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Last updated May 26, 1999
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Divison of Psychiatry
~ psychiatric conditions ~
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Suicide risk factors and warning signs
Suicide risk factors and warning signs
Risk factors for suicide: Age! Older people (as in over 75) are 3X more likely than young people to commit suicide. Recently however, adolescent and young adult rates have increased, especially in young males. Suicide is the 2nd leading cause of death in people aged 15-24. Males are more likely to be successful in suicide (3:1) -- they tend to use more violent methods like shooting themselvs, but females attempt suicide more often (3:1) -- overdosing on pills is quite common. White > non-white rates, 2:1. Also greater risk if unmarried or divorced, socially isolated, unemployed, professionals/high social status (!), chronic/disabling/painful/fatal physical illness, alcoholism, addiction, mental illness (depression, schizophrenia, panic disorder, personality disorders). Addiction -- alcoholism has a 22X greater risk. Histoy of previous attempts is a *big* risk factor, especially if the attempt occured in the past 3 months.
Of these risk factors, these are most significant: 1) hopelessness, 2) depression, 3) addiction (especially alcoholism), 4) history of previous attempts, 5) chronic illness.
Hopelessness is the best predictor of who will atempt suicide. A person may have had recent losses, increase in stress or conflict, or a friend or family member recently attempting suicide.
80% of patients who kill themselves give warnings of their intent, and 50% openly state their desire to die. You should listen for statements about not being able to "take it" or "handle it" any more, statements about giving up or the future looking bleak, jokes or off-hand comments about ending it all. Other danger signs are abruptly putting their affairs in order, giving away prized possessions, and recent onset of risk taking or having accidents.
Health care professionals must often assess whether or not a person is at high risk for suicide, because if they are, steps should be taken to protect the person from themselves. It is important to realize that most suicidal patients are usually very ambivalent about suicide, and talking about suicide reduces the risk of suicide -- ignoring it can increase the risk of suicide. You must decide whether the person is thinking about suicide, whether they've recently attempted suicide, what risk factors they have, and very important, what kind of social support they have.
You also have to find out if the person has a plan for committing suicide, if they have acquired the means to carry it out, and how close they are to going through with it. If the person has a plan, that's usually enough to warrant more aggressive intervention (protect the patient from themselves). If they have good social support and someone who can watch them 24 hours a day, sending them home is sometimes an option. Otherwise, the patient should be hospitalized, either voluntarily or involuntarily. If the person won't stay voluntarily, a qualified person -- depends on the county/state, but usually a police officer or other professional (psychiatrist, for example) -- can put the person in the hospital on a 72 hour involuntary hold. Counseling and sometimes medications (for depression or psychosis, depending on their mental needs) are very important.