Dr. Mary Dobbins: Everyone gets depressed sometimes. But what leads a person to the point of committing suicide? Suicidal tendencies vary from person to person, but understanding risk factors may help you or someone you love.
Q. Who is at Risk?
A. According to the American Foundation for Suicide Prevention, 90 percent of people who commit suicide suffer from a diagnosable psychiatric disorder, most often unrecognized or untreated depression.
Various personality traits and illnesses may also increase the risk for suicidal thinking. Commonalities between them include altered judgment, poor self-regulation, an impaired sense of reality, a sense of powerlessness, or the inability to think outside of the particular moment to envision a different experience. Those individuals with impulsivity, dis-inhibitions, substance abuse, or psychosis are at special risk.
Some personality types tend to make overly - catastrophic conclusions or are overly sensitive to interpersonal relationships. The resultant fear of abandonment, humiliation, or failure may lead to impulsive suicidal thinking during a crisis such as the loss of a relationship or employment. Suicide attempts often happen during an intense, frantic hopelessness when a person becomes overwhelmed and is not thinking reasonably.
Adolescents are at risk because they are impulsive and ego-centric by nature. Teens feel that the spotlight is always on them, so if one is "dumped" by a friend, the victim of cyber bullying, or suffers some other type of crisis, they don't have any way to put it in the context of a bigger, more tolerable, picture. Teens also tend to rely on their peers and may isolate themselves from more appropriate adult support.
There can be a certain contagion with suicide, especially among teenagers. The community mourning is seen as an outpouring of love. The desire for that type of attention can then lead to more suicidal activity. How the media reports the suicide can affect the contagion.
Most importantly, someone who has attempted suicide is more prone to try again - and to be successful.
Q. What are "suicidal tendencies"?
A. There is a continuum between thinking of and attempting suicide. Many people find themselves in situations that seem unbearable at times, and think: "I can't go on like this," but this is not necessarily a death wish, but a need for relief. Some begin to demonstrate risky behavior. Demonstrating "para suicidal" behavior (such as cutting or causing physical pain to oneself ) is not necessarily the same thing as being suicidal. It is often a chronic behavior that has developed as a way to alleviate emotional pain. However, it is a sign that the individual is overwhelmed and has not developed the resilience and skills to cope in healthy ways.
Unfortunately, some individuals continue to suffer and may begin to consider their own death, even to the point of planning or attempting suicide.
Q. What are the warning signs?
A. For people who think suicide is the way out, classic presentations include people who sound like they're saying goodbye, are putting their affairs in order, or giving away their things. Those who are severely depressed may seem withdrawn or unable to enjoy activities that used to give them pleasure. They may stop taking care of themselves, increase their intake of alcohol and drugs, and stop doing their usual day-to-day routines.
Q. How can a concerned friend help?
A. If you notice something and are concerned, don't be afraid to talk with the person about it. It's best to ask them about their behaviors. If you don't feel close enough to talk to the person, find a trusted friend, clergy or physician.
Make the environment more protective by decreasing access to guns (the most common method used in completed suicides) and substances that could be abused (and alter judgment or self-control). Offer to go with the person to see his or her family doctor, religious counselor, therapist, teacher or trusted friend.
Q. What is the treatment for suicidal behavior?
A. Typically, those who commit suicide have untreated depression. Consequently, treatment of depression (and related mental health problems) is the most effective method of suicide prevention.
Depression is not just having the blues for a day or two. Depression, related to low serotonin levels in the brain, is a biological, complex medical illness. Yet it is very common, with at least one in five people suffering from depression at some point in their lives.
A combination of treatment strategies is helpful. Simple self-care, such as getting enough sleep and cutting back on alcohol is a start. Therapy can help one work through the problems in their lives and improve their coping methods. Engaging a network of supportive relationships (such as family, friends, co-workers and neighbors) bolster personal resilience. In addition, a depressed brain is not healthy, and medications to normalize the serotonin level are typically quite helpful.
Thankfully, the stigma of mental illness is decreasing. There's no shame in asking for help to make yourself as healthy as you can and to be the best person you can be.
Q. Where can I find more information?
A. American Foundation for Suicide Prevention: www.afsp.org
Dr. Mary Dobbins is assistant professor and chief of the child psychiatry division at Southern Illinois University School of Medicine.