Suicide was defined by the sociologist Emile Durkheim as applying to ‘all cases of death resulting directly or indirectly from a positive or negative act of the victim himself, which he knows will produce this result’.
A person’s risk of committing suicide can be increased by a number of demographic and social risk factors. Demographic risk factors for suicide include being male; being relatively young; and being single, widowed, or separated or divorced. Social risk factors for suicide include being unemployed, insecurely employed, or retired; having a poor level of social support as is often the case for the elderly, prisoners, immigrants, refugees, and the bereaved; and having been through a recent life crisis such as losing a close friend or relative or being the victim of physical or sexual abuse.
As well as demographic and social risk factors, a person’s risk of committing suicide can also be increased by a number of clinical risk factors. The most important predictor of suicide is a previous act of deliberate self-harm, and a person’s risk of completing suicide in the year following an act of deliberate self-harm is approximately 100 times greater than that of the average person. Conversely, up to half of all people who complete suicide have a history of deliberate self-harm. Suicidal behavior tends to cluster in families, so a family history of deliberate self-harm also increases a person’s risk of suicide. This is perhaps because suicide is a learned behaviour or, more likely, because family members share a generic predisposition to psychiatric disorders that are associated with a higher risk of suicide. People with a psychiatric disorder who are resistant to their prescribed medication or non-compliant with it are also at a higher risk of suicide, as are people experiencing certain specific symptoms such as delusions of persecution, delusions of control, delusions of jealousy, delusions of guilt, commanding second person auditory hallucinations (for example, a voice saying ‘Take that knife and kill yourself’), and passivity which is the feeling that one’s thoughts, feelings, and actions are under the control of an external agency. Physical illness can also increase the risk of suicide, and this is particularly the case for physical illnesses that are terminal, that involve long-term pain or disability, or that affect the brain. Examples of such physical illnesses include cancer, early-onset diabetes, stroke, epilepsy, multiple sclerosis, and AIDS.
If you are assailed by suicidal thoughts, the first thing to remember is that many people who have attempted suicide and survived ultimately feel relieved that they did not end their lives. At the time of attempting suicide they experienced intense feelings of despair and hopelessness because it seemed to them that they had lost control over their lives and that things could never get better. The only thing that they still had some control over was whether they lived or died, and committing suicide seemed like the only option left. This is never true.
Some of the thoughts that may accompany suicidal thoughts include:
• I want to escape my suffering.
• I have no other options.
• I am a horrible person and do not deserve to live.
• I have betrayed my loved ones.
• My loved ones would be better off without me.
• I want my loved ones to know how bad I am feeling.
• I want my loved ones to know how bad they have made me feel.
Whatever thoughts you are having, and however bad you are feeling, remember that you have not always felt this way, and that you will not always feel this way.
The risk of a person committing suicide is highest in the combined presence of (1) suicidal thoughts, (2) the means to commit suicide, and (3) the opportunity to commit suicide. If you are prone to suicidal thoughts, ensure that the means to commit suicide have been removed. For example, give tablets and sharp objects to someone for safekeeping, or put them in a locked or otherwise inaccessible place. At the same time, ensure that the opportunity to commit suicide is lacking. The surest way of doing this is by remaining in close contact with one or more people, for example, by inviting them to stay with you. Share your thoughts and feelings with these people, and don’t be reluctant to let them help you. If no one is available or no one seems suitable, there are a number of emergency telephone lines that you can ring at any time. You can even ring for an ambulance or take yourself to an Emergency Room. Do not use alcohol or drugs as these can make your behavior more impulsive and thereby significantly increase your likelihood of attempting suicide. In particular, do not drink or take drugs alone, or end up alone after drinking or taking drugs.
Make a list of all the positive things about yourself and a list of all the positive things about your life, including the things that have so far prevented you from committing suicide (you may need to get help with this). Keep the lists on you, and read them to yourself each time you are assailed by suicidal thoughts. On a separate sheet of paper, write a safety plan for the times when you feel like acting on your suicidal thoughts. Your safety plan could involve delaying any suicidal attempt by at least 48 hours, and then talking to someone about your thoughts and feelings as soon as possible. Discuss your safety plan with a healthcare professional and commit yourself to it. Sometimes even a single good night’s sleep can significantly alter your outlook, and it is important not to underestimate the importance of sleep. If you are having trouble sleeping, speak to a physician.
Example of a safety plan
1. Read through the list of positive things about myself.
2. Read through the list of positive things about my life and remind myself of the things that have so far prevented me from committing suicide.
3. Distract myself from suicidal thoughts by reading a book, listening to classical music, or watching my favorite film or comedy.
4. Get a good night’s sleep. Take a sleeping tablet if necessary.
5. Delay any suicidal attempt by at least 48 hours.
6. Call Stan on (phone number). If he is unreachable, call Julia on (phone number). Alternatively, call my healthcare professional on (phone number), or the crisis line on (phone number).
7. Go to a place where I feel safe such as the community centre or the sports centre.
8. Go to the Emergency Room.
9. Call for an ambulance.
Once things are a bit more settled, it is important that you address the cause or causes of your suicidal thoughts in as far as possible, for example, a mental disorder such as depression or alcohol dependence, a difficult life situation, or painful memories. Discuss this with your physician or another healthcare professional, who will help you to identify the most appropriate form of help available.
See also my related article, Coping with Self-Harm