**Frequently Asked Questions**
Suicide is a significant cause of death in many western countries, in some cases exceeding deaths by motor vehicle accidents annually. Many countries spend vast amounts of money on safer roads, but very little on suicide awareness and prevention, or on educating people about how to make good life choices.
Attempts at suicide, and suicidal thoughts or feelings are usually a symptom indicating that a person isn't coping, often as a result of some event or series of events that they personally find overwhelmingly traumatic or distressing. In many cases, the events in question will pass, their impact can be mitigated, or their overwhelming nature will gradually fade if the person is able to make constructive choices about dealing with the crisis when it is at its worst. Since this can be extremely difficult, the following information is an attempt to raise awareness about suicide, so that we may be better able to recognize and help other people in crisis, and also to find how to seek help or make better choices ourselves.
So what sort of things can contribute to someone feeling suicidal?
People can usually deal with isolated stressful or traumatic events and experiences reasonably well, but when there is an accumulation of such events over an extended period, our normal coping strategies can be pushed to the limit.
The stress or trauma generated by a given event will vary from person to person depending on their background and how they deal with that particular stressor. Some people are personally more or less vulnerable to particular stressful events, and some people may find certain events stressful which others would see as a positive experience. Furthermore, individuals deal with stress and trauma in different ways; the presence of multiple risk factors does not necessarily imply that a person will become suicidal.
Depending on a person's individual response, risk factors that may contribute to a person feeling suicidal include:
Significant changes in Relationships:
- Well-being of self or family member.
- Body image.
- Job, school, university, house, locality.
- Financial situation.
- World environment.
- Death of a loved one.
- Loss of a valued relationship.
- Loss of self esteem or personal expectations.
- Loss of employment.
How would I know if someone I care about was contemplating suicide?
Often suicidal people will give warning signs, consciously or unconsciously, indicating that they need help and often in the hope that they will be rescued. These usually occur in clusters, so often several warning signs will be apparent. The presence of one or more of these warning signs is not intended as a guarantee that the person is suicidal: the only way to know for sure is to ask them. In other cases, a suicidal person may not want to be rescued, and may avoid giving warning signs.
Typical warning signs which are often exhibited by people who are feeling suicidal include:
- Withdrawing from friends and family.
- Depression, broadly speaking; not necessarily a diagnosable mental illness such as clinical depression.
- Loss of interest in usual activities.
- Showing signs of sadness, hopelessness, irritability.
- Changes in appetite, weight, behavior, level of activity or sleep patterns.
- Loss of energy.
- Making negative comments about self.
- Recurring suicidal thoughts or fantasies.
- Sudden change from extreme depression to being `at peace' (may indicate that they have decided to attempt suicide).
- Talking, Writing or Hinting about suicide.
- Previous attempts.
- Feelings of hopelessness and helplessness.
- Purposefully putting personal affairs in order.
- Giving away possessions.
- Sudden intense interest in personal wills or life insurance.
- Clearing the air' over personal incidents from the past.
This list is not definitive: some people may show no signs yet still feel suicidal, others may show many signs yet be coping OK; the only way to know for sure is to ask. In conjunction with the risk factors listed above, this list is intended to help people identify others who may be in need of support.
If a person is highly perturbed, has formed a potentially lethal plan to kill themselves and has the means to carry it out immediately available, they would be considered likely to attempt suicide
What should I do if someone tells me they are thinking about suicide?
When someone is considering suicide, even though you may wish you could talk them out of it, that is not the best way to help. Avoid saying things like, “You have so much to live for,” or “Think about how this will hurt your family.” Instead, show concern and compassion by saying, “Things must really be awful for you to be feeling that way.” Let them know you are there to listen. Encourage them to share what they are feeling. Let them know that people sometimes feel like there is no answer, but that treatment can help them to feel better. Tell them you will support them to find help. Ask if they have a specific suicide plan. If they do, do not leave them alone, and take away any firearms, drugs, or objects they could use to hurt themselves. Take them to a doctor, mental health professional, or hospital emergency room, or call 911 or the National Suicide Prevention Lifeline at 1-800-273-8255 for help.
If somebody really wants to end their life, is there anything I can do to stop them?
Most of the time, when someone thinks or talks about suicide they actually have mixed feelings about dying. Most often, suicidal feelings come from having a mental illness, and these illnesses can be treated with professional help. Medication, talk therapy, or a combination of the two has been shown to save lives. The best way to help is to encourage and assist the suicidal person to get the help they need.
What should I do if I encourage a suicidal person to get help but they refuse?
To someone feeling suicidal, depressed, or anxious, the idea of talking to a doctor or mental health professional can seem overwhelming. Sometimes suicide seems like the only way to control their pain. Continue to tell them that you are concerned about them, and to suggest that a professional who understands what they are feeling can help them to feel better. Let them know you are there to listen, and offer help finding or getting to a doctor, mental health professional, or hospital emergency room. You can also help by staying with them and calling the National Suicide Prevention Lifeline at 1-800-273-8255. If you are concerned that the person will hurt themselves call 911.
If a friend confides in me that they are thinking of suicide and makes me promise not to tell, shouldn’t I respect their right to privacy?
Privacy is very important, but your friend’s life is even more important. Depression and other mental disorders may be distorting their judgment and leading them to want to hurt themselves. Even if you lose your friendship, saving a life is the most important priority. Tell someone you trust about your friend and ask for their assistance getting them to a professional.
My friend purposely cuts herself when she is upset. Is this the same as making a suicide attempt?
Some people cut or otherwise hurt themselves when they feel overwhelmed by difficult or stressful feelings, or to relieve their inner tension. Many people who cut themselves never attempt to kill themselves. However, in some cases, self-harm is the first indication that someone may be at risk for suicidal behavior. Whether or not they feel an impulse to take their own lives, someone who is cutting or otherwise hurting themselves needs help. Health and mental health professionals are trained to determine whether a person is at risk for suicide, and to suggest a treatment plan to help them with their self-harm behavior and underlying feelings.
Is it true that a person who talks about suicide isn’t really planning to do it?
No, that is not true. In fact, most people who die by suicide tell someone they plan to hurt themselves before they take their lives. When someone tells you they are thinking of suicide, they are giving you a precious opportunity to help before it’s too late. All mentions of suicide should be taken seriously.
Why do I feel so uncomfortable at the thought of talking to someone who is thinking of killing themselves?
Many of us grow up with the belief that people who take their own lives are crazy, selfish, or have some kind of a moral defect. As they understand that suicidal thinking and behavior is the result of a treatable medical condition, people become less fearful and more able to listen to a person in distress with empathy and without judgment. Even if it makes you feel anxious, remember that listening and encouraging treatment can help.
With the combined stresses of work or school, relationships, financial pressures, and family problems, isn’t it normal to feel depressed sometimes? Do we all need mental health treatment?
Most of us do have a lot to feel stressed about, and it’s normal to feel depressed sometimes. However, the following signs may mean that someone is seriously depressed and in need of help. Someone who is seriously depressed may have little interest or pleasure in doing things they used to enjoy. They may have trouble falling or staying asleep, or they may sleep more than usual. They may lose their appetite, or eat more than usual. They may feel tired or without energy, or like everything around them is moving slowly. Or they may feel agitated, fidgety, and restless. They may have trouble concentrating. They may feel like a failure, or that they have let themselves or someone else down. They may feel that they would be better off dead.
When someone notices changes in some or all of these areas that continue, day in and day out for at least two weeks, they may be seriously depressed. Someone who feels this way for two weeks or more should talk to their doctor or a mental health professional about their feelings. Even though we all sometimes feel stressed and depressed, this type of persistent depression is not normal and it can be treated. There is help and there is hope.
What should I do if experience the signs of depression?
If you have lost interest in doing things you usually enjoy, have had changes in your sleeping or eating habits, feel listless or agitated, have trouble concentrating, and feel blue every day for two weeks or more, you may be seriously depressed. Talk to someone you trust about your feelings. Make an appointment with your family doctor, or ask someone for help making an appointment. Do not keep your feelings to yourself. Talking to someone may seem hard, but most people find it makes them feel better after they let someone know they need help. Your close friends and family may already have noticed that you seem sad or tired. Letting them know what’s going on will help them to understand and support you.
Is there a questionnaire I can fill out to find out if I’m depressed?
You may find user-friendly depression screening questionnaires online, such as the PHQ-9. These questionnaires can help you to learn the symptoms of depression, and to decide whether to seek out a mental health professional, or encourage someone to do so. However, questionnaires cannot take the place of a doctor or mental health professional who can help you to figure out why you are feeling the way you do. A trained professional can work with you to find out if you have a treatable illness or mental illness and get you started on the path to healing. You may wish to start by taking an online test, but the best way to get help is by meeting in person with your doctor or a mental health professional.
How long does depression last?
Untreated depression can last for months or even years. But there is hope: With treatment, most people feel much better within a couple of months. Even after you feel better, professionals generally recommend staying in treatment for six months to a year to make sure that you continue feeling well.
Can antidepressant medications change you, or make you suicidal?
Research shows that depression is caused, at least in part, by changes in brain chemistry. Antidepressant medications work to reset the brain, helping you go back to feeling like yourself. When they are working effectively, antidepressants will help you to sleep better and feel more able to cope with things that used to upset you. You may feel more energetic, more talkative, and more interested in the world around you.
Some people experience side effects from antidepressant medications. While taking antidepressants or other medications, it is important to stay in close touch with your doctor, and to talk with her or him about all of the changes you feel and notice. Your doctor can change your medication or adjust your dosage to help you get the most benefit with the fewest side effects.
Studies show that early treatment with antidepressant medication can stop symptoms of depression from becoming more severe and long-lasting. They can also reduce the risk of the depression coming back, and reduce the risk of suicide resulting from depression. In a very small percentage of adolescents and young adults, antidepressants may contribute to increased suicidal thoughts or behaviors.However, no studies have found antidepressant use in any age group to be associated with completed suicide. In general, the benefits of antidepressant medication outweigh any risks.
Is someone who has had suicidal ideation or a recent attempt and is now feeling better still at risk for suicide?
Successful treatment for serious depression or suicidal behavior significantly reduces the long-term risk for suicide. However, it can be difficult to know where a suicidal person is in their recovery. Someone who has felt suicidal may work hard to hide his or her feelings, and may appear to be functioning well socially, professionally, or academically. In some cases, a person who has made the decision to die may seem calmer and at peace. Each year, suicide claims the lives of people who seemed happy, well-liked, and successful to his or her friends, families, and others around them. Staying in treatment after the suicidal thoughts and symptoms seem to be getting better is the best way to ensure a successful recovery. The decision to stop treatment should be made together by the mental health professional and patient.
Does psychotherapy (talk therapy) help to heal depression?
Psychotherapy includes a broad range of treatments that may or may not help a particular person or mental health condition. Most forms of open-ended psychotherapy have not been systematically tested or proven to be effective in treating depression. Short-term (16 weeks or less) intensive, structured therapies—like cognitive behavioral therapy—have been shown to be effective for depression, anxiety, borderline personality disorder, and suicide attempts.
Can lay people be trained to help prevent suicide?
Recognizing the risk factors and warning signs of suicide can help to save lives. Equipped with information, even untrained people can intervene to get help for suicidal or at-risk family members, friends, or acquaintances. Some people seem to be more inclined and better equipped to observe and reach out to others in this way. These people are called “natural gatekeepers.” Research suggests that brief gatekeeper trainings may increase knowledge but may not be effective in actually helping at-risk individuals. However, there are many classes offered in your community. Check with your local suicide prevention organizations for resources and class availability schedules.