WARNING SIGNS OF ELEVATED SUICIDE RISK
Once an understanding of the demographics and circumstances surrounding suicidal behavior has been established, it is essential to understand key warning signs for suicidal behavior. Although there is no consensus on warning signs in youth, warning signs in adults have substantial empirical support (Hunt et al., 2017). Warning signs in adult populations can be divided into two groups: general warning signs that indicate generally elevated risk of suicidal behavior, and imminent-risk warning signs that have been linked to a high likelihood of suicidal behavior in the immediate future. The following are general warning signs for potential suicidal behavior: ● Talking about feeling hopeless or having no purpose. ● Talking about feeling trapped or being in unbearable pain. ● Talking about being a burden to others. ● Increasing the use of alcohol or drugs. ● Acting anxious, agitated or reckless. ● Sleeping too little or too much. ● Withdrawing or feeling isolated. ● Showing rage or talking about seeking revenge. ● Displaying extreme mood swings. (NIMH, 2018) ● Talking about wanting to die. ● Looking for a way to kill oneself. In addition to these general behaviors, additional clinical warning signs are defined and arranged in the mnemonic acronym “IS PATH WARM?” (see Table 2). It is also important to note that, whereas depression and/or depressed mood are psychiatric problems associated with risk for suicide, they are not warning signs for suicide. So, for example, while a diagnosis of major depressive disorder may increase an individual’s risk for suicide, the diagnosis alone does not indicate that the individual may be suicidal. However, a number of the warning signs, such as hopelessness, withdrawal, and mood changes, are, in fact, symptoms of a depressive episode; therefore, noting changes in associated symptoms is necessary in providing ongoing care and supervision of youth and adults who are at heightened risk for suicide. Further information will be provided in subsequent sections to assist clinicians in differentiating general risk factors and warning signs from the most important factors in the upcoming suicide risk assessment section. Beyond general warning signs for suicidal behavior, there are some behaviors that may mean a person is at either immediate or possibly imminent risk for suicide. This represents a higher degree of concern given that a general warning sign may indicate possible presence of suicide risk, while these imminent risk factors may indicate acute intervention is needed forthright. The presence of the following risk factors should prompt you to take action right away: ● Agitation. ● Social withdrawal. ● Talking or writing about wanting to die or to kill oneself. ● Looking for a way to kill oneself, such as searching online or obtaining a gun. ● Talking about feeling hopeless or having no reason to live. (Chu et al., 2015; UCLA, 2016) Case study 1: Adult suicidal ideation Mrs. B., 35 years old, married with two kids, presents for an annual checkup at her primary care doctor. She appears uncomfortable and refuses to make eye contact with the front desk nurse with whom she is usually friendly. She has been seeing Dr. Duke, but she is scheduled to see his partner, Dr. Cook, this afternoon because Dr. Duke is on vacation. Dr. Cook’s nurse, Joan, notices that Mrs. B. is not her usual self and appears “out of it” today. Mrs. B. has a remote history of depression, which was diagnosed as postpartum depression when her second child was born. Her second child is now 10
Other behaviors may also indicate a serious risk, especially if the behavior is new, has increased, and/or seems related to a painful event, loss, or change, such as: ● Talking about feeling trapped or in unbearable pain. ● Talking about being a burden to others. ● Increasing the use of alcohol or drugs. ● Acting anxious or agitated; behaving recklessly. ● Sleeping too little or too much. ● Severe weight loss. ● Withdrawing or feeling isolated. ● Showing rage or talking about seeking revenge. ● Displaying extreme mood swings. ● Marked irritability. ● Severe sleep disturbances. ● Making plans or preparations for an attempt (e.g., saying goodbye to friends and family, making plans for the care of children and pets, giving away cherished or important objects). In cases where an individual is displaying imminent warning signs of high-risk suicidal behavior, clear assistance and intervention should be made for the at-risk individual. Such efforts may include further clinical assessment, communication of risk to relevant health or educational authorities, and in some cases reaching out to law enforcement authorities to ensure the individual’s safety. Table 2: Warning Signs for Suicide: Is PATH WARM? Warning Sign Description I deation Threats or talk of wish to hurt or kill oneself.
S ubstance abuse Increasing alcohol or drug use. P urposelessness Expressing no reasons for living. A nxiety
Agitation, restlessness, inability to sleep.
T rapped
Feeling that there is no way out.
H opelessness
Self lacks value, others do not care, future is unchanging.
W ithdrawal
From friends and family members; sleeping all the time; anhedonia.
A nger
Uncontrolled and excessive expressions of anger.
R ecklessness Acting recklessly; high-risk behaviors. M ood changes Dramatic shifts from typical mood state: ask to get more information. Note : These warning signs are indicative of risk in adults. Conclusive warning signs for youth suicide have yet to be identified, thus caution should be taken when applying the above warning signs to youth. Adapted from Know the Warning Signs, American Association of Suicidology, 2019. Retrieved from http://www.suicidology.org/ resources/warning-signs/ years old, and she has had no depressive symptoms since then. Of note: during the postpartum period, she had an episode of a suicide attempt. Dr. Cook is extremely busy today, and when Joan brings Mrs. B.’s apparent depressed mood to his attention, he is extremely dismissive and remarks that her history of depression and prior suicide attempt is a thing of the past. Two weeks later, Mrs. B. is found by her older son after attempting to hang herself. She is admitted to the intensive care unit at the local hospital.
EliteLearning.com/Psychology
Book Code: PYCA1423
Page 54
Powered by FlippingBook