Preventing Suicide: How to Spot the Warning Signs

“Barbara” seemed like a happy, promising 16-year-old young woman. She lived in a small, southeastern town, had many friends and was active in her church. Her parents were kind and understanding, and although her mother was sick with a chronic disease, the family was always sharing, communicating and involved in each other’s lives. So when Barbara hung herself in the basement of her family’s home, everyone was shocked.

Few people knew Barbara had been treated for depression, and even those
who did thought she was on her way to a healthy recovery. What they did
not know was that Barbara, like the 30,000 other Americans who commit suicide every year, was caught in an emotional firestorm. She was trapped by feelings
of hopelessness and fear, and felt she had no place to turn.

“These are intensely personal crises where a person feels so isolated, so depressed, that they see no way out,” says Nancy H. Nielsen, M.D., Ph.D., an American Medical Association (AMA) trustee and an internist in Buffalo, N.Y. “It’s a tragedy happening across our country, with people of all ages, particularly adolescents and the elderly. We need to ask, ‘What can we as a society -- not just physicians, but as a society -- do to prevent this huge public health crisis?’”

* Recognizing the warning signs

That answer requires a thorough understanding of suicide’s treacherous scope. As Nielsen said, the situation is particularly alarming among young people -- in 1999, more teenagers and young adults died from suicide than from cancer, heart disease, AIDS, birth defects, stroke and chronic lung disease combined.

Older age groups are not immune. According to the National Institutes of Mental Health, the highest death rate from suicide in the nation is found among white men over the age of 85. A recent study published in the “The Archives of General Psychiatry,” a journal of the AMA, showed that factors such as birthplace, socioeconomic status and sex may be linked to attempted suicide.

“I think there is an increasing awareness about the incidence of mental illness in general, and the problem of suicide in particular,” says David Fassler, M.D., a child and adolescent psychiatrist from Burlington, Vt. and author of “Help Me, I’m Sad: Recognizing, Treating and Preventing Childhood and Adolescent Depression.” “But I think the public still underestimates just how many people are affected.”

The good news, Fassler reports, is that much is known about the early warning signs and risk factors of suicide. “An early warning signal may be a lack of future planning. Someone who appears to be putting their affairs in order by giving things away, making arrangements for the care of pets, and making overtly suicidal statements, such as ‘You won’t have to worry about me much longer,’ may be considering suicide.

Risk factors include a family history of suicide; mental illness, depression, substance abuse, a previous suicide attempt, or even simply a personal experience with suicide, be it a friend, family member or acquaintance. Regarding gender, while women are more likely to attempt suicide, males are more likely to have successful completion. And although there is no empirical data to support the widely-reported statistic that gay and lesbian youth are two to three times more likely to commit suicide than other youth, there is growing concern about such an association.

* How families can cope

Sharon Sweede, M.D., chair of the American Academy of Family Physician’s Commission of Public Health and a staff physician at the Julian F. Keith Alcohol and Drug Abuse Treatment Center in Black Mountain, N.C., has witnessed first-hand suicide’s ugly and far-reaching toll. In her role as part-time county medical examiner, she is exposed to its physical aftermath. But it is in her daily interactions with suffering patients and their families that she sees the emotional impact; and it is here that she has the opportunity to help families heal.

“Suicide should not be a shameful secret that divides a family,” Sweede said at a recent American Medical Association media briefing on suicide in New York. She explained how the mental health of surviving family members and friends affected by suicide is essential for effective recovery and may even help lower risk for future suicides.

Sweede says, medical professionals believe suicides can be prevented. Some tactics include talking to family members or loved ones when it appears they are withdrawing; and realizing that when someone is depressed, firearms should not be available. If a teenager is withdrawn and not communicating, people who care about them need to realize that sitting back and waiting might not be enough.

* Beginning to heal

“Healing is possible. It doesn’t mean a family won’t ever be sad, that they won’t still grieve on some level; but they can have joy and productivity and good relationships with others who are still living,” says Sweede.

For starters, surviving friends and families need to open the lines of communications and talk about the person who has killed themselves. “You need to get through the grieving process and out the other side, by remembering the good times. If you can’t do that on your own, you need to get help from your church, doctor, or other medical professional.”

As for Barbara’s family, Sweede says they handled it as well as could be expected. They had a memorial service, inviting teenagers from around town to come together and share their memories of Barbara.

“Suicide can happen even when everybody’s doing what’s generally recommended. As far as anybody could tell, things were going well with her. We can’t control what another person does. Suicide can still happen, but it’s possible to heal by doing the things we know work -- sharing our grief, talking about it, and letting each other know it’s okay to feel whatever we feel.”

[Courtesy of ARA Content]


Here are some statistics about suicide:


  • Suicide is the eighth leading cause of death for all Americans and the third leading cause in young people aged 15-24

  • The most common method of suicide in the U.S. is by firearm

  • The suicide rate is highest in the Western United States

  • More people die by suicide than are murdered every year

  • Suicide causes approximately 30,000 deaths annually in the United States alone

  • Suicide rates increase with age and are the highest among Americans 65 years of age and older, especially amongst elderly who are divorced or widowed

  • Mental disorders, particularly depression and substance abuse, are associated with more than 90 percent of suicides

  • 73 percent of all suicides are committed by white males

  • A recent study showed there may be certain brain differences in people whose suicide attempts are more likely to be fatal


Sources: National Alliance for the Mentally Ill, Archives of Psychiatry, the Surgeons General’s Call to Action to Prevent Suicide 1999, Centers for Disease Control and Prevention, World Health Organization

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