Suicide and our Veterans
According to the Center for Disease Control
(CDC), suicide is the 10th leading cause of death in the United
States. Individuals aged 65 and over are 16% of all suicides. Of those who attempt suicide, and live, 10-20%,
will make another attempt within a year, and 1-2% will complete suicide. In a
recent community study, it was identified that male Veterans were at twice the
risk of suicide, than male non-Veterans.
The mental health needs of our Veterans from Operation Enduring Freedom
and Operation Iraq Freedom (OEF/OIF) is a major concern as 17% of Army and Marine
Corps have self-reported experiencing early psychiatric symptoms.
Over 60% if individuals
who die by suicide suffer from depression.
Between 80% and 90% of people who have depression respond positively to
treatments and even a higher number report relief of symptoms. Suicide has been associated with bipolar
disorder, schizophrenia and drug and alcohol abuse. Suicidal thoughts are increased among groups
such as those with psychiatric disorders such as major depressive disorder,
bipolar, schizophrenia, PTSD, anxiety and chemical dependency.
A number of
psycho social factors also increase the risk of suicide and attempts. These may
include recent life events such as losses (loss of employment, careers,
financial problems, marital problems, legal problems. States of distress (humiliation, despair, guilt,
and shame) are often associated with suicide planning and attempts. Certain physical
disorders such as disease of the central
nervous stem (epilepsy, tumors, Alzheimer’s,
multiple sclerosis, cancers, HIV, to name a few also can contribute to
increased suicide risk in some individuals).
A recent national
survey found that 13.5% of Americans report a history of suicide ideation at
some point of their life, 3.9% reported having a plan, and 4.6% reported having
attempted suicide. The percentages were
higher for high school students; 16% reported having seriously considered
suicide, 13% report having made a suicide plan, and 8.4 reported having made an
attempt during the last 12 months.
Suicide ideation
can lead to attempt. Approximately 34% of individuals who think about suicide
report transitioning from seriously thinking about suicide to making a plan and
72% of planners move from plan to attempt. Ideation
usually precedes onset and planning.
Many will deny the feelings of suicide ideation for reasons such as: the
stigma with mental health issues, fear of being ridiculed and judged, and fear
of loss of control due to hospitalization.
Even if the person denies the feelings, there are clues in the behavior.
Signs and symptoms may include: social withdrawal, irrational thinking,
insomnia, agitation, anxiety, irritability, shame, humiliation, anger or rage. Asking about ideation and intent does not
increase the risk of suicide. Most
patients have reported relief when a caring person expresses interest; exploring
the pain and distress that leads them to consider suicide or self-injurious
behaviors. Most people become suicidal
in response to negative life events or stressors that overwhelm their ability
to cope and maintain control.
The presence of
a plan indicates that the individual has some intent to die and has begun
preparing to die. It is important to know if the person has begun to enact the
plan by having such behaviors as hoarding of medications, getting access to
firearms, rehearsal of the plan or writing a suicide note. Although most people only make one attempt,
about 16% will repeat in one year, 21% will attempt within the next 1-4. The history of a prior suicide attempt is the
best known predictor for suicidal behaviors. Here are some ways to be helpful to someone
who is threatening suicide or engaging in suicidal behaviors.
~learn the risk factors and warning signs for suicide and where
to get help
~be direct, talk openly about suicide and what you have observed
and your concerns
~be willing to listen and be non-judgmental
~don’t ask “why”, instead ask ‘”what is so bad that you are
thinking about suicide.”
~don’t be sworn to secrecy
~offer hope that alternatives are available
~take action to remove items such as pills, ropes, guns,
alcohol
~get help from others with more experience
Individuals
with posttraumatic stress disorder (PTSD) have been shown to be at greater risk
for suicide than the general population.
Also, in comparison to the general population, traumatic brain injury
(TBI) survivors are at increased risk for suicide ideation, attempts and
suicide. TBI problems may include motor
disturbances, sensory deficits and psychiatric symptoms such as (depression,
anxiety, psychosis and personality changes) as well as cognitive dysfunction. Cognitive impairments may include impaired
attention span, concentration problems, and memory and language problems,
issues with problem solving, judgment problems, and increased problems with impulsivity. These impairments may lead to life-long
increased suicide risk with which will require constant attention. The strongest predictors of suicide attempts
among the TBI survivors are strong feelings of aggression and hostility.
A recent report showed
that Veterans older than 65 and those aged 18-44 are more likely to complete
suicide than middle aged Veterans. The
greatest risk for suicide in the United States is older men over 65 years of age.
73% of all suicides happen in the home.
In order for the
Veteran to avert a crisis, it is important that the Veteran is able to
recognize their warning signs. The clinician can assist the Veteran in
identifying the warning signs by asking them what they encounter when they
start to think about suicide or experience extreme distress. Questions that
would be helpful include:
1.
What are you experiencing emotionally (anxiety,
irritability)
2.
What are you experiencing physically (tension,
fatigue)
3.
What are you thinking about (no one loves me, or
cares about me)
4.
How does the Veterans behavior change (isolation,
drinking)
After the Veteran is able to recognize his personal warming
signs, the clinician and should work with the patient to identify strategies
that the Veteran can employ to end the suicidal behavior. It is important to
identify what strategies the Veteran is most likely to uses and which would be
realistic to engage first. Examples of
coping strategies may include:
1.
Going for a walk
2.
Prayer
3.
Music
4.
Cleaning
5.
Caring for a pet
When coping strategies
do not work, support from others may be needed. People should be identified
that the Veteran could realistically contact during a crisis. When all of these steps do not divert the
suicidal crisis, the Veteran must know how to contact professional or agencies
to help them through the crisis.
Examples the Veteran may contact may include:
1.
Primary mental health clinician
2.
24-hour urgent care facility
3.
Veterans suicide prevention hotline
1-800-273-TALK (8255)
Information obtained from Veterans Affairs educational materials
