Department of Psychiatry
Penn Behavioral Health

PAH Outpatient Behavioral Health Clinic

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Newsletter: September 2009

Suicide: Prevention and Intervention

Keren Sofer, Psy.D.


Despite beliefs to the contrary, suicide is in fact comprehensible and preventable with the right knowledge and tools. This newsletter article will provide an outline of the risk factors for suicide, specific warning signs, ways one can help a person who is suicidal, and a resource list of informational websites. One may be tempted to avoid the topic of suicide altogether because of the strong negative feelings it may conjure up; however, learning about what to look for and how to intervene may ultimately save a suicidal individual’s life and get him or her the appropriate help.


Risk Factors

Though the presence of any single risk factor or combination of risk factors does not mean an individual is or will be suicidal, familiarity with these factors can make one aware of vulnerable individuals. A number of risk factors for suicide have been identified through research and are described below.


Psychiatric Disorders

Individuals with a diagnosable psychiatric disorder are at risk for suicide. According to the American Foundation for Suicide Prevention, over 90% of completed suicides were committed by individuals suffering from a psychiatric illness. These illnesses include major depression, bipolar disorder, posttraumatic stress disorder, schizophrenia, among others. These illnesses, in combination with substance abuse, put individuals at particular risk, because not only may they be feeling sad, worthless, guilty, among other symptoms, but the use of drugs or alcohol may further disrupt their ability to think through decisions and reach out for the appropriate help (Moscicki E., 2001).


History of Suicide Attempts or Family History of Suicide

Of the individuals who complete a suicide, between 20 to 50 percent of them have attempted suicide before. Additionally, people who have family members who have committed suicide are at a higher risk for suicide themselves. Those who have family members who committed suicide may view suicide as an option for coping with a crisis or stressors. They may also have a genetic disposition towards psychiatric illness.


Demographics

Certain demographic characteristics, such as gender, geographic location, and ethnic group are connected to variable suicide rates.  In terms of gender, females attempt suicide at a higher rate than males; however, males complete suicide at a higher rate, comprising 79. 4% of all suicides (CDC). Suicide rates vary by geographic location, with more populous areas of the United States having lower rates and more rural areas having higher rates. This discrepancy may be due to greater access to firearms in rural areas, lower population density, and fewer available resources for mental health care (Shumer, F., 2003).  Ethnic groups have varying rates of suicide as well. The highest rates are among American Indians and non-Hispanic Whites, while the lowest rates occur amongst non-Hispanic Blacks and Asians, with the very lowest rate among Hispanics. The group with the highest rate of completed suicide are white men over age 65 (CDC).


Other Risk Factors

The National Institute for Mental Health identifies several other risk factors. A history of family violence and/or physical or sexual abuse puts individuals at a higher risk. Incarceration is another factor that increases one’s risk. In addition, having firearms in the home is a risk, as half of all completed suicides are through this method (Miller, Azrael, Hepburn, Hemenway, & Lippmann, 2002).


Warning Signs

Many who intend to take their own life communicate some warning signs.  A person who is threatening to hurt or kill himself or who is expressing a desire to do so should be taken seriously. In addition, certain behaviors, such as finding a way to hurt or kill oneself are warning signs. For example, if a person seeks firearms or pills, this should alert those close to him or her. A person with a plan and a means to kill him or herself is at a high risk. Giving away one’s possessions may be part of such a plan. Other warning signs include an inability to find alternatives to suicide, the feeling of a lack of purpose in one’s life, withdrawing from others, impulsive or reckless behavior, and increased substance use (NIMH). 


How to Help Someone Who is Suicidal

The American Foundation for Suicide Prevention offers a number of suggestions for those seeking to help a suicidal individual. They urge family and friends to take threats seriously. They note that 50-75% of those who ultimately commit suicide give some warning to others. Listening to the thoughts and feelings of a suicidal loved one is another suggestion, including resisting the urge to talk the person out of it. It is a myth that encouraging one to talk about his or her suicidal thoughts and feelings will encourage him or her to follow through; in fact, allowing the individual to share these feelings is an important part of helping him or her. Accessing professional help, such as through a mental health agency, is strongly encouraged. Psychotherapy can help decrease one’s suicide risk by helping an individual improve coping skills and develop alternatives to hurting oneself.

In the case where someone is acutely suicidal, it is important to stay with that person and ensure he or she does not have access to weapons, pills, or other means to harm him or herself. If able, take the individual to the nearest emergency room or psychiatric crisis center or call 911. 


Suicide Prevention Resources

The Suicide Prevention Action Network

www.spanusa.org

American Association of Suicidology

www.suicidology.org

National Institute of Mental Health (NIMH)

www.nimh.nih.gov

National Youth Violence Prevention Resource Center

http://vetoviolence.cdc.gov/about_us.html

Substance Abuse and Mental Health Services Administration

www.samhsa.gov

Suicide Awareness Voices of Education

www.save.org

The Surgeon General’s Call to Action to Prevent Suicide

http://profiles.nlm.nih.gov/ps/retrieve/ResourceMetadata/NNBBBH

National Mental Health Organization

www.nmha.org


References

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS): http://www.cdc.gov/injury/wisqars/index.html

Miller M, Azrael D, Hepburn L, Hemenway D, Lippmann SJ. The association between changes in household firearm ownership and rates of suicide in the United States, 1981-2002. Injury Prevention 2006;12:178-182; doi:10.1136/ip.2005.010850

Moscicki EK. Epidemiology of completed and attempted suicide: toward a framework for prevention. Clinical Neuroscience Research, 2001; 1: 310-23.

National Institute of Mental Health: http://www.nimh.nih.gov/health/topics/suicide-prevention/index.shtml

Shumer, F. (2003, October 19). Some Stories Are So Jarring They Don't Go Away. New York Times.

 

 

 

 

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