Risk factors for suicide

1. Risk factors for suicide There is no typical profile for a person who might consider suicide. Most suicidal thoughts and behaviours occur as a result of a build up of a complex web of circumstances. However, there are a number of key factors we can be aware of and try to manage to reduce the risk of suicide. Suicide risk factors fall into two groups, causal factors and circumstantial factors.

2. Causal risk factors Causal factors for suicide include different mental illnesses or symptoms of being mentally unwell. While not all people who suicide have a mental illness, there is a very strong relationship between mental health problems and suicide. Some studies have shown that as many as 70% of people who think about suicide and act on it have a mental health problem. Therefore, mental health is one of the most important risk factors to consider and deal with … that is to manage the risk.

3. What is mental illness? There are a range of mental health problems somebody could be experiencing: Depression Bipolar Disorder Post Traumatic Stress Disorder Anxiety Psychosis Often symptoms of these illnesses overlap so professional help is important from an early stage to help with identifying the right management plan.

4. Depression Depression is one of the most common factors in suicidal thoughts. Not everyone with depression will think about suicide, but statistically as a group, they are at higher risk for suicide. However, depression is a treatable condition that most people can recover from or find ways to manage.

5. Depression Someone who is experiencing depression is likely to have a persistent low mood, they may feel overwhelmed, have trouble sleeping or feel tired. Many people have experienced low points or feelings of sadness, but when these feelings become severe and ongoing, it is important to seek professional help and support.

6. Bipolar disorder Bipolar disorder is characterised by feelings of extreme highs or lows, or ‘mood swings’. Everybody experiences a range of moods depending on their circumstances, but a person with bipolar disorder will experience extreme moods – being very high and over-excited to feeling low, depressed and helpless. Some people experience mostly the highs, some experience mostly the lows and others experience both. When someone is experiencing the extreme lows of a depressed episode, this becomes a risk factor for suicide.

7. Hopelessness and helplessness Feelings of hopelessness happen when pressures build up to the point where there don’t seem to be any answers. This state of mind can lead to suicide being considered as a way out. People with depression or bipolar disorder often experience a sense of hopelessness where everything feels overwhelming and difficult. They may also feel unmotivated or experience little joy when doing things they once enjoyed. It is important to understand that there are many other solutions and that positive outcomes are possible.

8. Anxiety Anxiety can take on many forms but is characterised by excessive worrying that can become debilitating and can have an impact on a person’s day to day life. There are a number of anxiety disorders that include: • Post traumatic stress disorder • Generalised Anxiety Disorder • Social Anxiety Disorder • Obsessive Compulsive Disorder • Phobias It is important to address anxiety with professional support to instigate a sense of hope and relief from the symptoms.

9. Psychosis When somebody experiences psychosis there is a loss of contact with reality. A person may experience unusual thoughts and feelings, they may be confused or they may have delusional thoughts. No experience is the same. It can be brought on by a stressful event and most people make a full recovery, but it does become a risk factor for suicide if symptoms continue.

10. Trauma and its effects Trauma is any impact or damage to the neurological, physical, psychological and social aspects of a whole person. Traumatic experiences can include anything from a person witnessing a violent event or accident, being directly involved in an accident or being harmed by something or someone. Trauma from such events can then be a precursor to someone developing a mental illness, such as Post Traumatic Stress Disorder (PTSD). PTSD is characterised as someone re-living a traumatic experience and the feelings from that experience. This can be triggered by smells, sounds, feelings or visual cues.

11. Trauma and its effects Not all individuals exposed to a traumatic event will develop a mental illness or need professional help, many people recover with the help and support of their family and friends. But for some it can have a profound and long-lasting impact, and this can become a risk factor for suicide. It is important for ex-service personnel to be aware of the possible effect of trauma on their lives and on the lives of those around them. PTSD is treatable and most people do recover, but early intervention is vital. Professional support is the first step towards sustained recovery.

12. When a child’s parent has PTSD PTSD can also have damaging effects on the family and friends of a person with PTSD as a parent with PTSD has to contend with a range of symptoms that are both frightening and exhausting. Children may not understand what is happening or why, and they may start to worry about their parent's well-being or that their parent cannot properly care for them. This can then impact their own emotional wellbeing, their behaviour and increase the likelihood for developing a mental illness, which is a risk factor for suicide. It is important for ex-service personnel to be aware of the impact of their PTSD on their family and friends and the increased risks not just to themselves but to others they care for and love. Seeking professional help is the first step to recovery.

13. Circumstantial risk factors On their own circumstantial factors may not often be a significant risk factor, but when combined with causal factors they increase the potential risk of suicide - that is they promote a ‘compounding’ effect and need to be managed. Every person’s life is different and their circumstances are always changing and can be changed but there are some key circumstantial factors, when coupled with causal factors, that can significantly increase the risk of suicide. These are: • Transition from military service • Injury and disability • Isolation • Excessive alcohol use • Loss of someone close • Heightened arousal • Risk taking • Sudden changes

14. Transition from military service Transition from military service is sometimes difficult. Changes have taken place, both at home and away, and returning is always a time of re-learning and requires patience. Ex-service personnel need to understand that a return to civilian life has similar characteristics and time is needed to become attuned to a new way of life and new expectations.

15. Injury and disability Injuries and disabilities are a distressing consequence of war and peacekeeping deployment. Coping with injury or disability in civilian life is more complex and sometimes results in feeling forgotten or marginalised. It is important for ex-service personnel to access information and support.

16. Alcohol Use of alcohol is a part of the Australian culture and often an accepted part of a social occasion. It becomes a problem and a risk for suicide when it is used at risky levels, or as self-medication. Under the influence of alcohol or other drugs, individuals experience impaired judgement which affects decision making ― many individuals who attempt or complete suicide often have high levels of alcohol or other drugs in their systems. Ex-service personnel and their families need to be aware of the risks to themselves and others associated with the misuse of alcohol.

17. Isolation Isolation can be physical (living in a remote area) or emotional (withdrawing from friends and family), either way it reduces the support around you and increases the risk of suicide. This is particularly important if you are experiencing depression, anxiety or bipolar disorder. For a healthier lifestyle, it is important to acknowledge the level of isolation in your life and explore ways of increasing social interaction.

18. Loss of someone close The death of someone close is a significant loss and grieving is difficult. People may experience a range of emotions which can often include feelings of shock, confusion, anger, guilt and exhaustion. The death of someone close, especially if they have suicided, can be a risk factor of suicide for grieving family and friends, so it is very important to have an understanding of the grieving process and to have access to professional emotional support.

19. Heightened arousal Heightened arousal or, hyper-vigilance, is a state of being constantly alert due to higher levels of adrenalin and cortisol in the body. It often follows an experience of trauma. Heightened arousal can be linked with Post Traumatic Stress Disorder (PTSD) and is also associated with increased risk taking and increased risk of suicide.

20. Risk taking Risk taking should always be considered within the context in which it occurs. It is important to understand the changes involved in the move from military to civilian life and what risks are reasonable within your new context. Risk taking can be a positive aspect of life, but it becomes a problem when risk taking begins to have a negative impact on health and wellbeing and can be life-threatening. Taking risks is often associated with heightened arousal and increases the chances of suicide.

21. Next steps The causal and circumstantial risk factors of suicide are serious, but they are not permanent. Support and professional help are available for anybody experiencing mental health problems and it is possible to recover. At times many of our circumstances may seem overwhelming and intractable, but life is not static and it is possible for our circumstances to change for the better. click here for information about protective factors against suicide