Paging Dr. Frischer: Suicide

Most of us have known someone who took his or her own life. Often, we had no idea that they were so despondent. Who is at risk? What are the clues? What actions can we take?
Suicide is a tragic and potentially preventable public health problem, and it has become more prevalent over time. It does not discriminate; people of all genders, ages, and ethnicities are at risk. There are roughly 40,000 suicide deaths each year in our country. It is the tenth leading cause of death overall, the second leading cause of death for those aged 10 to 24, and the fifth leading cause of death for those aged 45 to 59.

Men are four times more likely than women to die from suicide, but women are three times more likely to attempt suicide. The three most common methods used are firearms (51%), suffocation by hanging (25%), and poisoning (17%). Note that 90% of suicide victims had a diagnosed psychiatric illness at the time of death.
The most common risk factors for suicide are:

*A history of depression, alcohol or other substance abuse, or other mental disorders

*A major physical illness

*A prior suicide attempt

*Obvious hopelessness and helplessness

*Impulsive and/or aggressive tendencies

*Lack of social support and a sense of isolation

*Lack of health care, especially mental health and substance treatment

*Family history of mental disorders or substance abuse, suicide, or violence (including physical, emotional, or sexual abuse)

*The presence of guns in the home, or access to other lethal means

*Incarceration in prison or jail

*Certain cultural and religious beliefs, such as the belief that suicide is a noble solution

*Experiencing stressful life events, such as a death; divorce; or financial or job loss.

People who intend to kill themselves typically exhibit one or more warning signs, either through words or actions. The more warning signs, the greater the risk. Verbal red flags include talk about killing themselves, having no reason to live, being a burden to others, feeling trapped, or being in unbearable pain (either physical or emotional). Behavioral red flags include increased use of alcohol or drugs, looking for ways to kill themselves, acting recklessly, withdrawing from activities, isolating from family and friends, changes in sleep patterns, visiting or calling people to say goodbye, and giving away prized possessions.  
Improving the recognition and treatment of mental disorders and other suicide risk factors by primary care doctors is important, because adults who die by suicide are likely to have seen a primary care provider during the prior year. One particular at-risk group is those elderly who recently lost their primary caregiver or spouse.
There is no definitive measure to predict suicidal behavior. Those who are at high risk need appropriate intervention and support. Of course, many people have risk factors but do not attempt suicide, and, likewise, those with no apparent risk factors do commit suicide.
What action should we take if we do know someone who is contemplating suicide? Suicidal behavior is not a normal response to stress, or a harmless bid for attention, but a sign of extreme distress. I urge you to take their distress seriously, listen nonjudgmentally, and to not leave them alone. Remove any access to firearms, pills, knives, etc. Get them immediate medical attention by taking them to their doctor or to an emergency room. If that isn’t possible, call 911.
The phone number for the National Suicide Prevention Lifeline is 1-800-273-TALK (8255).

Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.