How to Spot the Warning Signs of Suicide

Surprise at a family member's suicide is not uncommon. The warning signs of suicide can be difficult for family and friends to spot, even in someone with a history of depression or other mental health problems.

Suicide and suicidal thinking are more widespread than you might think. According to the results of a government survey released in September 2009, roughly 8.3 million adults—or about 3.7% of the population age 18 and older—had "serious thoughts of suicide" in 2008.

How can you identify suicidal thinking in a loved one before it's too late? There is no foolproof checklist to follow, but there are some telltale signs that should spur you to intervene and seek the help of a mental health professional.

A Diagnosis of Depression or Bipolar Disorder

The symptoms of mental health conditions such as depression and bipolar disorder are the main factors that drive people to consider harming themselves. Depression is a chronic condition and it tends to recur, especially if it's not treated or is only partially treated. Sometimes the people who live with a depressed person are better at spotting the signs of a relapse sooner than the person himself. Increasing isolation is often a symptom of depression, as is sadness, expressions of worthlessness, and sleeping or eating too much or too little.

"Depression is the leading illness for suicide, so the deeper the depression gets or the longer it goes on, the more discouraged the person experiencing it feels," says Paula Clayton, MD, the medical director of the American Foundation for Suicide Prevention. "If you have a brief depression, say three or four months, and then get over it, I doubt you're as vulnerable as someone who has depression that lasts one or two years and despite all treatments doesn't get better."

In people with bipolar disorder, —a condition in which bouts of depression are interspersed with periods of mania, —suicide most often occurs while the person is depressed rather than manic.

Signs of Anxiety or Agitation

Suicide is associated not just with depressive symptoms, but even more so with the anxiety and agitation that often accompany depression. According to Ken Robbins, MD, a clinical professor of psychiatry at the University of Wisconsin, in Madison, about half of the people who are diagnosed with depression experience "melancholic depression," which features the classic symptoms associated with the disorder: listlessness, fatigue, loss of appetite, a desire to be alone.

The other half experience what's known as "agitated depression," which has a very different symptom profile. Anxiety is the main symptom, says Dr. Robbins, but these people may also experience restlessness, difficulty sleeping, and trouble focusing.

"People who are agitated are more at risk for suicide because anxiety is so uncomfortable," says Dr. Robbins. "Usually people with melancholic depression don't have the energy or the motivation to think about killing themselves. They just want to be left alone, and they don't really have the initiative to start thinking about doing something so dramatic as hurting themselves. Anxiety, however, drives people to do things to get rid of the discomfort."

Feelings of Guilt

Madelyn Gould, Ph.D., a professor of clinical epidemiology in psychiatry at Columbia University Medical Center, in New York City, says that excessive and inappropriate feelings of guilt—a common symptom of depression and anxiety—are something to be on the lookout for as well.

"You start to feel guilty about things—letting people down—and someone else who's listening would say, 'But you're not," says Gould. "It's just this very unrealistic guilt."

Drug Use or Drinking Too Much

Drug use and excessive alcohol use—which some agitated and anxious people turn to for relief—are warning signs for suicide, says Dr. Clayton. "You might not be an alcoholic or a drug abuser, but if you take things to make yourself feel better or to numb you, that makes you more vulnerable because it impairs your judgment and makes your thinking not as clear," she says.

Substance use can also contribute to impulsivity, Dr. Clayton adds. Studies have shown that up to 80% of all suicide attempts are done on the spur of the moment, with very little planning.

In addition to the symptoms of depression and anxiety, there are a number of concrete clues that could signal that someone is planning a suicide attempt. If they are stockpiling prescription medications, it could be a sign of a planned overdose, for instance.

Purchasing a Gun

One of the loudest and clearest warning signs is buying a gun. Access to a firearm in the home significantly increases the risk of suicide—by up to 10 times, according to a 2008 article in the New England Journal of Medicine. Guns account for less than 10% of all suicide attempts, but those involving guns are far more likely to be fatal.

"Two to one, men complete suicide more often than women," says Dr. Robbins. "And it's largely because of the method they choose, not because of the intent that they have. Men tend to use firearms; women tend to take overdoses."

Suicide-related Internet Searches

Signs that someone is considering suicide may also show up on a computer. For instance, a Web-browser history may show that a person has been researching suicide and ways to kill him or herself, Dr. Clayton says. "With a teen, especially, parents should be monitoring Facebook or MySpace," she adds.

Asking about suicidal impulses does not "put ideas" in a person's head, says Dr. Robbins. If you're concerned about suicide, you need to ask the person about it directly. If the person has access to guns, medications, or other items that could be used for self-harm, get rid of them. Most importantly, you should contact a health professional.