Save a Life: Learn the Suicide Risk Factors and Warning Signs

Consider sharing this post. It’s National Suicide Prevention Week— please take a moment to review the Risk Factors and the Warning Signs as they may apply to loved ones, friends, colleagues, or even yourself. Click here for the Risk Factors/Warning Signs page of the American Foundation for Suicide Prevention. People with Risk Factors or exhibiting Warning Signs are strongly encouraged to seek treatment—suicide is preventable. If you or someone you know feels the need to speak with a mental health professional, please consider contacting the National Suicide Prevention Lifeline at 1-800-273-8255.

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From AFSP:

“There’s no single cause for suicide. Suicide most often occurs when stressors exceed current coping abilities of someone suffering from a mental health condition. Depression is the most common condition associated with suicide, and it is often undiagnosed or untreated. Conditions like depression, anxiety and substance problems, especially when unaddressed, increase risk for suicide. Yet it’s important to note that most people who actively manage their mental health conditions lead fulfilling lives.”

Risk Factors are characteristics or conditions that increase the chance that a person may try to take their life:

Health Risk Factors—such as mental health conditions, substance abuse disorders, or serious/chronic health conditions and/or pain.

Environmental Risk Factors—such as stressful life events, prolonged stress conditions, access to lethal means, and exposure to suicide.

Historical Risk Factors—such as previous suicide attempts.

Be aware of Warning Signs.

According to AFSP, most people who take their lives exhibit one or more warning signs, either through what they say or what they do.

Warning Signs relate to a person’s Talk— about “being a burden to others,” or “feeling trapped,” or “experiencing unbearable pain,” or “having no reason to live,” or “killing themselves.”

Warning Signs relate to a person’s Mood—displaying one or more moods such as depression, loss of interest, rage, irritability, humiliation, anxiety.

Warning Signs relate to a person’s Behavior—such as increased use of alcohol or drugs, aggression, acting recklessly, withdrawing from activities, isolating from family and friends, sleeping too much or too little, visiting or calling people to say goodbye, giving away prized possessions, and looking for a way to kill themselves.

“Something to look out for when concerned that a person may be suicidal is a change in behavior or the presence of entirely new behaviors. This is of sharpest concern if the new or changed behavior is related to a painful event, loss, or change.”

How to help someone who may be struggling: click here for guidance from the American Foundation for Suicide Prevention.

Click on the infographic below to download a Warning Signs checklist.

When Someone You Know Has Depression

Dr. Susan J. Noonan, author of When Someone You Know Has Depression: Words to Say and Things to Do, will be the featured guest speaker at a “Readings on Mental Health” event on April 30 sponsored by the Mental Health Association in Tompkins County and hosted by Buffalo Street Books.

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Noonan’s latest book is a concise and practical guide to caring for someone who has depression or bipolar disorder, offering specific suggestions for what to say or do to cope with impaired thinking and fluctuating moods. The book contains chapters on mood disorders, signs of depression, support and communication strategies, finding professional help, and caring for caregivers.

When Someone You Know Has Depression, a companion volume to Noonan’s 2013 book Managing Your Depression: What You Can Do to Feel Better, draws on evidence-based medical information as well as her own first-hand experience of living with a mood disorder. As a physician she has treated, supported, and educated those living with and those caring for a person who has a mood disorder. Noonan is a Certified Peer Specialist at McLean Hospital and a consultant to Massachusetts General Hospital and CliGnosis.

Noonan’s appearance launches “Readings on Mental Health,” a 2017 series featuring authors of books on mental health topics made possible by a grant from The Sophie Fund.

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13 Reasons Why: Warning Label

The new Netflix series 13 Reasons Why is generating alarm among many mental health professionals and suicide prevention experts, who are concerned about the risks of glamorizing suicide and the possibility of contagion.

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Netflix kicked up a controversy with the series released on March 31 about a high school junior named Hannah who takes her own life. The series received a 91 percent critics approval rating and an 88 percent audience rating on Rotten Tomatoes. Critics praised the cast’s performances and the “authentic,” “sensitive,” and “hard hitting” portrayal of teenager angst.

However, 13 Reasons Why needs a warning label. The National Association of School Psychologists cautions that the series should not be viewed by vulnerable young people who experience any degree of suicidal ideation. NASP warns:

“Its powerful storytelling may lead impressionable viewers to romanticize the choices made by the characters and/or develop revenge fantasies. They may easily identify with the experiences portrayed and recognize both the intentional and unintentional effects on the central character. Unfortunately, adult characters in the show, including the second school counselor who inadequately addresses Hannah’s pleas for help, do not inspire a sense of trust or ability to help.”

NASP has problems with the accuracy of how mental illness and suicide are portrayed in the series. For example, it is concerned that the series does not emphasize that common among most suicide deaths is the presence of treatable mental illnesses. And that suicide is not the simple consequence of stressors or coping challenges, but rather, it is most typically a combined result of treatable mental illnesses and overwhelming or intolerable stressors.

Despite the strong misgivings, some see the widespread publicity around 13 Reason Why as an opportunity at least to spread greater awareness about suicide and suicide prevention. NASP says that the controversy is an “opportunity to better understand young people’s experiences, thoughts, and feelings,” educate parents, teachers, and students alike about suicide risk warning signs, and reinforce the message that suicide is not a solution to problems.

NASP advises that school psychologists and other school-employed mental health professionals can assist stakeholders such as school administrators, parents, and teachers to engage in supportive conversations with students as well as provide resources and offer expertise in preventing harmful behaviors. NASP published “Considerations for Educators,” guidance on 13 Reasons Why. Download it here.

Experts say if you’re thinking about the safest and best way to lead a discussion with teens about 13 Reasons Why and suicide, read the tip sheet co-authored by Suicide Awareness Voices of Education (SAVE) and the JED Foundation. Click here to download the tip sheet.

Some recommended reading from experts on the subject of suicide contagion:

Preventing Suicide With A “Contagion Of Strength” (National Public Radio February 25, 2015)

The Science Behind Suicide Contagion (New York Times, August 14, 2014)

Teen suicide: Prevention is Contagious, Too (Christian Science Monitor, December 8, 2013)

[If you or someone you know feels the need to speak with a mental health professional, you can contact the National Suicide Prevention Lifeline at 1-800-273-8255 or contact the Crisis Text Line by texting HOME to 741-741.]

Anxieties of the Post-9/11 Generation

TIME magazine has published a must-read article by Susanna Schrobsdorff on the epidemic of depression and anxiety affecting young Americans. Every parent should be aware of the mental health challenges being faced by millions of our kids.

As Schrobsdorff writes, “They are the post-9/11 generation, raised in an era of economic and national insecurity. They’ve never known a time when terrorism and school shootings weren’t the norm. They grew up watching their parents weather a severe recession, and, perhaps most important, they hit puberty at a time when technology and social media were transforming society.”

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The TIME article provides insights into real-life adolescent struggles:

The first time Faith-Ann Bishop cut herself, she was in eighth grade. It was 2 in the morning, and as her parents slept, she sat on the edge of the tub at her home outside Bangor, Maine, with a metal clip from a pen in her hand. Then she sliced into the soft skin near her ribs. There was blood–and a sense of deep relief. “It makes the world very quiet for a few seconds,” says Faith-Ann. “For a while I didn’t want to stop, because it was my only coping mechanism. I hadn’t learned any other way.”

The pain of the superficial wound was a momentary escape from the anxiety she was fighting constantly, about grades, about her future, about relationships, about everything. Many days she felt ill before school. Sometimes she’d throw up, other times she’d stay home. “It was like asking me to climb Mount Everest in high heels,” she says.

The statistics provide another kind of illustration:

In 2015, about 3 million teens ages 12 to 17 had had at least one major depressive episode in the past year, according to the Department of Health and Human Services. More than 2 million report experiencing depression that impairs their daily function. About 30% of girls and 20% of boys–totaling 6.3 million teens–have had an anxiety disorder, according to data from the National Institute of Mental Health.

Experts suspect that these statistics are on the low end of what’s really happening, since many people do not seek help for anxiety and depression. A 2015 report from the Child Mind Institute found that only about 20% of young people with a diagnosable anxiety disorder get treatment. It’s also hard to quantify behaviors related to depression and anxiety, like nonsuicidal self-harm, because they are deliberately secretive.

Read the entire article online here or download a pdf here.

Robin Williams’s Story

The widow of Robin Williams has written a detailed account of the brave struggle with an undiagnosed brain disease called Lewy Body Dementia that preceded the comedian’s suicide in 2014.

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Headlined “The terrorist inside my husband’s brain,” Susan Schneider Williams’s essay in Neurology reports that “the massive proliferation of Lewy bodies throughout his brain had done so much damage to neurons and neurotransmitters that in effect, you could say he had chemical warfare in his brain.”

Susan Schneider Williams used the platform of a medical journal to specifically address her words to medical researchers, saying she hoped the “personal story, sadly tragic and heartbreaking,” would further inspire them to persevere in the quest for a cure. Given the initial media frenzy that dwelled on the actor’s past struggles with depression and substance abuse, the essay also helps expose the harm of stigmatizing suicide through simplistic stereotyping.

Listen to a podcast with Susan Schneider Williams here.

Excerpts from her essay:

My husband Robin Williams had the little-known but deadly Lewy body disease (LBD). He died from suicide in 2014 at the end of an intense, confusing, and relatively swift persecution at the hand of this disease’s symptoms and pathology. He was not alone in his traumatic experience with this neurologic disease. As you may know, almost 1.5 million nationwide are suffering similarly right now. …

Although not alone, his case was extreme. Not until the coroner’s report, 3 months after his death, would I learn that it was diffuse LBD that took him. All 4 of the doctors I met with afterwards and who had reviewed his records indicated his was one of the worst pathologies they had seen. He had about 40% loss of dopamine neurons and almost no neurons were free of Lewy bodies throughout the entire brain and brainstem. …

Not until after Robin left us would I discover that a sudden and prolonged spike in fear and anxiety can be an early indication of LBD. …

I will never know the true depth of his suffering, nor just how hard he was fighting. But from where I stood, I saw the bravest man in the world playing the hardest role of his life. …

Robin was losing his mind and he was aware of it. Can you imagine the pain he felt as he experienced himself disintegrating? And not from something he would ever know the name of, or understand? Neither he, nor anyone could stop it—no amount of intelligence or love could hold it back. He kept saying, “I just want to reboot my brain.”…

After months and months, I was finally able to be specific about Robin’s disease. Clinically he had PD [Parkinson’s Disease], but pathologically he had diffuse LBD. The predominant symptoms Robin had were not physical—the pathology more than backed that up. However you look at it—the presence of Lewy bodies took his life. …