Suicide and self-harm

• Suicide is the 10th leading cause of death and is one of three leading causes that are increasing. Suicide is the second leading cause of death for youth between the ages of 15-24.
• On average, there are 121 suicides per day.
• For every completed suicide, there are 25 suicide attempts.
• In 2015, the highest suicide rate was among adults between 45 and 64 years of age.
• In 2015, the highest suicide rate was among Whites, and the second highest rate was among American Indians and Alaska Natives.
• Firearms account for nearly 50% of all suicides.
• People with mental illnesses are generally more likely to feel suicidal and try to take their own lives than the general population. In fact, about 90% of those who die by suicide had a diagnosable psychiatric disorder at the time of their death.
• The actual numbers are estimated to be even higher due to underreporting caused by stigma.

Common risk factors, or characteristics/conditions that make it more likely someone will try to take their life include:

• Mental disorders
• Stressful life events
• History of trauma or abuse
• Lack of social support
• Lack of healthcare
• Alcohol and other substance use disorders
• Chronic physical illness
• Family history of suicide attempts
• Previous suicide attempts

Suicide is most common when someone’s distress reaches beyond their current coping abilities. Many depression-related suicides occur during someone’s first three episodes of depression with suicidal thoughts before learning that the episode is only temporary. Suicidal thoughts may be passive (i.e., thinking about being dead) or active (i.e., making a plan). Severely depressed people may view suicide as a solution to their suffering when their emotional pain becomes unbearable. People who have survived suicide attempts often report not actually wanting to die, but rather wanting to stop living.

Common suicide warning signs:

• Talking about wanting to die
• Looking for a way to kill yourself
• Talking about feeling trapped or hopeless
• Isolating yourself from family and friends
• Having a sudden change in mood or extreme mood swings
• Engaging in risky behaviors
• Showing rage or talking about seeking revenge
• Talking about being in unbearable pain

While warning signs are associated with suicide, they may not be what actually causes a suicide.

Have a plan to refer to when you are experiencing suicidal thoughts or going through a mental health crisis. It is also helpful to give copies of your plan to your supporters. Create your plan when you are feeling relaxed and well. Your plan should include a list of:

• Warning signs (changes in mood, behaviors, thoughts) that might suggest you are becoming suicidal.
• Reasons to live. Examples: my pet, my children, experiences I still wish to have
• Activities you can do to distract yourself from suicidal thoughts. Examples: watch a movie, listen to music, take a walk.
• Coping strategies that work well for you. Examples: exercise, meditate
• Treatments and medications that help you feel better and those to avoid.
• What you want from your supporters when you are feeling this badly.
• Names and phone numbers of trusted friends and family you can reach out to when you are in a crisis.
• Names and phone numbers of mental health professionals, crisis teams and hospitals you can contact, including a suicide crisis line such as 1-800-273-TALK.

It is important to keep all of the following information together and easily accessible in case of emergency:

• Current diagnostic assessment
• A copy of your crisis plan
• Notes from phone calls and appointments
• Hospitalization history
• List of medications and dosages
• Health insurance information
• Names and phone numbers of mental health professionals and mental health agencies

Self-harm, or self-injury, is the act of hurting your body on purpose. This is most commonly done by cutting oneself with a knife, but burning or picking at sores is also common. Self-harm is typically done in secret.

Why do people self-harm?

People generally resort to self-harm as a way to cope with emotional pain. The physical pain brought on through self-harm may feel like a release or bring realness to the emotional numbness someone is experiencing. However, injuring oneself may lead to feelings of shame and guilt that lead to an urge to self-harm again. This can create a dangerous, long-lasting cycle of repetitive self-harm. People who self-harm are at an increased risk of accidental suicide or developing suicidal thoughts.

Coping in healthy ways

It is possible to learn to manage really intense feelings in ways that don't lead to self-harm, and many of these alternatives can also offer you long-term relief. If your self-harming is intense or long term, then the support of a health professional will be needed. A professional will recommend therapy to help you learn new, healthier ways of coping with your depression.

American Foundation for Suicide Prevention

Centers for Disease Control and Prevention (CDC) Data & Statistics Fatal Injury Report for 2015.

Hawton, K., Saunders, K. E., & O'Connor, R. C. (2012). Self-harm and suicide in adolescents. The Lancet, 379(9834), 2373-2382.

Suicide prevention: Steps to be taken. (2012) The Lancet, 379 (9834), p. 2314.