Suicide Prevention Guide

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Approximately 1 million people die each year from suicide, but many more attempt to end their own lives.

Help is available, and the first step for any person suffering a suicidal episode is to share their feelings with someone who will listen. In this guide, we explore the main risk factors for suicide, highlight the warning signs and explain how to best help someone who is considering suicide.

By Allianz Worldwide Care | September 26, 2017

Allianz Partners - suicide prevention

Risk factors for suicide

A combination of individual, relationship and societal factors contribute to the risk of suicide.

While many people who attempt suicide may be suffering from a mental health condition. For others, suicide is an impulsive reaction to a crisis; an inability to deal with life stresses, such as financial problems, a relationship break-up or chronic pain and illness.

In addition, experiencing conflict, disaster, violence, abuse, bereavement and a sense of isolation are strongly associated with suicidal behaviour.

Suicide rates are also high amongst vulnerable groups who experience discrimination, such as refugees and migrants, indigenous people, lesbian, gay, bisexual, transgender people and prisoners.

Health Factors

Mental health conditions
Depression
Bipolar disorder
Schizophrenia
Conduct disorder
Psychotic disorders
Anxiety disorders
Substance abuse
Terminal illness
Chronic pain

Environmental Factors

Stressful life events
Prolonged stress factors
Access to firearms and drugs
Exposure to another person’s suicide
Social isolation
Loneliness

Historical Factors

Previous suicide attempts
Family history of suicide attempts
History of trauma or abuse

Suicide and Depression

There is a strong link between suicide and mental health disorders such as depression, bipolar disorder, schizophrenia and drug and alcohol abuse.

The difficulty suicidal people have imagining a solution to their suffering is due in part to the distorted thinking caused by depression.

Depression is one of the most important risk factors in male suicide.  Unfortunately, male depression is under-diagnosed because men are less likely to seek help.

Although death by suicide is higher for men, attempted suicide rates are higher for women.

Women are more prone than men to experience anxiety and depression, at any age. Although the reasons why women experience higher levels of depression are unknown, many experts believe the pressures of balancing work and family responsibilities, including children as well as aging parents, may lead to added mental health burdens.

Preventative steps

You can’t just ‘get over’ depression, but it is a disease which can be conquered by reaching out for some help.

  • Talk to your doctor
  • Talk to family and friends
  • Exercise, eat well and get plenty of sleep
  • Don’t ignore stress – it may be hard to avoid, but it can be dealt with
  • Know your limits – it is ok to ask for help
  • Don’t self-medicate

Suicide warning signs

Most suicidal people give warning signs or signals of their intention to take their own life, either through what they say or what they do.

Being aware of these signs and knowing how to respond if someone displays them, is critical for helping someone who is contemplating ending their own life.

Something to look out for when concerned that a person may be suicidal is a change in behaviour or the presence of entirely new behaviours. These signals are even more worrying if the person has a mental health disorder, has previously attempted suicide or has gone through a traumatic experience.

Always take any suicidal talk or behaviour seriously. It's not just a warning sign that the person is thinking about suicide, it's a cry for help.

Some common warning signs include:

Talking about suicide – Openly talking about suicide, dying or self-harm and making statements like "I wish I hadn't been born," or "I'd be better off dead."

Seeking out lethal means –Such as buying a knife or seeking access to tablets or other objects that could be used in a suicide attempt

Personality changes – Having mood swings, such as being emotionally high one day and very low the next. Developing personality changes or being severely anxious or agitated, particularly when experiencing some of the warning signs listed above

Focusing on death – Being preoccupied with death, dying or violence. Writing poems, stories or drawing pictures about death

Hopelessness – Feelings of hopelessness and being trapped, and believing that things will never get any better

Self-loathing – Feelings of worthlessness, guilt, shame, self-hatred and being a burden

Sorting affairs – Making out a will, giving away possessions or discussing arrangements for family members, when there is no other logical explanation for doing this

Saying goodbye – Unusual or unexpected visits or calls to family and friends. Saying goodbye to people as if they won't be seen again

Withdrawing – Withdrawing from social contact and wanting to be left alone. Withdrawing from friends and family and increasing social isolation

Self-destructive behaviour – Taking unnecessary risks, driving recklessly or increasing alcohol or drug use

Sudden sense of calm – A sudden sense of calm and happiness after being extremely depressed can indicate that a person has decided to attempt suicide

How to help someone who is suicidal

A suicidal person may not ask for help, but that doesn't mean that help isn't wanted. People who end their own lives don't want to die—they just want to stop hurting.

Suicide prevention starts with recognising the warning signs and taking them seriously.

If you think a friend or family member is considering suicide, help them to get help. There are many national suicide prevention organisations you can call, who will provide a safe, non-judgemental place to talk.

In an emergency, call the emergency services and stay with the person contemplating suicide until help arrives.

Speak up

You might be afraid to bring up the subject, but talking openly about suicidal thoughts and feelings can save a life.

Don’t avoid the subject because you are concerned that you might plant the idea of suicide in that person’s head. You will not. Bringing up the subject shows that you support them and that you are concerned about them.

It’s normal to feel uncomfortable with talking to someone who you feel might be suicidal, about suicide. However, if you have spotted the warning signs, that person needs immediate help. That help begins with you talking to them.

Don’t put off a discussion until tomorrow because you want to see if things will improve, act now.

How to start the conversation:

While it is important to pick an appropriate time and place to have a conversation about suicide, it should be primarily focused on showing the person who may be suicidal that you care and that you want to listen.

Prepare yourself for the conversation you are about to have. Hearing the words ‘I want to kill myself’, from a family member or someone you care about is deeply shocking and upsetting. Try to remain calm and strong, this is your opportunity to help.

Remember the person is experiencing incredible psychological pain and their desire is not to die but to end their pain.

Try to centre the conversation around understanding what is causing the pain, and offering help and support towards addressing the issues.

Try starting the conversation with one of the following:

"I have been feeling concerned about you lately."

"Recently, I have noticed some differences in you and wondered how you are doing."

"I wanted to check in with you because you haven’t seemed yourself lately."

Questions you can ask:

Try to get the person to talk with you openly and honestly. Give them every opportunity to unburden their troubles and vent their feelings.

You don't need to say much, demonstrate your concern through listening, patience and understanding. Some questions you might want to ask:

"When did you begin feeling like this?"

"Did something happen that made you start feeling this way?"

"How can I best support you right now?"

"Have you thought about getting help?"

What you can say that helps:

Remember if a suicidal person talks to you and is unburdening themselves, let them know that you are going to listen and support them. A person going through a suicidal episode feels isolated, reassure them that they are not alone.

Use phrases such as:

"You are not alone in this. I’m here for you."

"I may not be able to understand exactly how you feel, but I care about you and want to help."

Do’s and Don’ts when talking to a suicidal person

Do:

Be yourself. Let the person know you care. There are no right words, your voice and manner will demonstrate your concern.

Listen. Let the suicidal person talk freely, unburden their pain and vent their anger. No matter how negative the conversation seems, the fact that it exists is a positive sign. Demonstrate patience and ensure you are not judgemental.

Offer hope. Reassure the person that you care, that help is available and that the suicidal feelings are temporary.

Don’t:

Be confrontational.  Never argue with a suicidal person. Avoid saying things like "How can you do this to your family," or “Lots of people have it worse than you.”

Lecture. Act shocked, lecture on the value of life, or say that suicide is wrong.

Promise confidentiality. Refuse to be sworn to secrecy. A life is at stake and you may need to speak to a mental health professional to keep the suicidal person safe. If you promise to keep your discussions secret, you may have to break your word.

Offer to fix their problems. You can’t fix this for them.

Blame yourself. You aren’t responsible for someone’s depression or unhappiness.

Respond quickly

If a friend or family member tells you that he or she is thinking about death or suicide, it's important to evaluate the immediate danger the person is in.

The following questions can help you assess the immediate risk for suicide:

  • Do you have a suicide plan? (PLAN)
  • Do you have what you need to carry out your plan (drugs, gun, etc.)? (MEANS)
  • Do you know when you would do it? (TIME FRAME)
  • Do you intend to take your own life? (INTENTION)

Those at the highest risk for suicide have a PLAN, the MEANS to carry out the plan, a TIME FRAME for doing it, and an INTENTION to do it.

If a suicide attempt seems imminent;

Call a local suicide crisis centre

Call the emergency services

or take the person to the nearest hospital

Remove guns, drugs, knives, and other potentially lethal objects from the vicinity but DO NOT, UNDER ANY CIRCUMSTANCES LEAVE A SUICIDAL PERSON ALONE.

Listen and Support

If someone close to you is suicidal, being prepared to listen and offer support is one of the best ways you can help them. Let them know that they are not alone and that you care.

But remember, you aren’t responsible for how they feel and you can’t make them better. Only they can, with help, make a personal commitment to recovery.

Follow up

Seek professional help. Do everything you can to get a suicidal person the help they need. Call a crisis line for advice and referrals. Encourage the person to see a mental health professional, help locate a treatment facility, or take them to a doctor's appointment.

Follow-up on treatment. If the doctor prescribes medication, make sure your friend or loved one takes it as directed. Be aware of possible side effects and be sure to notify the doctor if the person seems to be getting worse.

Be proactive. Those contemplating suicide often don't believe they can be helped, so you may have to be more proactive at offering assistance. Don’t wait for the person to call you or even to return your calls. Drop by, call again, invite the person out.

Encourage positive lifestyle changes. Such as a healthy diet, plenty of sleep, and getting out in the fresh air every day. Exercise is extremely important as it can relieve stress and promote emotional well-being.

Make a safety plan. Help the person develop a set of steps he or she promises to follow during a suicidal crisis. It should identify any triggers that may lead to a suicidal crisis, such as an anniversary of a loss, alcohol, or stress from relationships. Also include contact numbers for the person's doctor or therapist, as well as friends and family members who will help in an emergency.

Remove potential means of suicide. Such as pills, knives, razors, or firearms. If the person is likely to take an overdose, keep medications locked away or give out only as the person needs them.

Continue your support over the long haul. Even after the immediate suicidal crisis has passed, stay in touch with the person, periodically checking in or dropping by. Your support is vital to ensure your friend or loved one remains on the recovery track.

It takes a lot of courage to help someone who is suicidal. Witnessing a loved one dealing with thoughts about ending their own life can stir up many difficult emotions. As you're helping a suicidal person, don't forget to take care of yourself. Find someone that you trust to talk to about your feelings and get support of your own.

Suicide in teens and the elderly

In addition to the general risk factors for suicide, both teenagers and older adults can be at a higher risk of suicide.

Suicide in teens

Teenage suicide is a serious and growing problem. The teenage years can be emotionally turbulent and stressful. Teenagers face pressures to succeed and fit in. They may struggle with self-esteem issues, self-doubt, and feelings of alienation. For some, this leads to suicide. Depression is also a major risk factor for teen suicide.

Risk factors for teenage suicide include:

Previous suicide attempt
Mental health disorders
History of abuse or mistreatment
Family history of suicide
Substance abuse and/or alcohol disorders
Financial or social loss
Relationship loss
Isolation or lack of social support
Easy access to methods/means of suicide
Exposure to others who have committed suicide

Warning signs in teenagers:

Talking about suicide
Making statements about feeling hopeless, helpless, or worthless
A deepening depression
Preoccupation with death
Taking unnecessary risks or exhibiting self-destructive behaviour
Being impulsive or aggressive
A loss of interest in the things they normally care about

Suicide in the elderly

The highest suicide rates of any age group occur among persons aged 65 years and older. One contributing factor is depression in the elderly that is undiagnosed and untreated.

Other risk factors for suicide in the elderly include:

Recent death of a loved one, isolation and loneliness
Physical illness, disability, or pain
Major life changes, such as retirement or loss of independence
Loss of sense of purpose

Warning signs in older adults:

Reading material about death and suicide
Increased alcohol or prescription drug use
Failure to take care of themselves or follow medical orders
Stockpiling medications or sudden interest in firearms
Social withdrawal, elaborate good-byes, rush to complete or revise a will

If you are feeling suicidal

You're not alone, many people have had suicidal thoughts at some point in their life.

Feeling suicidal is not a sign of failure, it means that you have more pain than you can cope with right now. This pain seems overwhelming and permanent, but with time and support, you can overcome your problems and the pain and suicidal feelings will pass.

Pick up the phone and call a local crisis helpline, doctor, friend or loved one. They can help you to see solutions that you haven’t thought about. Give them a chance to help.

Talking about how you feel, and sharing your emotions can release a lot of the pressure that’s building up and help you identify a way to cope.

Remember a suicidal crisis is almost always temporary. Give yourself time for things to change and the pain you’re feeling now to subside. Solutions will be found.