The fear of openly discussing suicide, even within families, is part of the reason doctors have such a hard time preventing it, according to Julie Cerel, Ph.D., a psychologist and associate professor at the University of Kentucky. She is the current chair of the American Association of Suicidology (AAS).
Cerel uses breast cancer as an example of how an open discussion about disease can make all the difference. “In the 1970s, you would never go to the grocery store and talk about cancer, or talk about breasts. Neither one of those were topics we talked about publicly," she said. "And now you can’t avoid a store that isn’t pink for breast cancer awareness, which is wonderful. And the number of breast cancer deaths have declined so dramatically.”
Cerel believes that removing the stigma of suicide could also help reduce its steep global toll.
In an effort to encourage discussion, the World Health Organization (WHO) has launched its first global report on suicide: Preventing Suicide: a global imperative. The report states that more than 800,000 people die by suicide every year, which equates to one person every 40 seconds. Yet these deaths are preventable.
According to the Centers for Disease Control and Prevention (CDC), each year more than 39,000 Americans end their lives, and 1 million adults report making a suicide attempt. Many more people struggle with thoughts of suicide.
Suicide affects people of all ages and is the 10th leading cause of death for Americans overall. It is the second leading cause of death among adolescents and young adults ages 15 to 29, according to the CDC.
When Is a Moody Teen at Risk for Suicide?
Those young people are of particular concern to Scott Poland, Ed.D., a professor at Nova Southeastern University’s (NSU) Center for Psychological Studies in Fort Lauderdale, Florida. He is also co-director of NSU’s suicide and violence prevention office, and has led national crisis teams following numerous school shootings and suicides.
Identifying an at-risk student can be challenging, according to Poland. “We have difficulty trying to figure out what is teenage depression from what we might call moodiness, irritability, things that teenagers just go through,” he explained.
To help identify teen depression, Poland said to explore these questions: “Has this irritability and this moodiness gone on for more than two weeks? Are the activities the teen used to engage in, that were joyful — maybe it was dance, maybe it was club soccer — are they suddenly not engaging in these things that they chose to do and that were really helpful to them?”
Poland told Healthline that when we lose a young person to suicide, it is most probably due to untreated or undertreated depression. “I really want to emphasize the word undertreated. Yes, sometimes they actually did go to a therapist or a psychologist, but they didn't stay with it. Maybe the therapist really wasn't very skilled in working with teenagers or making suicide assessment.”
The urge to die by suicide waxes and wanes, Poland said, noting that teenagers are not suicidal all the time. “And the intervention of any one person can make all the difference in the world,” he added.
Poland said that the best national statistics say 8 percent of all high school students made a suicide attempt in the past 12 months. “What’s especially scary about that for me is, the majority of the time their teachers and their parents have absolutely no idea,” he said.
The most likely teenager to attempt suicide tomorrow would be the one with a history of previous suicide attempts, Poland said, adding, “And who always knows? That would be their friends. Unfortunately, in our schools, in our communities, we don’t talk enough about suicide prevention warning signs, what to look for and what to do.”
Kids do talk about suicide among themselves, Poland said. “These high school and middle school kids all know somebody who’s talked about suicide. Many of them know somebody who’s actually attempted or even died.” The important message to get across to youth is, “Don’t hesitate to get help for yourself, for your friend ... or go to the nearest trusted adult, a parent, a teacher, the band director, a teacher’s assistant,” he said.
The Clues Are There ...
When people do mention suicide, it’s often flippantly, but Cerel cautions against ignoring such remarks. “I was at the doctor earlier this week, and there was an elderly man who was complaining about how much pain he was in. And as the nurse called him back, she asked, ‘How are you doing today, sir?’ And he said, ‘Well if I get any better, I’m just going to end it all.’
“I wondered if anyone was taking that seriously. And probably, in that healthcare visit, no one did because it was offhand. We’re used to people saying things like that. But when you have someone in that pain, who makes a statement like that, it’s the kind of thing we all need to be better at stopping and saying, ‘You know, when you say something like that, it makes me really concerned.’”
When actor and comedian Robin Williams died by suicide in August, news accounts quoted friends and associates as being “stunned.” Although he was being treated for depression and alcoholism, many had not noticed any “signs.”
Cerel explained, “If you get a group of friends or family together, and interview them individually, you can piece it all together and say, ‘Oh, we could have seen this coming.’ But usually no one person has the knowledge or ability to have that awareness, especially with someone who's been suicidal before or been in a crisis before.”
Cerel added that people can't predict when someone might make a suicide attempt. “I think it’s important, if you have someone you care about who’s been suicidal in the past and is doing quite well, to talk about it when they’re well,” she said. “‘I know you’re well now, but if this happens again, what would be the best ways for us to work on this together?’”
... But Suicide Can Still Be Sudden
Although the person at risk for suicide may already be in treatment for depression or another mental illness, suicidal thoughts can occur suddenly.
Shane Owens, Ph.D., assistant director of Campus Mental Health Services at Farmingdale State College and chair of the New York State Psychological Association's Suicide Prevention Task Force, told Healthline, “About 1 in 5 people who die by suicide seek mental health treatment within a month of their death. On the other hand, interviews with attempt survivors indicate that about a quarter of them thought about suicide for less than five minutes before making the attempt, and that 90 percent thought about it for less than a day.”
Nevertheless, Owens said, typical warning signs do occur. “When you start to see warning signs in a family member, classmate, or colleague, it is important to ask that person directly about suicidal thoughts and plans.” However, he said, “The person who asks should be someone who has and can communicate genuine concern for the at-risk person; and someone who has the ability to deal with an answer that might be difficult to hear.”
If the at-risk person indicates any suicidal ideation or plan, he or she must be assessed by a mental health professional immediately, said Owens. “Even if there is no indication of threat, the at-risk person should be urged to seek some help for those issues that initially caught people’s attention," he said. "While suicide is an uncomfortable issue to talk about, most people — at-risk or not — like the fact that someone cares enough to ask.”
Along those same lines, James C. Overholser, Ph.D., a professor of psychology at Case Western Reserve University in Cleveland, told Healthline that when concerned about a friend or co-worker’s moodiness, irritability, or withdrawal, “It can be helpful to share that concern in a supportive way. It can be a simple act of kindness and respect to ask, ‘Is everything okay? You seem a bit down lately; is there anything I can do to help? Would you like to talk about it after work?’”
Be Aware of the Warning Signs
If you notice the following warning signs of suicide, contact a mental health professional or call 1-800-273-TALK right away:
- threatening to or talking about hurting or killing oneself
- looking for ways to kill oneself by seeking access to firearms, pills, or other means
- talking or writing about death, dying, or suicide, when these actions are out of the ordinary
- increased alcohol or drug use
- no reason for living; no sense of purpose in life
- anxiety, agitation, changes in sleep patterns
- feeling trapped like there's no way out
- withdrawal from friends, family, and society
- rage, uncontrolled anger, or revenge seeking
- acting reckless or engaging in risky activities, seemingly without thinking
- dramatic mood changes
Risk Factors for Suicide
The CDC notes that several factors can put a person at risk for suicide. However, having these risk factors does not always mean that suicide will occur:
- history of previous suicide attempts
- family history of suicide
- history of depression or other mental illness
- history of alcohol or drug abuse
- stressful life event or loss
- easy access to lethal methods
- exposure to the suicidal behavior of others
Suicide Prevention Resources
National Suicide Prevention Lifeline
Depression Screening - self-assessment
Suicide Prevention Resource Center
International Association for Suicide Prevention (IASP)
American Association of Suicidology