Risk Factors

AFSP
CDC
NAMI
NIMH
SPRC

Access to firearms

x

Access to firearms: a key suicide prevention measure is to reduce access to firearms, which can significantly increase suicide risk.

(6)

Access to lethal means including firearms and drugs

x

Access to lethal methods

x
4
7
4

Adverse childhood experiences such as child abuse and neglect

x

An arrest

(2)

Barriers to accessing mental health treatment

x

8

Barriers to health care

x

Being a pregnant teenager

Being between the ages of 15 and 24 or over 60.

11

Being exposed to others' suicidal behavior, such as that of family members, peers, or celebrities

x

Being born MAAB (Male Assigned At Birth)

Being in prison or jail

8

Being exposed to others' suicidal behaviors, family member, peer or media figure or graphic or sensationalized accounts of suicide

x

9

Bullying

x

Certain medical conditions

x

Childhood abuse, neglect or trauma

x

Childhood abuse, neglect, maltreatment or trauma

Chronic disease and disability

7

Chronic pain

x

Criminal problems

x

Cultural and religious beliefs (e.g., belief that suicide is noble resolution of a personal dilemma)

x

Cultural and religious beliefs such as a belief that suicide is noble resolution of a personal problem

x

Depression, other mental disorders, or substance abuse disorder

x

Easy access to lethal means among people at risk (e.g. firearms, medications)

x

End of a relationships or marriage

(2)

Ethnicity/race: the highest rates across ages are among American Indian/Alaska Native and white populations.

(7)

Exposure to another person’s suicide, or to graphic or sensationalized accounts of suicide

x

Family history of child maltreatment

Family history of suicide

x
x
x
x

Family history of suicide or child maltreatment

(2)

Family history of a mental health or substance abuse disorder

x

4

Family history of suicide

x

x

1
5
5

Family violence including physical and/or sexual abuse

6

Feelings of hopelessness

x

Financial problems

x

Gender. Although more women than men attempt suicide, men are nearly 4x more likely to die by suicide.

6

Having guns or other firearms in the home

x

Having recently been released from prison or jail

x

History of mental disorders, particularly clinical depression

x
x

2
3

History of trauma or abuse

7

Impulsive or aggressive tendencies

x

Impulsivity:One study found that more than 50% of suicide attempts were impulsive, which may explain in part why “up to 50% of people who attempt suicide make the decision to do so within minutes to an hour before they act.”

(5)

Internal stuff: Depression, addiction, Bipolar disorder, Schizophrenia, anxiety, chronic pain or other serious health conditions, traumatic brain injury

x

Isolation, a feeling of being cut off from other people

Intoxication. More than 1 in 3 people who die from suicide are under the influence of alcohol at the time of death.

x

Job problems or loss

x

Legal problems

x

Local epidemics of suicide

x

(2)

Loss of someone or something they care about

(2)

Loss (relational, social, work, or financial)

x

Major health issues

(2)

Mental illness: It is estimated that nearly 90% of people worldwide who die by suicide have a mental illness. However, only about half of people who die by suicide in the U.S. are actually diagnosed.

(3)

Medical illness - serious or chronic

5
10

Mental illness, such as depression

x

Mental health conditions: anxiety disorders, bipolar disorder, conduct disorder, depression, spersonality traits of aggression, mood changes and poor relationships, substance use problems, schizophrenia.

x

Misuse and abuse of alcohol or other drugs. Intoxication-More than 1 in 3 people who die from suicide are under the influence of alcohol at the time of death.

3

2

Personality traits of aggression, mood changes and poor relationships

Physical illness

Previous suicide attempt(s)

x
x

1
1

Previous attempt: The leading suicide risk factor is a prior suicide attempt.

(1)

Prior suicide attempt

x

Prolonged stress

x

Prolonged stress such as harassment, bullying, relationship problems or unemployment

x

Recent tragedy or loss

8

Relationship problems such as a break-up, violence, or loss

x

Serious financial problems

(2)

Serious illness

x

Serious or chronic medical illness

x

Serious physical health conditions including pain

x
x

Sexual orientation/gender identity: LGB youth are almost five times as likely to have attempted suicide compared to heterosexual youth. Transgender adults are at even higher risk with 40% reporting a suicide attempt in their lifetime

(8)

Sexual violence

x

Social Isolation, a feeling of being cut off from other people

x

Stigma associated with mental illness or help-seeking

x

Stressful life events, like rejection, divorce, financial crisis, other life transitions or loss

x

Substance abuse disorder

x
x
2
3

Substance abuse: People who are dependent on alcohol or use drugs have a 10–14 times greater suicide risk than the general population. This risk is even more significant when a there is a co-occurrence of substance use disordersand mental illness.

(4)

Substance use. Drugs can create mental highs and lows that worsen suicidal thoughts

x

Suicide cluster in the community

x

Traumatic brain injury

x

Triggers: These can include a wide range of significant events, especially relationship problems and unemployment. Additionally, a history of child abuse, including bullying or sexual abuse, traumatic brain injury, chronic pain and chronic health conditions may heighten suicide risk

(2)

Unsafe media portrayals of suicide

x

Unwillingness to seek help because of the stigma attached to mental health and substance abuse disorders or to suicidal thoughts

x

Work pressure or constant stress

(2)

Youth are more likely to take their life when:

(6)
Alcohol or drugs are involved

(6)
If their parents are divorced

(6)
If they have access to a fire arm

(6)
Are failing education

(6)
Are involved in teen pregnancy

(6)
Hear of other teen suicides

(6)
Have low self-esteem

(6)
Are highly sexually active

(6)

Legend: Red - Leading risk factor, Blue - 2nd leading risk factor

ASFP: https://bit.ly/2QKNlFz
CDC: https://bit.ly/3u9XJnT
NAMI https://bit.ly/3ywBQmd
NIMH https://bit.ly/3fejSgN
SPRC: https://bit.ly/2QKThOZ
(1) NAASP  National Action Alliance for Suicide Prevention https://conta.cc/3viIaf5
(2) "R  U OK?" A conversation could change a life. www.ruok.org.au/
(6) Brain Blogger https://bit.ly/3wshE2V

Risk factors can vary by age group, culture, sex, and other characteristics. For example:

  • Stress resulting from prejudice and discrimination (family rejection, bullying, violence) is a known risk factor for suicide attempts among lesbian, gay, bisexual, and transgender (LGBT) youth and
  • The historical trauma suffered by American Indians and Alaska Natives (resettlement, destruction of cultures and economies) contributes to the high suicide rate in this population.
  • For men in the middle years, stressors that challenge traditional male roles, such as unemployment and divorce, have been identified as important risk factors.

Precipitating Factors

AFSP
CDC
NAMI
NIMH
SPRC

Precipitating factors are stressful events that can trigger a suicidal crisis in a vulnerable person.

Alcohol/Drugs

5%

An arrest

x

Any real or anticipated eent causing or threatening:

Shame, guilt, despair, humiliation, unacceptible loss of face or status
Legal problems (loss of freedom), financial problems, feellings of rejection/abandonment

(3)

Death of a loved one

x

End of a relationship or marriage

x

Family Problems

40%

Financial

6%

Handling the arrest of a loved one

x

Physical health

17%

Recent exposure to another's suicide (of friend or acquaintance, of celebrity through media

(3)

Searching for a missing loved one

x

Serious financial problems

x

Serious health issues

Unknown

32%

NAMI:
SPRC:
(3) AAS: American Association of Suicidology: https://bit.ly/2SjtrSG

Protective Factors

AFSP
CDC
NAMI
NIMH
SPRC

Access to mental health care, and being proactive about mental health

x

Availability of physical and mental health care

x

Belief that happiness is an important part of life

x

Connections to friends, family, and community support

x

Connectedness to individuals, family, community, and social institutions

x

Coping and problem-solving skills

x

Cultural and religious beliefs that discourage suicide

x

Cultural and religious beliefs that discourage suicide and support instincts for self-preservation

x

Cultural, religious, or personal beliefs that discourage suicide

x

Cultural and religious beliefs that encourage connecting and help-seeking, discourage suicidal behavior, or create a strong sense of purpose or self-esteem

x

Easy access to a variety of clinical interventions and support for help seeking

x

Effective behavioral health care

x

Effective clinical care for mental, physical, and substance abuse disorders

x

Excitement about future plans

x

Family and community support (connectedness)

x

Feeling connected to family and community support

x

Having children

Life skills (including problem solving skills and coping skills, ability to adapt to change)

x

Limited access to lethal means

x

Limited access to lethal means among people at risk

x

Meaningful relationships with friends and family

x

Problem-solving and coping skills

x

Responsibilities towards others

x

Restricted access the lethal means

Self-esteem and a sense of purpose or meaning in life

x

Skills in problem solving, conflict resolution, and nonviolent ways of handling disputes

x

Social support

Support from ongoing medical and mental health care relationships

x

Supportive relationships with care providers

x

Survival instincts

x

Youth:

Strong, positive relationships with parents and guardians – feeling secure and supported

(5)
Connections to other non-parental adults

(5)
Closeness to caring friend

(5)
Academic achievement

(5)
School safety

(5)
Feeling a sense of belonging to something bigger than themselves – community, culture, religion, sports team

(5)
Neighbourhood safety

(5)
Awareness of and access to local health services overall resilience.

(5)

AFSP https://bit.ly/2QKNlFz
CDC: https://bit.ly/3u9XJnT
NAMI https://bit.ly/3bKLGHm
SPRC https://bit.ly/2QKThOZ
(5) Blue Beyond https://bit.ly/2RKpVR4

Warning Signs

AFSP
CDC
NAMI
NIMH
SPRC

Warning signs are behaviors that indicate that someone may be at immediate risk for suicide.

Acting anxious or agitated

x

Acting anxious or agitated; behaving recklessly *

x

Being isolated

x

Changing eating and/or sleeping habits

x

Displaying extreme mood swings *

x

Displaying extreme mood swings, suddenly changing from very sad to very calm or happy

x

Drastic change in appearance, personality, mood, attitude,and/ or behavior

Expressing hopelessness, great guilt or shame

x

Extreme mood swings

x

Feeling like a burden

x

Feeling of hopelessness or of being alone

Feeling trapped or in unbearable pain

x

x

Feeling unbearable pain, both physical or emotional

Giving away important (prized) possessions.

x

Increased anger or rage

x

Increased anxiety

x

Increased substance use

x

Increasing the use of alcohol or drugs *

x

x

Looking for a way to access lethal means

x

Looking for a way to kill oneself, such as searching online or obtaining a gun

x

Making plans for suicide

x

Persistent feelings of being overwhelmed, angry, depressed or pessimistic

Persistent feelings of being overwhelmed, angry, depressed, hopeless, pessimistic, being a burden or being alone

Planning or looking for a way to kill themselves, such as searching online, stockpiling pills, or newly acquiring potentially lethal items (e.g., firearms, ropes)

x

Planning, talking or thinking about suicide

Previous attempts to die by suicide or to harm oneself.

Putting affairs in order, making a will

x

Saying goodbye to friends and family

x

Showing rage or talking about seeking revenge *

x

x

Sleeping too little or too much

x

x

Taking risks that could lead to death, such as reckless driving

x

Talking about feeling hopeless or having no reason to live

x

x

Talking about being a burden to others *

x

x

Talking about feeling trapped or feeling that there are no solutions

x

Talking about wanting to die or to kill oneself

x

x

Talking or posting about wanting to die

x

Talking or thinking about death often

x

Withdrawing from family and friends

x

Withdrawing or feeling isolated *

x

Youth

Feeling like things may never get better, seeming like they are in terrible emotional pain (like something is wrong deep inside but they can't make it go away, or they are struggling to deal with a big loss in their life?

(8)
Talking about wanting to die, be dead, or about suicide, or are they cutting or burning themselves?

(8)
They are withdrawn from everyone and everything, have become more worried or on edge, seem unusually angry, or just don't seem normal to you?

(8)

* These behaviors may also indicate a serious risk—especially if the behavior is new; has increased; and/or seems related to a painful event, loss, or change according to SPRC

CDC https://bit.ly/3fwhWyZ
NIMH
SPRC: https://bit.ly/3oCaSFo
(8) YouthSuicideWarningSigns.org

Interventions

AFSP
CDC
NAMI
NIMH
SPRC

Send a handwritten card to let someone know you are thinking of them.

(1)

Check in by phone or text message to see how they are doing.

(1)

Invite them to meet for a coffee, ice cream or meal together.

(1)
Am I ready?

(2)
Am I in a good headspace?

(2)
Am I willing to genuinely listen?

(2)
Can I give as much time as needed?

(2)
Am I prepared?

(2)
Do I understand that if I ask how someone's doing, the answer could be: "No, I'm not."?

(2)
Do I understand that I can't "fix" someone's problems?

(2)
Do I accept that they might not be ready to talk? Or they might not be ready to talk? Or they might not want to talk to me?

(2)
Pick my moment?

(2)
Have I chosen somewhere relatively private and comfy?

(2)
Have I figured out a time that will be good for them to talk?

(2)
Have I made sure I have enough time to chat properly?

(2)
ASK: “Are you thinking about killing yourself?” It’s not an easy question, but studies show that asking at-risk individuals if they are suicidal does not increase suicides or suicidal thoughts.

x

Ask "R U OK?" It's ok to say "I'm not ok.".

Be relaxed, friendly and concerned in your approach.

(2)
Help them open up by asking questions like "How are you doing?" or "What's been happening?"

(2)
Mention specific things that have made you concerned for them, like "You seem less talkative than usual. How are you going?"

(2)
IF

(2)
they don't want to talk, don't criticize them.

(2)
Tell them you're still concerned about changes in their behavior and you care about them.

(2)
Avoid a confrontation.

(2)
You could say: "Please call me if you ever want to talk" or "Is there someone else you'd rather talk to?"

(2)

Listen with an open mind

x

(2)
Listen carefully and learn what the individual is thinking and feeling. Research suggests acknowledging and talking about suicide may reduce rather than increase suicidal thoughts.

x

Take what they say seriously and don't interrupt or rush the conversation

(2)
Don’t judge their experiences or reactions but acknowledge that things seem tough for them.

(2)
If they need time to think, sit patiently with the silence.

(2)
Encourage them to explain "How are you feeling about that?" or "How long have you felt that way?"

(2)
Show that you're listening by repeating back what you've heard (in your own words) and ask if you've understood them correctly.

(2)

Encourage action

(2)
You could say: "When I was going through a difficult time, I tried this... You might find it useful too."

(2)
Ask: “What have you done in the past to manage similar situations?”

(2)
Ask: “How would you like me to support you?"

(2)
Ask: “What’s something you can do for yourself right now? Something that’s enjoyable or relaxing?”

(2)
Get help

(2)
Help them think of next steps they could take to help them manage their situation.

(2)
Be positive about the role of professionals in getting through tough times.

(2)
Some conversations are too big for family and friends to take on alone. If someone’s been really low for more than 2 weeks - or is at risk - please contact a professional as soon as you can.

(2)
You could say, "It might be useful to link in with someone who can support you. I'm happy to assist you to find the right person to talk to.”

(2)
Help connect someone who is struggling with a trusted adult or professional behavioral health care provide trained in suicidality

(2)
You can also help make a connection with a trusted individual like a family member, friend, spiritual advisor, or mental health professional.

x

Keep them safe.

x

(2)
Reducing a suicidal person’s access to highly lethal items or places is an important part of suicide prevention. While this is not always easy, asking if the at-risk person has a plan? Removing or disabling the lethal means can make a difference.

x

Save the National Suicide Prevention Lifeline Number (800-273-8255) and the Crisis Text Line, text SOS to 741741) in your phone, so it’s there when you need it. Other specific target emergency contacts

x

(1)

Stay Connected

x

Staying in touch after a crisis or after being discharged from care can make a difference. Studies have shown the number of suicide deaths goes down when someone follows up with the at-risk person.

x

Follow up.

x

Schedule a reminder in yourr calendar to call them in a couple of weeks. If they're really struggling, follow-up sooner.

(2)
You could say: "I've been thinking of you and wanted to know how you've been doing since we last talked."

(2)
Ask if they've found a better way to manage the situation. If they haven't done anything, don't judge them. They might just need someone to listen to them for the bit.

(2)
Stay in touch and be there for them. Genuine care and concern can make a real difference.

(2)

Youth

Ask them if they are okay and listen to them like a true friend

(8)
Tell them you are worried and concerned about them and that they are not alone.

(8)
Talk to an adult you trust about your concerns and direct them to YouthSuicideWarningSigns.org

(8)

Schools: Tier 1 - Universal Interventinos

(4)
Faculty and Staff Awareness Training

(4)
Focus on Social Emotional Competency Development (SEL)

(4)
School Connectedness and School Climate

(4)
Upstream Prevention Programs

(4)
Mental Health Literacy Education

(4)
Student Suicide Prevention Education

(4)
Parent Education

(4)

Schools: Tier II: Targeted Interventions

(4)
Groups at Higher Risk

(4)

Schools: Tier III: Individualized Interventions

(4)
Determining Level of Suicide Risk

(4)
Assessment and Triage

(4)
Brief Safety Planning Intervention

(4)
Working with Parents

(4)
Working with Community Mental Health

(4)
Plan for Safe Return to School

(4)
In-School Suicide Attempts

(4)
Out-of-School Suicide Attempts

(4)

Schools: Postvention

(4)
After a Suicide: A Toolkit for Schools (76 page PDF)

x
(4)
Parent brochure – Talking to your teens about suicide.

(4)
The Role of High School Teachers (7 page PDF)

CDC https://bit.ly/2RG5F3c
NIMH:
(1) NAASP  National Action Alliance for Suicide Prevention https://conta.cc/3viIaf5
(2) "R  U OK?" A conversation could change a life. www.ruok.org.au/
(4) SPCNY Suicide Prevention Center https://bit.ly/3fJIFYW
(8) YouthSuicideWarningSigns.org

What not to do

AFSP
CDC
NAMI
NIMH
SPRC

Don't judge, mock, lecture or put down.

Don't promise secrecy. Say instead "I care about you too much to keep this kind of secret. You need help and I'm here to help you get it."

x

Don't debate the value of living or argue that suicide is right or wrong

x

Don't ask in a way that indicates you want "No" for an answer. i.e. "You're not thinking about suicide, are you?" "You haven't been throwing up to lose weight, have you?"

x

Don't try to handle the situation alone.

x

Don't try to single-handedly resolve the situation.

x

Remember, it's not your fault.

What not to say

AFSP
CDC
NAMI
NIMH
SPRC

"We all go through tough times like these. You'll be fine."

x

"It's all in your head. Just snap out of it."

x

Ways to Connect

NAMI https://bit.ly/3v4O9El (33 page PDF)

x

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