Statistically speaking, 50% to 90% of those who commit suicide suffer from a depressive disorder (Stolberg, Clark & Bognar, 2002; van Praag, 2005 as cited by Butcher, Menika, & Hooley, 2010) . However, those suffering from schizophrenia, substance use disorders, and personality and anxiety disorders also experience suicide ideation (Oquendo, Baca-García, Mann, Giner, 2008). Still others with no diagnoses at all succumb to feelings of hopelessness and sadness to the point of suicide. Suicide is the third leading cause of death among persons aged 10-14 and the second among persons aged 15-34 years. In the year 2013, over 41,140 people lost their lives by suicide in the United States (Centers for Disease Control and Prevention, 2015). Understanding the signs and symptoms of depression and suicide ideation can be a preventative measure to combat such a horrific and permanent solution to a temporary problem.
Those in the mental health field must be ever vigilant in picking up on subtle cues, symptoms, and signs of suicide ideation and actions associated with such behavior. One way to look for symptoms and signs of suicide and assess client stability is to conduct a Mental Status Exam (MSE) and a risk assessment (RA). If a counselor can gather enough information to assess such a risk, then he or she may be able to help save a life. A MSE is a useful checklist to guide a counselor in verifying a client’s diagnosis. By noting items such as appearance (is grooming acceptable?), manners and behaviors (is eye contact suitable for cultural and ethnic background?), thought processes (is he or she aware of the day of the week, the month?), and mood (are they abnormally anxious or sad?), a counselor can begin to get a better picture of the client, his or her presenting issues, and the history and managing skills he or she brings to the table.
An assessment such as the RA proposed by O’Conner, Warby, Raphael, and Vassallo (2004) helps to “improve detection and increase referral” of suicide while also helping to find an “appropriate plan of management” (p. 352-353). By knowing certain triggers a client may possess, along with understanding specific demographics, such as if the client belongs to a special risk group, has a past or present situation of concern or alcohol or drug abuse, homelessness issues, legal problems, and/or a prison record, a counselor may be able to detect other pressure points of instability guided by the RA. This also includes checking for at risk mental states, such as agitation, anger, guilt, and depression (O’Conner, et al., 2004). If there is any question as to the possibility of suicide, it must be addressed immediately.
O’Connor, et al., (2004) indicated that over 40% of people who commit suicide had seen a health professional prior to their death. Still others will never be a “client” or even see a doctor. Clients may not even realize they are at the point of acting on their suicidal thoughts until it actually occurs. Treating suicide ideation and the possibility of suicide under the guise of another disorder, intervening in a crisis situation, and working with groups at high risk are the only true preventions those in the field have at their disposal at this time and even then, it is not a guarantee. When labeled with another disorder, clients can be treated for depression associated with suicide through cognitive and psychotherapy interventions and medication (Butcher, et al., 2010). Crisis intervention may also occur through a suicide hotline in which the person at risk has someone to talk to during times of distress. Crisis intervention may be even in the hands of a loved one. Emergency treatment and referrals for inpatient care and involuntary hospitalization can possibly occur if someone else is involved and concerned about the person at risk.
Suicide is a serious epidemic. Being aware is the first step to prevention. Common warning signs of suicide that should not be ignored are threats of hurting oneself, preoccupation with death, changes in eating or sleeping habits, loss of interest in activities that were once important, marked changes in personality, persistent feelings of gloom and helplessness, and the action of giving away valued possessions (Cavanaugh & Kail, 2007).
If you are having these symptoms yourself or are worried about a loved one who may be exhibiting these behaviors, please call the Suicide Prevention Hotline at 1-800-273-8255, call 911, or for non-emergency situations, please call a medical profession or counselor for help.
American Psychiatric Association (APA). (2000). Diagnostic statistical manual of mental disorders – text revision. Washington, DC: Author.
Butcher, J. N., Mineka, S., & Hooley, J. M. (2010). Abnormal psychology (14th ed.). Boston, MA: Allyn & Bacon
Centers for Disease Control and Prevention. (2015). Retrieved from http://www.cdc.gov/Features/PreventingSuicide/
Cavanaugh, J.C. and Kail, R.V. (2007). Human Development: A Life-Span View (4th Ed.). Belmont, CA: Thomson Higher Education.
María A. Oquendo, M.A., Baca-García, E. Mann, J.J. & Giner, J. (2008). Issues for DSM-V: Suicidal Behavior as a Separate Diagnosis on a Separate Axis. Am J Psychiatry 165:1383-1384. doi: 10.1176/appi.ajp.2008.08020281
O’Connor, N., Warby, M., Raphael, B., & Vassallo, T. (2004). Changeability, confidence, common sense and corroboration: Comprehensive suicide risk assessment. Australasian Psychiatry, 12(4), 352–360.