How to Spot the Warning Signs of Suicide

If You Need Immediate Help

If there is a serious life-threatening emergency, please call 911 or go to your nearest emergency room.

Suicidality is incredibly painful. The thoughts can feel hopeless, isolating, and never-ending. Help is available. The Suicide and Crisis Lifeline can be reached by dialing 988. This lifeline is available 24 hours a day, 7 days a week, 365 days a year. You will be connected to a crisis center in your local area and speak with someone trained to support you. The Suicide and Crisis Lifeline also has a chat option available.

If you see a loved one post a distressing message on social media, you can help. Please outreach the social media safety team. These teams are specifically designed to connect a loved one to needed resources. These teams work in conjunction with the Suicide and Crisis Lifeline to ensure users are given adequate support.

If you are a veteran, there is support through the Department of Veterans Affairs (VA) by dialing 988 and pressing 1 to talk to a trained VA responder. Veterans can also send a text message to 838255. A confidential online chat session at Veterans Crisis Chat is available.

If you are a part of the LGBTQIA+ community, support is available via call, chat, or text with The Trevor Project. This project was launched to put an end to suicide within the LGBTQIA+ community. You can call (866) 488-7386‬, text ‘START” to 678-678, or chat with one of their trained counselors 24/7/365.

What Are the Warning Signs of Suicide?

The warning signs of suicide are not black and white. At times, warning signs of mental illness can be a person displaying or expressing distress, However, a person who has come to a place of acceptance that they will follow through on a suicide plan will appear to be doing well or even better than before.

The phenomenon of a person appearing ok right before they decide to follow through with their suicide plan is due to the level of comfort a person who has been suffering finds in knowing they have made the decision. This is why it is so important to be on the lookout for all types of changes in behavior, mood changes, and concerning statements.

Concerning Statements

Concerning statements are verbal expressions of suicidal ideation. These statements may be clear, such as “I want to die”, or more unclear, such as “I can’t do this anymore”. The nature of these types of states is pointing to an overall dissatisfaction with life. Therefore, any sentiments that touch on life feeling “overwhelming” or that a person is dealing with “too much” is a marker for needing support.

Additionally, there are statements related to how a person feels about themselves. These statements are often associated with feelings of self-loathing. A person will feel that they are a burden to the people in their lives. They may remark, “Everyone would be better off without me”.

Concerning statements someone who is considering suicide might make include:

• “I wish I were dead”
• “I wish I hadn’t been born”
• “I’m so tired of everything”
• “This is too much for me”
• “It would be easier if I wasn’t here”
• “I wish I wouldn’t wake up sometimes”
• “Everyone would be happier if I was gone”
• “This won’t matter much longer anyway”
• “They won’t miss me when I’m gone”

Mood Changes

Notable changes in mood are, at times, the most recognizable signs of suicide. These mood changes can vary and range from person to person. The mood change most associated with suicide is depression. Depression can show up in many different ways. From expressions of sadness to a person seemingly being lost in thought or in themselves. Similarly, intense emotions are generally evidence that risk is afoot. These emotions are ones of feeling overwhelmed, agitated, anxious, and even fearful.

Another mood change of which to remain cognizant is mood swings. These are drastic and often intense changes in mood in a short period. These mood changes often come seemingly out of nowhere. A person may appear happy one moment, angry or irritable the next, and/or depressed. As mentioned before, someone seeming depressed and then suddenly seemingly “okay” or better may point to the acceptance of follow through on suicidal behavior.

Mood changes someone who is considering suicide may experience include:

• Hopelessness
• Helplessness
• Feeling trapped
• Uncontrollable worry
• Anxiousness
• Overwhelming fear
• Shame
• Excessive guilt
• Worthlessness
• Self-loathing

Troubling Behaviors

Behaviors can be the clearest and notable when working with persons potentially struggling with suicidality. Troubling or distressing behaviors for which someone considering suicide may engage vary depending on the underlying concerns surrounding suicidality.

For example, a person struggling with substance use disorder may have lost their job, their home, and their family due to their addiction. Therefore, they could feel a want to end their life because of the hold addiction has had over them. Thus, increased substance use and intoxication are clear warning signs. It is the escalation of behaviors that can be most telling.

Troubling behaviors someone who is considering suicide may engage in include:

• Increased use of substances and/or alcohol
• Withdrawing and isolating from friends and family
• Giving away important items
• Appearing to put one’s affairs in order
• Researching ways to end one’s life
• Obtaining the means to take their own life
• Risk-taking, such as driving a car erratically
• Displaying extreme mood swings
• Saying goodbye to loved ones
• A complete change displayed in mood, such as appearing content

Suicide Vs. Suicidal Ideation

Suicide and suicidal ideation are not one and the same. Suicide refers to the fatal or non-fatal attempt or death of a person due to suicidal behaviors. Whereas suicidal ideation are the thoughts and feelings a person is experiencing around ending their life.

It is important to recognize that suicidal ideations do not always turn into suicidal intentions, plans, and/or behaviors. A person may experience suicidal thoughts with little to no intent of actually doing harm to themselves.

What Are the Risk Factors for Suicide?

There are markedly clear risk factors that correlate to an increase in suicidal thoughts and behaviors. However, not all people will necessarily experience these. It is less likely for a person who does not experience risk factors to end their life; however, nothing can be fully ruled out because life is constantly in flux.

Risk factors can be broken down into three categories: individual, relational, and environmental. Individual factors, such as a previous suicide attempt, relational factors, such as a history of trauma, and environmental such as lack of access to treatment, play a large role in one’s experience of suicidal symptoms. While there are many risk factors for suicidality, it has been found and indicated in suicide statistics that individual factors, such as depression and the experience of mental illness, play the largest role as a precursor to suicidal thoughts and behaviors.

Suicide risk factors often fall into the following categories:

Individual Factors

Individual factors are any personal and internal risk factors related to an increase in risk of suicidality. These factors can be hidden from others around us, further increasing one’s isolation. While these individual risk factors, such as a previous suicide attempt, do not exist in silos, they are often highly correlated with suicidal thoughts, intentions, and plans.

Individual risk factors that may increase the risk of suicide include:²

• Experiencing symptoms of or having a history of mental health diagnoses such as depression or trauma
• Previous suicide attempts
• Experiencing symptoms of or having a history of a substance use disorder
• Chronic pain or medical conditions
• Newly diagnosed medical conditions
• Legal issues
• Job loss
• Financial problems
• Impulsivity
• Aggressive tendencies
• Experiencing Adverse Childhood Experiences (ACEs)

Relational Factors

Humans exist in relation to one another. Relational risk factors are any painful experiences in relation to another person that contributes to one’s risk of suicidality.³ At times, our relationships can become toxic. It is in toxic relationships where abuse and mistreatment can occur. These factors, especially when existing with individual factors, can pose a greater risk of suicidal thoughts and behaviors.

Relationship risk factors that may increase the risk of suicide include:⁴

• Family history of death by suicide
• A history of being physically, sexually, emotionally, and/or psychologically abused
• Loss of relationships
• Ongoing violent or volatile relationships
• Social isolation

Environmental Factors

Environmental risk factors can be further broken down into community and/or societal factors. These factors are important as they put into perspective how the macro level inherently affects the micro, individual experience. Certain societal problems, such as racism and marginalization, contribute to chronic trauma, and studies show that black, brown, and LGBTQIA+ persons are at a high risk of suicidality.

Environmental risk factors that may increase the risk of suicide include:⁵

• Racism, discrimination, and prejudice
• Lack of access to mental health services
• Lack of culturally competent and attuned mental health services
• Community violence
• Intergenerational trauma and historical trauma
• Difficulties surrounding acculturation
• Ongoing stigma associated with mental illness, substance misuse, and seeking help
• Access to lethal means for which to die by suicide
• Harmful media portrayal of suicide

Suicide Risk Factors in Children & Teens

Certain environmental factors increase the risk of suicide among children and teens. Childhood trauma, chaos within the family unit, and other factors can increase the risk of suicide in younger individuals. Teen suicide is a public health crisis as suicide is the third leading cause of death among 14-18-year-olds.⁶

Suicide risk factors for children and teens include:

• Childhood trauma
• Mental health disorders
• Substance use disorders
• Exposure to suicide deaths and behaviors
• Family history of mental illness and/or suicidality
• Access to firearms
• Incarceration and/or institutionalization
• Bullying, cyberbullying, and unsafe social media portrayals regarding suicide
• Social rejection
• Toxic family life
• Low self-esteem
• Persistent interpersonal struggles
• Chronic medical illnesses
• Engagement in self-harming behaviors
• Adolescent stressors related to this time in the life-cycle such as next steps after high school
• Familial rejection for LGBQTIA+ youth
• Impulsivity and risky behaviors

Violence, Murder & Suicide

Over the past twenty years the influx of mass shootings and domestic gun violence has skyrocketed in the United States. Perpetrators of domestic violence, family violence, and intimate partner violence are most at risk for committing murder before dying by suicide.

Additionally, there has been a strong correlation between perpetrators of homicide-suicide and these perpetrators have had adverse childhood experiences (ACEs). Murder-suicide in the US is not insignificant. However, there is no formal tracking system in place, and therefore, the numbers surrounding the incidents of murder-suicide are best estimates. Current estimates indicate that 11 murder-suicides occur in the US every week, with nine out of ten of these incidences involving a gun.⁸

Preventing Suicide

Like any other thoughts, suicidal thoughts may ebb and flow, be more or not as intense, but they will eventually pass with time. If you are experiencing suicidal ideations, help is available. You can dial 988 to be connected to someone for support. If you have a trusted friend or family member, reach out to let them know you are struggling.

You can work to prevent thoughts and feelings of suicide by:

• Call/text/chat a crisis line: The crisis lines available in the US are dedicated to you and your wellbeing. They often offer 24/7/365 services and connect you with a licensed, trained, or survivor of suicide to offer you support.
• Ask a trusted person for help: Connecting rather than disconnecting is one of the most supportive acts you can do for yourself. Talking about suicidal thoughts can be scary; however, you do not have to experience them alone.
• Seek professional support: There are various treatment methods for depression, trauma, among other mental health conditions that work with you to understand the scope of your experience. A practitioner will guide you and help you to identify different internal coping skills to build up your resiliency.
• Remember your reasons to live: There are many important reasons to live, and when you consider your life, you will find many ‘whys’ for staying alive. Take time to identify your why. If you are struggling to do so, please consider enacting one of the previous prevention methods.

How to Help Someone You Believe Is Suicidal

It can feel daunting to talk to a loved one about your concerns that you believe may be suicidal. However, the best and first course of action is to ask them if they are having thoughts of suicide. It is a common misconception that talking about suicide will “make it happen” or “cause more suicidal thoughts”. This is not true.

If your loved one confirms that yes they are struggling with suicidal thoughts, then remain connected with them. Keep talking with them or go see them in person. Gently offer to help them get connected to a professional. Most of all, assist them in removing any lethal means from their home.⁹

When to Seek Professional Help

Any and all suicidal thoughts and threats of suicide must be taken seriously. Help is available by dialing 988. For Veterans, please press option one, and for LGBTGIA+ persons, you can also call or text The Trevor Project at (866) 488-7386 or text ‘START” to 678-678. In addition to crisis lines, therapy, and medication are available for those experiencing depression, post-traumatic stress, and other mental health conditions coupled with suicidal ideation.

Effective treatment options for suicidal ideation include:

• Safety Planning: Safety planning is not a specific treatment model. However, it is a viable and helpful tool utilized by therapists to garner a patient’s resources and resilience factors amidst suicidality. It is completed collaboratively as a tool for patients to utilize when suicidal thoughts occur.
• Cognitive behavioral therapy (CBT): CBT was developed to support a person’s understanding of how their thoughts-feelings-behaviors are connected. This type of therapy helps to target negative thoughts and challenge them accordingly.
• Cognitive behavior therapy for suicide prevention (CBT-SP): CBT-SP was developed to support persons with a prior suicide attempt in reducing the risk of re-attempts. This practice combines aspects of DBT and CBT in its prevention strategies.
• Dialectical behavior therapy (DBT): DBT is a therapy developed by Marsha Linehan in the treatment of Borderline Personality Disorder. It has shown efficacy across mood disorders as well and can specifically target suicidal ideation. For example, riding the wave of an emotion or thought, such as suicidal ideation, with imagery of the wave ebbing and flowing and not necessarily remaining stagnant.
• Medication: Antidepressant medications are often prescribed in the treatment of depression and suicidality. These medications work to increase certain neurotransmitters and hormones that the brain and body may be lacking, for which depressive symptoms occur.
• Attachment-based family therapy (ABFT): ABFT is a manualized 16-week treatment for adolescents and young adults aged 14 to 24 and their families. This therapy operates under the guise that the family unit and its function are central to suicidality. Therefore, the improvement of the family ultimately leads to a reduction in suicidality.¹⁰
• Collaborative assessment and management of suicidality (CAMS): CAMS is an evidenced-based treatment model for the treatment of patients experiencing suicide. CAMS targets the “drivers” of suicidal thoughts and urges and specifically builds coping skills around these to reduce risk.¹¹
• Mindfulness: Mindfulness is a practice of presence. While not specifically a therapy targeting suicidal thoughts, it has been shown to decrease symptoms of depression to which suicide is often linked.

Antidepressants & Suicide

Antidepressant medications are often used to treat depression, as well as other disorders such as anxiety. However, antidepressant medication can increase the risk of suicide. This is particularly true in younger patients. Some evidence suggests that this can be due to the increase in motivation a patient feels when prescribed antidepressants. Thus, this motivation to follow through on suicidal thoughts and plans may increase.⁷

Ultimately, the benefits of antidepressants in mitigating suicidal thoughts and depression often outway the risks. It is recommended that when starting any new antidepressant medications to have close follow-up with one’s therapist and psychiatrist, as well as a safety plan in place.

In My Experience

Suicide is a vast and complex public health crisis. In my experience, suicidality can be successfully treated with the right support in place. While talking about suicidal thoughts is scary, and the fear of how others will respond is very real, silence, in my opinion, is suicide’s closest ally.

In my own work, when a client presents with suicidality, I take time to understand the scope and intensity of suicidal thoughts and intent/plans. I work collaboratively to develop a safety plan. If the risk of a suicide attempt is evident, I walk through a higher level of care interventions with my clients, such as further evaluation at an emergency room and what could occur thereafter. I remain open and transparent about my own limitations as an outpatient provider and this transparency has often helped clients express themselves more openly.

While suicidal thoughts often darken the world around you, not all is lost. A combination of therapy and antidepressant medications, especially for persons with a higher risk of suicidality, is beneficial. For those weary of medications, I hear you, and I see you. First and foremost, one’s opinions and comfort level with their treatment plan are vital. Former President Barack Obama once said, “To anyone out there who’s hurting — it’s not a sign of weakness to ask for help. It’s a sign of strength.” Please know that if you are here, and you are reading this, you are so much braver than you realize.