Suicidal ideation (patient information)

# Overview
Suicidal thoughts, also known as suicidal ideation, are thoughts about how to kill oneself, which can range from a detailed plan to a fleeting consideration and does not include the final act of killing oneself

# What are the symptoms of Suicide?
Often, but not always, a person may show certain symptoms or behaviors before a suicide attempt, including:
- Having trouble concentrating or thinking clearly
- Giving away belongings
- Talking about going away or the need to get my affairs in order
- Suddenly changing behavior, especially calmness after a period of anxiety
- Losing interest in activities that they used to enjoy
- Performing self-destructive behaviors, such as heavily drinking alcohol, using illegal drugs, or cutting their body
- Pulling away from friends or not wanting to go out
- Suddenly having trouble in school or work
- Talking about death or suicide, or even saying that they want to hurt themselves
- Talking about feeling hopeless or guilty
- Changing sleep or eating habits

# What causes Suicide?
- Suicide and suicidal behaviors usually occur in people with:
- Bipolar disorder
- Borderline personality disorder
- Depression
- Drug or alcohol dependence
- Schizophrenia
- People who try to commit suicide are often trying to get away from a life situation that seems impossible to deal with. Many who make a suicide attempt are seeking relief from:
- Feeling ashamed, guilty, or like a burden to others
- Feeling like a victim
- Feelings of rejection, loss, or loneliness
- Suicidal behaviors may be caused by a situation or event that the person views as overwhelming, such as:
- Aging (the elderly have the highest rate of suicide)
- Death of a loved one
- Dependence on drugs or alcohol
- Emotional trauma
- Serious physical illness
- Unemployment or money problems
- Most suicide attempts do not result in death. Many of these attempts are done in a way that makes rescue possible. These attempts are often a cry for help.
- Some people attempt suicide in a way that is somewhat non-violent, such as poisoning or overdose. Males, especially elderly men, are more likely to choose violent methods, such as shooting themselves. As a result, suicide attempts by males are more likely to be completed.
- Relatives of people who attempt or commit suicide often blame themselves or become very angry. They may see the suicide attempt as selfish. However, people who try to commit suicide often mistakenly believe that they are doing their friends and relatives a favor by taking themselves out of the world.

# Who is at highest risk?
Risk factors for suicide in teenagers include:
- Access to guns
- Family member who committed suicide
- History of hurting themselves on purpose
- History of being neglected or abused
- Living in communities where there have been recent outbreaks of suicide in young people
- Romantic breakup

# When to seek urgent medical care?
Call a health care provider right away if you or someone you know is having thoughts of suicide.

# Treatment options
- A person may need emergency treatment after a suicide attempt. They may need first aid, CPR, or mouth-to-mouth resuscitation.
- People who try to commit suicide may need to stay in a hospital for treatment and to reduce the risk of future attempts. Therapy is one of the most important parts of treatment.
- The condition that may have caused the suicide attempt should be treated. This includes:
- Bipolar disorder
- Borderline personality disorder
- Drug or alcohol dependence
- Major depression
- People who are at risk for suicidal behavior may not get treated for many reasons, including:
- They believe nothing will help
- They do not want to tell anyone they have problems
- They think it is a sign of weakness to ask for help
- They do not know where to go for help
- If you or someone you know is thinking about suicide, there are numbers that you can call from anywhere in the United States, 24 hours a day, 7 days a week: 1-800-SUICIDE or 1-800-999-9999.
- As with any other type of emergency, call the local emergency number (such as 911) right away if someone you know has attempted suicide. Do not leave the person alone, even after you have called for help.

# What to expect (Outlook/Prognosis)?
- Always take suicide attempts and threats seriously.
- About one-third of people who try to commit suicide will try again within 1 year.
- About 10% of people who threaten or try to commit suicide will eventually kill themselves.
- The person needs mental health care right away. Do not dismiss the person as just trying to get attention.

# What to expect (Outlook/Prognosis)?
- Always take suicide attempts and threats seriously.
- About one-third of people who try to commit suicide will try again within 1 year.
- About 10% of people who threaten or try to commit suicide will eventually kill themselves.
- The person needs mental health care right away. Do not dismiss the person as just trying to get attention.

# Possible complications
Complications depend on the type of suicide attempt.

# Prevention
- Avoiding alcohol and drugs (other than prescribed medicines) can reduce the risk of suicide.
- In homes with children or teenagers:
- Keep all prescription medicines high up and locked.
- Do not keep alcohol in the home, or keep it locked up.
- Do not keep guns in the home. If you do keep guns in the home, lock them and keep the bullets separate.
- Many people who try to commit suicide talk about it before making the attempt. Sometimes, just talking to someone who cares and who does not judge them is enough to reduce the risk of suicide. For this reason, suicide prevention centers have telephone hotline services.
- Never ignore a suicide threat or attempted suicide.