By Katherine Ponte, JD, MBA, CPRP
If you or someone you know is experiencing a mental health, suicide or substance use crisis or emotional distress, reach out 24/7 to the 988 Suicide and Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline) by dialing or texting 988 or using chat services at suicidepreventionlifeline.org to connect to a trained crisis counselor. You can also get crisis text support via the Crisis Text Line by texting NAMI to 741741.
Suicide is a public health crisis.
Suicide rates rose 25% in the U.S. from 1999 to 2016. In 2018, nearly 50,000 people died by suicide, around 11 million seriously thought about it, about 3 million made a plan and over 1 million attempted suicide.
These numbers represent immeasurable tragic losses to human life, friends, family and society.
There is an urgent need to address the causes. Most suicide prevention programs focus on the now — the risk factors, which are essential. However, these programs should also focus on protective factors to have a longer lasting impact on those vulnerable to suicide.
Here are some of the primary risk factors for suicide, which may help us identify at-risk populations and individuals.
Previous attempt: The leading suicide risk factor is a prior suicide attempt.
Triggers: Thesecan include a wide range of significant events, especially relationship problems and unemployment. Additionally, a history of child abuse, including bullying or sexual abuse, traumatic brain injury, chronic pain and chronic health conditions may heighten suicide risk.
Mental illness: It is estimated that nearly 90% of people worldwide who die by suicide have a mental illness. However, only about half of people who die by suicide in the U.S. are actually diagnosed.
Substance abuse: People who are dependent on alcohol or use drugs have a 10–14 times greater suicide risk than the general population. This risk is even more significant when a there is a co-occurrence of substance use disordersand mental illness.
Impulsivity:One study found that more than 50% of suicide attempts were impulsive, which may explain in part why “up to 50% of people who attempt suicide make the decision to do so within minutes to an hour before they act.”
Access to firearms: a key suicide prevention measure is to reduce access to firearms, which can significantly increase suicide risk.
Ethnicity/race: the highest rates across ages are among American Indian/Alaska Native and white populations.
Sexual orientation/gender identity: LGB youth are almost fivetimes as likely to have attempted suicide compared to heterosexual youth. Transgender adults are at even higher risk with 40% reporting a suicide attempt in their lifetime
A combination of therapy and medication can help address some of these risk factors. But we also need to think about how we can protect the most vulnerable in other ways.
We often take a “reactive” approach to suicide risk. We identify risk factors and watch for warning signs. But sometimes, by the time warning signs are visible to others, it’s too late. An additional approach that may increase our impact is to identify protective factors that can help shield individuals from becoming at-risk in the first place.
Each person has their own “reasons for living” and recognizing them can be life-saving. The Reasons for Living Scale identifies possible protective factors for suicide, including meaningful relationships with friends and family, survival instincts, excitement about future plans, and the belief that happiness is an important part of life. These protective factors can not only reduce suicide risk, they can be good for general well-being and foster happiness.
During my extended periods of suicidal ideation in my struggles with bipolar, I would often reflect on my reasons for living. I felt that a suicide attempt or death would hurt my family too much, and I would not want them to suffer. I imagined the reactions of my spouse who had stuck by me. I imagined how my parents would take it after lovingly raising me and always being there for me. I imagined them heartbroken and filled with inconsolable grief and blaming themselves. I even thought of my cat, Dude, who never left my side in my darkest moments.
I also feared death. I’d hear examples of suicide in the news and it would heighten my own thoughts, but I ultimately couldn’t go through with it. I was scared of dying and knew deep down I wanted to live.
As I moved towards recovery, I discovered that I did have reasons for living and recovery itself gave me even more. My overwhelming pain and suffering, hopelessness and self-stigma had blinded me to these reasons and possibilities. I finally reached a point where I no longer thought of suicide, but instead recognized all the good in my life.
I realized that I had caring and loving social support, which I learned to accept. While this may not be for everyone, I also — very skeptically at first — learned to have greater faith in a higher power to “take care” of the things I could not control and help me in times of need. As my condition improved, my hope grew. Hope bolstered my belief that I had a future worth living, which I had to seize day-by-day. It would be a future supported by my friends and family.
We need to start coming together and speaking to each other more. We need to nurture and develop protective factors, especially among those closest to us. We need to stop missing opportunities to save lives through more caring and loving action among and between each other.
We can help prevent suicide, but we have to do it together. Suicide is not only an individual tragedy, it is a collective tragedy, our tragedy.
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