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Suicide and suicidal behavior

Definition

Suicide is the act of deliberately taking one's own life. Suicidal behavior is any deliberate action with potentially life-threatening consequences, such as taking a drug overdose or deliberately crashing a car.

Causes, incidence, and risk factors

Suicidal behaviors almost always occur in people with depression, bipolar disorder, schizophrenia, and alcohol dependence.

People who attempt suicide are often trying to get away from a life situation that seems impossible to deal with. Many who make a suicide attempt are seeking relief from:

• Bad thoughts or feelings
• Feeling ashamed, guilty, or like a burden to others
• Feeling like a victim
• Feelings of rejection, loss, or loneliness

Suicidal behaviors may be triggered by a situation or event that the person views as overwhelming, such as:

• Aging (the elderly have the highest rate of suicide)
• Death of a loved one
• Dependence on alcohol or other drug
• Emotional trauma
• Serious physical illness
• Unemployment or financial problems

Risk factors or triggers for suicide in adolescents include:

• Access to firearms
• Family member who committed suicide (almost always someone who shared a common mood disorder)
• History of deliberate self-harm
• History of neglect or abuse
• Living in communities where there have been recent outbreaks of suicide in young people
• Romantic breakup

Suicide attempts that do not result in death are much more common than completed suicides. Many of these suicide attempts are carried out in a way that makes rescue possible. These attempts often represent a desperate cry for help.

The method of suicide may be somewhat nonviolent, such as poisoning or overdose. Males, especially elderly men, are more likely to choose violent methods, such as shooting themselves. As a result, suicide attempts by males are more likely to be completed.

Relatives of people who seriously attempt or complete suicide often blame themselves or become extremely angry, seeing the attempt or act as selfish. However, when people are suicidal, they often mistakenly believe that they are doing their friends and relatives a favor by taking themselves out of the world. These irrational beliefs often drive their behavior.

Symptoms

Most people who develop thoughts about suicide have already been diagnosed with depression, bipolar disorder, or some other psychiatric disorder. As a result, they may continue to have symptoms, even when they are receiving treatment.

Often, but not always, certain symptoms or behaviors may be present or getting worse before a suicide attempt:

• Difficulty concentrating or thinking clearly
• Giving away belongings, taking about going away or the need to "get one's affairs in order"
• Sudden change in behavior, especially calmness after a period of anxiety
• Loss of interest in activities that were previously enjoyable
• Performing self-destructive behaviors, such as drinking alcohol, using illegal drugs, or cutting
• Sudden difficulty in school or work performance
• Talking about death or suicide, or even stating the desire to harm themselves
• Talking about feeling hopeless or guilty
• Unusual changes in sleep or eating habits
• Withdrawal from friends or an unwillingness to go out anywhere

Signs and tests

Treatment

A person may need emergency measures after attempting suicide. First aid, CPR, or mouth-to-mouth resuscitation may be needed.

Hospitalization is often needed to treat a suicide attempt and to prevent future attempts. Mental health intervention is one of the most important aspects of treatment.

After suicidal behavior is addressed, any underlying disorders should be treated (such as major depression, bipolar disorder, or alcohol dependence).

Adolescents may fail to seek help for suicidal thoughts, for all of the following reasons:

• They believe nothing will help
• They are reluctant to tell anyone they have problems
• They think it is a sign of weakness to seek help
• They do not know where to go for help

There are numbers that you can call from anywhere in the United States, 24 hours a day, 7 days a week: 1-800-SUICIDE or 1-800-999-9999.

Support Groups

Expectations (prognosis)

Suicide attempts and threats should always be taken seriously. About one-third of people who attempt suicide will repeat the attempt within 1 year, and about 10% of those who threaten or attempt suicide eventually do kill themselves.

Mental health care should be sought immediately. Dismissing the person's behavior as attention-seeking can have devastating consequences.

Complications

Complications vary depending on the type of suicide attempt.

Calling your health care provider

Call a health care provider right away if you notice one or more suicide warning signs.

Prevention

Avoiding alcohol, narcotics, sedatives that have not been prescribed, and illegal drugs can help prevent suicide. These substances affect the brain and can make the depression worse over time.

In homes with adolescents:

• All prescription medicines should be kept secure.
• Do not keep alcohol in the home, or keep it locked up.
• Securely lock all guns and keep the ammunition separate.

Many people who attempt suicide talk about it before making the attempt. Sometimes, simply talking to a sympathetic, nonjudgmental listener is enough to prevent the person from attempting suicide. For this reason suicide prevention centers have telephone "hotline" services. Again, do not ignore a suicide threat or attempted suicide.

As with any other type of emergency, it is best to immediately call the local emergency number (such as 911). Do not leave the person alone even after phone contact with an appropriate professional has been made.

References

Zuckerbrot RA, Cheung AH, Jensen PS, Stein RE, Laraque D. GLAD-PC Steering Group. Guidelines for Adolescent Depression in Primary Care (GLAD-PC):I. Identification, assessment, and initial management. Pediatrics. 2007;120:e1299-e1312.

American Psychiatric Association. Practice guidelines for the treatment of patients with major depressive disorder. 2nd ed. September 2007. Accessed January 22, 2010.

Bridge JA, Iyengar S, Salary CB, et al. Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials. JAMA. 2007;297:1683-1696.

Cheung AH, Zuckerbrot RA, Jensen PS, Ghalib K, Laraque D, Stein RE. GLAD-PC Steering Group. Guidelines for Adolescent Depression in Primary Care (GLAD-PC):II. Treatment and ongoing management. Pediatrics. 2007;120:e1313-e1326.