What is suicidality?
Suicidality refers to suicidal ideation and suicide-related behaviors including completed suicide. Suicidal ideation means thoughts related to suicide and suicide plans. Suicide related behaviors include:
- completed suicide: self-inflicted death with intention to die,
- suicidal attempts: self-inflicted potentially harmful behavior without fatal issue but with intention to die,
- self harm: deliberate self-inflicted potentially harmful act regardless of motive.
Suicide is one of the ten leading causes for deaths worldwide (7), contributing 1.5% of all deaths. Approximately 1 million people die due to suicide each year (19, 20).
Risk of suicidal ideation increases rapidly during adolescence and young adulthood and stabilizes in early midlife (9). The greatest risk for suicidal attempts is in adolescence and early adulthood. The prevalence rates in adolescents are reported cross-nationally to be 19.8-24.0% for suicidal ideation, and 3.1% - 8.8% for suicidal attempts (9).
Suicide is the second cause of death among young people, after accidents. The rates of suicide vary according to age; in childhood and early adolescence suicide is rare but suicide rates increase in adolescents and young adulthood. The latest mean worldwide annual rates of suicide per 100 000 were 0.5 for females and 0.9 for males among 5-14-year-olds, and 12.0 for females and 14.2 for males among 15-24-year-olds, respectively (12). Males generally outnumber females in completed suicide, but suicide attempts are more frequent in females.
What is Medication Related Suicidality (MRS)?
Medication-Related Suicidality (MRS) is defined as any suicide-related symptoms that are reported during the period of treatment with a drug. Generally they apply to worsening of suicidal ideation or new-onset suicidal ideation. Symptoms include suicidal ideation, suicidal plans and suicidal behaviours and sometimes also extend to non-suicidal self-harm. Mechanisms of MRS are unknown. A small proportion of children, adolescents and young adults develop MRS with antidepressants, although these drugs generally improve both depressive symptoms and suicidal ideation and behaviors.
What conditions or circumstances increase the risk of suicidal ideation or behaviors?
Depression is one of the major risk factors of suicidal ideation or behaviors. Depression can occur in episodes or as a chronic condition (dysthymia). Recurrent depressive episodes are a feature of depressive disorder and bipolar disorder.
Other conditions heighten the risk of suicidality: anxiety disorders, eating disorders, substance abuse, psychotic disorders and behavioral disorders.
Previous suicide attempts, adverse life circumstances, impulsivity, physical illness, exposure to suicide through media or peers, also increase suicidality.
What are the warning signs of suicidality?
- Behavioral signs
- Statements such as «Life is not worth living», «I would rather be dead»…
- Withdrawal from family, friends, activities
- Giving away possessions, writing a will
- Impulsive acts, risk-taking or self-destructive behavior
- Drug or alcohol use
- Emotional signs
- Feelings of sadness, hopelessness
- Emotional lability or dullness
- Humiliation, anger, guilt, anxiety
What should you do if you are worried about suicidality in a friend or relative?
- Suicidal signs or statements are to be taken seriously,
- Potential concerns about suicidality should be addressed openly,
- Show emotional availability, be willing to listen, let the child/adolescent know you are concerned,
- Encourage and guide the access to professional help,
- Share your concerns,
- Secure the environment (ensure the person has no access to lethal means),
- Do not: judge, provoke, challenge, be intrusive, ignore
What can you do to cope with suicidal thoughts?
- Get professional help
- Avoid staying alone
- Talk to someone
- Avoid alcohol and drugs
- Stay away from lethal means
- Keep in mind that suicidal ideation and depression are temporary states
What are the warning signs of depression?
Depression manifests itself through sadness or irritability persisting over long periods (more than 2 weeks) and lasting the major part of the day. Children and adolescents with depression often have a negative view of themselves (“I’m a looser”), of their social relations (“Nobody understands me”), and of the future (“I’ll never succeed in my projects”). They may be overanxious or bored and emotionless. They tend to abandon activities and projects they used to find pleasant, refuse to meet their friends. Appetite and sleep are generally altered during depression (they may increase or diminish). Depressed youth generally find it hard to concentrate and engage in school tasks. Severe depression is associated with intense hopelessness, incapacity to fulfill simple everyday activities and can lead to delusional ideas of ruin and disaster.