Risk Factors and Warning Signs of Suicide

If someone you love has clinical depression, there is a strong risk that they will at some point think about suicide. Although estimates vary, the U.S. Department of Health and Human Services reports that around 2% of people who have ever had outpatient treatment for depression die by suicide.

But depression is not the only risk factor for suicide. Suicide accounts for about 1.5% of all worldwide deaths. Other psychiatric conditions including substance use disorders, anxiety disorders, and psychosis can also be risk factors for suicide. While there is a strong relationship between mental health and suicide and the risk is serious, it is important to remember that the majority of people with mental health conditions do not attempt or complete suicide. In fact, the Centers for Disease Control and Prevention (CDC) reports that 54% of people who die by suicide did not have a known mental health condition.

The best way to prevent suicide, according to Suicide Prevention Resources, is to make sure you know the risk factors and warning signs of suicide.

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Risk Factors of Suicide

Risk factors can include both the situations a person experiences and how the person is feeling internally. Though it may be easier to recognize situations and times when suicide is more common, understanding how someone is feeling inside requires a little more detective work.

Life Situations

Certain conditions and situations are associated with an increased risk of suicide, including:

• Death or terminal illness of a relative or friend
• Divorce, separation, or the breakup of a relationship
• Loss of health (real or imagined)
• Loss of job, home, money, status, self-esteem, or personal security
• Drug or alcohol misuse
• Depression

In addition, there are certain times when people may be more prone to suicidal feelings, such as:

• Holidays and anniversaries
• The first week after discharge from a hospital
• When treatment with an antidepressant first begins
• Just before and after diagnosis of a major illness (for example, the risk of suicide in cancer patients is highest shortly after diagnosis rather than after cancer has spread or progressed)
• Just before and during disciplinary proceedings

Emotional and Behavioral Changes

Emotionally, the suicidal person may be feeling:

• Overwhelming pain
• Hopelessness
• Powerlessness
• Worthlessness, shame, guilt, or self-hatred
• Fear of losing control and harming themselves or others

Behaviorally, the person may:

• Appear sad, withdrawn, tired, apathetic, anxious, irritable, or prone to angry outbursts
• Not be performing well in school, work, or other activities
• Become socially isolated or fall in with the "wrong crowd"
• Have declining interest in sex, friends, or activities previously enjoyed
• Neglect personal welfare or let their appearance go
• Experience a change in eating or sleeping habits

Types of Suicide Risk Factors

There are two different types of suicide risk factors: proximal risk factors and distal risk factors.

• Proximal risk factors are immediate signs that signal that a suicide attempt may take place such as recent suicidal thoughts, feelings of hopelessness, recent stressful life events, access to firearms, and learning about someone else dying by suicide.
• Distal factors are background issues or events that can increase the risk of suicide such as comorbid psychiatric conditions, a family history of suicide, and a history of previous suicide attempts.

Warning Signs of Suicide

Suicide warning signs which you should be aware of include:

• Depression
• Previous suicide attempts
• Preoccupation with death
• Statements like, "You would be better off without me" or "I wish I were dead"
• Talking openly about wanting to kill oneself
• Development of a suicide plan, acquiring the means to carry it out, "rehearsal" behavior, or setting a time for the attempt
• Making out a will or giving away favorite possessions
• Inappropriately saying goodbye
• Making ambiguous statements like, "You won't have to worry about me anymore," "I wish I could go to sleep and never wake up," or "I just can't take it anymore"
• Suddenly switching from being very depressed to being very happy or calm for no apparent reason

Safety Plan

While not exclusive to depression, suicidal thoughts are common among people with depression. If you are living with depression but do not feel suicidal, some people find it helpful to make up a contingency plan on the chance that they may feel suicidal in the future.

Suicide Prevention

If you don't know if you should be concerned about a loved one and aren't ready to take them to the emergency room or call the suicide hotline, here are some things you can do.

Be Alert

Know the risk factors and warning signs. Be particularly concerned if your loved one shows multiple suicide warning signs.

Encourage a loved one with depression to seek help. Help them locate treatment resources such as a doctor, therapist, or suicide hotline.

Communicate

Don't discount your loved one's feelings. Even if a situation seems easily fixable to you that doesn't mean that your loved one sees it the same way.

Show Support

Express your love. Even if you feel your love should be obvious through your actions, many people crave—and feel validated by—the expression of that love in words.

Share your feelings with one another. Your loved one may ask you to keep what they share with you to yourself and not tell anyone. But when it comes to suicide warning signs, not only is that ask not fair to you, but it may be in their best interest to involve others if needed. Use your best judgment, and make your loved one's health and safety your first priority.

A Note About Warning Signs

While most people who attempt suicide do show some sort of warning signs, there are also those people who, because of social stigma or a desire to not appear weak, will successfully hide what they are feeling. If you fail to recognize that your loved one is considering or considered suicide, do not blame yourself. Remember that you did the best you could with the information you had.