This Issue

Suicide: Out of the darkness

The tough road for those left behind

A preventable loss of life

Q & A

Need more information?

What puts a person at risk for suicide?

  • Depression or other mental health disorders

  • Substance abuse

  • Family history of mental disorder or substance abuse

  • Family violence, including physical or sexual abuse

  • Firearms in the home

  • Family history of suicide

  • Exposure to suicide of family members, peers or celebrities

  • Gender — occurs in almost four times as many males as females

  • Race — more common in American Indians and whites, but the number is increasing among blacks

  • Age — more common in people under the age of 24 and 65 and older

  • Incarceration

  • Previous attempts

Suicide is not a normal response to these risks and can often be prevented by appropriate treatment for the mental or substance abuse disorder.

What puts a person at risk for suicide?

Don’t keep it to yourself!
If you or someone you know is contemplating suicide,
make a call instead.
Telephone Number Organization Hours of Availability
800-273-TALK (8255) Nat’l Suicide Prevention Lifeline 24 hours a day
800-981-HELP (4357) Boston Emergency Service Team 24 hours a day
800-784-2433 Nat’l Suicide Prevention Lifeline 24 hours a day
617-247-0220 Samaritans 24 hours a day
877-870-HOPE (4673) Samaritans 24 hours a day
800-252-TEEN (8336) Samaritans – for teens 24 hours a day
866-508-HELP (4357) Massachusetts Suicide Prevention Lifeline 8 AM to 11 PM

Pay attention to the warning signs!
  • Threatening to hurt or kill oneself or talking about wanting to hurt or kill oneself

  • Looking for ways to kill oneself by seeking access to firearms, available pills or other means

  • Talking or writing about death, dying or suicide

  • Feeling hopeless

  • Feeling rage or uncontrolled anger or seeking revenge

  • Acting reckless or engaging in risky activities — seemingly without thinking

  • Feeling trapped — like there’s no way out

  • Increasing alcohol or drug use

  • Withdrawing from friends, family and society

  • Feeling anxious, agitated or unable to sleep or sleeping all the time

  • Experiencing dramatic mood changes

  • Giving away belongings or getting affairs in order

  • Seeing no reason for living or having no sense of purpose in life

Source: Substance Abuse and Mental Health Services Administration (SAMHSA).

Pay attention to the warning signs!

Don’t keep it to yourself!

What should you do if you think
someone is thinking of suicide?
  • Take the threat seriously

  • Let the person know you care

  • Ask questions

    Are you thinking about killing yourself?
    Do you think you might hurt yourself today?
    Have you thought of ways that you might hurt yourself?
    Do you have pills or weapons in the house?

  • Do not leave him or her alone

  • Remove potential tools for suicide

  • Tell him or her that you will get help

  • Call 911 or go to the nearest emergency room

  • Call 800-273-TALK — the National Suicide Prevention Lifeline

What should you do if you think
someone is thinking of suicide?

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Need more information?

It’s a call or click away …

American Foundation for Suicide Prevention • 888-333-AFSP (2377)

National Organization for People of
Color against Suicide • 202-549-6039

American Association of Suicidology • 202-237-2280

Suicide Prevention Action Network
(SPAN) USA • 202-449-3600

Centers for Disease Control and Prevention
800-232-4636 (CDC-INFO)

Suicide: A preventable loss of life

Wrestling with financial hardships. Losing loved ones to divorce or death. Grappling with mental health issues, alcoholism and drug abuse. Tough realities like these can make people question whether life is worth living.

Thankfully, such feelings are fleeting for many people. Yet others seem to sink deeper and deeper down, sometimes reaching a place where suicide appears to be the only escape from their problems.

It’s not always possible to prevent suicide, but sometimes it is. Learning the signs of depression and other factors that make suicide attempts more likely may help you save a life — that of a loved one, or possibly even your own.

“If someone you know talks about suicide, especially if he or she is depressed, take it seriously. Odds are high that this is not just a bid for attention,” says Dr. Jan Cook, medical director at Blue Cross Blue Shield of Massachusetts. “Urge that person to get help, or even take steps to find help by making the first phone call. You can also make a confidential call to a local helpline like Samitaritans, Inc. or the National Suicide Prevention Lifeline, which are available 24 hours a day, seven days a week (see back page).”

Who commits suicide?

While suicide cuts across lines of age, ethnicity and gender, it affects some groups more than others. In 2006, suicide claimed 33,300 lives, reaching number 11 in leading causes of death for all Americans. Usually, the highest suicide rate occurs among people ages 80 or older. That may be shifting, however. This spring, a U.S. Centers for Disease Control and Prevention (CDC) survey of violent deaths in 16 states during 2007 found middle-aged people, 45 to 54, had the highest rate of suicide.

When considering ethnic and racial backgrounds, American Indians, Alaska Natives and whites are most likely to commit suicide. Asian and Pacific Islanders, non-Hispanic blacks and Hispanics have lower rates, but rates among blacks are increasing. While women attempt suicide three times as often as men do, almost four times as many males as females actually die this way. Guns, suffocation and poisoning through overdoses of medications are the most common means of death. And for every death by suicide, experts estimate there are 12 to 25 attempts that don’t prove fatal.

The impact of depression

Nine out of 10 people who commit suicide have suffered from depression and other mental disorders, or struggled with substance abuse, or both. Brain chemicals called neurotransmitters may also affect risk for suicide, according to some studies. Lower levels of serotonin have been found in people with depression, impulse disorders and a history of suicide attempts, as well as in the brains of people who have killed themselves.

Sad moods occasionally affect us all, but depression can last for weeks or months on end. While you may intuitively know some signs of depression, others, like marked changes in sleep or appetite, irritability or agitation are less obvious.

The National Institute of Mental Health lists the following signs and symptoms for depression:

  • Persistent sad, anxious or “empty” mood

  • Feelings of hopelessness, pessimism

  • Feelings of guilt, worthlessness, helplessness

  • Loss of interest or pleasure in once-enjoyed hobbies and activities

  • Fatigue and decreased energy

  • Difficulty concentrating, remembering details and making decisions

  • Insomnia, early–morning wakefulness or excessive sleeping

  • Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment

Clearly, not everyone who is depressed commits suicide. Yet depression plays a major role in suicide and should be taken seriously. Even when suicide is unlikely, depression has a big impact on quality of life and health. Getting treatment for it is important.

Reduce the risk

Medicine, therapy and exercise can do a great deal to relieve depression. If you are depressed, talk to your doctor or visit on the Blue Cross Blue Shield of Massachusetts website for more information. For helpful quizzes and tools go to the section on depression. Urge loved ones who are depressed to get help, and if necessary, help them reach out to get assistance.

Often a combination of medicine and therapy can turn the tide. A type of psychotherapy known as cognitive therapy shows promise in helping to prevent suicide, at least among people who have made attempts. In such cases, cognitive therapy encourages people to consider other possible actions when suicidal thoughts crop up. Research shows cognitive therapy halved the number of repeated attempts at suicide over the course of a year of follow-up.

People who have certain mental health disorders may benefit from other types of therapy. For example, dialectical behavior therapy, which teaches behavior skills, cut suicide attempts by half in people with borderline personality disorder, when compared to other types of therapy.

Additionally, addressing underlying problems like substance abuse and mental health disorders may well lessen risks for suicide. Alcohol, for example, was a factor in roughly a third of suicides reported in the CDC survey (and almost two-thirds of those people tested above the legal limit for blood alcohol concentration).

Depression can be successfully treated, and suicide can often be prevented or avoided with the right treatment. Don’t be afraid to seek help or reach out to someone else in need — you may possibly save a life, maybe even your own.