Despite popular notions suggesting that suicides occurring during the second half of life relate predominately to incurable medical conditions, this is not true. Most often they reflect the effects of clinical depression and multiple personal and social factors. While sharp ethical debate surrounds the issue of a person's right to choose suicide to end intolerable pain and debilitation associated with terminal diseases, the vast majority of people who die by their own hands do not have such conditions. Rather they typically are suffering the mental anguish associated with treatable depressive disorders, which often occur in the context of age-related life and functional changes, social isolation (for example, a man living alone long after the death of his wife), and the stresses associated with chronic or nagging-but not life threatening-medical conditions. While the factors contributing to this anguish are multiple and complex, the pain of depression can be as overwhelming and disabling as that of any serious physical disorder. Yet it is not as readily apparent others, in comparison to a cast on the leg or the knowledge that someone is recovering from a "heart attack."
Here are the hard numbers:
- Every year, about 32,000 people kill themselves in the U.S.
- Older adults, especially older white males, have the highest suicide rate.
- Estimates say for every suicide there are six survivors.
- Based on these estimates, during the past 25 years, about five million Americans became survivors of a loved one's suicide.
- The cumulative social, functional, and financial impact on our society of depression and suicide together, including disability and death, exceeds that of cancer. Indeed, they nearly attain the level of cardiovascular diseases. When alcohol related disorders and substance use disorders are added (they often coexist with depression and suicide), they far exceed the impact of caridiovascular disesases.
Depression is treatable! These treatments save lives.
If you or someone you know is in a crisis and needs help right away, call this toll-free number, available 24 hours a day, every day: (8255). You'll reach the National Suicide Prevention Lifeline, a service available to anyone. All calls are confidential.
You can also find valuable information about depression at these earlier episodes of Second Opinion: Second Opinion, Depression, Episode 201, and Second Opinion Heart Disease and Depression, Episode 302..
- Every year, about 32,000 people kill themselves in the U.S.
- Older adults, especially older white males, have the highest suicide rate.
- Estimates say for every suicide there are six survivors.
- Depression is probably the leading cause of suicide, but substance abuse may be involved in half of all cases.
- Major risk factors for suicide include traumatic events, major life changes, past suicide attempts, substance abuse, and a family history of mental problems, suicide, and substance abuse.
- Warning signals that someone may be planning suicide include talking about suicide, or about the worthlessness of life, looking for ways to commit suicide (such as actively trying to buy a gun), withdrawing from friends and family, abrupt changes in mood, routine, and/or personality, dangerous behavior, and increased use of drugs or alcohol.
- Survivors of the suicide of a loved one have experienced a severe, traumatic event. They should seek help from professionals such as grief counselors, social workers, and psychologists, and should also consider joining a bereavement group.
- Friends trying to help survivors of a suicide should try to understand their complex, intense emotions, avoid giving advice, especially when it consists of simplistic clichés, and, most of all, listen to the survivors and be as open, compassionate, and non-judgmental as possible.
Ask Your Doctor
This list of questions is a good starting point for discussion with your doctor. However, it is not a comprehensive list.
If you believe you or a loved one suffers from depression
- What exactly is depression? Is there a widely accepted definition?
- Is there a difference between depression and a "mood disorder"?
- How do I know if I (or a loved one) suffer from depression or am simply going through a "rough patch"?
- What causes depression?
- What are the most common symptoms?
- Does depression affect appetite or diet? Sleep patterns? Energy level? How I view and relate to other people?
- What are the most common treatments?
- Can I be depressed and still work and function more or less normally?
- Is there a relationship between emotional suffering and depression?
- What sort of "environmental" or circumstantial changes affect mental health?
- What's the connection, if any, between depression and physical pain?
- What's the role, if any, of genetics or biological factors in depression?
- What goes into a doctor's development of a diagnosis?
- Why do some people become depressed while others don't?
- My child seems to be always depressed. What can I as a parent do?
If you suspect a loved one is contemplating suicide
- My loved one has been showing these symptoms... What can I do to help him or her? What should I not do?
- Can you recommend a mental health professional to help him or her?
- Can you recommend a support group to help him or her?
- What should I do if the symptoms seem to get worse?
If you are a survivor of a loved one's suicide
- Can you recommend a mental health professional to help me (and my family)?
- Can you recommend any bereavement groups to help me (and my family)?
- Are there other things (treatments, medications, activities, etc.) you can recommend to help me (and my family) at this difficult time?
- I have been suffering these symptoms since my loved one's death... What treatments are available to relieve them? What can I do to relieve them?
- Is there anything I should stop or start doing to help my situation?
Key Point 1
Suicide happens across all demographics. But older white males have the highest suicide rate.
According to the National Institute of Mental Health, suicide is one of the nation's leading preventable causes of death with 11 suicide deaths per 100,000 Americans. For every person who does commit suicide, another 8 to 25 attempt it. That means at least half a million people try to kill themselves in the United States every year. Suicide can happen in any community and in any family. It cuts across gender, age, race and socioeconomics. There is no typical suicide victim. There are, however, groups of people that tend to be at a higher risk than others.
Suicide is the eighth leading cause of death for males and the sixteenth leading cause of death for females. Suicide attempts by men are more often fatal than those by women, perhaps because of the choice of method. Though the numbers are low, very young children (less than 10 years of age) do die by suicide. Suicide is the third leading cause of death among young people 15 to 24 years of age, following unintentional injuries and homicide.
Younger people lose more years of life to suicide than to any other single cause except heart disease and cancer. Perhaps that's why there's a common misperception that suicide rates are highest among the young. In fact, older Americans are disproportionately likely to die by suicide (20% of the population and 40% of suicide victims are over 60) and older white males have the highest suicide rate in the United States.
Experts are divided over how to explain the elevated risk of suicide for older white men. They speculate that men:
- Don't acquire the resilience and coping mechanisms that women do throughout their lives
- Experience more pressure from the expectations our culture puts on them to be achievers versus their capacity to reach those expectations, both present and past
- Are socialized to be in control and react more dramatically than women to:
- Retirement and loss of an important role and the self esteem that accompanies it
- The loss of autonomy
- Functional disability
- Socioeconomic decline
- The feeling they are no longer useful to those around them and, worse, may become a burden to family members
- Are less likely to share their feelings with anyone
- Are more successful at suicide because they tend to choose more lethal means to accomplish it
Suicide is rarely, if ever, caused by any single event or reason. Many factors work in combination over time to make people feel hopeless and overcome by despair. The important points to note are that most suicidal people usually don't want to die but are desperate to stop the pain, and the majority can improve if they receive treatment with antidepressant medication, psychotherapy, or a combination of both.
Key Point 2
While there are certain traits and personalities that make a person a greater suicide risk, families and friends are often surprised when a person takes his or her own life. Knowing these traits and personalities, as well as any significant life changes the individual is going through, could help in the assessment of his or her suicide risk.
First, be aware of the risk factors for suicide and suicide attempts. Some of them depend on a person's age, gender, or ethnic background, and they can change over time. In general, men and older people are at higher risk than women and younger people. The most important risk factors are depression and other mental disorders (such as bipolar disorder, schizophrenia, or personality disorders). Other major risk factors include the following, many of which can trigger depression:
- Traumatic events, such as:
- The loss of a loved one
- The onset of a major disease
- Being fired
- Financial reversal or ongoing financial problems
- The end of a relationship, separation, or divorce
- Major life changes, such as:
- A major (and disruptive) move
- A major job change, especially one involving a demotion or loss of status
- Past suicide attempts
- Alcohol or drug abuse
- Family history of mental disorders
- Family history of suicide
- Family history of alcohol or drug abuse
- Violence within the family
- Serious illness or chronic pain
- Disruptive behavior (a risk factor in young people)
Risk factors are general conditions affecting one's life. But there are also specific warning signs or signals that someone is contemplating suicide. One of the most obvious is talking about it. Although some people give no warning about a planned suicide, many others say things like "I wish I were dead," "I wish I'd never been born," or even "I'd like to kill myself." People around the potential suicide may think this is "just talk" and ignore its serious implications.
Other warning signals include:
- Direct or indirect threats to commit suicide
- Talking or writing about death, dying, or suicide (if the person doesn't normally do this)
- Increasingly talking about or acting out emotions of
- Tension or anxiety
- Rage or uncontrolled anger
- Seeking revenge
- Feeling trapped, as if "there's no way out"
- Seeing no reason for living or having no sense of purpose in life
- Looking for (or talking about looking for) ways to commit suicide, such as
- Trying to get a gun
- Trying to get pills
- Withdrawing from friends, family, and social contact; wanting to be left alone
- Abrupt changes in mood, such as being very "down" one day, very high the next
- Changes in routine
- Unusual sleep patterns
- Unusual eating patterns
- Changes in personality or behavior (especially sudden ones), such as becoming calm after being very anxious, or outgoing after being shy
- Dangerous or self-destructive behavior, such as unsafe driving
- Giving away belongings or "getting affairs in order"
- Saying goodbye to people as if they won't be seen again
- Increasing alcohol or drug use
The American Association of Suicidology, a not-for-profit organization dedicated to understanding and preventing suicide, has come up with a device to help us remember the major warning signs, the emotions and actions of a potential suicide. The device is the phrase, IS PATH WARM? It stands for:
I - Ideation (expressing the Idea of suicide; threatening or talking about it; etc.) S - Substance Abuse
P - Purposelessness A - Anxiety T - Trapped H - Hopelessness
W - Withdrawal A - Anger R - Recklessness M - Mood Change
Although these warning signs are very typical, some people who commit or attempt suicide give no warnings at all. They have become very adept at hiding their feelings.
This is especially true of men. Unfortunately, many men still believe the ideal male is the "strong, silent type." They refuse to show negative emotions, despite overwhelming evidence that the stress produced by repressing them can lead to a wide range of health problems, including an increased risk of suicide. Worse, the culture as a whole remains less supportive of men talking about their feelings.
This may partly explain why older men, especially older white men, have the highest suicide rates. They believe they must still be "the head of the family;" they don't want to "burden others" with their unhappiness; if they're retired, they think this "should be" the best time of their lives. Finally, many men still see a stigma attached to any admission of depression or other mental health issues. And for some, mental health care is inaccessible or too expensive. The result: men kill themselves.
If you do notice the risk factors and/or warning signs of suicide in someone, the best way to find out if they really are contemplating suicide is to ask them. This isn't always easy; you may be very uncomfortable bringing up the issue. But don't be afraid that you'll plant the idea of suicide in the other person's mind. That's not how suicide works. In fact, asking the other person directly gives them a chance to open up and discuss their feelings, which can be very helpful to them.
But also remember not to try to "play therapist." Their problems may be very complex. If they are thinking of suicide, they need treatment by professionals. The worst you can do is offer simplistic clichés such as, "Think of all you have to live for," "Time will heal all wounds," or "You have to be strong for others." The best you can do is guide them to the professionals they need.
If someone has attempted suicide, no matter how ineffectively, take it seriously. It's not an attention getting device. It's an expression of extraordinary mental pain and spiritual anguish. That person should not be left alone; he or she needs compassion and immediate mental-health treatment.
You can find more information about depression, which can lead to suicide, at these earlier episodes of Second Opinion: Second Opinion, Depression, Episode 201 and Second Opinion, Heart Disease and Depression, Episode 302.
Key Point 3
Suicide and suicide attempts affect everyone, not just the victim. The healing process is important for the well being of family and friends, and counseling and other forms of treatment should be considered by everyone involved.
The death of a loved one is always devastating. When the death is self-inflicted, the shock and pain to the survivors can be overwhelming. No one can know exactly what another person is feeling. Still, experience shows that there are techniques that can help survivors cope, and ways friends and loved ones can help.
Survivors need to prepare for the rush of powerful emotions they'll have to deal with. The first is probably shock at the unexpected suddenness of the death, accompanied by denial (the feeling or wish that you're living through a nightmare that will soon be over) and later, perhaps, by a kind of numbness. This may be followed by bewilderment because you don't understand why your loved one chose to die (even if he or she had spoken about it previously). Then, inevitably, comes grief that may turn into despair, depression, and a sense of powerlessness and hopelessness.
There is also a "triangle" of interconnected emotions, each one both causing and being caused by the others. These are:
- At the victim, for leaving you and other loved ones in this awful state.
- At people whom you think "should have known" this might happen and "should have helped more".
- At yourself for the same reason - you think you could have prevented the suicide. This is the anger that leads to guilt.
- Guilt, growing out of the anger and compounded by regrets over past problems, arguments, etc. you had with the victim.
- Shame that a loved one chose to die and that you did not prevent it.
These feelings may be misplaced; that is, there may have been nothing more anyone could have done to prevent the suicide. But you can't help feeling them. They are completely natural. The best way to deal with them is to let them out - talk to loved ones about them and to a professional grief counselor, social worker, psychologist, psychiatrist, or other mental health professional. There are also many bereavement groups you can join, including those specifically for survivors of a loved one's suicide.
You may also have physical reactions, such as eating and sleeping problems, headaches, nausea, digestive complaints, inability to concentrate, fatigue, etc. Or you may have outbursts of uncontrollable crying. Finally, you may suffer some of the symptoms of post-traumatic stress disorder, such as nightmares and flashbacks, especially if you experienced the trauma of witnessing the death or discovering it.
It can take months, maybe longer, for these reactions to gradually subside. Again, you need to get professional counseling and treatment – and you need to accept that you have a right to it.
You also need to work on healing with other family members, not only as individuals, but also as a group. One of the worst consequences of a suicide can be the break-up of a surviving family through divorce, separation, or family members simply refusing to see or speak with each other. Each family member may suffer in a different way, but all are suffering, and all need help. There are family therapists specially trained to treat such families, and bereavement groups for families.
Among the traditional suggestions for helping people deal with a loved one's death are:
- Stay social; don't withdraw from family and friends, although you will want to. You may benefit from quiet, meditative periods of being alone, but don't isolate yourself; other people can help you heal.
- Let your feelings out; talk about your experience, in a supportive bereavement group and/or with supportive loved ones, family members, and friends. Some people may be awkward around you (or even avoid you at first) because they're afraid they may unintentionally say "the wrong thing." Often the best way to handle this is to be direct; take the lead in the conversation, and discuss as much (or as little) as you can deal with at that moment, including how your loved one died.
- Prepare yourself for birthdays, holidays, and other painful reminders of times you used to spend with your loved one. Grief at such times is normal and expected.
- Take as much time as you need, even if that means more time off from work than the standard bereavement allowance or if friends say you've mourned long enough. Don't be surprised if, after a period of doing better, you're suddenly overwhelmed with grief again. This can happen even years later. The memories will never go away, and they can bring pain. But memories of a loved one can also be soothing, and eventually the pain will go away.
- Do what feels right for you; express your grief in your own personal way. Some people keep a journal, others visit the grave frequently and "talk" to their loved one, others rarely go the grave.
- Don't feel guilty for starting to enjoy yourself again. That's part of the healing process, and you're allowed to heal.
Friends and loved ones of survivors can help in various ways. First, accept the survivor's emotions, the grief, anger, guilt, and confusion. Of course you can't know exactly what they are feeling, but you can expect those feelings to be complex and intense. Try to learn about them; read material designed to help survivors cope.
Second, when you listen to survivors, be as compassionate, open, and non-judgmental as possible. And do listen. Being ready to listen is the best way to help someone who needs to talk. Let survivors express their mix of feelings in their own way.
Just as simplistic clichés (such as, "You're doing so well," "Time will heal all wounds," or "You have to be strong for others") do nothing for someone thinking of suicide, they are equally useless to the survivors. Nor should you disparage the victim in any way; never say he or she "must have been crazy to do that." Each suicide survivor will come to their own understanding of what has happened. All you can do is hold their hand during the trip.
Be aware that helping a suicide survivor will not be easy. It may take more time, love, compassion, and openness than you ever expected. But you will also be doing more good than you expected. That's what caring means.
You'll find much more valuable information about how to help, what to say and do and what to avoid, at Survivors of Suicide.
Conduct an off-site search for Suicide information from MedlinePlus. These up-to-date search results are based on search terms specific to Second Opinion Key Points.
Suicide- main page
Depression- main page
Alcoholism- main page
There are many local, national, and international associations dedicated to preventing suicide and helping suicide survivors. The following are only a few of them. Many of the websites listed include links to many other organizations and sites.
The National Institute of Mental health, one of the federal government's National Institutes of Health, is the first place to turn for information about mental health issues, including depression and suicide, and links to many other organizations and websites.
The Survivors of Suicide web site is an independently owned and operated web site not associated with any specific group, organization or religious affiliation. Its purpose is to help those who have lost a loved one to suicide resolve their grief and pain in their own personal way.
The American Association of Suicidology is a not-for-profit organization dedicated to understanding and preventing suicide. It promotes research, public awareness programs, public education, and training for professionals and volunteers and is a national clearinghouse for information on suicide.
Mental Health America (formerly known as the National Mental Health Association) is a leading nonprofit dedicated to helping all people live mentally healthier lives.
The International Academy for Suicide Research publishes Suicide Studies, formerly Archives of Suicide Research. The objectives of the Academy include promoting high standards of research and scholarship in the field of suicidal behavior by fostering communication and cooperation among scholars engaged in such research.
The National Strategy for Suicide Prevention creates a framework for suicide prevention for the nation, including a set of 11 goals and 68 objectives, and provides a blueprint for action. The National Strategy was published by the U.S. Department of Health and Human Services in May 2001 with leadership from the Surgeon General.
The Suicide Prevention Action Network (SPAN USA) is a not-for-profit organization dedicated to preventing suicide through public education and awareness, community action and federal, state and local grassroots advocacy.