Suicide prevention and recognizing the warning signs

Suicide is the 10th leading cause of death in the United States and the second leading cause of death for American adolescents.

The recent deaths of fashion designer Kate Spade and food documentarian Anthony Bourdain shed light on the fact that suicide does not discriminate across gender, or economic or social divides.

These high-profile suicides lit a fire for suicide awareness campaigns; but as time passes, the emphasis on this matter slowly dies down again, like a flame reduced to embers.

The Center for Disease Control considers suicide a public health problem and it's reported that suicides can cost the U.S. up to $45 million per year in combined medical bills and lost wages.

One of the keys to suicide prevention is recognizing warning signs and letting people know that there are resources and alternative coping mechanisms.

"Suicide is a sensitive topic and it can be hard for people to discuss — especially for those who have considered it or those who have suffered the loss of someone from a suicide," said Mark Gronski, a licensed clinical social worker at Cape Fear Valley Health who works with patients who might have attempted suicide. "However, prevention goes hand-in-hand with awareness. The more aware people are of the warning signs of suicide, the better. Facilitating an open dialogue about suicide can also lessen the stigmatization of it."

Humans are complex beings with a range of emotions and life experiences, thus there is no singular underlying cause for suicide. However, the following factors can contribute to (but do not necessarily imply) an increased risk for an attempted or completed suicide:

"There is no typical suicide victim," said John Bigger, corporate director of Behavioral Health services at Cape Fear Valley Health. "That's why we think all health care providers should screen for the thoughts about it. The people that are typically at risk for suicide are ones that have attempted suicide in the past."

Bigger also highlighted a fallacy of suicide — that only depressed people are at risk.

"Most people will say, 'If somebody's suicidal, then they're depressed.' Well, that's not always true," Bigger explained. "Some people can [commit suicide] as an impulsive reaction to something, or just to get rid of the immense amount of pain that they're in, not because they've been chronically depressed."

Some groups of people, such as active or retired military personnel, for example, are at a higher risk for suicide.

Warning signs that someone is considering suicide may or may not present themselves, as some people are able to mask their emotions or keep things to themselves. However, the following signs may indicate that a person is in danger of taking their life:

Screening for suicide is one of the best ways to prevent it.

The Columbia-Suicide Severity Rating Scale is an assessment tool that hospitals and other facilities can use to evaluate a person’s suicidal thoughts or behavior. According to several research studies, the Columbia University-developed tool has proven to be reliable and favorable over other assessment tools.

Cape Fear Valley Health employs the "Screener Version - Recent" variation of the tool. It asks questions such as, "In the past month, have you wished you were dead or wished you could go to sleep and not wake up?" and "In the past month, have you actually had any thoughts of killing yourself." Depending on the answers to these first two questions, respondents are asked to move on to other questions.

"It's a real simple thing and it's not," Bigger said. "The studies will show most people don’t mind being asked those questions. It's a good way to bring [suicide] to the forefront and talk about it. One of the cool things about the C-SSRS is that it can be administered by a layperson. It doesn't have to be a mental health professional asking those questions."

Cape Fear Valley Health clinicians have trained school counselors, EMS responders and other emergency personnel on the tool. He said differentiating between thoughts and possible action is of paramount importance.

"Thinking about suicide is not nearly as dangerous as actual behaviors," he said. "Asking [about suicide] doesn't make people want to do it. Asking the questions makes them less likely to do it."

Depending on the assessment responses, an appropriate course of action can be taken, whether it is a psychiatric referral or immediate emergency aid.

Bigger said anybody can get trained on how to use the assessment and help start a conversation that can lead to professional assistance. He said the most important thing is having compassion and making the person feel heard.

He noted local community mental health centers, the national suicide hotline, a clergy member, or a trustworthy friend or family member as great resources to seek help from.

"If anybody who is reading this article is having challenges, reach out and talk to somebody. Somebody will listen," Bigger pleaded.