Suicide is a complex issue that affects individuals, families and communities. It is also a preventable public health problem.
Helping someone who is at risk for suicide is not easy, but it can be done. The first step is to connect them with resources, like the 988 Suicide and Crisis Lifeline (call or text 988).
Identifying people at risk
Suicide takes an enormous toll, costing the healthcare system over $70 billion and resulting in untold losses by families. It’s not easy to know how to prevent suicide because it isn’t entirely within one person’s control and can be triggered by many different factors.
People of all ages and genders can experience suicide, and it is important for everyone to learn to recognize warning signs. These include being preoccupied with thoughts or writing about death, having impulsive or risk-taking behaviors, or withdrawing from social activities that they normally enjoy. It’s also important to know that a person who is expressing suicidal thoughts may want to talk about them or be helped in finding ways to cope.
Several states, including Colorado, North Carolina and Vermont, are promoting safe storage of lethal means in rural areas to help reduce access to firearms. Funded states are also identifying and supporting people at risk by providing gatekeeper training.
Supportive relationships and community connectedness
Researchers have found that people who feel supported by friends and family members are less likely to kill themselves. Similarly, having access to lethal means of suicide can be a suicide risk factor.
Fullerton explains that relationships with adult figures, both at home and within the community, are important. For adolescents, having an adult who cares and believes in their success can make a big difference. Similarly, adolescent’s who felt that their teachers cared about them at school tended to have lower suicide attempt rates than those who did not.
For those not able to draw on supportive relationships at home, she adds that social group interventions and infrastructural changes can also make a big difference. Residents of Town A, for example, made mention of the fact that they were able to engage with their community through the health intervention’s provision of safe, communal areas to meet and congregate. They also referred to other infrastructural and social change unrelated to the programme that had impacted their sense of connectedness.
Identifying risk factors
The ability to identify and assess risk factors for suicide is important for people working in health care, including those within mental health care who are developing effective intervention plans and providers outside of the specialty who are often the first to screen their patients. People who are thinking about suicide, self-harm or are at risk of harming others should be referred to mental health care and given access to help.
Research on risk factors for suicide has focused primarily on psychological autopsy studies. These studies provide useful effect sizes for a wide range of risk factors that contribute to a person’s risk of suicide, including mental health disorders, adverse life events and family history.
Among the most significant risk factors for suicide are a history of past attempts or death by suicide, access to lethal means and a belief that taking one’s own life is a good solution. Other risk factors include a diagnosis of depression or other mental illness, drug or alcohol use and exposure to the suicidal behavior of other people.
Identifying protective factors
Research is increasingly focused on finding ways to reduce the risk factors for suicide. It’s also important to identify protective factors – characteristics that make it less likely that people will consider, attempt or die by suicide.
For example, a person who has strong social connections is protected from suicide by a sense of belonging and support. Research has shown that people who feel cared for and esteemed by others are less at risk for suicidal thoughts and behaviours. The mindfulness practice of acceptance and gratitude may also help people regulate intense emotions. A person who experiences chronic physical illness or pain may be protected by a sense of self-compassion and the belief that their suffering is worthy of compassion.
Psychological factors that may increase suicide risk include a history of depression or other mental health issues, a family history of suicidal ideation and impulsivity. A sense of being a burden on others is also a risk factor, especially when it’s related to discrimination and prejudice against LGBT people.