At a family reunion several years ago, my Uncle rose to announce that he “hoped he wouldn’t be around” for the next family gathering.

His statement was at first greeted with laughter, then glances of concern and horror as we all recognized he wasn’t joking.

I wish I could report it was an idle threat. But not long after his initial announcement, my Uncle informed my mother, his sister, that he had set a date and had the means to end his life.

My mother, his five children, and his psychologist tried to argue him out of his decision. When medications and therapy didn’t change his mind, his children begged him to reconsider for his grandchildren, to look to the future.

But he remained resolute. A few months after he had talked to my mother, his oldest son found his father on the floor of his D.C. condominium, gone.

Like many suicides, my Uncle’s passing left a trail of confusion, guilt, and sorrow. Why had he made this choice? Could he had been stopped? What more might we have done?

Who Is at Highest Risk of Suicide

Around the world, the number of people who reported contemplating suicide has risen during the COVID-19 pandemic. According to the Centers for Disease Control and Prevention (CDC),1 more than twice as many US adults said they were thinking of suicide in June 2020 (10.7%) than in all of 2018 (4.3%). Equally disturbing, a quarter of young people aged 18 to 24 reported that they had contemplated killing themselves during the same period.

In 2018, the date of the most recent statistics, white middle-aged men accounted for the highest rate of suicide in the US, with men dying from suicide 3.6 times more often than women, according to the American Foundation for Suicide Prevention.2

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Although women have higher rates of depression and suicide attempts, fewer are successful, in part because they employ less violent means.

Contrary to the popular belief that most suicide attempts occur around December holidays, data from the CDC show that suicide rates across the US tend to reach their highest point each year sometime between March and August.

Additional figures reveal that in 2017 the leading cause of suicides was firearms (47,173), suffocation (13,075), and poisoning (6,554).

According to the National Institute of Mental Health3, the risk for suicidal behavior is complex. People who possess risk factors for suicide — such as a family history — will not kill themselves or even make an attempt. But people who may attempt suicide often have risk factors plus other disorders, including depression, substance abuse, anxiety, borderline personality disorder, and psychosis.

There is also a wide variability in how individuals approach suicide.

“Many people make multiple attempts,” said Dr. Nadine Kaslow PhD, a former APA president and professor and chief psychologist at Emory University School of Medicine in Atlanta. “Sometimes at the end of multiple attempts they get better or they eventually do die from suicide. There are people who jumped from the Golden Gate bridge, who regretted it as they were jumping. I’ve met with other people who felt that their greatest failure was that their suicide attempt had failed.”

[Click to Read Kevin Hines Story of Surviving a Jump From the Golden Gate Bridge]

And, experts agree not all suicides are preventable.

“Suicide is typically a way to end pain, either psychological or physical pain. People think that they can’t stand the pain anymore, and they need to kill themselves to make it stop,” said Joel Dvoskin, PhD a licensed clinical psychologist in Tucson, Arizona. “If they think that killing themselves is the only way to end this physical or psychological pain, then they might do that.”

But for many people, other ways of avoiding this pain may start to appear, said Dr. Dvoskin.

“When people get help, they may decide, well I don’t have to kill myself. Maybe there’s another way to feel less pain. Psychotherapy, for some people, is a way to do that.

For other people, it might be a community of faith. They talk to their minister, their Iman or their rabbi, and come to a spiritual understanding that helps them to feel less pain,” he said.

When it comes to suicide prevention, “a lot depends on whether people communicate what’s on their minds and on how much they can convey and share,” said Dr. Kaslow.

Reading the Suicide Warning Signs

People who are thinking about suicide often signal their plans to others. Red flags include talking about wanting to die or kill themselves, feeling empty or hopeless without a reason to live, talking about or searching for ways to kill themselves (such as stockpiling pills or acquiring potentially lethal items), withdrawing from family or friends, and talking about great guilt and shame.

Any of these behaviors – particularly if they are new – should not be ignored and family or friends should try to get them to seek professional aid.

Such help can include a combination of psychotherapy and medication or in the case of severe depression ECT (Electric Convulsive Therapy), a medical treatment that involves brief electrical stimulation of the brain while the patient is under anesthesia.

For patients with other mental health disorders, such as borderline personality, there are specific programs that are effective in reducing suicide attempts.

People may also enter psychiatric hospitals for more intensive help or treatment or move into more supportive living environments.

Discussing Depression and Suicide

When it comes to discussing mental illness issues such as suicide, depression or attempts at suicide within the extended family, such conversations can be a “mixed bag,” said Dr. Kaslow.

“It can be important to discuss instances of depression in a family,” said Dr. Kaslow. “But communication and honesty in families can be elusive, and there can be a great deal of secrecy and dishonesty about how someone dies. With suicide there can be a lot of shame.”

For those who have attempted suicide, communication within a family about their situation can be problematic.

“If a person who has tried to kill themselves feels that by sharing this information with other family members, you’re going to make it worse for them, that needs to be taken into consideration,” said Dr. Dvoskin. “What you want is to find ways for a person to relieve their intolerable pain or stress or anxiety, not add to it.”

“It very much depends on the situation and whether the family affected thinks it might help,” he said.

If a relation wants to talk about their depression or suicidal thoughts, experts recommend listening carefully. Individuals considering suicide are often very aware of who they are speaking with and how that particular person may react.

“They may know that they’re calling a person who is going to pick up a phone and call the police and say, “My Uncle is trying to kill himself,” said Dr. Dvoskin. “Or, they may know that you are the sort of person to talk them out of it or they may wish that you will try to talk them out of it.”

Taking Action to Save a Life

If a relative or friend tells you that they want to kill themselves, it’s vital not to leave them alone, or promise to keep their suicidal thoughts a secret. Attempting or thinking about suicide is never a cry for attention or a simple plea for help. Rather, it’s a medical emergency that requires professional attention as soon as possible.

“People should be proactive if a friend or family member tells them about a suicidal ideation. People don’t want to break a confidence, but I’d rather make somebody mad than have a dead friend,” said Dr. Dan Jones PhD, the director of the East Tennessee State University Counseling Center.

If a person calls and tells you they are actively suicidal, the best route is to get them to a hospital. If they refuse help or help is unavailable at the moment, Dr. Jones suggested some strategies from a protocol used by a suicide hotline available for students at his university.

In general, the goal is to make a plan and distract them from their suicidal thoughts until they can get professional help.

  • Make a plan. “If someone is suicidal and calling late at night, I try to get a person through the night and to a counseling center the next day by first setting out a plan,” said Dr. Jones. This might mean if they have a gun, to ask them to give the gun to someone else or if they refuse to give it up, to lock it in a table where they don’t have the key. If neither of these work, suggest that they put a picture of a family member on the gun cabinet or something, anything to deter them.
  • Ask what worked before. If they say they’ve been suicidal before, Dr. Jones suggested asking them how they handled that situation. “If they say I called a friend, we try to identify one or several friends that they might call. If someone says, “Well, I took a hot shower,” that might help.”
  • Recognize such terrible thoughts can pass. “Most of the time when somebody’s thinking of suicide they’re in a suicidal moment that doesn’t last for long periods of time, ” said Dr. Jones. Sometimes getting them through the moment can help. “I’ve had clients who said music calms them down so I prescribe that they listen to music. Others say they that they are able to get caught up in a video game. So there may be times a video game may distract them.”

In the end, though families may struggle to understand why a person turned to suicide, sometimes the truth will elude everyone.

“We know what we know, and we don’t know what we don’t know,” said Dr. Dvoskin. “You don’t often know why even if the person leaves a letter since that is simply the way they want the story to be told.”

“We think we have a story with a bow tied around it, but the exact truth of what the person’s motivation may not be possible to know.”

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Last Updated: Sep 23, 2020