- Chronic illness increases people's vulnerability to suicidal thoughts and behaviors in several ways.
- Aspects of chronic illness, such as chronic pain, social disconnection, and perceiving oneself as a burden to others, are risks for suicidality.
- There are many ways to intervene in risk factors for suicidality. Small changes in even one risk factor can have profound effects.
September is Suicide Prevention Awareness Month. Suicide is a difficult but necessary topic to address. As suicide rates are elevated in people with chronic illness (Rogers, Joiner, & Shahar, 2021), it’s important to be aware of the ways that chronic illness can increase vulnerability to suicidality.
If you live with illness and are experiencing thoughts of suicide, please know that help is available and effective. If you are not currently experiencing suicidal thoughts, you may still wish to read on in order to learn how to prevent, identify and seek help for any early manifestations of suicidal ideation.
Risk Factors for Suicidal Thoughts and Behaviors
As George Orwell wrote: “Of pain, you could only wish for one thing: that it should stop.” The duration and intensity of chronic pain can feel unbearable. Depression is highly comorbid with chronic pain, and depression and suicidality are often intertwined (Racine, 2018).
Loneliness, separation from people and societal structures, and isolation are risk factors for suicidality (Rogers, Joiner, & Shahar, 2021). Chronic illness often creates physical and emotional barriers that keep people isolated. Symptoms may prevent people from fully participating in employment, schooling and leisure activities that facilitate connection. The emotional toll of “being different” can also be a barrier to intimacy with others.
The belief that one is a burden on others has been linked to increased suicidality (Rogers, Joiner, & Shahar, 2021). Perceived burdensomeness is associated with chronic illness, with many people living with illness expressing worry and grief that their illness is “too much” for family members and friends.
Critical Expressed Emotion
“Critical expressed emotion” is another factor that elevates the risk of suicidal thoughts and behaviors (Rogers, Joiner, & Shahar, 2021). Critical expressed emotion is defined as critical and hostile interactions directed from family members to individuals. Chronic illness affects the entire family. Family caregivers experience increased stress and may express that stress in critical and hostile interactions that deeply affect the emotional well-being of the chronically ill family member.
Hopelessness and Helplessness
Chronic illness can create a vulnerability to both hopelessness — the belief that nothing will change — and helplessness — the belief that one has no power to create change. Both states of mind are risk factors for suicidality (Karasouli, Latchford, & Owens, 2014).
Toxic self-criticism, another risk factor for suicidality, occurs when we set unrealistically high self-standards. People living with chronic illness can run into trouble when they compare themselves unfavorably to healthy people and/or to the person they were prior to illness (Karasouli, Latchford, & Owens, 2014).
Treatment: Effective Intervention Where Risk Exists
It’s sobering to consider all of the ways that chronic illness makes us more vulnerable to suicidal thoughts and behavior. But the existence of multiple risk factors also means that there are multiple ways to intervene. Addressing and improving even one area of risk will reverberate, improving other areas and the system as a whole (Rogers, Joiner, & Shahar, 2021). It’s important to remember that a seemingly small change can have profound effects.
As a therapist, I’m trained to help clients make these changes. We look at thought patterns and beliefs together and assess whether they’re true and whether they are working for you. To think something (“I would be better off dead”; “The sky is full of purple polka-dots”) does not make it true. We also tend to your emotions. True or not, these thoughts and beliefs are hurting you deeply, and we hold that pain together in therapy, finding ways to help you mitigate and manage it. We look at family systems and friendship networks, helping you build and strengthen intimacy and connection. We also look at societal injustice that may be contributing to your pain. We help you advocate (and often advocate alongside you) for change in systems (including medical systems) that need to do better.
If you see yourself in this post, please know that effective treatment for suicidal thoughts and behavior exists. If you don’t know where to begin to find a therapist, ask your doctor or insurance company for a local referral. You matter. You deserve support. We are standing by, ready to help.
If you or someone you love is contemplating suicide, seek help immediately. For help 24/7 contact the National Suicide Prevention Lifeline, 1-800-273-TALK, or the Crisis Text Line by texting TALK to 741741. To find a therapist near you, see the Psychology Today Therapy Directory.
Karasouli, E., Latchford, G., & Owens, D. (2014). The impact of chronic illness in suicidality: a qualitative exploration. Health Psychology and Behavioral Medicine, 2(1): 899-908.
Racine, M. (2018). Chronic pain and suicide risk: a comprehensive review. Progress in Neuropsychopharmacology and Biological Psychiatry, 87: 269-280.
Rogers, M.L., Joiner, T.E., & Golan, S. (2021). Suicidality in chronic illness: an overview of cognitive-affective and interpersonal factors. Journal of Clinical Psychology in Medical Settings, 28(1): 137-148.