Ask The Experts
Is suicide genetic?
Can antidepressants cause suicide?
Why do some depressed people kill themselves, while others don't?
Do you have to talk about it to heal?
Is this just normal grief, or do I need professional help?
Five of the nation's leading experts on suicide prevention and bereavement sat down with a live studio audience for a unique, open-ended opportunity for the public to ask absolutely any question they had about suicide, its causes, and its aftermath. Hundreds of questions were also submitted in advance through AFSP’s Facebook page.
Compassionate and knowledgeable, these experts thoughtfully answered the questions most frequently asked by survivors of suicide loss, survivors of suicide attempts, their family members and friends, and anyone who’s been touched by and cares about the issue of suicide.
The 60-minute program was professionally filmed, and the DVD (with closed captioning) was provided free of charge to all AFSP Chapters for use in connection with International Survivors of Suicide Day or as a separate educational program at a later date. This special Ask The Experts section contains in-depth resource information on all of the topics covered in this year’s program. The 2013 DVD will be available for purchase through the AFSP Store.
Please feel free to submit questions for possible discussion in our next Ask The Experts program to AskTheExperts@afsp.org. We will not respond to these inquiries but all questions will be considered for inclusion in future programs.
TABLE OF CONTENTS
2013 Participating Experts
Connect With AFSP
Understanding Suicide
On risk factors for suicide
On the comorbidity of substance abuse and other mental illness
On suicides where there is no prior diagnosis of mental illness
On suicide risk among varying age groups
On distinguishing between depression and typical teenage behavior
On the difference between suicidal behavior and self-injury
Preventing Suicide
On reducing stigma and encouraging help-seeking behaviors
On helping people who have previously attempted suicide
On the effectiveness of limiting access to lethal means
On addressing the risk of suicide among law enforcement, the military, and first responders
On what to do if you're worried someone is suicidal
Coping With Suicide
On programs available to survivors of suicide loss
On asking why
On helping others understand grief after a suicide loss
On experiencing relief after a suicide loss
On genetic factors and family history contributing to suicide among survivors of suicide loss
On complicated grief
On the effects of losing a patient to suicide
On talking to children
2013 Participating Experts
Christine Moutier, M.D.
Edmond Yomtoob, Psy.D.
Sidney Zisook, M.D.
Danielle Glorioso, LCSW
Brittany Kirby, MSW
The American Foundation for Suicide Prevention (AFSP) is the nation’s leading organization bringing together people across communities and backgrounds to understand and prevent suicide, and to help heal the pain it causes. Individuals, families, and communities who have been personally touched by suicide are the moving force behind everything we do.
Learn more about our organization, mission, and history.
Connect With AFSP
"Like" us on Facebook: AFSPNational
Follow us on Twitter: @AFSPNational
Sign up for our e-mail list: Join the Survivor e-Network
Understanding Suicide
On risk factors for suicide:
Risk factors for suicide are characteristics or conditions that increase the chance that a person may try to take her or his life. Suicide risk tends to be highest when someone has several risk factors at the same time. The most frequently cited risk factors for suicide are health problems, including-
- Depression or bipolar (manic-depressive) disorder
- Alcohol or substance abuse or dependence
- Previous suicide attempts
- Family history of attempted or completed suicide
- Serious medical condition and/or pain
- History of childhood trauma
- See the full list here
When these baseline conditions are present and converge with significant psychosocial stressors, the risk for suicide is higher. It is important to bear in mind that the large majority of people with mental disorders or life stressors do not engage in suicidal behavior.
On the comorbidity of substance abuse and other mental illness:
Suicide risk tends to be highest when someone has several risk factors at the same time.
Current AFSP-funded researchers doing Substance Abuse Studies.
On suicides where there is no prior diagnosis of mental illness:
A death by suicide can be shocking. However, many cases of mental illness are unfortunately undiagnosed, undetected, and/or not treated adequately. Psychological autopsy studies look back retrospectively after a suicide has occurred, often showing evidence of an undiagnosed mental illness. Stigma can play a huge role in preventing help seeking behaviors for mental health issues.
It's important not to blame yourself, as hindsight is always 20/20. People can be excellent at hiding their problems. Impulsive suicidal actions are also difficult to foresee.
Many things are still unknown about suicide and suicide risk, which is why AFSP continues to fund research in these vital areas.
On suicide risk among varying age groups:
In 2010, the highest suicide rate (18.6 per 100,000) was among people 45 to 64 years old. The second highest rate (17.6) occurred in those 85 years and older. Younger groups have consistently had lower suicide rates than middle-aged and older adults. In 2010, adolescents and young adults aged 15 to 24 had a suicide rate of 10.5. See other Facts and Figures on Suicide.
Key Research Findings based on data by the Centers for Disease Control and Prevention show clear differences in the gender and age patterns of suicide attempters and those who die by suicide. Young women, for example, are estimated to make 100 or more suicide attempts for every completed suicide, but yet they have a lower rate of completed suicide. In contrast, the elderly have a suicide rate that is twice the rate among youth, but make relatively few non-fatal suicide attempts.
On distinguishing between depression and typical teenage behavior:
Familiarize yourself with the Risk Factors and Warning Signs. It can be easy to write off things to normal angst, but look for significant changes in behavior like withdrawing from their usual activities or friend groups.
Research that was funded by an AFSP Grant has shown that Adolescents Who Make Suicide Attempts Consider Risks Differently.
On the difference between suicidal behavior and self-injury:
People who engage in self-harming behaviors are not necessarily trying to kill themselves. However, it should be taken very seriously. It can be indicative of serious problems and mental health treatment would be advisable. Without help, self-harm can turn into suicidal ideation or an unintended suicide.
AFSP has funded research to explore different aspects of self-harm behaviors as recently as 2009, 2010, and 2012.
Preventing Suicide
On reducing stigma and encouraging help-seeking behaviors:
The Interactive Screening Program is AFSP's signature prevention program. This innovative, web-based program connects people at risk for suicide to a counselor who provides information and support for help-seeking, while protecting the individual's anonymity. It is designed to be used in a variety of settings, including universities and workplaces, and can be adapted for outreach to at-risk groups in the population at large. It is based on the following principles:
- Anonymity for the user
- Personalized contact with real counselors
- Interactive engagement between user and counselor
- Responding to the individual’s feelings rather than making a diagnosis
- Identifying and resolving the individual’s personal barriers to treatment
Read more about the Interactive Screen Program's success in college and university settings.
AFSP partnered with the Department of Veterans Affairs and the National Suicide Prevention Lifeline to adapt the ISP for use by veterans, military services personnel, and their families. AFSP has also partnered with the National Suicide Prevention Lifeline and other leading experts in crisis counseling and health communications to develop a Self-Check Quiz for current and former NFL players, their families and NFL team and league staff.
On helping people who have previously attempted suicide:
Key Research Findings on interventions to reduce and prevent suicide.
About 20% of people who die by suicide have made a prior suicide attempt, and clinical studies have confirmed that such prior attempts increase a person’s risk for subsequent suicide death. Suicide risk appears to be especially elevated during the days and weeks following hospitalization for a suicide attempt, especially in people with diagnoses of major depression, bipolar disorder, and schizophrenia (Tidemalm, et al., 2008).
The majority of people who make a suicide attempt, however, do not ultimately die by suicide. Studies that have followed suicide attempters identified in hospital emergency rooms have found that just 7–10% died by suicide over the next two decades (Jenkins, et al., 2002; Carter, et al., 2007).
Protective Factors for Suicide are characteristics or conditions that may help to decrease a person’s suicide risk. While these factors do not eliminate the possibility of suicide, especially in someone with risk factors, they may help to reduce that risk. Protective factors for suicide have not been studied as thoroughly as risk factors, so less is known about them. Protective factors include:
- Receiving effective mental health care
- Positive connections to family, peers, community, and social institutions such as marriage and religion, that foster resilience
- The skills and ability to solve problems
FIND HELP. The single biggest risk factor for suicide is mental illness, particularly untreated chronic depression. This can be fatal and depression should be treated as a chronic, potentially malignant, recurring disorder.
If you are concerned about a loved one, it is important for you to reach out for family and community support as well. You can also check with your local NAMI for Family Support Groups.
On the effectiveness of limiting access to lethal means:
Most studies looking at access to means—whether guns, pills, carbon monoxide, bridges, or other suicide methods—have found that making these methods less available reduces suicide rates.
On addressing the risk of suicide among law enforcement, the military, and first responders:
Key Research Findings on interventions to reduce and prevent suicide.
The following environmental factors can increase suicide risk in people who are already vulnerable due to preexisting mental health disorders or other major risk factors:
- A highly stressful life event such as losing someone close, financial loss, or trouble with the law
- Prolonged stress due to occupational traumatic exposure or adversities such as unemployment, serious relationship conflict, harassment, or bullying
- Exposure to another person’s suicide or to graphic or sensationalized accounts of suicide (contagion)
- Access to lethal methods of suicide during a time of increased risk
- Experiencing trauma, post-traumatic stress, or traumatic brain injury
Exposure to extreme or prolonged environmental stress can also lead to depression, anxiety, and other disorders that in turn, can increase risk for suicide. Best practices include leaders in these fields taking a clear stand that vulnerabilities to suicidal behaviors are not a sign of weakness, but a reality for all people.
Current AFSP-funded researchers doing Military and Veteran Studies.
Encourage veterans, active service personnel, members of the National Guard and Reserves, and their families to take The Veterans Self-Check Quiz.
On what to do if you're worried someone is suicidal:
Take it seriously.
- 50% to 75% of all people who attempt suicide tell someone about their intention.
- If someone you know shows the warning signs listed here, the time to act is now.
Ask questions.
- Begin by telling the suicidal person you are concerned about them.
- Tell them specifically what they have said or done that makes you feel concerned about suicide.
- Don't be afraid to ask whether the person is considering suicide, and whether they have a particular plan or method in mind. These questions will not push them toward suicide if they were not considering it.
- Ask if they are seeing a clinician or are taking medication so the treating person can be contacted.
- Do not try to argue someone out of suicide. Instead, let them know that you care, that they are not alone and that they can get help. Avoid pleading and preaching to them with statements such as, “You have so much to live for,” or “Your suicide will hurt your family.”
Encourage professional help.
- Actively encourage the person to see a physician or mental health professional immediately.
- People considering suicide often believe they cannot be helped. If you can, assist them to identify a professional and schedule an appointment. If they will let you, go to the appointment with them.
Take action.
- If the person is talking about imminent or specific plans for suicide, this is a crisis requiring immediate attention. Do not leave the person alone.
- Remove any firearms, medications, or sharp objects that could be used for suicide from the area.
- Take the person to a walk-in clinic at a psychiatric hospital or a hospital emergency room.
- If these options are not available, call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) for assistance.
Follow-up on treatment.
- Still skeptical that they can be helped, the suicidal person may need your support to continue with treatment after the first session.
- If medication is prescribed, support the person to take it exactly as prescribed. Be aware of possible side effects, and notify the person who prescribed the medicine if the suicidal person seems to be getting worse, or resists taking the medicine. The doctor can often adjust the medications or dosage to work better for them.
- Help the person understand that it may take time and persistence to find the right medication and the right therapist. Offer your encouragement and support throughout the process, until the suicidal crisis has passed.
Help shore up social support for the person when possible.
Coping With Suicide
On programs available to survivors of suicide loss:
International Survivors of Suicide Day brings survivors of suicide loss together across 6 continents every year to grieve, heal, and honor their loved ones with a community that understands.
The Survivor Outreach Program is available in select areas of the United States. Survivors of suicide loss visit with the newly bereaved to offer peer support and empathy, share resources, and listen to their stories.
The Lifekeeper Memory Quilt Program transforms statistics into stories, putting a human face on the tragedy of suicide loss.
Out of the Darkness Walks raise awareness about depression and suicide, and provide comfort and assistance to those who have lost someone to suicide.
On asking why:
We are sorry for your loss and know that it may be difficult to understand why this happened. You may never find an answer to this question, or you may find your answer evolves over time.
You are not alone and many others have also had to suddenly cope with a suicide loss. For starters, you can begin here.
On helping others understand grief after a suicide loss:
No matter the cause of death, the grief process is highly individual. There are many different ways to engage in this process. You may or may not want to talk about your loss right now. Others can support you by allowing for the emotional space to experience the full range of your personal reaction. Ask them just to be there for you and that can often be enough.
You can provide information on surviving a suicide loss and how they can help you.
On experiencing relief after a suicide loss:
It can be extremely difficult to admit you may feel some relief after a suicide loss, inducing additional feelings of guilt, shame, or anger. It is not uncommon to feel relieved in some ways. Chronic mental illnesses can take a huge emotional and physical toll on families and communities. It is very hard to watch the person you love suffer with severe mental health issues. It can be a relief that their suffering is over, as well as your struggles. That does not mean you do not hurt and grieve for your loved one.
On genetic factors and family history contributing to suicide among survivors of suicide loss:
Key Research Findings have shown that the risk for suicide can be inherited (Juel-Nielsen & Videbech, 1970; Roy, et al., 1991; Lester, 2002). Exposure to completed and attempted suicide in the family has also been found to increase suicide risk among family members by providing a “social model” of self-harm behavior (de Leo & Heller, 2008). While these studies indicate that a family history of suicide can be a risk factor for suicide, they do not suggest that a suicide in the family automatically heightens suicide risk for all family members. Family history is one among many factors that can contribute to a person’s vulnerability or resilience. As with other genetically-linked illnesses and conditions, awareness of possible risk and attention to early signs of problems in oneself or a loved one can be protective if it leads those who have lost a relative to suicide to seek timely treatment or intervention.
See the research we are funding on Genetic Family Studies to deepen our understanding of possible links.
On complicated grief:
Grief is a normal process related to loss. While most move through the normal process of grief and adjustment, others experience prolonged impairing grief accompanied by complicating thoughts, feelings and behaviors and don’t seem to progress through the process of grief and mourning. When acute grief does not seem to pass and prolonged and impairing grief continues this is called Complicated Grief.
AFSP funded a large research grant to optimize treatment of complicated grief. The study is being carried out in Boston, New York, Pittsburgh, and San Diego.
On the effects of losing a patient to suicide:
It is a very personal experience to lose a patient to suicide. Clinicians may also lose medical students and physician colleagues to suicide. Psychiatrists, in particular, often work directly with people struggling to manage chronic, refractory mental illnesses. After a suicide, it can cause the treating clinician to reflect on what they could have done differently and whether they really did enough. It can even lead them to ask whether they should be in this field altogether. They may struggle with overcoming professional shame and humiliation, in addition to their grief.
Listen to Terresa tell her story of losing a patient to suicide. "That's what really kind of stopped me in my tracks and made me realize how very little training we get as clinicians."
On talking to children:
You can help children understand by providing truthful information using age-appropriate language, encouraging questions, and offering loving assurance.
See our resource page for books on helping children understand suicide loss.