Common Single Predictors of Adult Suicide

Studies indicate that 90% of decedents give verbal or behavioral clues within a week or so before the event. In addition to these clues there are other warning signs to watch out for including:

• Prior suicide attempts – highest risk.
• Planning for suicide – putting affairs in order.
• Alcoholism, drug abuse.
• Suicidal ideation – talking about death or suicide.
• Isolation – living alone, loss of support.
• Hopelessness.
• Being an older white male.
• Modeling – suicide in the family, family violence.
• Economics – loss of job, financial difficulties.
• Suicidal careers – jobs with extremely high stress factors.
• Marital problems, family pathology.
• Stress – life events.
• Anger – aggression, hostility, irritability.
• Physical illness – especially if terminal or causing constant pain.

Suicide Risk Factors of Adolescents (15-19)

• History of running away from home.
• History of incarceration – conduct disorders.
• Recent severe stress disorders.
• Unplanned pregnancy.
• Psychiatric disorders.
• Alcohol or other drug abuse.

Child and adolescent psychiatrists recommend that if one or more of these signs occurs, parents need to talk to their child about their concerns and seek professional help when the concerns persist:

• Changes in eating and sleeping habits.
• Withdrawal from friends, family, and regular activity.
• Violent actions, rebellious behavior or running away.
• Drug and alcohol use
• Unusual neglect of personal appearance.
• Marked personality change
• Persistent boredom, difficulty concentrating, or decline in the quality of schoolwork.
• Frequent complaints about physical symptoms, often related to emotions, such as stomach aches, headaches, fatigue, etc.
• Loss of interest in pleasurable activities.
• Not tolerating praise or rewards.

A teenager who is contemplating suicide may also …

• Complain of being “rotten inside.”
• Put his or her affairs in order – give away possessions, clean his/her room, throw belongings.
• Become suddenly cheerful after a period of depression.
• Give verbal hints with statements such as “I won’t be a problem for you much longer”; “Nothing matters”; “I won’t see you again.”

Caregivers must understand that they are NOT mental health experts and may need to refer someone to a specialist. At the same time, there are specific indicators we may watch for that indicate a potential for suicide and take appropriate measures to intervene.

Constriction

“Constriction” refers to a narrowing, funneling focus of attention by an individual on the pain or overwhelming desperation he/she is feeling. It is this pain that consumes the individual’s thoughts. This leads to a sense of hopelessness, helplessness, and powerlessness which converge together in the mind of the individual. This results in focused expressions of desperation used by a suicidal individual, as in the expression, “Suicide is my only way out.”

Stress Factors

Severe stress can overwhelm an individual’s ability to cope and suicide becomes a possibility. Stress factors include:

1. Significant family events: suicide of a parent, spouse or loved one; death of a spouse or child; death of a parent; divorce or separation from a spouse (or parents); remarriage of former spouse (or parents).
2. Relationship issues: breakup with significant other; lack of meaningful attachments; belief that one is not wanted by others.
3. Medical & health related issues: serious illnesses, loss of health, becoming  disabled, psychiatric illness; history of suicidal behavior.
4. Issues of abuse and victimization: emotional and physical abuse; domestic violence, sexual abuse or rape.
5. Substance abuse: self, family members.
6. Educationally related issues: moving to a new school or geographical location; pressure from high achievers; learning disabilities; school work failure; college rejections; rejection from class mates.
7. Other significant life events and interpersonal stressors: running away from home; sexual identity crisis; sense of rejection or alienation; low self-esteem; feelings of powerlessness, hopelessness; rigidity and perfectionism; loss of identity and status; financial setback and crisis; loss of employment or retirement.
8. Crime and violence: disciplinary crisis; arrest and incarceration; victim of violence or crime; presence of a gun in the home; witnessing a violent event.

Progressive Stages of Suicide

Stressful events …

Suicidal thoughts …

Suicidal plans …

Suicidal preparation …

Suicidal attempt.

Danger Signs

D – Depressed mood

A – Abuse of alcohol and drugs

N – Negativity

G – Giving away possessions

E – Estrangement

R – Rebellious behavior

Specific Indicators

(The numbers on the left indicate progressive stages of risk. The text on the right represent behavioral/verbal clues and associated inquiries.)

0-2: Suicidal ideology is expressed. Directly, in response to a question such as “Are you thinking about killing yourself?” Indirectly, implied by statements such as, “It’s just not worth it anymore” or “I can’t take any more.”

3-5: Suicide method is identified. In response to the question, “How would you do it?,” or the spontaneous revelation that the individual has a specific method to carry out suicide; along with the availability/capability of carrying it out.

6-8: A location is specified. In response to the question “Where would you go to do this?” or they otherwise identify the place where they are thinking about ending their life.

9-10: A specific time is identified. In response to the question, “When do you plan to do this?”