dismissing someone as “crazy” dismisses the pain they are feeling and the illness they are experiencing. The person who attempts or dies from suicide may be experiencing mental illness, but they aren’t necessarily insane. In most cases, those who die by suicide are feeling distraught, lost, hopeless, depressed, or filled with grief.
Are you or someone you know at risk for suicide?
Take the following quiz, choosing any answers that apply.
Life is pointless and isn’t worth living.
If I don’t pass/achieve/obtain/win _____________, there’s no point in even living.
Go ahead, take my ___________________ collection. I know it’s worth a lot/has a lot of sentimental value, but I don’t care.
If she/he leaves me, my life is over.
Nobody gets me. I don’t even know why I try.
I can’t take this anymore, but there’s no way to make it stop.
I wouldn’t be missed by anyone if I ceased to exist.
Next time, I’ll take more pills/use a bigger gun/use a sharper knife to end it all.
Abnormal and sudden interest in anything related to suicide, such as music, movies, books or websites.
Drastic change in personal hygiene, clothing or presentation to others.
Without a good reason, obtaining a large amount of pills, firearm or other instrumentality that can be used for suicide.
Abnormal desire to be alone and avoid others.
If you are dealing with suicidal thoughts, if you believe the world might be better off without you in it is definitely time to seek help. There’s no shame in reaching out for help in a situation that is so overwhelming. In fact, those who love you and care for you will be forever grateful that you took the brave step of searching for help before you did something that would take you away from them forever.
Asking for help can be difficult – when it comes to telling someone that you need help for the terrible thoughts you are having, it can be even tougher. When you ask for help, you are turning to them and asking for one of the most important things they could possibly do for you. Keep in mind that asking for help is what your friend or family member wants you to do – they want to you to get better.
When you are trying to figure out how to ask for help, there are some things you should remember:
Everyone deals with overwhelming emotion and difficult situations during their lifetime. Responding to these situations with feelings of suicide does not make you a bad person. It does not make you weak. Rather, it proves that you are in a situation that is too much to handle, and that you need help in order to deal with it. Getting that help means you are strong, brave, and willing to do what it takes to get better.
It is important to remember that in the depths of despair, you are not seeing the situation clearly any longer. Your mind and heart have been taken over by the negative thoughts, and you are blinded to the more positive ones. There is always a solution other than suicide, even if it is one you can’t see right now – you must trust that it is there, and ask someone for help to find it.
If you are feeling as though you can’t control your suicidal impulses, work to convince yourself to give it another 24 hours. Just a little more time can help you rise out of the cloud of despair. During that time, you can seek help by speaking to someone you trust, calling a suicide helpline, or otherwise trying to find a different perspective.
If you can talk to friends and family, and stay close to them so that you don’t act upon the impulses, do that. If you don’t have anyone you can talk to at that point, go to a public place. See a movie, sit in the park, walk through the mall, and simply be around others. Human interaction can go a long way toward ensuring that you don’t act on the suicidal impulses that might seem overwhelming when you are alone.
Asking for help can be very difficult. For some, it might feel like admitting some sort of defeat. For others, it might be tough to ask because they feel as though they might become a burden. The following tips might help you cope with what you are feeling as you take that very important step of asking for help.
“Depression is an illness and it is very treatable,” expert Michele Tedder said. “Getting help for depression is no different than getting help for a bad tooth, diabetes, a broken bone or anything else that needs medical attention. With treatment people suffering from depression get better and lead healthy productive lives.”
Now is the time to talk about things – do not sweep it under the rug. “Talk to someone you trust who is not a peer,” Tedder said. “It can be a parent, an aunt or uncle, a teacher, a coach or any adult who you trust and can help. Keeping secrets about depression and suicide only makes things worse.”
When you speak to someone about what you are feeling, be blunt. They need to know exactly what is going on so they can get the proper help for you. Though it might be hard to do, telling someone that you are contemplating suicide can set the wheels in motion, and you will find almost immediate relief by the help that is offered.
If you can’t talk to a friend or family member, speak to a healthcare professional. Simply walk into the emergency room and tell the first medical personnel you see that you are struggling with suicidal thoughts. They take such things very seriously, and you will get immediate help.
Admitting that you need help can be tough, especially if you are normally the kind of person who keeps such things inside. Many people hesitate to reach out because they are worried that they will burden the person they speak to about the problem. You aren’t a burden – you are someone asking for the help you need and deserve. Your loved ones, family, friends, healthcare professionals, and the like will recognize this for what it is: A person taking a very brave step.
The following resources can be a lifeline – use them!
Call the suicide hotline. 1-800-273-TALK is your connection to someone who can help. The hotline is open around the clock, 24 hours a day, every day of the year. You will be connected to a trained counselor at a crisis center in your area, and he or she can help you immediately.
Go to the emergency room. Healthcare professionals are trained to leap into action the moment you say “Help me.” They will be more than happy to assist you in any way they can. Never hesitate to go, and don’t worry about insurance or payment – in many cases, the evaluation and follow-up services are free.
When someone comes to you with a request for help, pay close attention. Don’t let them say that they are dealing with depression or suicidal thoughts and then allow them to dismiss it as something “not so bad” or
something that they “can handle on their own.” If they are talking to you about their feelings, they are asking for help – even if they aren’t explicitly saying “Help me.”
Of all the people they could choose to speak to, they turned to you. That is a great honor, as well as a great responsibility. Knowing what to say to them and how to act can mean the difference that turns their life around. Here’s how you can help them.
Don’t sweep difficult subjects under the rug. Don’t assume someone is okay. Ask them how they are feeling, and encourage them to talk to you. Let them know that you care, and that you are there to listen to them.
Sometimes a person who is thinking terrible thoughts just needs a friend to be a sounding board. They need to get a lot of things out into the open. Listen to what they have to say. Ask follow-up questions. Be sympathetic, open, and encouraging as they speak to you.
After you listen to them, ask them point-blank: Are you thinking about suicide? Have you thought about harming yourself? If the answer is yes, it’s time to get immediate help. But even if the answer is no, be wary. Someone going through a very difficult time might not want to burden you with the absolute truth of what they are really feeling.
It might be easy for someone who isn’t depressed to see things through a less-than-generous light. Things like “toughen up” or “it’s not as bad as you think” or “grow up” are not what that person needs to hear. Remember that they are struggling with something that you can’t imagine – and you might feel the same if you were in their shoes.
If someone needs help, you have a responsibility to help them. Don’t agree to confidentiality. “It is never appropriate to promise to keep secrets about suicidal thoughts or behavior,” Tedder said. You might worry that you will push them away if you tell, but the truth is very different. “The reality is that telling an adult might be the key to keeping your friend alive so they can keep on being your friend for years to come.”
If your friend is thinking about suicide, professional help is vitally important. Tell someone you trust, speak to a healthcare professional, call a crisis line, or otherwise get the ball rolling.
Once the plan for help is in motion, make sure your friend stays on track. If they need to take medication, encourage them to take it every day. If they need to go to counseling, make sure they get there – drive them yourself if need be. Encourage them to do the things that will make them better.
Don’t just say “call if you need me.” Be the one to call them instead. Take the initiative to remove all methods of suicide from the home they live in. Make your own home a safe haven for them. Be there for them, even after the initial crisis has passed.
These resources can help your friend find the help they need, both in the immediate future and long-term.
1-800-273-TALK. This hotline isn’t just for the person who is suicidal; you can help them by calling it yourself and asking for leads to local support groups and other help in your area. Have a pen and paper ready to write down important information.
911 or your local police department. If you are worried that a suicide attempt is imminent, get in touch with the authorities and give them your friend’s address. They will respond immediately.
A close friend or relative. If you are with the suicidal person, stay with them. If you aren’t, get in touch with their closest friend or relative living in their area and impress upon them the importance of getting there – right now.
Find a state suicide hotline. This link will take you to the suicide hotline in your state, where you may find more targeted information to help your friend. Suicide Hotline Help
Remove the means. If someone has the means to die by suicide, such as a stockpile of pills or a lethal weapon, remove the means to suicide or restrict their ability to get to those items while you call 911.
The causes of suicide vary widely, but there are some risk factors that tend to be common among those who attempt suicide. According to the Center for Disease Control and Prevention and the American Foundation for Suicide Prevention, mental illness is often a major factor; specifically, depression is a major risk factor for suicide. Other major risk factors or causes include:
If someone has tried to die by suicide before and they weren’t just doing it for attention, they’ll probably try again. Those who have tried to die by suicide in the past should be watched very closely if there is any concern about their mental well-being.
Exposure to someone who has tried or succeeded in death by suicide makes it more likely someone will do so to imitate behavior. There might also be a genetic component involved.
Since mental illness and substance abuse are commonly found in those who die by suicide, and some mental illnesses and forms of substance abuse are genetic, a family history of suicide can create a higher risk of suicide in future generations.
The majority of those who die by suicide are suffering from mental illness. In fact, 90 percent of those who do are suffering from a diagnosable psychiatric disorder.
A significant portion of those who die by suicide are suffering from substance abuse. In 30 percent of all suicides, alcoholism is a factor; the rate might be higher among those using illicit drugs.
Victims of abuse often face isolation, depression, feelings of despair, and much more. Extreme pain, stress or anxiety with a feeling of hopelessness increases one’s risk of suicide.
Feelings of rejection or loneliness can increase the risk of suicide. This might be especially true after a serious breakup of a friendship or relationship, when feelings of isolation and loneliness can be combined with emotional upheaval.
Chronic and severe physical issues with no end in sight can be conducive to suicide. This might be especially true among those who have been diagnosed with a terminal illness, have dealt with a chronic illness that is progressively becoming worse, or are faced with chronic pain.
Imitative behavior plays a role in suicide. This might be true for those who have lost a close friend or family member to suicide. There has also been much discussion in recent years about how much the media might play a role in “copycat” suicides.
Though it sounds counterintuitive, some anti-depressant medications have been shown to actually increase the risk of suicide for a brief period of time after starting them. This is especially true if the person is on this type of medication for the first time.
In some cases, the risk factors for suicide are all present – but for others, there might only be one or two. In addition, some people are very good at hiding their feelings or being flippant about situations that hurt. It is important to watch closely for these signs, and keep in mind that they might be more subtle than you expect.
Among the general population, there could be some who are at particular risk for suicide, depression and the like. Some of these populations identified by experts to be most at risk include teenagers, those suffering from severe trauma, and those who identify as lesbian, gay, bisexual, transgender, queer or questioning of their sexual identity.
When compared to heterosexual peers, those who identify as LGBTQ or questioning of their sexual identity are at a higher risk for suicide. One of the biggest reasons for this higher risk is the fact that many individuals who identify as something other than heterosexual often find difficulty in obtaining support. They might be treated differently – and in some cases, poorly – by family members, their church family, at their school or in the workplace. In addition, they often face the problems of discrimination or a stigma based on their sexual identity. This can create a “perfect storm” of feeling isolated, alone and without support from those who are most important to them, at a time when they need support the most.
Other reasons that contribute to the suicide risk include a higher level of substance abuse or depression, especially for those under the age of 25. According to the Substance Abuse and Mental Health Services Administration, it’s estimated that 20-30 percent of gay and transgender people abuse substances, compared to about 9 percent of the general population. These situations might be a result of the lack of support these individuals receive; however, regardless of the root causes, substance abuse and depression are well-known to contribute to a higher rate of suicide.
Finally, access to adequate mental health care might be limited for those LBGTQ individuals. This might be due to the stigma associated with sexual identity questioning, discrimination that is unfortunately a routine occurrence, or ignorance about the mental health situations that might arise for someone who is struggling with their sexual identity.
In addition to the general warning signs one might look for when it comes to suicidal thoughts, there are other warning signs of suicide that might be present in those who identify as LBGTQ. They are:
Friends and family who see these warning signs in LGBTQ and questioning individuals should be aware of the possibility of suicidal thoughts. But how can you help?
Transgender warrants special mention because the suicide rate for transgender people is exceptionally high. According to the National Transgender Discrimination Survey conducted by the National Gay and Lesbian Task Force and National Center for Transgender Equality, the suicide attempt rate of transgender and gender non-conforming people is a staggering 41 percent. Compare that figure to the national suicide attempt rate (4.6 percent), or even the rate for lesbian, gay, and bisexual adults (10-20 percent), and a disturbing story starts to emerge.
A 2014 study by the Williams Institute at UCLA School of Law and the American Foundation for Suicide Prevention examined why this rate is so high. The numbers for transgender people who have attempted suicide tell a distressing story about the reasons for the suicide attempts:
And perhaps the most distressing statistic of all, 57 percent of transgender and gender non-conforming people reported a suicide attempt because their family chose not to speak with them or be around them.
Non-acceptance seems to be the overriding theme regarding transgender suicide, as Diego Sanchez, policy director for PFLAG National, told the Los Angeles Times. “This report punctuates what PFLAG families know is fundamental — that there is life-saving merit, demonstrable value, and paramount need for family acceptance.”
Warning signs for suicide contemplation in transgender people are similar to those in other populations, but if you or someone you is transgender or gender non-conforming and has experienced violence, non-acceptance or rejection, it’s imperative to get help. There are people who can and want to help. Those in immediate stress should contact the National Suicide Hotline at 1-800-273-TALK, but these other resources, particularly the first one, can also help.
The teen years are often very stressful, with a transition from carefree child to responsible adult. They are facing new social situations, which might include bullying, their first serious relationships, an exploration of sexuality, rejection, changes in friendships, and upheavals with family members. Add in constantly changing hormones, which might spark depression or similar issues, and you have a few tough years.
Some teens might suffer from even more tenuous situations. This might include those who are dealing with their first serious breakup, questions of sexual orientation, the challenging of their religious beliefs, issues with body image, changes in social circles, low self-esteem, and introductions to drugs or alcohol. Other potential risk factors and warning signs of suicide in teens may include:
Girls are typically more likely to attempt suicide than boys are, but teen males tend to complete an attempt with more frequency. Also keep in mind that teenagers who are members of the military are at a much higher risk of suicide than their civilian friends might be.
Now that you know how to spot the warning signs, how can you help?
Those who have suffered a serious trauma in their lives, such as those who have dealt with an abusive situation or the sudden and violent loss of a loved one, might be at much higher risk for suicide than the general population. Included in this group are those who have seen or dealt with traumas that might not be immediately clear to others, such as those who are disabled, veterans, those who have been diagnosed with PTSD, those who have suffered from addiction and the consequences of that, or the elderly.
Historically, the highest levels of suicide have occurred among the elderly. That is often attributed to the loss of loved ones, the lack of a proper support system, dealing with chronic health issues, a feeling of isolation or loneliness, and undiagnosed depression – and all of these things might occur at once.
Military personnel have higher rates of suicide as well. They are often separated from their loved ones for long periods of time, sometimes in environments that are very hostile and dangerous. The high levels of constant stress can take a toll on their well-being. They might also face the sudden, violent loss of those who are important to them during combat missions, a loss that will echo for years afterward, often in the form of post-traumatic stress disorder. In addition, they have ready and constant access to firearms, which can make it easier to act upon suicidal thoughts.
How can you help those who are suffering from trauma, loss or isolation?
When suicidal thoughts begin to creep in, it’s beyond time to get help. Those who are dealing with a very difficult situation, showing signs of depression, or suffering from serious losses or grief should immediately seek help before the situation becomes more severe.
However, most people don’t seek help until the feelings become overwhelming – and that might include suicidal thoughts. That’s why it is so important to form a safety plan that will help those who are thinking about suicide. This safety plan will allow them to reach out to someone when they are feeling overwhelmed or very tempted to die by suicide, and might be able to save their life.
Remember that there are four key points to determining whether someone will try to die by suicide and be successful at their attempt: They have formulated a plan to do it, they have the means to do it, they have set a time to do it, and they have the intention of following through.
At any point, that path to suicide can be disrupted with a strong safety plan.
A safety plan is typically formulated with the help of a counselor or therapist, but it can also be created with the help of a suicide prevention counselor, or even with the help of an understanding friend. A safety plan provides the person at risk with specific actions to take and people to call if they begin to have thoughts of hurting themselves. They then go through the steps of their safety plan, one at a time, until they reach a point of feeling safe again.
The safety plan must be written down and kept in a safe, very accessible place, such as a wallet, purse or cell phone. Here is a good example of a safety plan: Suicide Prevention Safety Plan
The best way to deal with suicide is to prevent it. The list below offers online resources where you can learn more about suicide prevention.
Offers ways to identify suicide warning signs, how to find treatment, as well as how to learn more about suicide prevention.
Discusses at risk groups, warning signs, and methods of preventing suicide.
Lists resources for preventing suicides from a public health perspective.
If you have attempted suicide and come through the other side, you already know how desperate the feelings can be – and how frightening it can be to look back and realize that you almost took your own life. In a situation like that, you might wonder how to keep those suicidal feelings from coming back, or need strong suggestions in how to prevent yourself from acting on them in the future. These tips might help you stay strong.
Now is the time to take care of you. That means exercising regularly, eating right, getting enough sleep, taking any prescribed medications, and otherwise living a healthy lifestyle.
You want to be surrounded by positive people, and you need to have someone there you can reach out to when life gets rough. Your team should include a counselor or mental health professional, friends or family members who are willing to listen, support groups filled with those who have walked the same path, and individuals that you know will be there for you in the event of an emergency.
Though it might be tough at first, getting out to do new things will introduce you to new hobbies, new people and new perspectives. Having something new to focus on can help you put the past behind you.
If a suicide attempt seems immediate, call 911. If the threat is urgent, you can also call the National Suicide Hotline at 1-800-273-TALK, 1-800-SUICIDE, your local crisis center, dial 911, or go to a nearby emergency room.
If someone you love has tried to die by suicide, you are probably reeling with overwhelming emotions. You might feel intense guilt, and wonder what you could have done differently that might have prevented the suicide. You might be worried that the same thing will happen to those around you – or to you. You might be filled with questions and feel helpless, or you might be flooded with anger at the person or the situation.
The best thing you can do for yourself and those around you is to connect with supportive groups, or turn to a counselor to help you work through the emotions you are feeling. You are facing one of the most difficult challenges you might ever deal with, and having a strong support system in place will help you get through it.
Here are a few resources to help you get started on the journey toward healing:
Want to do more to prevent suicide? Here are some ways to get involved with suicide prevention:
One of the risk factors for suicide is feelings of rejection. Members of the LGBT group are especially at risk for suicide. The It Gets Better Project aims to provide support for the LGBT community and increase awareness of some of the difficulties they face.
Organizations, such as the American Foundation for Suicide Prevention, host or sponsor community walks which can help raise awareness, honor a loved one or help raise money for suicide prevention and research.
There are local chapters of the American Foundation for Suicide Prevention where individuals can help organize fundraisers, reach out to the community or deliver suicide prevention messages.
Help the American Foundation for Suicide Prevention decrease the amount of people that die every year from suicide by becoming an advocate.
You can do this at your school or workplace. Freedom from Fear offers materials to help organize an event.
Visit Take5tosavelives and discover the five simple ways you can lend support and get involved in the suicide prevention movement.
This could include providing information on your social media or webpage as well as posting fliers in your community.
Workshops such as ASIST or safeTALK as offered by LivingWorks prepare you to identify those that need help and intervene or prevent suicide.
It could be a tweet, a Facebook post or a YouTube video explaining suicide warning signs or informing your audience where they can get help if they need it.