BY JENNIFER WOODWORTH, PSY.D.
Suicide is “death caused by self-directed injurious behavior with an intent to die as a result of the behavior” (Center for Disease Control). According to the Substance Abuse and Mental Health Services Administration, 40,000 people in the United States die by suicide every year. On a larger scale, there are 25 suicide attempts for every completed suicide and many others, approximately 9.3 million people in 2014, who have serious suicidal thoughts. Veterans comprise 20 percent of national suicides, resulting in about 8,000 deaths, with approximately 22 veterans dying by suicide every day. Three out of five veterans who died by suicide were diagnosed as having a mental health condition, which means that they were in contact with at least one medical professional prior to their suicide.
There are no one set of “typical” signs of suicide, even though there are contributing factors and many signs to look out for. Sometimes the loss of a loved one happens unexpectedly or without any noticeable changes in the factors listed below, other times there are signs that are missed or minimized by the person suffering or the family member.
The impact of suicide is long-term and far-reaching. There are many questions surrounding suicide and, typically, answers are complicated or left unanswered. Mostly, the people left behind question the signs they might have missed or wonder what they could have done to prevent the loss.
Many people have thoughts of death or dying that may be fleeting or cross their mind from time to time; however, chronic suicidal thinking may include a plan or preoccupation with death. Below are some factors that might contribute to suicidal thoughts:
• Experience of a stressful life event (divorce, loss of child/family member, loss of job, marriage)
• Mood disorder (depression or anxiety)
• Trauma (from combat, sexual assault, car accident)
• Financial problems
• Chronic pain
• Substance use (alcohol, pain medication)
• Relationship in distress
• Feeling persecuted because of your identity
• Perceived lack of support from family or friends
• Family history of suicide
Following through on suicidal thoughts is often seen as the only solution to the person’s current situation. Below are factors contributing to suicidal behavior; remember, these are risk factors not necessarily things that caused the suicide.
• Continued substance use
• Impulsive behavior; not thinking about consequences of actions
• Hopelessness (thoughts that things are not going to get better)
• Access to a weapon or other chosen method (medication)
• Previous attempts of self-harm or suicide
• Recent hospitalization for depression or substance use
All of the above factors relate to those who find themselves thinking about death or dying. There are multiple complicating factors for veterans, or those currently serving in the military. Again, each person experiences and processes events differently and these may or may not increase risk for suicidal thoughts or gestures.
• Multiple traumatic events occurring over a short period of time (lives lost, witnessing death, person’s life was in danger, decisions led to unexpected outcomes)
• Returning home to a family with certain expectations
• Feeling emotionally disconnected from family
• Denying help due to fear that it will impact career
• Emotional instability or mistakes being made at work leading to questions from superiors
• Feelings of guilt and/or shame
• Not feeling safe or feeling constantly threatened
• Unrealistic expectations of self or others at work or home
• Access to weapons
• Continually being around others who have also experienced trauma
• Stressful work situations, long hours
• Moving to a new unit or duty station
Protective factors are factors that may assist a person in reaching out for help instead of following through on their plan and can moderate some of the contributing factors to suicidal thoughts and gestures. These may include:
• Accessing treatment for any diagnosed medical or mental health condition
• Awareness of warning signs that might lead to suicidal thoughts
• Being honest about any suicidal thoughts to medical providers
• Attending appointments as scheduled
• Taking medications as prescribed
• Being involved in the community (such as religious organization, sports)
• Spending time with supportive people
• Engagement in consistent physical activity
• Awareness of triggers (anniversaries, birthdays, certain events/sounds) and having a safety plan in place
• Structure of work routine
• Willingness to try medical and psychiatric interventions presented by professionals
• Cultural and religious beliefs that discourage suicide as a problemsolver
• Learning new skills to manage emotions and resolving conflicts
If you notice a family or friend exhibiting a combination of these warning signs, do not ignore them. This might be the only way they know how to reach out for help and, with your vigilance, can be directed to resources that can assist them in recovery.
• Talking about wanting to die or kill oneself
• Looking for a way to kill oneself
• Talking about feeling hopeless or having no reason to live
• Talking about feeling trapped or being in unbearable pain
• Talking about being a burden to others
• Increasing the use of alcohol or drugs
• Acting anxious or agitated
• Engaging in risky, dangerous, or reckless behavior (speeding, picking fights, unsafe sexual encounters)
• Sleeping too little or too much
• Withdrawing or feeling isolated
• Showing rage or talking about seeking revenge
• Displaying extreme mood swings (excitement shifts to rage or depression)
What you can do in the moment if you suspect someone is currently suicidal:
• Ask them if they are thinking about killing themselves. (This will not put the idea into their head or make it more likely that they will attempt suicide)
• Do not try and persuade the person not to do it, just listen without judging and show you care.
• Do not keep this information a secret or tell the person you will keep it private.
• Stay with the person (or make sure the person is in a private, secure place with another caring person) until you can get further help.
• Remove any objects that could be used in a suicide attempt.
• Call SAMHSA’s National Suicide Prevention Lifeline at 1-800-273-TALK (8255) and follow their guidance. If danger for self-harm seems imminent, call 911.
EVIDENCE BASED TREATMENT
There are effective treatments for suicidal thoughts in non-emergency situations. Exploring these options can assist in decreasing or eliminating suicidal thoughts and/or gestures and can create an increased understanding of oneself.
Psychotherapy: a therapist can assist in creating a safety plan, calming strategies, emotional regulation techniques, and ways to tolerate distress. Therapy can also address underlying issues that resulted in the suicidal thoughts. Therapy should be a collaborative process which works towards your goals.
Medications: visit your primary care physician or psychiatrist to consult about medications that can assist in reducing symptoms of depression, anxiety, or other interfering factors that may be leading to suicidal thoughts. Sleep, or lack thereof, can be a major contributing factor to stress.
Treatment for addiction: recognizing that you are abusing a substance can be shameful in itself but also empowering. Treatment leads to healthier medical and mental health and can include outpatient, inpatient, or residential treatment. Treatment might include detoxification, education, groups, and attending self-help meetings.
Involving family in care: keeping your family informed of mental illness and how they can be supportive is important in the recovery process. They will also be able to build their own set of coping skills and can improve communication among family members.
SUPPORT FOR SPOUSES, PARENTS AND CHILDREN
When supporting a family member or friend who is experiencing suicidal thoughts or behaviors, it is important to take care of yourself as well. You can access resources about suicide and increase your knowledge about what to do in a crisis. Take advantage of mental health services for yourself, participate in the community, seek social support from others, and continue to engage in healthy eating and sleep habits. •
ABOUT THE AUTHOR:
Jennifer Woodworth is a licensed clinical psychologist in private practice in Vista, CA. She has worked in the mental health field for seven years. Her husband is retired from the Marine Corps and she has three children ages six, eight, and ten.
INVISIBLE WOUNDS: SUICIDE PREVENTION RESOURCES
Veteran’s Crisis Line, in partnership with SAMHSA’s National Suicide Prevention Lifeline, connects veterans in crisis and their families and friends with qualified, caring Department of Veterans Affairs (VA) responders through a confidential toll-free hotline, online chat, or text. Veterans and their loved ones can call 1-800-273-8255 and press 1, chat online, or send a text message to 838255 to receive confidential support 24 hours a day, 7 days a week, 365 days a year.
www.veteranscrisisline.net
Veteran’s Affairs: Resources, warning signs, crisis line
www.mentalhealth.va.gov/suicide_prevention
Department of Veterans Affairs Health Services Research & Development Service: Strategies for Suicide Prevention in Veterans
www.hsrd.research.va.gov/publications/esp/Suicide-Prevention-2009.pdf
Military OneSource
www.militaryonesource.mil/phases-military-leadership?content_id=268663
Real Warriors: Family support
www.realwarriors.net/family/support/preventsuicide.php
Center for Disease Control: Violence and injury prevention
www.cdc.gov/violenceprevention/suicide/definitions.html
