Assessing Suicidal Risk
By Maryanne Watson, PhD, ABPP
Following a suicide or an attempted suicide, invariably the first questions are “Why?” and “What could I have done?” The reasons for suicide are often unclear and the survivors are left to speculate about the cause.
Several suicide risk factors have been identified.
Those most at risk are individuals with depressive disorders, alcoholics, those with a previous suicide attempt, and those with a relative who has committed suicide. Men are 3 times more likely to complete suicide than women, while women have 3 times more attempts than men. With both men and women, the suicide risk factor increases after the age of 45.
The highest percentage of suicides (over 50%) occur when a person is depressed. A person with a mood disorder (such as depression or manic depression) has a 15% chance of completing suicide. With depression, the person feels worthless, there is a loss of interest in aspects of life associated with happiness, and life becomes a painful existence without hope for relief. Under these conditions, thoughts occur in which suicide is the only solution for the despair. Depression is treatable with medication.
Another major cause of suicide (approximately 20%) is substance abuse, particularly alcoholism (daily to weekly drinking). The destructive effect of alcoholism involves the impact the alcoholic has on important relationships. Alcoholics frequently give the following reasons for the suicide attempt: family trouble, legal trouble, or loss of job. Alcoholism is a treatable problem. Because there are suicides that are unexplained by depression or alcoholism, we can only speculate about the causes. Many experts believe that a major cause of suicide is anger turned inward (against the self). The suicidal person is furious and has no outlet for anger. The internalized anger becomes a motivating force to “get even” with another person. Using this theory, suicide is committed toward at least one other person for the purpose of expressing anger. The belief is that the survivor will live on, yet forever bear the impact of the suicide.
What should I do if I suspect that someone is contemplating suicide? Two contradictory myths surround suicide. The first myth is that if someone talks about suicide, they will not act on it. In fact, most people who attempt or complete suicide have communicated their intent to at least one other person. Although suicide intent is expressed, many times the person receiving the communication does not know how to respond. The second myth is that asking about suicidal intent may encourage suicide. The fact is that many lives have been saved because significant others have sought immediate intervention either through hospitalization or with a trained mental health professional.
There are many danger signs of suicidal potential. Isolation with absence of a support system is a major sign of both depression and suicidal risk. Extreme changes in behavior such as withdrawal, sadness or expressionless appearance, or acting out behavior (driving recklessly, increased drinking or taking illegal drugs) are danger signs. Of course communication of suicidal thoughts and feelings should always be taken seriously. The most dangerous people are those who have a plan to kill themselves, the means to carry it out, and who have the perception of suicide as a viable option. Giving away belongings is often a precursor of a suicide attempt.
Suicidal behavior always involves faulty thinking. The suicidal person has one or more of the following cognitive errors: suicide will be a relief to my family because I am a burden; I will never get better; people will get over it in time; the world is a better place without me. Correcting these cognitive errors decreases suicidal risk.
If you or someone you love perceive suicide as a solution for your problems, please get help. If you are uncertain whether or not someone you love is contemplating suicide, ask.To perceive suicide as an option, a person is often in denial about the impact suicide has on the survivors. Communicate the impact the loss would have on you and seek professional help. Trained mental health professionals can provide the suicidal patient with adaptive coping mechanisms. Many times the most effective means of reducing suicidal risk is to hospitalize the person temporarily. The high rates of communication of intent indicate that suicide is a premeditated act with time to seek treatment.
Treatment involves correctly diagnosing the underlying problem. If the person is depressed, treatment often involves medication with an anti-depressant. Therapy will aid in developing adaptive coping mechanisms. The suicidal person will learn to discriminate between thoughts, feelings, and behaviors. By developing impulse control, the suicidal person will learn to express the feelings and thoughts about suicide and suicidal despair without acting on the feelings.
Many times developing a life plan or “life box” for times of danger will buy the necessary time to keep safe. A life plan or “life box” contains
- A written contract not to act on suicidal thoughts or impulses.
- A list of reasons to live and those who would be affected by a suicide is also included. Pictures of loved ones help decrease denial related to the impact on others.
- What to do during a time of crisis (such as phone numbers of the therapist and psychiatrist involved in treatment, as well as the suicide crisis hot line.)
A suicidal person can not control their thoughts and feelings. They can, with help, control their behaviors.