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A person who is experiencing or could experience suicidal thoughts may show the following signs or symptoms:

• feeling or appearing to feel trapped or hopeless
• feeling intolerable emotional pain
• having or appearing to have an abnormal preoccupation with violence, dying, or death
• having mood swings, either happy or sad
• talking about revenge, guilt, or shame
• being agitated, or in a heightened state of anxiety
• experiencing changes in personality, routine, or sleeping patterns
• consuming drugs or more alcohol than usual, or starting drinking when they had not previously done so
• engaging in risky behavior, such as driving carelessly or taking drugs
• getting their affairs in order and giving things away
• getting hold of a gun, medications, or substances that could end a life
• experiencing depression, panic attacks, impaired concentration
• increased isolation
• talking about being a burden to others
• psychomotor agitation, such as pacing around a room, wringing one’s hands, and removing items of clothing and putting them back on
• saying goodbye to others as if it were the last time
• seeming to be unable to experience pleasurable emotions from normally pleasurable life events such as eating, exercise, social interaction, or sex
• severe remorse and self criticism
• talking about suicide or dying, expressing regret about being alive or ever having been born

A significant number of people with suicidal ideation keep their thoughts and feelings a secret and show no signs that anything is wrong.

Suicidal ideation can occur when a person feels they are no longer able to cope with an overwhelming situation. This could stem from financial problems, death of a loved on, a broken relationship, or a devastating or debilitating illness.

The most common situations or life events that might cause suicidal thoughts are grief, sexual abuse, financial problems, remorse, rejection, a relationship breakup, and unemployment.

The following risk factors may have an impact on the probability of someone experiencing suicidal ideation:

• a family history of mental health issues
• a family history of substance abuse
• a family history of violence
• a family history of suicide
• a feeling of hopelessness
• a feeling of seclusion or loneliness
• being gay with no family or home support
• being in trouble with the law
• being under the influence of alcohol or drugs
• for children, having disciplinary, social or school problems
• having a problem with substance abuse
• having a psychiatric disorder or mental illness
• having attempted suicide before
• being prone to reckless or impulsive behavior
• possessing a gun
• sleep deprivation
• knowing, identifying, or being associated with someone who has committed suicide

Conditions that are linked to a higher risk of suicidal ideation include:

• adjustment disorder
• anorexia nervosa
• bipolar disorder
• body dysmorphic disorder
• borderline personality disorder
• dissociative identity disorder
• gender dysphoria, or gender identity disorder
• major depressive disorder
• panic disorder
• post-traumatic stress disorder (PTSD)
• schizophrenia
• social anxiety disorder
• generalized anxiety disorder
• substance abuse
• exposure to suicidal behavior in others

Genetic factors may increase the risk of suicidal ideation. Individuals with suicidal thoughts tend to have a family history of suicide or suicidal thoughts.

Family and friends may notice through a person’s speech or behavior that they could be at risk.

They can help by talking to the person and by seeking appropriate support, for example, from a doctor.

The National Institute for Mental Health (NIMH) suggests the following tips for helping someone who may be going through a crisis:

• Asking them if they are thinking about suicide. Studies show that asking does not increase the risk.
• Keeping them safe by staying around and removing means of committing suicide, such as knives, where possible
• Listening to them and being there for them
• Encouraging them to call a helpline or contacting someone the individual might turn to for support, for example, a friend, family member, or spiritual mentor
• Following up with them after the crisis has passed, as this appears to reduce the risk of a recurrence

Other tips include keeping some emergency phone numbers at hand, for example, a trusted friend, a helpline, and the person’s doctor.

Suicide ideation can be a symptom of a mental health problem, such as depression or bipolar disorder.

A significant number of mental health problems, including depression, can be successfully treated or managed with medications and talking therapies, such as cognitive behavioral therapy (CBT) or counseling.

It is important to seek treatment if you or a loved one is experiencing mental health problems.

Once treatment starts, it is important to follow the treatment plan, attending follow-up appointments, taking medications as instructed, and so on.

Reducing the risk

The following may help lower the risk of suicidal ideation and suicide attempts:

• getting family support, for example, talking to them about how you feel and asking them to meet your health provider and possibly attend sessions with you
• avoiding alcohol and illegal drugs
• avoiding isolation and staying connected to the outside world, as much as possible
• doing exercise
• eating a well-balanced, healthful diet
• getting at least 7-8 hours continuous sleep in every 24-hour period
• removing any guns, knives, and dangerous drugs, for example, by giving them to a trusted friend to take care of
• seeking out things that give you pleasure, such as being with friends or family you like, and focusing on the good things you have
• attending a self-help or support group, where you can discuss issues with people who understand, get help from others, and help people with similar problems to get through their difficulties
• seeking and following treatment

Remember that many people experience suicidal thoughts at some time, and many of them find a solution, for example, by sharing their problem with someone.

It does not mean that there is anything wrong with you. Even if you feel alone in a place and afraid to share what you are going through, a confidential hotline may help.

If you or a loved one are having thoughts of suicide, it is important to get help.

National Suicide Prevention Lifeline: Available for a confidential chat 24 hours a day, 7 days a week. Toll-free: 1-800-273-TALK(8255).

Befrienders Worldwide: Contact numbers and support information for your country in different countries and different languages.

Childhelp: National Child Abuse Hotline for the U.S. Call 1-800-4-A-CHILD (1-800-422-4453). All calls are anonymous and confidential.

Veterans crisis line: Confidential support for veterans or those who are concerned about a veteran.

• Call: 1-800-273-8255 and press 1
• Text 838255

These services offer confidential help.

In the U.S., suicide was the tenth leading cause of death in 2015, responsible for over 44,000 fatalities.

It was the third leading cause of death among those aged 10 to 14 years, and the second cause in those aged 15 and 34 years.

The number of suicides in 2015 was double the number of homicides.

Males are more likely to take their own lives than females.

Suicide is the third leading cause of death among 15 to 24 year-olds. Twenty per cent of all suicides are among this age group.ش