A. Conditions associated with increased risk of suicide
- Death or terminal illness of relative or friend.
- Divorce, separation, broken relationship, stress on family.
- Loss of health (real or imaginary).
- Loss of job, home, money, status, self-esteem, personal security.
- Alcohol or drug abuse.
- Depression. In the young depression may be masked by hyperactivity or acting out behavior. In the elderly it may be incorrectly attributed to the natural effects of aging. Depression that seems to quickly disappear for no apparent reason is cause for concern. The early stages of recovery from depression can be a high risk period. Recent studies have associated anxiety disorders with increased risk for attempted suicide.
B. Emotional and behavioral changes associated with suicide
- Overwhelming Pain: pain that threatens to exceed the person's pain coping capacities. Suicidal feelings are often the result of longstanding problems that have been exacerbated by recent precipitating events. The precipitating factors may be new pain or the loss of pain coping resources.
- Hopelessness: the feeling that the pain will continue or get worse; things will never get better.
- Powerlessness: the feeling that one's resources for reducing pain are exhausted.
- Feelings of worthlessness, shame, guilt, self-hatred, "no one cares". Fears of losing control, harming self or others.
- Personality becomes sad, withdrawn, tired, apathetic, anxious, irritable, or prone to angry outbursts.
- Declining performance in school, work, or other activities. (Occasionally the reverse: someone who volunteers for extra duties because they need to fill up their time.)
- Social isolation; or association with a group that has different moral standards than those of the family.
- Declining interest in sex, friends, or activities previously enjoyed.
- Neglect of personal welfare, deteriorating physical appearance.
- Alterations in either direction in sleeping or eating habits.
- (Particularly in the elderly) Self-starvation, dietary mismanagement, disobeying medical instructions.
- Difficult times: holidays, anniversaries, and the first week after discharge from a hospital; just before and after diagnosis of a major illness; just before and during disciplinary proceedings. Undocumented status adds to the stress of a crisis.
C. Suicidal Behavior
- Previous suicide attempts, "mini-attempts".
- Explicit statements of suicidal ideation or feelings.
- Development of suicidal plan, acquiring the means, "rehearsal" behavior, setting a time for the attempt.
- Self-inflicted injuries, such as cuts, burns, or head banging.
- Reckless behavior. (Besides suicide, other leading causes of death among young people in New York City are homicide, accidents, drug overdose, and AIDS.) Unexplained accidents among children and the elderly.
- Making out a will or giving away favorite possessions.
- Inappropriately saying goodbye.
- Verbal behavior that is ambiguous or indirect: "I'm going away on a real long trip.", "You won't have to worry about me anymore.", "I want to go to sleep and never wake up.", "I'm so depressed, I just can't go on.", "Does God punish suicides?", "Voices are telling me to do bad things.", requests for euthanasia information, inappropriate joking, stories or essays on morbid themes.
A WARNING ABOUT WARNING SIGNS
The majority of the population at any one time does not have many of the warning signs and has a lower suicide risk rate. But a lower rate in a larger population is still a lot of people - and many completed suicides had only a few of the conditions listed above. In a one person to another person situation, all indications of suicidality need to be taken seriously.
Crisis Intervention Hotlines that accept calls from the suicidal, or anyone who wishes to discuss a problem, are (in New York City) The Samaritans at 212-673-3000 and Helpline at 212-532-2400.
This material was prepared by Suicide Prevention Resources, a non-profit public education organization that is dedicated to three goals: reduce the degree and duration of suffering of despairing individuals, prevent attempted and completed suicides, and reduce the hardship and stigma suffered by relatives and friends of suicide victims. Suicide Prevention Resources (Box 7693, FDR Station, NY NY 10150-1914) gives talks and workshops in New York City. Permission is granted to reproduce copies of this material for use within your organization or facility.