Not all people with depression and anxiety will think about suicide but some people with anxiety or depression will1. Why might you? Many things might contribute to you having suicidal thoughts. For example, stressful life events like the ending of a relationship2, being unemployed3, exposure to other people’s suicidal thoughts and behaviors4, having an abuse history or feeling hopeless about your situation5, all can contribute to suicidal thinking. People who perceive themselves as being discriminated against might have higher levels of suicidal thinking6. People who believe that most people hold negative views of those seeking mental health treatment have increased risk of having suicidal thoughts, plans and attempts7. Each person has a unique set of ingredients that contribute to suicidal thinking.
Once the unique mix happens, a person might have suicidal thoughts. These can be perplexing and distressing.
We all know fire safety rules like “Stop, drop, and roll” but few moms told us what to do if we have suicidal thoughts. When humans don’t know what to do, they may do nothing. They may worry that people will think they’re crazy and they may keep suicidal thoughts a secret8. That’s exactly what you don’t want to do. Doing nothing allows the possibility that the thoughts will transition to planning a suicide attempt. People who go onto attempting suicide will do so within the first year of thinking about suicide but the longer the time between the start of suicidal thinking and attempting, the less likely it is that a person will attempt.9
This means that the window of opportunity for doing something can be narrow. Attempting suicide10 increases your risk of suicide and suicide attempts are higher with people with anxiety and substance use disorders.11
So what should you do if you have thoughts of suicide? Here are 5 steps you can take.
Step 1: Find a trusted professional to talk to
One option is to contact the National Suicide Prevention Lifeline at 1-800-273-TALK [8255) which can connect you to a network of crisis centers throughout the U.S. Alternatively, you can go to your nearest emergency room for an evaluation.
Step 2: Remove firearms and don't stockpile medications
Give your firearms to your local police for temporary safekeeping. Owning a firearm increases your risk of suicide12. Or you can talk to your prescriber about prescribing weekly so that you can’t stockpile medication at home.
Step 3: Get treatment
Get treatment for your mental health condition. Although not all people with suicidal thinking have a mental health condition13. Check the list of behavioral health providers on your insurance plan. You can also find therapists at these websites.
Step 4: Read stories of hope and recovery
Read stories of hope and recovery on the Suicide Prevention Lifeline website at https://suicidepreventionlifeline.org/stories.
Step 5: Make a list of your reasons to stay alive
Make a list of your reasons to stay alive. Most people with thoughts of suicide don’t 100% want to die, they want to escape pain14. A part of them wants to die to escape pain but a part of them would like to find an alternate solution to their problems and stay alive. Suicidal people are ambivalent. One way to manage your ambivalence is to clarify your reasons to live. If you need some ideas, read Matt Haig’s book “Reasons to Stay Alive” (Penguin Books, 2016). One suggestion he makes is: “Remember that the key thing about life on earth is change. Cars rust. Paper yellows. Technology dates. Caterpillars become butterflies. Nights morph into days. Depression lifts.”15
Your friends are right when they tell you, “This too shall pass.” Some other reasons to live might be loved ones who depend on you, wanting to accomplish your bucket list of future goals, your track record of being able to cope with problems, your spiritual beliefs about life, and even wanting to find reasons to live. Collect tangible reminders of these reasons to live into a hope box or alternatively download and use a free phone app called Virtual Hope Box16 . One person obtained clothing from people who were important to her and made a quilt17. Be creative about what will work for you to remind you of your reasons to live when you are thinking about suicide.
You can download the Virtual Hope Box app on the Apple Store or Google Play Store.
The important step is to take action. If you are the one with suicidal thoughts, reach out for help. If you know someone with suicidal thoughts, stay with them until they connect to help (see blog on how to help someone who is suicidal).
References
1Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., & ... Nock, M. K. (2017). Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychological Bulletin, 143(2), 187-232.
2Love, H.A., Nalbone, D.P., Hecker, L.L., Sweeney, K.A., Dharnidharka, P. (2018). Suicidal risk following the termination of romantic relationships. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 39(3), 166-174.
3Blakely, T.A., Collings, S.C.D., & Atkinson, J. (2003). Unemployment and suicide. Evidence for a causal association? Journal of Epidemiology & Community Health, 57(8).
4Ribeiro, J.D., Franklin, J.C., Fox, K.R., Bentley, K.H., Kleiman, E.M., Chang, B.P., & Nock, M.K. (2016). Self-injurious thoughts and behaviors as risk factors for future suicide ideation, attempts, and death: a meta-analysis of longitudinal studies. Psychological Medicine, 46(2), 225-236.
5Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., & ... Nock, M. K. (2017). Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychological Bulletin, 143(2), 187-232.
6Perez-Rodriguez, M. M., Baca-Garcia, E., Oquendo, M. A., Wang, S., Wall, M. M., Liu, S., & Blanco, C. (2014). Relationship between acculturation, discrimination, and suicidal ideation and attempts among US Hispanics in the National Epidemiologic Survey of Alcohol and Related Conditions. Journal of Clinical Psychiatry, 75(4), 399-407.
7 Goodwill, J. R. & Zhu, S. Z. (2020). Association between perceived public stigma and suicidal behaviors among college students of color in the U.S. Journal of Affective Disorders, 1(262), 1-7.
8Keefe, R.A. (2018). The Lifesaving Church: Faith Communities and Suicide Prevention. St Louis, MO: Chalice Press, p. 49.
9Borges, G., Chiu, W.T., Hwang, I., Panchal, B.N., Ono, Y., Sampson, N.A., Kessler, R.C., & Nock, M.K. (2012). Prevalence, onset, and transitions among suicidal behaviors (pp. 65-74, Ch. 4) in M.K. Nock, G. Borges, & Y. Ono (eds.). Suicide. Cambridge University Press.
10Cooper, J., Kapur, N., Webb, R., Lawlor, M., Guthrie, E., Mackway-Jone, K., & Appleby, L. (2005). Suicide After Deliberate Self-Harm: A 4-Year Cohort Study. The American Journal of Psychiatry, 162(2), 297-303.
11Nock, M.K., Borges, G., & Ono, Y. (2012) Suicide: Global Perspectives from the WHO World Mental Health Surveys. Cambridge Univ Press.
12Anestis, M.D., & Houtsma, C. (2018). The association between gun ownership and statewide overall suicide rates. Suicide and Life-Threatening Behavior, 48(2), 204-217.
13Kessler, R., Berglund, P., Borges, G., Nock, M., & Wang, P. (2005). Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990-1992 to 2001-2003. The Journal of the American Medical Association, 293(20), 2487-2495. (About 1-3% of people with a mental health condition will die by suicide).
14Blair-West G.W., & Mellsop G.W. (2001). Major depression: Does a gender-based down-rating of suicide risk challenge its diagnostic validity? Australian and New Zealand Journal of Psychiatry, 35(3):322–28).
15Shneidman, E.S. (1996). The Suicidal Mind. New York: Oxford University Press, p. 133
Haig, M. (2016). Reasons to Stay Alive. Penguin Books.
16
https://apps.apple.com/us/app/virtual-hope-box/id825099621 or https://play.google.com/store/apps/details?id=com.t2.vhb&hl=en_US
17Wenzel, A., Brown, G.K., & Beck, A.T. (2009). Cognitive Therapy for Suicidal Patients: Scientific and Clinical Applications. Washington, D.C: American Psychological Association, p. 192.
