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Med Travelers - December 2019

Risk Factors and Warning Signs of Suicide

Angela Moss, PhD, RN, APRN-BC, Nika Ball, MOT, OTR/L, ATP

September 5, 2019



What are the risk factors and warning signs of suicide? 


Suicide affects everybody and you have most likely already encountered it either in your personal life or in your professional life, whether it's working with a patient, a family, or a friend who has contemplated suicide, completed suicide or is a suicide survivor.

Risk factors are characteristics or conditions that increase the chance that a person may try to take their life. It doesn't mean that they're going to; they may never become suicidal. But these are some risk factors: 

  • Mental Health Conditions - include depression, anxiety, substance abuse, PTSD, bipolar, schizophrenia, issues with aggression or mood swings or poor social skills or relationships, and conduct disorder. This does not mean if someone has these mental health conditions, they are automatically going to be suicidal. It just puts them at a higher risk of becoming suicidal.
  • Physical Health Conditions - include cardiovascular disease, diabetes, obesity, cancer, arthritis, etc.  Chronic pain or a functional disability is also a risk factor.   Any chronic physical health condition can be a risk factor for suicidal ideation. Traumatic injuries including traumatic brain injury or spinal cord injury. Finally, post-partum depression is a physical health condition that certainly puts someone at a higher risk for suicidal ideation.
  • Environmental Conditions - The first environmental factor is access. If someone has access to lethal items such as firearms, drugs, poisons, etc., then they have a high risk of being able to complete suicide. Prolonged stress such as homelessness or incarceration. If the person has a history of being a victim of harassment, bullying, rape, abuse, domestic violence or chronic childhood adversity, that puts them at risk for suicide. Stressful life events such as the death of a loved one, divorce or a relationship instability, financial crisis, or unemployment.  Also, lack of social support, isolation or institutionalization and exposure to sensationalized accounts of suicide can put an individual at higher risk for suicidal ideation.
  • Historical Risk Factors - include anything not included in the other three areas. If the person has a previous suicide attempt, if there's a family history of suicide or suicidal ideation, a family history of mental illness, particularly bipolar disorder and/or alcoholism, childhood abuse, neglect and trauma, prolonged trauma or stress in the past, poor problem-solving skills and also surviving the loss by suicide of a loved one.

When thinking about our patients or clients, chances are most of them have at least one of the risk factors listed above.  Once a patient is identified with a risk factor, then you want to look for warning signs. It’s important to know what these warning signs are so that they are on your radar when talking with a client or a family member of your client.

Warning signs can be a change in behavior or sudden occurrence of completely new behaviors. This could be related to a sudden change in life, some type of loss or painful event. Specifically look for changes in the way a person talks, change in behavior or change in mood.

If someone says they were thinking of killing themselves, that is a major warning sign. But, if they talk about feelings of hopelessness, such as, “I just don't really have any reason to live” or “I'm a burden to others” or talk about feeling “trapped” that can also be a warning sign (e.g., trapped in a job, trapped financially, trapped in a relationship).  If that type of talk is persistent, that can be a warning sign for someone at risk for suicidal ideation. Talking about unbearable pain is another warning sign (e.g., “I just can't take this anymore.”).

  • Behavior Warning Signs – these include increased use of drugs or alcohol.  Also, looking for or researching a way to end life. Withdrawing from activities is a behavior warning sign that you want on your radar. Isolation from family and friends is another one. Sleeping too much or too little; any change in their normal sleep pattern that seems to be extreme in either direction can be a warning sign. Visiting or calling people to say goodbye is certainly a warning sign. Giving away prized possessions, showing aggression and fatigue are all behavior warning signs.
  • Mood Warning Signs - include depressed moods, anxiety, loss of interest, irritability, humiliation or shame, agitation or anger, relief or sudden improvement.  Relief or sudden improvement usually occurs after a person has made the decision to end their life by suicide and they feel relief because they know they feel like the end might be in sight soon.

​Recognize that you might only see your patients or clients for a brief window of time, but their friends, family members, teachers, etc. might be involved in their care.  Together you might be able to pick up on some of these warning signs.

*If you suspect someone may be at risk for suicide, it's important to ask directly about suicidal thoughts.  You want to ask them very clearly, “Are you having thoughts of suicide or are you thinking about killing yourself?” Be sure to ask the questions without dread and without expressing negative judgment.  Be aware of your body language and your facial expression when asking these questions.  Clearly state to the person, “Thoughts of suicide are often associated with a treatable mental disorder. With the right treatment, these thoughts will go away.  Let me help you get treatment so that these thoughts will go away.” This can help instill a sense of hope. Oftentimes, healthcare providers don't know what to do. If you ask somebody if they are having thoughts of suicide and they say yes, please don’t react with, “Well, I don't know what to do about that.”  The above statements give you some words for what to say and do in an acute situation. 

How to Keep a Person Safe in Acute Situations

An actively suicidal person should not be left alone. If you cannot stay with the person, then arrange for someone else to do so, whether that's a friend or a family member. Calling 911 is an option if you're concerned about the person's immediate safety or if you're concerned about your own safety (e.g., if the person has a weapon or is behaving aggressively toward you).

The National Suicide Prevention Hotline (1-800-273-8255) is available 24-7 across the country and is also a very valuable resource.  If you find yourself in an acute situation and don't know what to do, call the 1-800 National Suicide Prevention Hotline and they will walk you through the steps of what to do.

Please refer to the SpeechPathology.com course, Suicide Awareness, Assessment and Intervention for more information on suicide awareness, screening, intervention, and referral principles.

angela moss

Angela Moss, PhD, RN, APRN-BC

Dr. Angela Moss, PhD, RN, APRN-BC, is Assistant Dean of Faculty Practice and Assistant Professor, Community Systems and Mental Health, at Rush University College of Nursing in Chicago, Illinois. She is responsible for the development and maintenance of over 30 diverse community-based partnerships whereby faculty nurses and nurse practitioners provide primary and mental health care to vulnerable populations in communities across Chicago. Dr. Moss is a board certified, practicing Adult Nurse Practitioner, and beginning in 2009, founded a nurse-managed primary care health clinic with mental health integration for low-income foodservice workers near Chicago’s O’Hare International Airport. Dr. Moss is passionate about mental health awareness and is an American Foundation for Suicide Prevention (AFSP) community walk team leader and advocate.

nika ball

Nika Ball, MOT, OTR/L, ATP

Nika Ball, MOT, OTR/L, ATP, is the CEU Administrator/Assistant Editor for OccupationalTherapy.com. She has been an occupational therapist for 14 years and worked in a variety of settings, including hospital, acute rehabilitation, skilled nursing facility, outpatient, and home healthcare. Ms. Ball received her Assistive Technology Professional certification from RESNA in 2017. She is an American Foundation for Suicide Prevention (AFSP) field advocate and is passionate about mental health awareness, advocacy, and education. Ms. Ball has participated in multiple annual AFSP fundraiser/awareness community walks for suicide prevention as team leader and participant.

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