Guide for families - Detection and prevention of suicidal conduct
- Article by Cosme Moya
The World Health Organisation (WHO) identifies suicide attempts as one of the most serious
health problems that can affect people and therefore recommends to all its state members to
treat it as a priority.
Suicide seemingly presents to people as a permanent solution to intense emotional mental
and /or physical temporary pain, or to interpersonal disruptive relationships. The important
thing to note, is that often the despair, the pain and the emptiness are temporary and not
permanent states.
Suicide may be the result of a sudden impulse or it could be planned very carefully.
Most people who think about suicide do not really want to carry this out; they just want to
break free from the intolerable circumstances of their lives and the mental, emotional and
physical anguish. Therefore they almost always live between the reasons for living versus
reasons for dying, and suicidal behaviour is the only alternative they might see.
The challenge for people attempting suicide is to find ways to solve those intolerable
feelings. The support of family and / or friends, psychopharmacological treatments and
psychotherapy are invaluable factors for the prevention of suicide attempts.
Suicide is a very serious problem in public health. Suicide in industrialised countries is
among the ten leading causes of death. In the age groups between 15-24 years, it is the
second or third leading cause of death, in the age group of 35-45 years old it is the fourth
cause of death, and between 45-65 years old it ranks from the fifth to the eighth leading
cause of death. Despite these figures, suicide can be prevented in many cases.
It is estimated that at least 90% of people who take their own life experience some form of
mental illness. Suicide is the leading cause of premature death among people diagnosed
with depression, bipolar disorder, schizophrenia, or drug use.
People affected by depression have a greater chance of suicide, the risk being 20 times
higher in comparison with the general population. Up to 15% of people die following a
suicide attempt.
People with bipolar disorder have a probability of suicide risk 15 times higher to that
compared with the general population. Up to 15% of people die after a tentative attempt and
up to 56% attempt suicide at least once in their lifetime.
People with schizophrenia have a probability of suicide risk 9 times higher than that of the
general population. Up to 10% of people died after an attempt and up to 30% try it at least
once in their life.
Those diagnosed with borderline personality disorder have probability of suicide risk
between 4 and 8 times higher as compared to the general population. Up to 8% of people
die after a tentative suicide attempt and up to 70% attempt suicide at least once in their life.
People with psychoactive substances dependencies, including alcohol and other drugs have
a higher suicide risk than the general population, particularly if they are young people who
have difficulties with interpersonal relationships or with family members.
It is estimated that 30 to 40% of suicide deaths are preceded by suicide attempts.
Cosme Moya
Suicide Prevention
ARAFMI NSW Inc
1
Guide for families - Detection and prevention of suicidal conduct
- Article by Cosme Moya
Translated from:
Javier Jimenez Pieatropaolo, et al. (2011). Detección y prevención de la conducta suicida
(Guide for Families. Detection and prevention of suicidal behaviour). Madrid Ministry of
Health, Madrid, 2011.
Myths and misconceptions about suicide
Myth: Talking about suicide is a bad idea as it may give someone the idea to try it.
Fact: Suicide can be a taboo topic in society. Often, people feeling suicidal don’t want to
worry or burden anyone with how they feel and so they don’t discuss it. By asking directly
about suicide you give them permission to tell you exactly how they feel. People who have
felt suicidal will often say what a huge relief it is to be able to talk about what they’re
experiencing. Once someone starts talking they’ve got a better chance of discovering other
options to suicide.
Myth: People who talk about suicide aren’t serious and won’t go through with it.
Fact: People who commit suicide have often already told someone that they do not feel life
is worth living or that they have no future. Some may have actually said they want to die.
While it is possible that someone might talk about suicide as a way of getting the attention
they need, it’s vitally important to take anybody who talks about feeling suicidal seriously.
Myth – Who talks about it, doesn’t do it.
Reality – The person could have expressed the intention with words, threats, gestures or
behavioural changes.
Myth - Suicide can’t be prevented because it is an impulse.
Reality - Every person before committing suicide displays a number of symptoms that have
been defined as Pre-Suicidal Syndrome, consisting of a constriction of feelings and intellect,
inhibition towards aggression which is no longer directed towards other people but directed
to themselves instead and existence of suicidal fantasies. This can all be detected given
time and can aim to prevent a person from carrying out their intentions.
Myth – Only people with serious problems commit suicide.
Reality - Suicide is multi-layered. Many small problems put together can lead to suicide
attempts. Additionally, a problem that is trivial for some may be catastrophic to others.
Protective factors
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Effective clinical care for mental, physical and substance use disorders
Easy access to a variety of clinical interventions
Early identification and treatment of mental illness.
Long term holistic treatment for patients with mental disorders, physical disabilities or
drug and alcohol abuse.
Support through ongoing medical and mental health care relationships
Hope
Restricted access to highly lethal means of suicide
Cosme Moya
Suicide Prevention
ARAFMI NSW Inc
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Guide for families - Detection and prevention of suicidal conduct
- Article by Cosme Moya
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Presence of a significant and supportive other
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Positive attitudes and values, such as respect, solidarity, cooperation, justice and
friendship
Strong connections to family and community support
Skills in problem solving, conflict resolution and handling problems in a non-violent
way
Cultural and religious beliefs that discourage suicide and support self-preservation
Self Confidence
Responsibility for children (particularly for women).
Ability to develop good personal and interpersonal relationships.
Asking for advice and help when difficulties arise.
Ability to cope with stress, crisis and loss (National Suicide Prevention Line)
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Risk Factors
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Mental disorders, particularly mood disorders, schizophrenia, anxiety disorders and
certain personality disorders
Alcohol and other substance use disorders
Hopelessness
Impulsive and/or aggressive tendencies
History of trauma or abuse
Major physical illnesses
Previous suicide attempt
Family history of suicide
Job or financial loss
Loss of relationship
Easy access to lethal means
Local clusters of suicide
Lack of social support and sense of isolation
Stigma associated with asking for help
Lack of health care, especially mental health and substance abuse treatment
Exposure to others who have died by suicide (in real life or via the media and
Internet)
Cultural and religious beliefs, such as the belief that suicide is a noble resolution of a
personal dilemma (National Suicide Prevention Line)
Warning signs of suicide
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Always talking or thinking about death
Clinical depression -- deep sadness, loss of interest, trouble sleeping and eating -that gets worse
Having a "death wish," tempting fate by taking risks that could lead to death, such as
driving fast or running red lights
Losing interest in things one used to care about
Making comments about being hopeless, helpless, or worthless
Putting affairs in order, tying up loose ends, changing a will
Saying things like "it would be better if I wasn't here" or "I want out"
Sudden, unexpected switch from being very sad to being very calm or appearing to
be happy
Cosme Moya
Suicide Prevention
ARAFMI NSW Inc
3
Guide for families - Detection and prevention of suicidal conduct
- Article by Cosme Moya
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Talking about suicide or killing one's self
Visiting or calling people to say goodbye, giving valuable and personal objects as
presents for family and friends (WedMD, 2015).
Physical changes
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Major changes to sleeping patterns – too much or too little
Loss of energy
Loss of interest in personal hygiene or appearance
Loss of interest in sex
Sudden and extreme changes in eating habits – either loss of appetite or increase in
appetite
Weight gain or loss
Increase in minor illnesses
Behaviours
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Alcohol or drug misuse
Fighting and/or breaking the law
Withdrawal from family and friends
Quitting activities that were previously important
Prior suicidal behaviour
Self-harming
Putting affairs in order e.g. giving away possessions, especially those that have
special significance for the person
Writing a suicide note or goodbye letters to people
Uncharacteristic risk-taking or recklessness (e.g. driving recklessly)
Unexplained crying
Emotional outbursts
Conversational signs
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No future – "What's the point? Things are never going to get any better"
Guilt – "It's all my fault, I'm to blame"
Escape – "I can't take this anymore"
Alone – "I'm on my own … no-one cares about me"
Damaged – "I've been irreparably damaged… I'll never be the same again"
Helpless – "Nothing I do makes a bit of difference, it's beyond my control"
Talking about suicide or death
Planning for suicide
Feelings
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Sadness
Anger
Shame
Desperation
Disconnection
Hopelessness
Worthlessness
Cosme Moya
Suicide Prevention
ARAFMI NSW Inc
4
Guide for families - Detection and prevention of suicidal conduct
- Article by Cosme Moya
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Powerlessness
Loneliness
Isolation
The identification of these warning signs could be directly related to the presence of suicidal
ideation. However the fact that these signals are not detected does not mean that the person
cannot carry out a suicide attempt (Suicide Line, 2015)
What Should I Do if Someone I Know Shows Warning Signs of Suicide?
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First, if someone you know appears to be depressed and is contemplating
suicide, take that person seriously. Listen to what he or she is saying. Take the
initiative to ask that person what he or she is planning. But don't attempt to argue him
or her out of committing suicide. Rather, let the person know that you care and
understand and are listening. Avoid statements like: "You have so much to live for."
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If someone you know appears to be depressed and talks about suicide, makes a
suicidal gesture, or attempts suicide, take it as a serious emergency. Listen to the
person, but don't try to argue with him or her. Seek immediate help from a health
care professional.
Limit access to lethal means of suicide. (E.g. firearms, pills, rope…)
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Always think that if the person was unsuccessful in a previous attempt, he/she will try
to use a deadlier method than the one used in the previous attempt.
Be mindful of people living in high apartments
Never leave him/her alone, involve family and friends
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Sometimes friends can reach where families can’t, ask them to help.
Feelings such as hopelessness, impulsivity and isolation are social factors that when
combined together can multiply the risk of suicide and help synchronise the action.
Improve your asking and listening skills
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It has been proven that asking and talking to the person about the presence of
suicidal thoughts lowers the risk of acting on them. As a matter of fact it might be the
last chance we have to prevent it.
It is very important to:
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Do not judge the person. Do not criticise his/her way of thinking
Take that person seriously
Do not panic
Show you care, genuinely listen.
Understand that he/she is going through a very difficult time in his/her life.
Use pleasant and kind terms that show respect. (e.g. "I would like you to give me an
opportunity to help").
Talk about his/her idea of committing suicide openly and without fear (discard the
myth that by talking about suicide we could lead them to do it).
Try to find out the reasons which lead him/her to want to end his life and look for
options in order to find solutions, or provide emotional support if there isn’t a solution.
Cosme Moya
Suicide Prevention
ARAFMI NSW Inc
5
Guide for families - Detection and prevention of suicidal conduct
- Article by Cosme Moya
Taking care of the family environment or family self-care
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This strategy should be present throughout the process of helping our family
member. We cannot put aside the family or environment of the person with suicidal
ideology. Following all recommendations of this Guide takes a toll on the person who
carries them out, we must be aware that although we can overcome the
myths surrounding suicidal behaviour, identify the warning signs and implement all
the recommended preventive measures, It may not be possible for us to control or
watch our family member 24 hours a day. We must not adopt the role of health
professionals. If necessary, the family of the person with suicidal risk should also
seek specialized help for themselves.
References:
Javier Jimenez Pieatropaolo, et al. (2011). Detección y prevención de la conducta suicida
(Guide for Families. Detection and prevention of suicidal behaviour). Madrid Ministry of
Health, Madrid, 2011. Accessed 22 April 2015 at:
http://www.madrid.org/cs/Satellite?blobcol=urldata&blobheader=application%2Fpdf&blobhea
dername1=Contentdisposition&blobheadername2=cadena&blobheadervalue1=filename%3DGUIA+FAMILIARE
S+DetecPrev+Conducta+Suicida+2011_REv.pdf&blobheadervalue2=language%3Des%26si
te%3DPortalSalud&blobkey=id&blobtable=MungoBlobs&blobwhere=1310771483300&ssbin
ary=true
National Suicide Prevention Line. Suicide risk factors. Accessed 22 April 2015 at
http://www.suicidepreventionlifeline.org/learn/riskfactors.aspx
Suicide Line (2015). Recognising suicide warning signs. Accessed 22 April 2015 at
http://suicideline.org.au/worried-about-someone/recognising-suicide-warning-signs
WebMD (2015). Recognize the Warning Signs of Suicide, Accessed 22 April 2015 at
http://www.webmd.com/depression/guide/depression-recognizing-signs-of-suicide
Cosme Moya
Suicide Prevention
ARAFMI NSW Inc
6