Module 2 - Risk of Suicidal Behavior
Transcript
Module 2: Risk of Suicidal Behaviour
Understanding the Suicidal Process
1. Suicide is rarely a sudden act. More often, it’s the result of a process that unfolds over days, months, or even years. Much of this process happens internally and may go unnoticed by those around the person. However, most individuals find ways, subtle or direct, to communicate their distress. In this section, you’ll learn more about the suicidal process and how people may express their pain at different stages along the way.
2. The graph illustrates the suicidal process over time, highlighting fluctuations in suicidal intent. Intent is difficult to predict, as it changes depending on risk factors and the level of distress a person experiences. Suicidal thoughts may temporarily subside but can return during periods of crisis.
Some aspects of this process are noticeable to those around the person, including changes in statements or behaviors. However, thoughts, intentions, and impulses are often unnoticeable and remain hidden from others.
The process often begins with a person facing a difficult life situation that feels hopeless. They may feel trapped in despair, expressing this outwardly with vague statements like “I’m not doing well” while internally struggling to cope.
You might notice changes in their mood—feeling more sad, irritable, tired, anxious, withdrawn, or angry. These emotional shifts are often accompanied by changes in behavior. For example, a sociable person may start avoiding others. A once hard-working individual may lose interest in their job. Someone who normally keeps up their appearance may begin to neglect themselves.
At first, they may not actively consider suicide but rather wish for escape, thinking, “It would be easier if I never woke up again.” They might wonder what is the point of going on or feel that it would be easier for everyone without them, which intensifies their desire for death.
As distress deepens, changes in mood and behavior may become more pronounced. While thoughts of death may arise, the primary wish is often relief from emotional pain. Suicidal thoughts can emerge in response to unbearable psychological suffering and may be accompanied by verbal cues indicating a wish to escape pain through death.
Statements like this need to be taken very seriously, as they indicate that someone might be seriously thinking about suicide or already having a suicidal intent. At that point, the individual might make and verbalize a decision to end their life, believing that only death can bring relief.
When intent solidifies, a suicide plan may develop. At this stage, the person decides when, where, and how they intend to take their life. The risk is extremely high when a plan is present. Behaviors such as saying goodbye, arranging personal affairs, giving away valuables, making funeral plans, or preparing lethal means, like collecting pills or a rope, can be critical warning signs.
If the individual carries out the plan, it results in a suicide attempt, which may or may not result in death. After an attempt, suicidal intention may change, decreasing slightly or intensifying. However, the risk of another attempt remains high, particularly in the first two years. A fatal suicide attempt is considered suicide and in some cases, it may occur on the first attempt.
It is important to remember that the suicidal process is not always linear. Some people experience a gradual progression, while others may skip stages, making their crisis more abrupt. Certain aspects may be more noticeable in some individuals, while in others, distress remains hidden.
It’s essential to know that the suicidal process can be interrupted at various points. Protective factors, especially support from close people, can make a critical difference. By recognizing changes in behavior and speech, those around the individual can intervene and offer help. You will learn more about how to support a person in distress in Module 3.
3. The suicidal process varies across age groups. Among older individuals, it tends to unfold over a longer period, making suicide plans more deliberate. This age group also faces a higher risk of suicidal behavior, with 18–40% reporting passive suicidal thoughts. Older adults are more likely to choose aggressive and highly lethal methods. Due to these methods, a smaller social network to recognize distress, and poorer physical health, nearly one in three suicide attempts in this age group results in death.
4. Compared to other age groups, the suicidal process in adolescents is generally shorter, with decisions often made impulsively. Similar to older individuals, 20–40% of adolescents experience suicidal thoughts. However, suicide attempts in this age group are far more frequent and less often fatal—only about one in 200 attempts results in death.
Adolescents’ distress is more likely to be noticed by those around them, such as parents and friends. They often choose less lethal methods, have less detailed plans, and, in many cases, use suicide attempts as a way to signal their distress and seek help. These individuals urgently need psychological support and family intervention.
Suicide attempts with a non-fatal outcome and a help-seeking intention are more common in girls, whereas boys have a higher rate of attempts that result in death.
5. The suicidal process unfolds differently across the lifespan, with notable contrasts between adolescents and older adults.
6. Among adolescents, the suicidal process is typically shorter and more impulsive than in older adults. Studies estimate that approximately 20–40% of adolescents report experiencing suicidal thoughts. However, the vast majority of suicide attempts in this age group do not result in death. Research shows that only about one in 200 suicide attempts among adolescents ends in a fatal outcome. This lower lethality is attributed to the frequent use of less deadly methods, the impulsive nature of many attempts, and the presence of people, such as parents, teachers, or friends, who may notice the distress and intervene. In many cases, the act may not reflect a settled desire to die, but rather a cry for help or a response to overwhelming emotional pain. Such young people need timely psychological support and a compassionate response from their surroundings. Gender differences are also evident: girls tend to engage more often in non-fatal suicide attempts, while boys more often use methods with a higher risk of death.
7. In contrast, the suicidal process in older adults tends to be more prolonged and premeditated. Between 18% and 40% of older adults report passive suicidal deation, such as wishing they were dead or feeling that life is no longer worth living. When suicide attempts do occur in this group, they are much more likely to end in death—about one in four, according to international data. This heightened fatality is linked to the choice of more lethal methods, reduced physical resilience, and a smaller likelihood that someone will detect the warning signs in time. Older adults are more likely to be socially isolated, to suffer from chronic illness, and to face emotional burdens such as bereavement or loss of purpose, all of which can contribute to suicide risk.
While these patterns are consistent across many studies, it’s crucial to note that national and regional differences exist. The rates of suicidal ideation, attempt, and completion, as well as the most commonly used methods, vary based on access to healthcare, societal attitudes, means availability, the strength of social support systems, and other factors.