Be aware of the cofactors of high risk suicide.
Length: 1,000 words
Reading Time: 4 minutes
In this post/video, I’ll talk a little bit about suicide and how to identify the potentiality of it happening.
What to look for in your loved ones if you are worried about suicide. (Length: 7:30)
First, I’ll cover this in a general sense, and then I’ll go into some specifics about how it relates to men and men’s issues.
The General Confusion Surrounding the Probability of Suicide
Suicide, and acknowledging that you want to kill yourself, is not a particularly pleasant topic to talk about.
It is also something that has not been very well studied and documented. So the literature and our knowledge about it is slowly grinding on to a better understanding.
It is something that we in the mental health profession are still a long way from being able to diagnose with any degree of certainty. We have not been able to condense the ingredients of a suicide, to the point where we could give the patient/client a questionnaire, and know beyond the shadow of a doubt that this person is about to kill themselves. We are very far away from that point.
Whenever a low base rate phenomenon occurs, like suicides, mass shootings, etc., somebody always puts a microphone in front of me and says, Dr. Klajic, why couldn’t we have predicted this?
Mostly, it’s because it is a low base rate event. This means that we don’t have enough data about it to study and to be able to generalize it out to the larger population. We just don’t have enough statistical power. Anything that doesn’t happen very often is difficult to study.
Even after we add in all the cofactors for suicide (as discussed below, gender, intoxication, and so on), then we start to see that the probability that someone who is imminently suicidal is going to walk into my office, and I’m going to detect it, is very very low.
Even though we mental health providers like to think that we can predict these kinds of things, in fact, we’re not very good at that. It’s just not that likely.
So that’s the bad news.
What do we know about Suicide?
Here’s a couple things that we do know about suicide.
There are a number of factors that go into either a suicide, an imminent suicide, a suicidal mindset, or what some people call suicidology. We don’t have a great name for it.
We call these factors, static and dynamic factors.
Static factors are things that you can’t change and are not going to change. For example…
- Present age
- Previous attempts at suicide
- Personal characteristics
Dynamic factors are those situations that the person is going through in their life right now. For example…
- Getting fired
All these things are dynamic in the sense that it changes from day to day.
Aside from all that, what we also know from the literature are some cofactors that go along with a situation in which people try to kill themselves.
I won’t quote any specific citations that would be useful for this, but basically, what we know is that…
- A humongous percentage of suicides have happened within 90 days of an emotional disruption or a significant life event. For example, a devastating break up or a divorce has happened very recently.
- Of that group, most are men.
- Of that group, a vast majority of those people have not seen any health professional within the past 12 months leading up to their suicide – not a podiatrist, not a dentist, not anything.
- Of that very large group of folks, most of those will make the decision to kill themselves within 24 hours after they get the thought.
- A pretty significant percentage of them will do it within 8 hours.
- A pretty significant percentage of them will actually do it impulsively.
So that’s the average profile.
What can we do about this?
Whenever a competent health professional is evaluating a patient, he is supposed to be assessing a person for suicide risk. They should always have these risk factors going through their minds in the background, like an algorithm or a script, whenever they are evaluating someone, even if they are just in a therapy session.
It’s not that everyone is suicidal, but everyone has some pretty rough spots in life. Everybody goes through break ups, job losses, and these other kinds of experiences. Everybody has these kinds of thoughts in their lives.
Those kinds of disruptions are particularly difficult for men in the ambient culture that we live in.
Since men tend to kill themselves at a higher rate, using more lethal means, I think it’s important that we start looking at why that is, instead of just looking at it as a static risk factor.
The good news is that most of these factors can be detected much more readily by the people around us.
We should be empowering people to be looking at the people closest to them, and being able to recognize that. We should be able to say, “Hey! This person just lost their job and broke up with their wife/girlfriend, and they haven’t been to a doctor for a while! They are at a higher risk for suicide!”
The hard part of identifying a person with a high risk of suicide is that suicide is supposed to be a secret until you do it, or else, someone will try to stop you.
That’s the catch 22. If I’m really wanting to kill myself, then why would I tell you about it? Because then you’ll only try to stop me.
The deck is stacked against detecting those who are truly suicidal, but that doesn’t mean that we can’t be more aware of the risks and factors, and make some effort to recognize those risks in people who are close to us.
I also do coaching across state lines.
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