Suicidality: Causes and Triggers

Suicide is considered a serious, and many times preventable outcome. In an attempt to clarify this often skirted around topic, the following article aims to provide an agreed upon definition of suicidality, outline several leading causes of suicide, and review key suicide information.

Suicidality: A Concrete Wish to End One’s Life

The American Psychiatry Association (APA) defines suicidality, which is also known as suicidal ideation, as thoughts about self-harm, with the deliberate intent of causing one’s own death. Suicide is defined as intentionally causing one’s death.

Suicidality vs. Thinking About Dying

The key aspect of suicidality is a more concrete focus on wishing to end one’s life. Merely thinking about death and dying at different moments during one’s life is not, however, considered to be suicidality. In fact, having a passing thought on these subjects is actually quite common, and should not be conflated with more serious suicidal contemplation.

Assessing the Severity of Suicidal Thinking

To gauge the seriousness of their thought content, individuals who have experienced thoughts on suicide should ask themselves:

• Whether they have recently begun thinking much more about this subject.
• Believed causes of suicidal thoughts, and whether the individual themselves is able to connect their suicidal thoughts to a certain event or experience.
• If their thoughts remain more general and passive, or if they contain a concrete plan to kill themselves.
• Whether their thoughts on dying are connected to an already recognized mental health or physical issue.
• Whether thoughts on suicide are linked to low self-esteem, or the belief that they do not deserve to live.
• Whether their suicidal thinking has led to acts of self-harm, or suicide attempts.
• If such an attempt has indeed occurred, they should consider how damaging it has been to their physical or mental health.

Suicidality: Facts and Info

According to the American Foundation for Suicide Prevention, suicide is the 12th most common cause of death in the US.

In 2020 alone, over 45,000 Americans took their own lives. 130 Americans are believed to die by suicide each day.

Age wise, suicide rates are relatively high among those aged 25-34, and 75-84, with the highest suicide rate of 20.9% found at ages 85 and above.

Men typically have a higher rate of completed suicide than women. In 2020, 3.9 more men died by suicide than women. Middle-aged white men were found to have the highest suicide rate, accounting for 69.7% of all completed suicides in the US during 2020. 52.53% of US completed suicides during 2020 were carried out using firearms.

Information on acts of completed suicide are more available, compared to attempted suicide, which is often confused with acts of self-harm that were not intended to end one’s life. Nevertheless, certain information does exist: 0.5% of the adult US population, or 1.4 million US adults, are believed to have attempted suicide. Women report attempting suicide 1.5 times more than men (though, as stated above, men die of suicide much more than women). Native Americans report the highest rate of suicide attempts, at 25.5%.

Suicidal Behavior Disorder: Acting to End It All

Further distinguishing between the severity of one’s actions and their thoughts, the APA defines suicidal behavior—and not suicidal thinking—as a mental health disorder. A further distinction made by the APA is drawn between suicidal behavior and acts of self-harm that were not meant to lead to one’s death.

To receive this disorder, an individual must have attempted suicide at least once over the past two years.

Additional, definitive aspects of suicidal behavior disorder include the following:

• How violent the attempt was, for example, in cases of an overdose vs. a gunshot wound.
• The medical consequences of the attempt, and how debilitating it ended up being.
• Whether the attempt itself was the result of impulsivity or planned out in advance.
• Another feature of suicidal behavior is ambivalence, which can shed some light on how much the individual had actually wished to kill themselves, and how much they wished to signal to others or themselves that they are suffering and need help.

Several other factors should also be considered when attempting to diagnose suicidal behavior disorder. They include the individual’s willingness to be forthcoming with the details of their suicidal ideation. Many of those who have attempted suicide try to hide their intentions, describing their suicide attempt instead as an accident.

Another factor of suicidal behavior disorder is what medication they had been taking or had stopped taking prior to their attempt. Specifically, discontinuing to take a mood stabilizer, such as lithium, or an antipsychotic, such as clozapine, has been shown to cause suicidal ideation.

Suicidal Behavior: Facts and Info

Suicidal behavior is very rarely found among children under the age of five.

25%-30% of those who have carried out one suicide attempt, will try to do so again.

The presentation of suicidal behavior disorder varies among different cultures. Some of this heterogeneity may be due to method availability, with poisoning through pesticides more easily procured in developing countries, and gunshot wounds more possible in the southwestern US.

Suicidal behavior disorder has been shown to appear in comorbidity with the following mental health disorders:

• Major depressive disorder (depression)
• Obsessive-compulsive disorder (OCD)
• Anorexia
• Bulimia
• Bipolar disorder
• Body dysmorphic disorder
• Disruptive mood dysregulation disorder
• Dissociative identity disorder (commonly known as split personality disorder)
• Dissociative amnesia
• Opioid abuse
• Panic disorder
• Persistent complex bereavement disorder

Getting Help

For those contemplating suicide, and for fearing a loved one may attempt to do so, help is available, now more than ever. A number of treatment options have been shown to offer individuals at risk of attempting suicide with the support they need to avoid doing so, or to help them recover after such an attempt. They include:

• Psychotherapy. Discussing one’s pain with an empathetic mental health professional can help them feel less alone, understood, and valued, during a deeply dark time in their life.
• Hospitalization. Checking into a mental health facility can allow patients who struggle to protect themselves for acts of suicide or self-harm, from serious risk.
• Medication. Medication treatment for suicidality must be carried out under the careful supervision of a licensed professional, since certain medications can increase one’s energy, allowing them to carry out a concrete attempt.

Reach out to your primary mental health provider, or contact a licensed professional today, to set up an appointment and begin building together a mental healthcare plan that best addresses your needs.