Suicide: Risk factors and warning signs
This entry compliments our Psych Chat video series on Youtube, find it here: https://youtu.be/PV9dhKhrzm4
Today Bell is spreading awareness through their annual campaign Bell Let’s Talk. So, let’s talk. Let’s talk about how, according to Public Health Services, 11 Canadians per day die by suicide, and 33% of deaths by suicide are amongst those who are aged 45 to 59 (Government of Canada, 2023). Additionally, it is found that suicide is the second leading cause of death among individuals aged 15 to 34 years old (Government of Canada, 2023). It is sad in and of itself to note that, according to Statistics Canada, suicide rates have been on the rise since 2019 from 2% to 4.2% as of Spring 2021 (Government of Canada, 2023). What does this data mean? It means that people are struggling at various different stages in their lives, particularly during adolescence and young adulthood as well as middle-aged individuals.
From a psychoanalytic perspective, it seems as though that individuals aged 15 to 34 are struggling with two significant psychosocial conflicts, which are unconsciously hidden behind defences mechanisms. In other words, Erik Erikson suggests that individuals aged 12 to 18 years old struggle with the unconscious psychosocial conflict concerning identity versus role confusion. Erikson outlines, individuals at the identity versus role confusions stage of development are fundamentally searching for a sense of self, personal identity, and autonomy through experimenting in social situations to determine their values, beliefs, and future aspirations. Some people find it difficult to “fit in” with the crowd, and thus feel rejected and abandoned, which then becomes internalized as the adolescent develops into an adult. Individuals aged 18 to 40 years old struggle with, according to Erikson, intimacy versus isolation. At the intimacy versus isolation stage, young and middle-aged adults begin to learn how to formulated intimate bonds with another person, and learn who they are within an intimate relationship. Those who have exhibited aspects of rejection and abandonment during the identity versus role confusion stage, those individuals are more likely to align with isolation aspect of Erikson’s intimacy versus isolation stage. In other words, if an individual grew up believing that he/she/they are a “burden” to others and/or have experienced a pattern of rejection, then it is more likely the individual during adulthood would act in such a way as to isolate from the world. Projecting into the future that the rejection would continue, and thus trying to safeguard themselves from the perceived future anticipated pain.
Growing up is hard! It is not easy to figure out who we are, how we show up in the world, and how others relate to us. Being able to fit in is not easy, especially if you are a teen trying to figure out who you are. No everyone struggles with suicidal ideation, or has a plan and timeline, but there are certain risk factors that can increase the likelihood one is struggling with suicidal thoughts.
Risk factors can include, but are not limited to:
Family history of suicide
Child maltreatment
History of suicide attempts
Exposure to violence and/or experiencing abuse
Mental illness including but not limited to major depressive disorder (MDD) and trauma
Substance abuse or increased substance use
Physical illness including chronic pain
Hopelessness
Irritability in those who identify as sis male
Impulsiveness
Aggressiveness
Local epidemics of suicide
Isolation
Access to weapons
Barriers to accepting or accessing mental health treatment
Unwillingness to seek help
Loss (relational, social, financial, career, etc) (Haney et al., 2012; Masango et al., 2008).
When identifying if you or someone you love is at risk for ending their own life, then it is important to be aware of these risk factors. If you are aware of the risks that can increase the likelihood you or someone is at risk for suicide, then you can do something different that could save a life. Determining if risk is imminent or non-imminent includes a process of identifying clusters of risk factors. For instance, if a you are struggling with depression, have recently stopped taking your medication, have a history of suicide attempts, have a difficult/complex family dynamic, feeling hopeless and helpless, drinking alcohol more often, and exhibits impulsive behaviour, then you are more at risk for ending your own life. That does not mean to say you are in fact in imminent danger of ending your life, but rather you are more at risk based on the risk factors.
Secondly, it is important to identify any subtle and direct warning signs that may suggest you or someone you know is at risk for ending their own life.
Here is a list of some of the warning signs:
Talking about death frequently
Talking about wanting to die, frequently fantasizing about what death might be like, or talking about wanting to end their own life (other people aren’t as straightforward)
Talking about feeling empty, hopeless, or having no meaning or reason to live
Talking about feeling trapped and not having a solution
Feeling an a lot of emotional and/or physical pain
Talking about being a burden to others, and others are “better off without me”
Giving away important possessions
Saying goodbye to family and friends
Putting affairs in order such as making a will, organizing one’ s room/home
Taking risks including but not limited to driving fast or not taking your prescribed medication or not taking your medication as prescribed
Mood swings
Researching or Making a plan to end their own life
Access to weapons increases the imminent risk of harm
Talking about feeling and overwhelming sense of guilt and shame
Using more and more recreational substances
Acting anxious or agitated
Change in eating or sleeping habits
Showing rage or talking about seeking revenge (Rudd et al., 2006; Rudd, 2008).
Warning signs are different than risk factors. Warning signs are red flags that suggest imminent risk. Identifying risk factors can increase the likelihood someone is at risk, but it might not be imminent risk of suicide. But an increase cluster of warning signs can signify imminent risk of suicide, and the individual requires immediate medical/psychiatric attention.
What if you or someone you know is at imminent risk of ending their own life? What do you do? Your goal is to contact emergency services so you or the individual can go to the hospital to receive a psychiatric evaluation. If you are at imminent risk of suicide then you can contact emergency services directly or contact a distress line, so someone can help you with the emotional transition of going to the emergency department.
If you are made aware of someone you love is at imminent risk of suicide, then it is advantageous to work with the individual to help the at-risk individual choose to go to the emergency department to ensure their safety. In other words, you may inform the at-risk individual that attending the emergency department can be an added resource, where the individual will receive support from a psychiatrist, nursing staff, therapists, and/or a social worker. Providing the individual with reassurance that he/she/they will have access to many resources can be appealing for someone who feels lost and abandoned by the world. If the individual is at risk for suicide, and is not onboard with going to the hospital, then you may be in a position of letting them know your goal is for them to go to the hospital. You might say something along the lines of, “I understand you are hesitant or reluctant to go to the hospital, and you have your valid reasons. Additionally, I would like you to understand my position, which involves keeping you safe and ensuring you receive the proper medical treatment that will help keep you safe. You might not like the idea that I plan to contact emergency services, but I am doing this because I care and want to you to be safe”. By validating the individual’s thoughts and feelings surrounding their resistance can help open the pathways of communication, which will more likely allow room for you to disclose your thoughts, feelings, and plan of action.
These are some suggestions on how to approach a very difficult situation if you or someone you know is at risk for ending their life.
Learn more about therapy services here.
References
Government of Canada. (2023). Suicide in Canada. Retrieved from. https://www.canada.ca/en/public-health/services/suicide-prevention/suicide-canada.html#a1
Haney, E. M., O'Neil, M. E., Carson, S., Low, A., Peterson, K., Denneson, L. M., ... & Kansagara, D. (2012). Suicide risk factors and risk assessment tools: A systematic review.
Masango, S. M., Rataemane, S. T., & Motojesi, A. A. (2008). Suicide and suicide risk factors: A literature review. South African Family Practice, 50(6), 25-29.
McLeod, S. (2013). Erik Erikson's stages of psychosocial development.
Rudd, M. D. (2008). Suicide warning signs in clinical practice. Current psychiatry reports, 10(1), 87-90.
Rudd, M. D., Berman, A. L., Joiner Jr, T. E., Nock, M. K., Silverman, M. M., Mandrusiak, M., ... & Witte, T. (2006). Warning signs for suicide: Theory, research, and clinical applications. Suicide and Life-Threatening Behavior, 36(3), 255-262.
