Suicide | Early Warning Signs & Risk Factors
In this month’s article, we will be considering two questions: what are the early warning signs that somebody may be at risk of acting on suicidal thoughts? And how can we help people to find the right support?
Research into risk factors for suicide shows that previous suicide attempts, bereavement by suicide, where a person has lost a loved one to suicide, and self- harming – specifically self-injury – statistically increase the risk of suicide.
However, we may not know if these factors feature in a person’s life. So, what else can we look out for? If you know somebody well, then looking out for indications of unmet emotional needs can identify risk of thoughts of suicide arising in response.
For example, money worries, domestic abuse, bullying - including experience of discrimination, are all significant barriers to feeling safe and secure. An unmet emotional need to feel in control of our lives can increase risk: perhaps, if we are affected by long-term physical pain or chronic illness; if we are experiencing pressure to conform or meet other people’s expectations; or struggling with an addiction.
Loss of meaning and purpose, perhaps following retirement or redundancy, can increase the risk of suicidal thoughts. If we hear somebody saying things like, “what’s the point in trying/doing anything?” “why should I go on?” or “the world would be better off without me?” - these are expressions of an unmet need for meaning and purpose, which increase the risk of depression and suicidal thoughts.
The loss of emotional connection is statistically the biggest risk factor for suicide; losing a relationship to bereavement, suicide, relationship break-up, separation and divorce. If a person seems withdrawn socially, it may be an early indicator that they are experiencing depression, a symptom of which can be suicidal thoughts. Social isolation and loneliness, unmet needs for community and sharing attention are also risk factors for depression.
Particular groups may be more vulnerable than others. Studies show that people who identify as LGBTQ are at increased risk of experiencing and acting upon suicidal thoughts. It is not fully understood why, but bullying, discrimination, homophobia, biphobia or transphobia are all factors which would prevent the need to feel safe and secure from being met; negative responses from family members or the wider community would likely contribute to feelings of loneliness and isolation.
Men between the ages of twenty-nine and fifty-nine are the group most at risk of suicide, with rates of suicide amongst men three times higher than those for women in the UK. Societal expectations which affect the need for status and to feel valued – to provide financially for their families, to succeed in the workplace and to be seen as a source of strength and independence – are thought to be a significant factor in preventing men from meeting emotional needs.
Encouraging men to ‘open up’ or express themselves emotionally may help some men to seek help, but may also trigger ‘fight-or-flight’; nature’s threat avoidance response, in others, increasing the likelihood that they will avoid asking for help. The instinct to problem-solve may drive men to act upon suicidal thoughts, and is reflected in the methods they use which lower the chances of survival. Again, the loss of an emotional connection is the biggest risk factor for men experiencing and acting on suicidal thoughts.
How can we use this information to reduce the risk of people acting on suicide? While existing mental ill health can increase the risk, not everybody experiencing mental ill health is receiving support from the NHS, and so they may not be known to be at risk.
If we learn to look out for unmet needs in ourselves and others, we are more likely to recognise when somebody may be at risk. Does somebody you know appear to be withdrawn? Have they recently lost a relationship or are they going through relationship difficulties? Have they spoken about suicide, or expressed a loss of hope or meaning in their lives? Listening out for when a person sees no point in trying or going on, might be an expression of suicidal thoughts.
We can then ask them how they are feeling and if they need help. Avoid saying things like, “you’re not thinking of doing something silly, are you?” which can be stigmatising, but we should be clear about our concerns and use the term suicidal thoughts when we talk about our concerns.
If a person shares that they have had suicidal thoughts, ask them when they are going to speak to their GP about it – getting a date in the diary creates a concrete action and something to look towards. Make sure that they have the number for the Samaritans - 116 123 - and ask who they can speak to if they are experiencing suicidal thoughts.