Suicide

• Talking about suicide, including making such statements as "I'm going to kill myself," "I wish I was dead" or "I wish I hadn't been born"
• Getting the means to commit suicide, such as getting a gun or stockpiling pills
• Withdrawing from social contact and wanting to be left alone
• Having mood swings, such as being emotionally high one day and deeply discouraged the next
• Being preoccupied with death, dying or violence
• Feeling trapped or hopeless about a situation
• Increased use of alcohol or drugs
• Changing normal routine, including eating or sleeping patterns
• Doing risky or self-destructive things, such as using drugs or driving recklessly
• Giving away belongings or getting affairs in order
• Saying goodbye to people as if they won't be seen again

Developing personality changes, such as becoming very outgoing after being shy
Warning signs aren't always obvious, though, and they vary from person to person. Some people make their intentions clear, while others keep suicidal thoughts and feelings secret.

Causes

Suicidal thoughts have numerous causes. Most often, suicidal thoughts are the result of feeling like you can't cope when you're faced with what seems to be an overwhelming life situation. These situations could include financial problems, the death of a loved one, a relationship breakup or a debilitating illness. If you don't have hope for the future, you may mistakenly think suicide is a solution. You may experience a sort of tunnel vision, where in the middle of a crisis you believe suicide is the only way out.

There may also be a genetic link to suicide. People who complete suicide or who have suicidal thoughts or behavior are more likely to have a family history of suicide. While more research is needed to fully understand a possible genetic component, it's thought that there may be a genetic link to impulsive behaviour that could lead to suicide.

Risk factors

Suicide risk factors include:

• Having a prior suicide attempt
• Having an underlying psychiatric disorder, such as depression or post-traumatic stress disorder
• Being intoxicated — a large percentage of suicides are committed under the influence of alcohol or drugs
• Having a substance abuse problem
• Behaving recklessly or impulsively
• Feeling hopeless
• Having a family history of mental disorders or substance abuse
• Having a family history of suicide or violence, including physical or sexual abuse
• Recently undergoing a stressful life event, such as the loss of a loved one or a breakup
• Having firearms in your home
• Having a significant medical illness, such as cancer or chronic pain
• Feeling socially isolated or lonely
• Having legal problems
• Having trouble in school, social problems or disciplinary problems if you are a child or young adult
• Being male — men are more likely than women to complete suicide because they typically use more lethal means, such as a firearm
• Being homosexual with an unsupportive family or in a hostile environment
• Being a man age 65 or older

Murder and suicide

In some cases, people who are suicidal are at risk of killing others and then themselves. This is known as a homicide suicide or murder suicide. The types of feelings that trigger this tragic behavior can stem from a number of sources. Some common risk factors for murder suicide include:

• A history of conflict with a spouse or romantic partner
• Current family legal problems
• A history of mental health problems, particularly depression
• Alcohol or drug abuse or addiction
• Having access to a firearm — nearly all murder suicides are committed using a gun

Starting antidepressants and increased suicide risk

Some studies have shown a possible link between starting treatment with an antidepressant and an increased risk of suicide. The Food and Drug Administration (FDA) requires manufacturers of all antidepressants to include a warning stating that antidepressants may increase suicide risk in young people during the first two months of treatment.

However, the link between antidepressants and suicidal thinking isn't clear — and not taking an antidepressant when it's needed also increases the risk of suicide. To be safe, anyone who starts taking an antidepressant should be watched closely for signs of suicidal thinking. If you — or someone you know — has suicidal thoughts when taking an antidepressant, immediately contact your doctor or get emergency help.

Complications

Suicide and suicidal thoughts have many potential complications. The most obvious and tragic, of course, is death.

But suicide and attempted suicide exact a toll in other ways, too — both for those who want to take their own life and for their loved ones. You may be so consumed by suicidal thoughts that you can't function in your daily life, for instance. And while many suicide attempts are impulsive acts during a moment of crisis, they can leave you with permanent serious or debilitating injuries, such as organ failure or brain damage.

For those left behind after a suicide — people known as survivors of suicide — grief, anger, depression and guilt are common.

Diagnosis

Your doctor will do a physical exam. He or she will ask you a number of questions about your mental and physical health to help determine what may be causing your suicidal thinking and to determine the best treatment.

Mental health conditions

In most cases, suicidal thoughts are linked to an underlying mental health issue that can be treated. These can include:

• Depression
• Bipolar disorder
• Personality disorders
• Post-traumatic stress disorder
• Anxiety
• Detachment from reality (psychosis) or paranoia
• Drug or alcohol use disorders

If your doctor thinks you may have an undiagnosed mental health condition that could be causing suicidal thinking, you may need to answer further questions or fill out a psychological questionnaire. You may need to see a doctor who specializes in diagnosing and treating mental illness (psychiatrist) or other mental health provider.

Physical causes

In some cases, suicidal thinking may be linked to an underlying physical health problem. You may need blood tests or other tests to determine whether this is the case. Some conditions that can be linked to depression and suicidal thinking include:

• Thyroid disease
• Inflammatory bowel disease
• Lupus (systemic lupus erythematosus)
• Wilson's disease

Alcohol and drugs

Your doctor will want to know whether you have any problems with alcohol or drug use - such as bingeing or being unable to cut back or quit using alcohol on your own. For many people, alcohol or drugs play a role in suicidal thinking and completed suicide.

Although drinking or using drugs may seem to help because it numbs emotional pain, it's likely to worsen depression and suicidal thinking. Substance abuse also makes you more likely to act on impulsive thoughts of suicide or behave recklessly. Many people who feel suicidal need treatment to help them stop using alcohol or drugs for their suicidal feelings to improve.

In some people, certain prescription or over-the-counter drugs can cause suicidal feelings. Your doctor will want to know about any medications you take to see whether they could be linked to your suicidal thinking.

Children and adolescents

Children who are feeling suicidal generally need to see a psychiatrist experienced in diagnosing and treating children with mental health problems.

With children and adolescents, the doctor will want to get all the information possible to determine what may be causing the problem and whether the child or adolescent is at risk of suicide.

The doctor will want to get information from as many sources as possible to get an accurate picture of what's going on. Sources can include the young person, parents or guardians, other people close to the child, school reports, and previous medical or psychiatric evaluations.

Suicide in children or adolescents often follows stressful life events. However, keep in mind that what a young person sees as serious and insurmountable may seem minor to an adult — such as problems in school or the loss of a friendship. In some cases, a child or adolescent may feel suicidal due to certain life circumstances he or she may not want to talk about. Some of these include:

• A history of physical or sexual abuse
• Problems with alcohol or drugs
• Becoming pregnant
• Having a sexually transmitted disease
• Being the victim of bullying
• Being homosexual

Physical examinations, tests and in-depth questioning may be needed to help determine an underlying cause.

References

http://www.hse.ie/eng/services/list/4/Mental_Health_Services/NOSP

http://www.nhs.uk/conditions/Suicide/Pages/Introduction.aspx

http://www.thelancet.com/series/suicide

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00234-2/abstract