Understanding and Helping to Prevent Suicide

Who Commits Suicide?

Suicide and attempted suicide are all too common. Each year more than 800,000 people around the world take their own lives, including almost 40,000 in the United States (World Health Organization, 2014). For every death by suicide, it’s estimated that 25 people have attempted suicide—a total of about 1,000,000 attempts a year in the United States alone (Centers for Disease Control, 2012). In any given year, almost 500,000 people in the United States require emergency room treatment as a result of attempted suicide (CDC, 2012).

Most people don’t realize that more than twice as many Americans die each year from suicide as from homicide. In 2009, suicide was the 10th leading cause of death, while homicide ranked 15th (Kochanek & others, 2011). The global numbers are equally surprising. One recent headline read: “More People Die from Suicide Than from Wars, Natural Disasters Combined” (Schlein, 2014).

In the United States, women outnumber men by three to one in the number of suicide attempts. However, men out-number women by more than four to one in suicide deaths, primarily because men tend to use more lethal methods, such as shooting and hanging (CDC, 2012; Kochanek & Smith, 2004).

Suicide is the third leading cause of death for young people ages 15 to 24, accounting for 20 percent of annual deaths in this age group (CDC, 2012). Over the past four decades, the suicide rate for adolescents and young adults has increased by almost 300 percent (U.S. Public Health Service, 1999). Although this trend has received considerable media attention, the suicide rate of adolescents and young adults is still below that of older adults. In fact, the highest suicide rate consistently occurs in the oldest segments of our population—among those aged 75 and above (Kochanek & Smith, 2004).

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A notion that is often perpetuated in the popular press is that there is a significant increase in the number of suicides during the winter holidays. This claim is a myth, plain and simple. However, there are consistent seasonal variations in suicide deaths. In the United States, suicide rates are lower during the fall and winter months and higher during the spring and summer months (Kposowa & D’Auria, 2010).

What Risk Factors Are Associated with Suicidal Behavior?

Hundreds of studies have identified psychosocial and environmental factors associated with an increased risk of suicidal behavior (see L. Brown & others, 2004; Gould & others, 2003; Hawton & others, 2012; Joiner & others, 2005; Lieb & others, 2005; Nock & others, 2013). Factors that increase the risk of suicidal behavior include:

Why Do People Attempt or Commit Suicide?

The suicidal person’s view of life has become progressively more pessimistic and negative. At the same time, his view of self-inflicted death as an alternative to life becomes progressively more acceptable and positive (Shneidman, 1998, 2004).

Some people choose suicide to escape the pain of a chronic illness or the slow, agonizing death of a terminal disease. Others commit suicide because of feelings of hopelessness, depression, guilt, rejection, failure, humiliation, or shame (Lester, 1997, 2010). The common denominator is that they see suicide as the only escape from their own unbearably painful emotions ( Jamison, 2000; Lester, 2010).

When faced with a dilemma, the average person tends to see a range of possible solutions, accepting the fact that none of the solutions may be ideal. In contrast, the suicidal person’s thinking and perceptions have become rigid and constricted. She can see only two ways to solve her problems: a magical resolution or suicide. Because she cannot imagine a realistic way of solving her problems, death seems to be the only logical option (Shneidman, 1998, 2004).

How Can You Help Prevent Suicide?

If someone is truly intent on taking his or her own life, it may be impossible to prevent him or her from doing so. But that does not mean that you can’t try to help a friend who is expressing suicidal intentions. People often turn to their friends rather than to mental health professionals. If a friend confides that he or she is feeling hopeless and suicidal, these guidelines may help you help your friend.

It’s important to stress, however, that these guidelines are meant only to help you provide “psychological first aid” in a crisis situation. They do not qualify you as a suicide prevention expert. Your goal is to help your friend weather the immediate crisis so that he or she can be directed to a mental health professional.

Guideline 1: Actively listen as the person talks and vents her feelings.

The majority of those who attempt suicide communicate their intentions to friends or family members (Shneidman, 1998). When a friend is despondent and desperate, you can help by listening, expressing your understanding and compassion, and, if necessary, referring him to a professional counselor or suicide prevention specialist.

The suicidal person often feels isolated or lonely, with few sources of social support (Joiner, 2010). Let the person talk, and try to genuinely empathize with your friend’s feelings. An understanding friend who is willing to take the time to listen patiently without passing judgment may provide just the support the person needs to overcome the immediate suicidal feelings.

Guideline 2: Don’t deny or minimize the person’s suicidal intentions.

Brushing aside suicidal statements with platitudes, like “Don’t be silly, you’ve got everything to live for,” or clichés, like “Every cloud has a silver lining,” is not a helpful response. This is not the time to be glib, patronizing, or superficial. Instead, ask your friend if she wants to talk about her feelings. Try to be matter-of-fact and confirm that she is indeed seriously suicidal, rather than simply exaggerating her frustration or disappointment.

How can you confirm that the person is suicidal? Simply ask, “Are you really thinking about killing yourself?” Talking about specific suicide plans (how, when, and where), giving away valued possessions, and putting one’s affairs in order are some indications that a person’s suicidal intentions are serious.

Guideline 3: Identify other potential solutions.

The suicidal person is operating with psychological blinders that prevent him from seeing alternative courses of action or other ways of looking at his problems. How can you remove those blinders? Simply saying “Here are some options you may not have thought about” is a good starting point. You might list alternative solutions to the person’s problems, helping him to understand that other potential solutions do exist, even though none may be perfect (Shneidman, 1998).

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Guideline 4: Ask the person to delay his decision.

Most suicidal people are ambivalent about wanting to die. If your friend did not have mixed feelings about committing suicide, he probably wouldn’t be talking to you. If he is still intent on suicide after talking about other alternatives, ask him to delay his decision. Even a few days’ delay may give the person enough time to psychologically regroup, consider alternatives, or seek help.

Guideline 5: Encourage the person to seek professional help.

If the person is seriously suicidal and may harm herself in the near future, do not leave her alone. The most important thing you can do is help to get the person referred to a mental health professional for evaluation and treatment. If you don’t feel you can do this alone, find another person to help you.

There are any number of resources you can suggest, including local suicide hotlines or mental health associations, the college counseling service, and the person’s family doctor or religious adviser. You can also suggest calling 1-800-SUICIDE (1-800-784-2433), which will connect you with a crisis center in your area.