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The heartbreak of suicide has been in the headlines lately, with the tragic loss of Stephen Boss, aka tWitch, the talented dancer and personality from "The Ellen DeGeneres Show." Many people expressed shock that someone who on the surface was so joyous and energetic could die by suicide, but unfortunately, suicide is often more surprising to loved ones than people realize.
Mental health symptomology, and in many demographics, suicidal behavior, have been rising precipitously for years. And silence makes it worse. Suicide is more common than homicide—by a large ratio—and yet the stigma and shame of it mean that many people do not realize the risk factors and warning signs of it, because conversations about it just don't happen with the frequency they should. Stigma leads to silence, and that leads to people not getting help.
New data has suggested that the rising suicide rate among children is particularly a cause for alarm, and that overall this increased risk disproportionately affects children with minority status in terms of race, ethnicity, sexual orientation, or gender identity, and also children who are living in poverty. Children and teens' warning signs may be missed because of the ways that they differ from those of adults, and so it is particularly important to include them whenever we discuss suicide risk as a whole.
The following are some factors that research has shown to statistically increase the risk of someone engaging in suicidal behavior, with special notations for the risk factors that apply uniquely to children and teens. Though none of these on their own mean that someone is absolutely high-risk, and they can't automatically tell us anything about someone's state of mind, the more layers of risk factors that someone has, the more it pays to be mindful that changes in behavior and other warning signs (which we'll discuss below) need to be taken extremely seriously.
Statistical risk factors for suicidal behavior:
- The presence of a psychological disorder; especially depression. But the more severe the disorder, the higher the risk—and only a small minority of people who die by suicide were in psychiatric or psychological treatment at the time of their deaths
- Having had a suicide in the family
- The loss of a significant relationship, whether through death, separation, divorce, or estrangement
- Having a firearm in the home (2/3 of gun deaths are suicide deaths)
- Substance abuse
- A stressful life event, especially involving humiliation or shame
- Past suicidal behavior
- Impulsive or aggressive tendencies
- Violence, whether as a perpetrator or a victim
- Abuse or neglect, or other adverse childhood experiences
- Distress about sexuality or gender identity
- Lack of achievement or having missed a long-planned-for goal
- Serious illness or chronic pain
- Lack of access to healthcare
- Social isolation
Additionally, for children and teens:
- Problems with friendship or social rejection
- Conduct disorder or behavioral problems
- Disruptive family environments
- Recent change in make-up of family
- Physical or psychiatric illness within the family
- Inconsistent parenting
- Suicide in one's friend group
- Poor coping skills
- School failure
- Overly perfectionistic attitudes
Next, we have warning signs. Unlike the statistical risk factors, these are signs that more urgent concern is justified, that at the very least someone may be suffering and their mental health at risk. And although none of these signs mean that we can predict suicidal behavior for sure, reaching out to someone and expressing concern is warranted when you notice the following behaviors, as they are commonly associated with a decline in mental health and with the possibility of a suicidal mindset.
Warning Signs:
- Talking about suicide, indirectly or directly (like feeling trapped or things being unbearable)
- Increased risk-taking and impulsivity or violence
- Having thought of a plan or method for suicide
- Severe hopelessness
- Giving away things/tying up loose ends
- Severe shame
- Expressing that someone feels they are a burden to others
- Severe agitation, insomnia
- Severe mood swings
- Increased substance abuse
Additionally, for children and teens:
- Severely dropping grades
- An increase in drawings about death or writing stories about it
- Talking about not belonging
- A substantial uptick in somatic symptoms such as headache or stomachache
- Sudden school refusal
- Sudden changes in eating patterns
- Sudden withdrawing from previous activities like youth sports
- Searching online for death-related topics
So what can you do?
Don’t be afraid to have a frank conversation and ask directly about thoughts of suicide. Many people wrongly assume that asking empathetically and compassionately if someone has had thoughts of ending their life will put the idea of killing themselves in their head; on the contrary, there is no evidence of this. Being direct is an important step in assessing risk, and also planting the seeds of concern, and destigmatizing speaking out.
Convey a message of support and hope, that there is help. It is important to emphasize that depression, agitation, and mental health struggles are real and treatable. Offer to help make an appointment with a mental health practitioner, drive them somewhere, or reach out to an additional loved one. But it is also not your burden to carry alone. And remember, caregivers need their own support as well.
If you or someone you know is in crisis, in the United States, call 988 to reach the Suicide and Crisis Lifeline. You can also call the network, previously known as the National Suicide Prevention Lifeline, at 800-273-8255, text HOME to 741741, or across the world visit SpeakingOfSuicide.com/resources for additional resources.
