National suicide prevention lifeline
Studies indicate that suicide is a process starting days, months, or even years before the suicide act. There are several elements to this process:
- Mental pain, which may reflect traumatic life events
- Experience of emptiness
- An awareness of a disruption in the person's ability to maintain a sense of wholeness and social unity.
Research shows that the drive toward suicide is often more easily treatable early on in the process, but accelerates as the sense of helplessness grows. The suicidal individual may see it as an escape from unbearable emotional pain, a pain as real, unrelenting, and acute as pain related to a physical problem. Another aspect of this suicide process is that the individual will have at some point attempted to adapt and recover to an earlier less troubled state. That attempt, however, often fails, leaving the individual feeling more emotional pain, a greater sense of loss, failure, hopelessness and helplessness. All of these combine to push the individual farther down the slippery slope of self-destruction.
Depression has a downward spiraling effect. Depressed individuals feel fatigued, lose interest in life, and start to fail in school or at work, reinforcing their belief that they are worthless. That sense of worthlessness causes them to withdraw even more. It has already been noted that hopelessness is the key variable in predicting suicide. Hopelessness relates to the future. If there is no hope for relief in the future, then why continue to suffer in the present? Conceptually, anyone, under the right circumstances, may give suicide serious consideration.
The role of chemical dependency
Substance abuse is very often an integral part of the suicidal process. Numerous research studies have concluded that suicidal ideation is highly linked to the severity and frequency of substance abuse, especially among cocaine users, and those who use both cocaine and alcohol.
Suicide among the elderly
White males over the age of 85 have one of the highest rates of suicide. Divorced, separated, and widowed persons have a high rate of suicide. The result is that white males over the age of 85, a group that will include many singles, be it from death of the spouse or divorce, will contain a high percentage of potential suicide risks.
Communicating with the suicidal patient
Perhaps no other group of mentally ill persons has more difficulty in expressing their fears, concerns, anxieties, and worries than those who are depressed. Often there is great inconsistency between what depressed people say and what they are thinking and feeling. Not being able to communicate what they are feeling further increases their frustration and anxiety. Even though their communication may become more inhibited, their silence does communicate a problem. It becomes important for the clinician to initiate effective communication.
There are numerous and varied verbal cues that should raise awareness that the patient is considering suicide. These include the obvious: "I wish I were dead," "I might as well end it all," "I have nothing to live for," "They would be better off without me," etc. Other times the verbal cues are less obvious: "I'm tired of living this way," "I'm under so much pressure," "No one cares about me, or "It seems like the end of the world." And sometimes the verbal cues are well hidden for example the patient may relate a dream in which a theme of death, destruction, or a traumatic event is prevalent.
It is not uncommon for the suicidal patient to shut down verbally as well as emotionally. In those cases the healthcare provider must be alert to non-verbal cues. Body language reveals significant information. Assess for downcast eyes, slowed speech, disheveled appearance, crying, or sad affect. The sad affect combined with a distracted look should give the clinician cause for concern. Also, be suspicious of those who have been sad and emotionally removed whose mood suddenly brightens. Such a change could signal a sense of relief from their emotional struggle by finally deciding to kill themselves.
Ciancio, Jack The Adult Suicidal Patient: Understanding, Assessing, Safeguarding
National Suicide Prevention Lifeline: 1-800-273-TALK (8255)