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treatment is fraught with possible crises, such as the patient having
panic attacks, intense guilt and shame, serious insomnia, having to
disclose suicidal depression to family, or going through withdrawal
from addictions, any one of which might push the patient into suicide.
This situation can be demanding, frustrating, and very uncomfortable
for the professional, too. The therapist may have a deep personal
involvement with the patient. Moreover, his or her professional
reputation and career as well as financial well-being are at risk.
Suicides account for the largest number of malpractice lawsuits filed
against psychiatrists (Robert Simon, Psychiatric Times, September,
2002).
Possible warning signs
Wide assortments of lists of warning signs have been published. I’ll
give you three or four samples. The same warning signs appear on
many of the lists, but they all have unique ways of predicting.
Professionals disagree about how many suicide victims have suffered
from depression, ranging from about 50% to over 80%. But it is
accurate to say signs of depression are serious warnings. Also, one in
four suicide attempters have a family history of suicide. Alcohol and
drug use are warning signs because they are related to impulsiveness
and poor judgment. Sudden mood changes are another sign. Also,
previous attempts (25%-40% have tried before), verbal hints ("You
won't have to worry about me much longer"), suicidal talk and
especially specific plans, preparing behaviors (giving away prized
possessions, getting affairs in order), moodiness and social
withdrawal, mental problems, preoccupation with death, carrying
weapons, taking risks, and doing poorly in school or at work are
common. In many cases there has been a loss--health, economic, self-
esteem, love, pride--or involvement in an addiction, crime,
homosexuality, or divorce. 75% of teenagers attempting suicide report
family problems; many have a psychological illness as well. For some
reason, panic attacks and migraine headaches are associated with a
greater risk of suicide. Almost any loss, conflict, or crisis increases the
risk of suicide (Neiger & Hopkins, 1988; Lester, 1992). Don't be misled
by the common misconceptions or myths about suicide mentioned
above.
We’ve discussed that scientifically predicting suicide is hard. There
are so many variables to consider. But Lewinsohn, Rohde, & Seeley
(1994) found that 73% of a sample of teenagers who had attempted
suicide had 3 or more of these 6 warning signs: (1) previous suicide
attempt, (2) suicide attempt by a friend, (3) suicidal thoughts, (4)
depression, (5) low self-esteem, and (6) being born to a teenage
mother. So, objective measurement of warning signs is promising.
Remember, however, that warning signs that identify 73% of this
sample of attempters may not be very accurate in predicting
attempters within much larger groups where false positives may be
frequent. More about empirically assessing individual suicide risk-
takers will soon be made available in Life Attitudes Schedule by the
above authors. It is to be published by MHS (http://www.mhs.com/).
