The warning signs of suicide can be completed missed by most family members but with the right know- they can be recognized before its too late.  Warning signs of suicide tend to be subtle changes in someone’s typical behavior and not obvious, drastic life changes.  As a psychiatris,t helping families deal with the suicide of a loved one is the most difficult part of my job and family members always ask if they should have recognized the warning signs of suicide and prevented their loved one from killing themselves.  Of course there is never blame to be placed on any family but there definetly are some things to keep in mind if you have a loved one struggling wtih depression or are concerned they may be suicidal.

There are two main types of suicide risk factors used to category overall risk: fixed (unchangeable) and modifiable.  Fixed risk factors include: being male, being over 65, prior suicide attempt, family history of suicide, chronic medical condition.  Examples of modifiable risks include: intoxication with alcohol or drugs, symptoms of anxiety or panic, insomnia, feelings of depression or mania (bipolar disorder), owning or having access to a firearm, having a medical condition that may be better treated and isolating behavior.

Other common concerning behaviors include: expressing hopelessness, giving away prize possessions, making drastic changes in life such as quitting a job abruptly and any behavior that is out of the norm for a loved one.

To clarify, here is an example of a patient with a combinations of fixed and variable risk factors. Recognizing the warning signs of suicide in this person saved his life:  An older man aged 72 was struggling with relatively new onset worsening of depression following having a triple bypass heart surgery. He was left being unable to do activities he usually enjoyed, felt “useless” and was contemplating suicide but never discussed this with any family or friends.    He began to have insomnia on a nightly basis and began to express to his wife the feelings of “seeing no light at the end of the tunnel.”  He had started numerous new medications for his heart health and felt surges of anxiety throughout the day which was a new symptom.  He stopped communicating with his wife as well as he used to and began to isolate himself.

Luckily the patient was very open with me but his family was quite surprised when he finally did tell them he had been contemplating suicide.  Here are the important risk factors he displayed-

-fact he was older and male

-new insomnia, and anxiety

-new chronic debilitating medical condition

-isolation and expressing hopelessness

Fortunately I was able to work with this patient and their family to help him with some of the modifiable risk factors.  We controlled his anxiety with cognitive behavioral therapy and medication. Treated his insomnia with relaxation techniques.  Started regular psychotherapy and focused on learning how to enjoy life with his limitations again and he began to have hope about the future.  I made sure he had no firearms at home.  I continued to treat his depression with medications and the psychotherapy.  I worked with his cardiologist to change some of the heart medicines that were worsening his anxiety and overall he was much more comfortable, less anxious, was sleeping, was hopeful about the future and luckily was not using alcohol or drugs.

In this case, recognizing the warning signs of suicide is straightforward if you know what to look for, yet in reality, unless a family knows to watch for them, they often go unnoticed.   Family members can also help by opening a good ongoing line of communication regarding how their family feels.  In general being really supportive and upbeat to instill a sense of hope can go a long way. Sometimes when someone cannot see any end to their suffering, it pushes them over the edge to complete suicide, so any hope that family can instill can prevent someone from crossing the ledge with no return.


Michael Yasinski M.D