Suicide and suicidal behavior

Causes

Suicide and suicidal behaviors usually occur in people with one or more of the following:

• Bipolar disorder
• Borderline personality disorder
• Depression
• Drug or alcohol dependence
• Schizophrenia
• Stressful life issues, such as serious financial or relationship problems

People who try to commit 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:

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

Suicidal behaviors may occur when there is a situation or event that the person finds overwhelming, such as:

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

Risk factors for suicide in teenagers include:

• Access to guns
• Family member who committed suicide
• History of hurting themselves on purpose
• History of being neglected or abused
• Living in communities where there have been recent outbreaks of suicide in young people
• Romantic breakup

Most suicide attempts do not result in death. Many of these attempts are done in a way that makes rescue possible. These attempts are often a cry for help.

Some people attempt suicide in a way that is less likely to be fatal, 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 result in death.

Relatives of people who attempt or commit suicide often blame themselves or become very angry. They may see the suicide attempt as selfish. However, people who try to commit suicide often mistakenly believe that they are doing their friends and relatives a favor by taking themselves out of the world.

Symptoms

Often, but not always, a person may show certain symptoms or behaviors before a suicide attempt, including:

• Having trouble concentrating or thinking clearly
• Giving away belongings
• Talking about going away or the need to "get my affairs in order"
• Suddenly changing behavior, especially calmness after a period of anxiety
• Losing interest in activities they used to enjoy
• Performing self-destructive behaviors, such as heavily drinking alcohol, using illegal drugs, or cutting their body
• Pulling away from friends or not wanting to go out
• Suddenly having trouble in school or work
• Talking about death or suicide, or even saying that they want to hurt themselves
• Talking about feeling hopeless or guilty
• Changing sleep or eating habits
• Arranging ways to take their own life (such as buying a gun or many pills)

Treatment

People who are at risk for suicidal behavior may not seek treatment for many reasons, including:

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

A person may need emergency treatment after a suicide attempt. They may need first aid, CPR, or more intensive treatments.

People who try to commit suicide may need to stay in a hospital for treatment and to reduce the risk of future attempts. Therapy is one of the most important parts of treatment.

Any mental health disorder that may have led to the suicide attempt should be evaluated and treated. This includes:

• Bipolar disorder
• Borderline personality disorder
• Drug or alcohol dependence
• Major depression
• Schizophrenia

If you or someone you know is thinking about suicide, 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.

As with any other type of emergency, call the local emergency number (such as 911) right away if someone you know has attempted suicide. Do not leave the person alone, even after you have called for help.

Outlook (Prognosis)

Always take suicide attempts and threats seriously. About one-third of people who try to commit suicide will try again within 1 year. About 10% of people who threaten or try to commit suicide will eventually kill themselves.

The person needs mental health care right away. Do not dismiss the person as just trying to get attention.

When to Contact a Medical Professional

Call a health care provider right away if you or someone you know is having thoughts of suicide.

Prevention

Avoiding alcohol and drugs (other than prescribed medicines) can reduce the risk of suicide.

In homes with children or teenagers:

• Keep all prescription medicines high up and locked.
• Do not keep alcohol in the home, or keep it locked up.
• Do not keep guns in the home. If you do keep guns in the home, lock them and keep the bullets separate.

Many people who try to commit suicide talk about it before making the attempt. Sometimes, just talking to someone who cares and who does not judge them is enough to reduce the risk of suicide.

However, if you are a friend, family member, or just know someone who you think may attempt suicide, never try to manage the problem on your own. Seek help. Suicide prevention centers have telephone "hotline" services.

Never ignore a suicide threat or attempted suicide.

References

Cole JCM, Walter HJ, DeMaso DR. Suicide and attempted suicide. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 25.

Brendel RW, Lagomasino IT, Perlis RH, Stern TA. The suicidal patient. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 53.

American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder; third edition. Arlington (VA), American Psychiatric Association; 2010 Oct. 152 p.

Update Date: 2/11/2012

Updated by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, and David B. Merrill, MD, Assistant Clinical Professor of Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.