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Risk Factors
Adapted from Rocky Roads: The Journeys of Families Through Suicide Grief by Michelle Linn-Gust, Ph.D.
Suicide is hard to generalize about because it is so complicated. Behind each suicide is a story as unique as the person who died. Ultimately, we are left to decipher that story based on what we know about the person and who was left behind (called a psychological autopsy). That loved one took with him or her the actual reasons for ending a shortened life. I often tell people that if suicide were so easy to prevent, suicidologists could hand everyone a flyer and send them home. Instead, we spend hours discussing and learning what could be warning signs and risk factors and those hours are still not enough because we also must discuss how you help someone you are concerned about.
Suicide is not determined by one event. Most suicides occur after a series of events in one’s life. The bereaved typically can look back on the history of a loved one and see a pattern and history leading up to the death.
Even though suicide is complicated and knows no boundaries, there are risk factors. In the United States, they include living in western states (isolation and access to firearms), mental illness, previous suicide attempt, previous loss, sexual orientation questioning, alcohol/drug abuse, stigma, poverty, being male, and having a family member who died by suicide.
Terminally ill people sometimes choose suicide as a means to end their pain rather than waiting out their time to die. Such decisions raise the question, If life is sacred, should we “be allowed” to end our own lives when we are terminal and/or in constant pain? This issue is not likely to be resolved any time soon (or ever). It is important to understand that, just as our politics vary from person to person, we have individual beliefs about how we end our lives, often related to religious inclination. My experience is that the people bereaved by these deaths often understand why their loved ones chose to end their lives on their terms and are in a different place than many other survivors of suicide loss. While they are sad that their loved one has died, they feel relieved that their pain has ended and they respect the decision that the loved one made.
In the United States, it appears that a high percentage of the people who die by suicide have a diagnosable mental disorder, although we currently have no way to track this data. A mental disorder could be anything from depression to bipolar disorder to schizophrenia. Many times mental disorders bring with them an array of other issues: substance abuse, relationship issues, and unemployment among others. While some people are getting help for their mental disorder, others have refused help and still others do not have access to it (or cannot afford it).
Even though women are more likely to attempt suicide, men are more likely to use lethal means that end in death, which makes being male a risk factor. Traditionally, much of the funding, particularly in the United States, has gone to support youth suicide prevention to avoid the tragedy of lives cut short. Youth suicide is the third leading cause of death for fifteen to twenty-four year olds, after accidents and homicides, as youth typically do not die of diseases and illnesses. (Suicide is the eleventh leading cause of death for all age groups, with the top ten comprising diseases and illnesses,,particularly heart disease and cancer.) Unfortunately, putting the majority of funding into youth suicide has left an open wound for all the children and young people who are losing their fathers and male role models to suicide.
While it is often assumed that most suicides are related to mental disorders (like depression and substance abuse), the World Health Organization (2010) points out that this is not true in all countries. For instance, in Asian countries (and the United States), there is an impulsivity factor. It is imperative to keep cultural factors in mind when looking at risk factors. While guns are used by the majority of people who end their lives in the United States, in the world overall pesticides are the method of choice. Keeping the most lethal methods out of the hands of people who might use them to end their lives (also known as means restriction) is a key piece of any suicide prevention program. In some countries, pesticides are placed in locked boxes, and in the United Kingdom some medications are packaged so that lethal doses of over-the-counter painkillers cannot be purchased all in one container.
In the United States, environmental risk factors include living in the western states, as you probably noticed from reading the names of the five states with the highest rates of suicide. One factor in the high rate of suicide in the West is probably the number of people living in rural areas where mental health care is not as accessible or not available at all. Often, people who live remotely can be identified as more independent and could be less apt to reach out for help even when it is available to them. They also might be more likely to have access to firearms and to live in an environment where firearms are part of the culture (even for people who might have talked about suicide previously).
People who live alone are at a higher risk for suicide. They might not reach out for help because they are alone, and if they don’t have regular contact with anyone it is less likely that someone will recognize any warning signs. Being unemployed and the ending of a marriage are also risk factors. Think of anything in a person’s environment that might make him feel less hopeful and/or less able to ask for support.
Any sort of previous loss in one’s life can be a risk factor for suicide. Many people who are reading this book are reading it because of a loss and understand that sense of longing for the physical presence of the loved one who is no longer here. Because society traditionally has not accepted the grief journey as one that should be processed and allowed to happen (think about how people traditionally receive several days of bereavement leave and then are expected to return to work and resume their lives), people who are grieving often do not feel they can reach out for help. They wonder what is wrong with them because they feel sad and miss their loved one when the rest of the world seems to be telling them to move on with their lives. What they do not realize is that it is a normal part of the journey and one that does not have to lead to hopelessness.
While there are ethnic groups that have higher rates of suicide, the GLBT (Gay Lesbian Bisexual Transgender) community also has a heightened risk for suicide. This is because of the confusion, stigma, and shame they feel about coming out about their sexuality. If someone is uncertain he (or she) will be accepted by family and loved ones because of his sexual identity, he is less likely to reach for help. For information and support for this group, see The Trevor Project (www.thetrevorproject.org) which offers a suicide and crisis prevention helpline for gay and questioning youth.
Family history of suicide is an important risk factor. There is some debate over the part that genetics play in suicide, but exposure to suicide is correlated with an increase in suicidal behavior by surviving family members. When suicide happens in a family, it becomes part of that family’s history and the family’s everyday language. It no longer is something that happens to a family down the street. Hence some family members might see suicide as a method of coping with stress.
Family history also can include violence and trauma. In families with a history of one or both (they usually come together, since where there is violence, there is trauma), for some family members the only escape might be to kill oneself. And in some families a single member has been exposed to war and violence (currently this is particularly true for active military and for veterans who have served in the conflicts in the Middle East).
While the risk factors described above do not encompass all people who are at risk for suicide (and there are people who fall into these categories but might not ever consider suicide), these people are the ones we generally believe are more likely to exhibit suicidal thoughts that lead to possible lethal attempts to end their lives.
