Monica Crawford
January 4, 2023
Suicide is a topic that many people struggle to approach. For some, even in clinical and research settings, there is a fear that talking or asking about suicide might cause or worsen suicidal thinking. Perhaps you can breathe a little easier knowing that there is no evidence to suggest that this is true [1].
Key Terms
Suicidal ideation is defined as thinking about or considering suicide [2]. In Canada, 11.8% of the population reports having experienced thoughts of suicide in their lifetime [3]. Suicidal ideation can range in its severity from passive ideation (e.g., desiring to be dead) to active ideation (e.g., desiring to kill oneself) [4]. Although most individuals who experience suicidal ideation do not attempt suicide [5], suicide attempts can have devastating consequences for the person, their loved ones, their community. For every death by suicide, seven to ten people are significantly impacted [6]. It is therefore important to take all levels of suicidal ideation very seriously [4].
A suicide attempt is when an individual engages in a behaviour with the intent that it will end their life, which may or may not result in actual injury to the individual [2]. This is different than nonsuicidal self-injury, which is self-inflicted injury that is not intended as a suicide attempt [7]. If you would like more information on this topic, you can read about it in a previous blog post here. In Canada, 3.1% of individuals 15 years and older report having attempted suicide in their lifetime [3].
Suicide is when an individual engages in a behaviour with the intent that it will end their life, with a fatal outcome [2]. For every 10 people who attempt suicide, one of these attempts will be fatal [8]
What Causes Suicidal Ideation?
When you find out that someone is experiencing suicidal ideation, your mind might immediately jump to the conclusion that the person is depressed or experiencing some other type of mental illness; however, this is not always the case. There is typically no single cause of a person’s suicidal ideation, but rather a cumulation of risk factors. These risk factors include depression, social isolation, low social support, anxiety, stress, intoxication, drug use, and insomnia, [9] and the lengthy list continues from there. Populations at higher risk for suicide include men and boys, people serving federal sentences, individuals who have lost someone to suicide and survivors of suicide attempts, some First Nations and Métis communities, and all the Inuit regions in Canada [6]. Lesbian, Gay, Bisexual, Trans, Two-Spirit or queer/questioning youth are also at an increased risk of suicide [6].
Options Available for Treatment & Support
Getting help for suicidal ideation sooner rather than later is beneficial. Early identification and treatment of risk factors can promote earlier assessments, leading to targeted interventions that can reduce the risk of poor mental health outcomes and suicidal behaviours [10].
- Seeking support and treatment from a mental health professional such as a registered clinical counsellor (RCC), psychologist, and/or a psychiatrist (which you can get a referral for from your family doctor). *It is important to note that the term “counsellor” is not currently regulated in British Columbia [11]. What this means is that anyone can call themselves a counsellor, whether or not they have received appropriate education. The term “Registered Clinical Counsellor” (RCC) and “Registered Marriage and Family Therapist” (RMFT) are both regulated terms, meaning to have this designation, these professionals have completed specialized training and supervised clinical work with patients, and must follow a code of ethics [11].
- One gold standard treatment for self-injurious thoughts and behaviours, including suicide attempts, is dialectical behaviour therapy (DBT) [12]. DBT shows promising results in reducing suicidal ideation for individuals with and without borderline personality disorder [13,14].
- Cognitive behaviour therapy (CBT) has also shown promising results. A 2018 study found that people who received brief CBT experienced lower rates of suicidal behaviour than people who received standard treatment in the community, regardless of initial symptom severity [15].
- Seek support from loved ones, such as family or friends if it is safe to do so. Studies show that perceived social support may protect individuals from suicide risk [16].
- Call a local crisis line or the national suicide line, Talk Suicide (1-833-456-4566), to speak with a trained responder. Crisis lines and suicide hotlines may be beneficial for in the moment, short term emotional support [17, 18], and can help direct service users to long-term resources and support.
If things have gotten to the point where you feel that someone is in immediate danger of harming themselves, it is time to call 911 or take them to the nearest emergency department. Similarly, if you yourself feel that you have reached a point where you are unable to keep yourself safe, you can call 911 or take yourself into the emergency department for immediate support.
Tips to Support Someone Who is, or May be Experiencing Suicide Ideation
“I feel so exhausted and I don’t know if I can keep living like this”
“I don’t want to wake up tomorrow after I fall asleep tonight”
“I just don’t feel like I have any reason to keep living”
“Sometimes I wish I would die so that I don’t have to do this anymore”
These are some examples of cues that someone might be thinking about suicide. So how do you know if someone is considering ending their life or just feeling exhausted from an off day? Asking directly is one way to find out.
This can feel frightening and awkward if this is the first conversation you have ever had about suicide. It is important to reiterate that there is no evidence that asking or talking about suicide will make things worse. In fact, it may help reduce to suicidal ideation by making the person feel heard and understood [1]. It is okay to not know exactly what to say. It is okay if the conversation does not go perfectly.
- Try to listen to what the person is going through and approach the conversation with respectful curiosity to help you understand what has been going on for them. Respectful curiosity is a genuine willingness and desire to understand something, while approaching the topic or person in a kind and gentle manner.
- Validate the feelings that the person is experiencing.
- Encourage the person to seek support from a mental health professional or speak to their doctor.
- Offer support – whether this is talking more, going for a walk with them, or helping them find resources.
- Try to not pass judgement or use statements that start in “at least” (e.g., “well at least you’re on medication now”). Despite good intentions, this can be perceived as invalidating.
We have included some examples below on how to ask and talk about suicidal ideation, however you can also reach out to a crisis line, suicide hotline, or your own mental health professional to help navigate your specific situation.
Still don’t feel comfortable asking or talking about suicide? You can call the national suicide hotline, Talk Suicide (1-833-456-4566), and request an outreach call to the person of concern.
When to call 911
If you believe there may be a suicide in progress, or that someone is in immediate danger of harming themselves, call 911 or bring them to the nearest emergency department.
Asking and Talking About Suicide
“It sounds like things are really weighing heavily on you right now. Is suicide something that you’re thinking about?”
“That’s a lot to have going on. And when people are going through as much as you are, it’s understandable that they might be considering suicide. Is that something you’ve been thinking about?
“How long have you been having these thoughts for?”
“It sounds like you’ve been carrying a lot of weight on your shoulders”
“Thank you for choosing to trust me with this information. How might I be able to support you right now?”
“It’s so hard to navigate through those feelings, especially trying to do it all on your own. Have you considered speaking to a mental health professional or your doctor? Is that something you would be open to trying?
“Would you feel comfortable reaching out to me for support if you needed it, or if you felt like you couldn’t keep yourself safe?”
Recommendations for Further Reading & Learning
“Talk to Me” free training course designed to help individuals recognize concerning behaviours and feel better prepared to have conversations about mental health. https://www.edx.org/course/talk-to-me-improving-mental-health
What to do when someone is suicidal. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/suicide/in-depth/suicide/art-20044707
Suicidal thoughts – How to support someone. Rethink Mental Illness. https://www.rethink.org/advice-and-information/carers-hub/suicidal-thoughts-how-to-support-someone/
Risky Behaviour Lab Resource List. https://onlineacademiccommunity.uvic.ca/riskybehaviourlab/resources-2/
References
[1] Dazzi, T., Gribble, R., Wessely, S., & Fear, N. (2014). Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine. 44(16), 3361-3363. https://doi.org/10.1017/S0033291714001299
[2] National Institute of Mental Health. Suicide. (2019). Retrieved December 14th, 2022 from https://www.nimh.nih.gov/health/statistics/suicide.shtml
[3] Stats Canada. (2020). Suicide in Canada: Key Statistics. Government of Canada. https://www.canada.ca/en/public-health/services/publications/healthy-living/suicide-canada-key-statistics-infographic.html
[4] Liu, R. T., Bettis, A. H., & Burke, T. A. (2020). Characterizing the phenomenology of passive suicidal ideation: a systematic review and meta-analysis of its prevalence, psychiatric comorbidity, correlates, and comparisons with active suicidal ideation. Psychological Medicine, 50(3), 367–383. https://doi.org/10.1017/S003329171900391X
[5] May, A. M., & Klonsky, E. D. (2016). What Distinguishes Suicide Attempters From Suicide Ideators? A Meta-Analysis of Potential Factors. Clinical Psychology: Science and Practice , 23(1), 5–20. https://doi.org/10.1037/h0101735
[6] Stats Canada. (2022). Suicide in Canada. Government of Canada. https://www.canada.ca/en/public-health/services/suicide-prevention/suicide-canada.html
[7] Klonsky, E. D., Victor, S. E., & Saffer, B. Y. (2014). Nonsuicidal self-injury: What we know, and what we need to know. The Canadian Journal of Psychiatry, 59(11), 565-568. https://doi.org/10.1177%2F070674371405901101
[8] Owens D, Horrocks J, House A. (2002). Fatal and non-fatal repetition of self-harm: Systematic review. British Journal of Psychiatry, 181(3), 193–199. https://doi.org/10.1192/bjp.181.3.193
[9] Shobhana, S. S., & Raviraj, K. G. (2022). Global trends of suicidal thought, suicidal ideation, and self-harm during COVID-19 pandemic: a systematic review. Egyptian Journal of Forensic Sciences, 12(1), 28–28. https://doi.org/10.1186/s41935-022-00286-2
[10] Cash, S. J., & Bridge, J. A. (2009). Epidemiology of youth suicide and suicidal behavior. Current Opinion in Pediatrics, 21(5), 613–619. https://doi.org/10.1097/MOP.0b013e32833063e1
[11] Work BC. (n.d.) Family, marriage and other related counsellors. Accessed December 16th, 2022. https://www.workbc.ca/careers/4153#view-full-profile
[12] DeCou, C. R., Comtois, K. A., & Landes, S. J. (2019). Dialectical Behavior Therapy Is Effective for the Treatment of Suicidal Behavior: A Meta-Analysis. Behavior Therapy, 50(1), 60–72. https://doi.org/10.1016/j.beth.2018.03.009
[13] Decker, S. E., Adams, L., Watkins, L. E., Sippel, L. M., Presnall-Shvorin, J., Sofuoglu, M., & Martino, S. (2019). Feasibility and preliminary efficacy of dialectical behaviour therapy skills groups for Veterans with suicidal ideation: pilot. Behavioural and Cognitive Psychotherapy, 47(5), 616–621. https://doi.org/10.1017/S1352465819000122
[14] Torok, M., Han, J., McGillivray, L., Wong, Q., Werner-Seidler, A., O’Dea, B., Calear, A., & Christensen, H. (2022). The effect of a therapeutic smartphone application on suicidal ideation in young adults: Findings from a randomized controlled trial in Australia. PLoS Medicine, 19(5), e1003978–e1003978. https://doi.org/10.1371/journal.pmed.1003978
[15] Bryan, C. J., Peterson, A. L., & Rudd, M. D. (2018). Differential Effects of Brief CBT Versus Treatment as Usual on Posttreatment Suicide Attempts Among Groups of Suicidal Patients. Psychiatric Services, 69(6), 703–709. https://doi.org/10.1176/appi.ps.201700452
[16] Kleiman, E. M., Riskind, J. H., Schaefer, K. E., & Weingarden, H. (2012). The Moderating Role of Social Support on the Relationship Between Impulsivity and Suicide Risk. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 33(5), 273–279. https://doi.org/10.1027/0227-5910/a000136
[17] Hoffberg, A. S., Stearns-Yoder, K. A., & Brenner, L. A. (2020). The Effectiveness of Crisis Line Services: A Systematic Review. Frontiers in Public Health, 7, 399–399. https://doi.org/10.3389/fpubh.2019.00399
[18] Shaw, F. F. T., & Chiang, W. H. (2019). An evaluation of suicide prevention hotline results in Taiwan: Caller profiles and the effect on emotional distress and suicide risk. Journal of Affective Disorders, 244, 16–20. https://doi.org/10.1016/j.jad.2018.09.050
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