If you’ve never had suicidal thoughts, it can be difficult to understand what it feels like. And if you’ve ever thought of suicide yourself, it can feel incredibly isolating and hard to know how to even begin talking about such complicated feelings. But no matter who you are, if someone you know — whether personally or a celebrity — kills themseves, it can be shocking and devastating, and can leave everyone asking, “Why did she do it?” and “Could we have done something to stop him?” Like most things in life, there are no easy answers or solutions. But here are some important things to know about suicide in general.
1. Suicide is preventable
One of the biggest misconceptions about suicide is that it’s something that just happens, and nothing can be done to stop or prevent it. That’s not the case, said Dr. Joshua Gordon, director of the National Institute of Mental Health (NIMH) in Bethesda, Maryland. In fact, doctors and scientists are working hard on ways to pick up on people who are at risk and help them stay alive, as well as identifying all the many things happening in society that can contribute to suicide.
The NIMH has helped develop a suicide screening tool that takes 20 seconds to complete and can be used to identify children and teens who are having suicidal thoughts. Computer-based algorithms can help doctors predict whether a patient is at risk of suicide based on electronic health records, and studies have shown that screening people in ERs and following up with them does decrease suicide attempts, Gordon said.
“In a perfect world, suicide would be completely prevented,” Gordon said in an email to BuzzFeed News. “While we are not there yet, researchers are studying how to better identify who is at greatest risk for attempting and dying by suicide, so they can get the help they need.”
2. There are things you can do personally to help someone you are concerned about
When someone close to you is in emotional pain, it can be hard to tell if they are thinking about suicide or know what to do. Gordon and other experts suggest a five-step approach:
—Ask the person if they are thinking about killing themselves
—Reduce their access to lethal items or places
—Listen carefully to the person and ask how they are thinking and feeling
—Help them get them in touch with resources like the National Suicide Prevention Lifeline
—Stay in touch with them during and after a crisis or any treatment
“Studies have shown the number of suicide deaths goes down when someone follows up with the at-risk person,” Gordon said.
3. Suicides can happen at any time of the year
At one time, people thought year-end holidays — Christmas, Hanukkah, New Year’s Eve — were the riskiest time for people with depression. In fact, when experts look at patterns by season, suicides tend to peak in spring and early summer. However, those seasonal relationships are declining, Gordon said. In fact, people don’t know exactly why certain seasons have higher suicide rates than others, and they can happen at any time of the year.
4. Suicide is on the rise in the US
About 45,000 people die every year by suicide, and suicide is the 10th leading cause of death in the US. Overall, the total suicide rate increased from 10.5 to 13.4 per 100,000 people, a 28% rise, in a 17-year period between 1999 and 2016. Some states — Montana, Wyoming, South Dakota, North Dakota, and Idaho — had even greater increases, more than 30%. Why? That’s a complex question to answer, but researchers have found that “deaths of despair,” including those due to alcohol, suicide, overdoses, and homicide vary widely by geography, with some areas at much higher risk than others.
5. Thoughts of suicide are not uncommon
It can be hard to determine exactly how many people have had suicidal thoughts at some point in their lives. About 4% of people 10 and older had thoughts of suicide, according to 2016 data, with the highest rate of serious thoughts of suicide — 8.8% — in adults ages 18 to 25, Gordon said. However, rates can be higher in certain groups of people. For example, one study found 32% of young people seeking mental health care had suicidal thoughts.
“People who have thoughts of suicide should know that they are not alone and that there is help available for them,” Gordon said. “The first step is to reach out and ask for help by, for example, talking with a trusted adult, teacher, friend, or doctor.”
6. There are treatments for suicidal thoughts
There are treatments that work in people with suicidal thoughts, Gordon said. “Strategies that have worked well for mental health conditions related to suicide such as depression and anxiety are often used in the treatment of suicidal thoughts,” he said. “These treatments often consist of psychotherapy, medication, or a combination of the two. Recovery is possible with treatment.”
But if you don't know where to start getting treatment, suicide lifelines can point you in right direction. You can call the National Suicide Prevention Lifeline at 1-800-273-8255 to talk to a trained crisis worker 24-7. Suicide prevention lines aren’t always perfect, but they’re a good place to start and here’s what you can expect if you call one.
The calls go to a crisis center near you, which can provide counseling and referrals for additional mental health assistance. You can also contact the Crisis Text Line, which is also free and available 24-7, by texting “HOME” to 741741
But if you are in a potentially life-threatening situation you should call 911 or get to a hospital emergency room, Gordon said.
7. There are often warning signs, but they can be subtle, too
It’s sometimes hard to tell how someone is feeling, but often there are warning signs when a person is at risk for a suicide attempt — and it doesn’t always look like “feeling sad.”
People who are in emotional distress might have anxiety, extreme mood swings, including anger and rage, and feel like a burden to others. They might sleep a lot or very little and talk or post on social media about feelings of hopelessness or wanting to die. They may feel trapped, isolated, or in unbearable pain, and might be abusing drugs or alcohol.
8. How we talk about suicide matters
If someone is at risk of suicide, exposure to other people’s suicidal behavior, whether it’s a family member, friend, or high-profile celebrity, can be, well, risky. Research suggests that how suicide is covered in the media and talked about in pop culture and online, can influence behavior.
That’s why shows like 13 Reasons Why have sparked controversy and include warning disclaimers. And there are guidelines for journalists on how to cover news related to suicide and for teens who might be talking about suicide online.
9. Suicide does not discriminate
Suicidal thoughts can happen to anyone regardless of age, gender, ethnicity, and socioeconomic status. However, some groups of people are at higher risk than others. Women are more likely to attempt suicide, but men are more likely to die by suicide. In women, those ages 45 to 64 have the highest rate of suicide deaths, while for men, it’s 75 and older.
Suicide is the second leading cause of death for people ages 15 to 34, and although less common, is on the rise in children ages 10 to 14. There are about 425 deaths in this group each year in the US, more than due to traffic accidents. And Native American and Alaskan Natives young and middle-aged people have the highest suicide rates, followed by non-Hispanic white men who are middle-aged or older, according to the Centers for Disease Control and Prevention (CDC).
Black Americans have the lowest rates of suicide, except in children under 12. And other groups are at risk too, including Muslims in America, who face additional issues of bigotry and stigma in their community.
That said, most people who have risk factors never attempt suicide, Gordon said. “It remains difficult to predict who will act on suicidal thoughts.”
10. Life stressors can also play a role — in the short term and even going back to childhood
Mental illness, such as chronic depression, and substance abuse problems are known risk factors for suicide. And people undergoing a crisis are also at risk, such as those having relationship problems; financial or job difficulties; physical health problems, such as chronic pain; a loss of housing; or having criminal or legal problems, including being recently released from jail.
A family history of violence, substance abuse, suicide, and childhood physical or sexual abuse are also risk factors.
“Many stressful situations contribute to suicide among those with and without known mental health conditions,” Gordon said.
11. You should never assume someone is threatening suicide to get attention
If someone has suicidal thoughts or actions, you should take it seriously, said Gordon.
“Any warning sign or symptom of suicide should not be ignored,” he said. “All talk of suicide should be taken seriously and requires attention. Threatening to die by suicide is not a normal response to stress and should not be taken lightly.”
12. Asking someone about suicide doesn’t “put the idea in someone’s head”
If you think someone might be thinking about suicide, it’s OK — even essential — to ask them if that’s the case. “People often worry that asking about suicide might make things worse, but actually studies show that asking at-risk individuals if they are suicidal does not increase suicidal thoughts or behaviors; in contrast, asking can often be the first step towards getting those who are suffering the help they need,” Gordon said.
13. Suicide has a profound impact on survivors, and can trigger intense emotions.
People often feel anger, grief, despair, guilt, and confusion after a suicide, Gordon said.
"Survivors should give themselves time to grieve, try not to blame themselves for their loved one’s death, and should consider staying in touch with their friends and family who can serve as a source of support," he said. "People who need help coping and recovering from their loss should seek help from their doctor or a mental health provider."
14. Thinking of suicide as a "selfish act" doesn't take into consideration the emotional pain and mental state of people who kill themselves
Although survivors may feel grief and anger, it’s not true that suicide is a selfish act. People who kill themselves are in intense and overwhelming pain, and often have distorted thinking and perception. Although it's hard to understand, they may feel like people are better off without them. This personal story at the National Alliance on Mental Illness may help you understand it a little bit better.