Health Library Suicidal Thoughts or ThreatsFrom Healthwise

Suicide occurs almost twice as often as murder. Each year, about 30,000 people in the United States die by suicide. In the United States:¹

• Suicide is the third leading cause of death for people ages 15 to 24.
• White men commit suicide more often than any other group.
• Suicide rates are higher in the western states than in the rest of the country.
• Unemployment increases the number of suicides.
• A gun is used in almost 3 of every 5 suicides.
• Suicide rates increase with age. More people over age 65 commit suicide than any other age group.

Only about 1 out of every 40 people who attempt suicide die. Women try suicide more often, but men are 4 times more likely to die from a suicide attempt.

Many people have fleeting thoughts of death. Fleeting thoughts of death are less of a problem and are much different from actively planning to commit suicide. Your risk of committing suicide is increased if you think about death and killing yourself often, or if you have made a suicide plan.

Most people who seriously consider suicide do not want to die. Rather, they see suicide as a solution to a problem and a way to end their pain. People who seriously consider suicide feel hopeless, helpless, and worthless. A person who feels hopeless believes that no one can help with a particular event or problem. A person who feels helpless is immobilized and unable to take steps to solve problems. A person who feels worthless is overwhelmed with a sense of personal failure.

Most people who seriously consider or attempt suicide have one or more of the following risks:

• A personal or family history of suicide attempts
• A family history of suicide attempts or completed suicide
• A personal or family history of severe anxiety, depression, or other mental health problem, such as bipolar disorder (manic-depressive illness) or schizophrenia
• An alcohol or drug problem (substance abuse problem), such as alcoholism

The warning signs of suicide change with age.

• Warning signs of suicide in children and teens may include preoccupation with death or suicide or a recent breakup of a relationship.
• Warning signs of suicide in adults may include alcohol or substance abuse, recent job loss, or divorce.
• Warning signs of suicide in older adults may include the recent death of a partner or diagnosis of a life-limiting illness.

Anytime someone talks about suicide or about wanting to die or disappear, even in a joking manner, the conversation must be taken seriously. A suicide attempt—even if the attempt did not harm the person—also must be taken seriously. Don't be afraid to talk to someone you think may be considering suicide. There is no evidence that talking about suicide leads to suicidal thinking or suicide. Once you know the person's thoughts on the subject, you may be able to help prevent a suicide.

People who have suicidal thoughts may not seek help because they feel they cannot be helped. This usually is not the case. Many people with suicidal thoughts have medical conditions that can be successfully treated. People who have suicidal thoughts often have depression or substance abuse; both of these conditions can be treated. It is important to seek help when suicidal thoughts occur because medical treatment usually is successful in diminishing these thoughts.

The possibility of suicide is most serious when a person has a plan for committing suicide that includes:

• Having the means, such as weapons or medications, available to commit suicide or do harm to another person. Nearly 3 out of every 5 suicides is committed with a firearm.
• Having set a time and place to commit suicide.
• Thinking there is no other way to solve the problem or end the pain.

People who are considering suicide often are undecided about choosing life or death. With compassionate help, they may choose to live.

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a health professional.

• A plan, or know someone who has a plan, for committing suicide that includes all of the following:
  • Having the means, such as weapons or medications, available to commit suicide or do harm to another person
  • Having set a time and place to commit suicide
  • Thinking there is no other way to solve the problem or end the pain

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

	Yes	Have you recently tried to commit suicide?
When to See a Doctor See significance of a recent suicide attempt if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Have you recently tried to commit suicide? Note: Report all suicide attempts, even minor attempts that do not cause an injury, to your health professional. If a suicide attempt has caused a minor injury, see the appropriate injury topic for first aid measures. If you are not able to talk with your health professional immediately, call your local suicide hotline or the national suicide hotline (1-800-SUICIDE or 1-800-784-2433). If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Are you considering suicide, but you do not have a plan?
When to See a Doctor See significance of considering suicide but not having a plan if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Are you considering suicide, but you do not have a plan? Note: If you are unable to reach your health professional immediately, go directly to the nearest hospital emergency department. If you are not able to talk with your health professional immediately, call your local suicide hotline or the national suicide hotline (1-800-SUICIDE or 1-800-784-2433). If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have frequent thoughts of suicide?
When to See a Doctor See significance of frequent thoughts of suicide if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you think about suicide much of the time? Note: If you are unable to reach your health professional immediately, go directly to the nearest hospital emergency department. If you are not able to talk with your health professional immediately, call your local suicide hotline or the national suicide hotline (1-800-SUICIDE or 1-800-784-2433). If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think that a friend or family member is considering suicide?
When to See a Doctor See significance of a friend or family member considering suicide if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you think that someone you know has made suicide plans? Note: If you are not able to talk with your health professional, call your local suicide hotline or the national suicide hotline (1-800-SUICIDE or 1-800-784-2433). If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Are you being treated for depression, but you are not getting better?
When to See a Doctor See significance of not getting better with treatment for depression if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: Be sure to follow your health professional's instructions about when to call if you are not feeling better. Antidepressant medicines often need to be taken for as long as 4 to 12 weeks before they start to fully relieve the symptoms of depression, although you may notice some improvement in 2 to 3 weeks. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you have frequent thoughts of death or suicide? Call your health professional today if you answer "Yes" to any of the following questions. Yes Have your symptoms of depression gotten worse since starting treatment or medicine for depression? Yes Have your symptoms of depression not gotten better as expected? Yes Have your symptoms of depression not gotten better after starting treatment or medicine for depression, but you are not sure when you should start to feel better? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Do you have any of the following symptoms?

• Feelings of depression or sadness: Go to the topic Feeling Depressed.
• An alcohol or drug (substance abuse) problem: Go to the topic Alcohol and Drug Problems.
• A sleep problem: Go to the topic Sleep Problems, Age 12 and Older.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

If you are thinking about suicide, talk to someone about your feelings. It is important to remember that there are people who are willing and able to talk with you about your suicidal thoughts. With proper treatment, most suicidal people can be helped to feel better about life.

People for you to consider talking with include:

• A family member, friend, or member of the clergy.
• Your health professional, such as a doctor or counselor.
• Other mental health resources, such as a community mental health agency or employee assistance program.
• Your local suicide hotline or the national suicide hotline (1-800-SUICIDE or 1-800-784-2433).

Tips for family and friends

You may be able to help someone who is considering suicide.

• If the suicide threat seems real, and the person has a specific suicide plan:
  • Call 911 (or the police if 911 is not available) in order to prevent the person from carrying out the threat.
  • Consider your own safety. If you are in a safe environment and the person will not harm you:
    • Stay with the person, or ask someone you trust to stay with the person, until help arrives.
    • Don't argue with the person or make statements like "It's not as bad as you think," and don't challenge the person by saying "You're not the type to commit suicide." Arguing with the person may only increase his or her feelings of being out of control of his or her life.
    • Talk about the situation as openly as possible. Tell the person that you don't want him or her to die or to harm another person. Show understanding and compassion.
  • If you think that someone you know has made a suicide plan, call your health professional.
    • Your health professional may be able to help identify a mental health specialist and arrange an appointment for a person you think is considering suicide. An appointment with your health professional may not be needed.
    • If you are not able to talk with your health professional, call your local suicide hotline or the national suicide hotline (1-800-SUICIDE or 1-800-784-2433).
    • Once a treatment plan has been developed, you may be able to assist the person obtaining the help he or she needs.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following symptoms occur before you see your health professional.

• The suicide threat becomes real.
• Symptoms become more severe or frequent.

Suicide can be prevented. While some suicides occur without warning, most do not. You can learn to recognize the warning signs of suicide and take action when the signs are present. Take action to evaluate your suspicions if you think that someone you know is considering suicide.

• The warning signs of suicide change with age. Know the warning signs of suicide:
  • Warning signs of suicide in children and teens may include preoccupation with death or suicide or a recent breakup of a relationship.
  • Warning signs of suicide in adults, such as alcohol or substance abuse, recent job loss, or divorce
  • Warning signs of suicide in older adults, such as the recent death of a partner or diagnosis of a life-limiting illness
• Take all warning signs seriously, even if the suicidal threat or attempt seems minor. Take any conversation about suicide seriously, even if the person mentions it in a joking manner.
• Don't be afraid to ask "What is the matter?" or bring up the subject of suicide. There is no evidence that talking about suicide leads to suicidal thinking or suicide.
• Be willing to listen. If a family member, friend, or coworker talks about suicide or wanting to die or disappear, even in a joking manner, the conversation must be taken seriously. Once you know the person's thoughts on the subject, you may be able to help prevent a suicide.
• Help the person make arrangements to see a doctor or mental health professional immediately.
  • Since a suicidal person may feel he or she cannot be helped, you may have to take an active role in finding a health professional and getting the person to the appointment.
  • If you are unfamiliar with mental health resources in your area, a doctor, counselor, community mental health agency, local suicide hotline, or the national suicide hotline (1-800-SUICIDE or 1-800-784-2433) may be able to help identify a health professional.
  • Make sure the person will have someone with him or her at all times until contact is made with a mental health professional.
  • Help the person identify other potential sources of support from people who care about him or her, such as family, friends, or a member of the clergy.
• Follow up to find out how the person's treatment is going. A suicidal person may be reluctant to seek help and may not continue with treatment after the first visit with a health professional. Your support may help the person decide to continue treatment.
• Remove all firearms from the home. Firearms were used in about half of suicides committed in the United States during 2001.¹ Studies have shown that suicide attempts are more likely to lead to death in homes that have a gun, even if the gun is kept unloaded and securely locked up.
• Discard all prescription and nonprescription medicines that are not currently being used.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your health professional diagnose and treat your condition by being prepared to answer the following questions:

• How long have you had suicidal thoughts?
• How often do you think about committing suicide?
• What was going on in your life when you first noticed the depressed or suicidal feelings?
• Have you ever had similar thoughts in the past? If so, did you seek and receive treatment?
• Have you attempted suicide in the past? If so, did you seek and receive treatment?
• Have you ever been diagnosed with a mental health problem, such as severe anxiety, depression, or schizophrenia?
• Has a family member or close friend ever attempted or committed suicide?
• Has anyone in your family ever been diagnosed with a mental health problem, such as depression or schizophrenia?
• Have you had a recent stressful event in your life?
• Do you keep firearms in your home?
• Are you a regular or heavy user of alcohol or illegal drugs? Have you used alcohol or illegal drugs to reduce symptoms of depression?
• Are you taking any prescription or nonprescription medicine? If so, make a list of your medicines and take it with you.
• Are you taking a medicine to treat depression? What is the medicine? When did you start the medicine?
• Do you have any health risks?

• Alcohol Abuse and Dependence
• Alcohol and Drug Problems
• Bipolar Disorder
• Depression
• Depression in Children and Teens
• Sleep Problems, Age 12 and Older

Citations

1. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (2004). Suicide: Fact sheet. Available online: http://www.cdc.gov/ncipc/factsheets/suifacts.htm.

Author:	Susan Van Houten, RN, BSN, MBA	Last Updated: January 12, 2007
Medical Review:	William M. Green, MD - Emergency Medicine Lisa S. Weinstock, MD - Psychiatry
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