Suicide rates in the U.S. are at their highest in 30 years. In 2014, the last year for which there are official government figures, nearly 43,000 Americans killed themselves. That’s nearly four times as many as were shot to death by others.
The rise in suicide comes despite intensive prevention efforts by mental health professionals, citizen-volunteers, people affected by suicide, teachers, religious leaders and others.
Could the key to prevention be identifying people about to make an attempt?
To intercede in the minutes or hours beforehand, you’d need a sign. But one meta-analysis — a careful examination of other studies — considered the results of 365 research articles that looked at the presence of depression, talk about self-harm, feelings of hopelessness and other factors related to suicide.
The conclusion: There are no clear predictive patterns, meaning mental health workers can do little more than guess.
“We’ve had this list of warning signs for years and the rate of suicide isn’t going down,” says Julie Cerel, a psychologist and professor at the University of Kentucky, and president of the American Association of Suicidology. “The whole thing needs a rethink.”
Another study, this one of 82 people who had attempted suicide, showed that for nearly half the patients, only 10 minutes or less passed between the decision to kill themselves and the actual attempt. For the rest, it was hours, days or months.
Paul Currington of Olympia, Washington, has noted only one common feature among people who have tried.
“We didn’t necessarily want to die,” he says. “We just wanted the pain to end.”
His attempt came after years of depression.
“I just kept sinking lower and lower as the years went on until one day in 2012 when that well of inner strength ran out,” Currington says.
He had broken up with his girlfriend, and hoped to get back together. He ran into her at a musical performance at a café — with her new boyfriend.
“It was horrible and the worst part was I couldn’t get away,” he says. “The place was packed. The singer was by the front door.”
He finally escaped at a break, and ran out of the café. Later that night, he sat on the floor of his living room, hunched over on his knees and rocking in agony for hours.
“There was just this sound in my head, this roaring,” he says.
It was like falling off a cliff and never hitting bottom. “And finally the fear and anxiety of falling is so great you start praying to hit the bottom of that cliff because it’s better than falling forever,” he says.
In the heat of the moment he didn’t want to call a crisis line — he was embarrassed. Somehow, he’s not sure how, he got over that, and called.
“We must have talked until it was two or three in the morning and finally I just passed out from exhaustion and from trying to explain to him why I wanted to end my life and why it seemed like the best choice,” Currington says.
Dese’Rae Stage, on the other hand, had thought about suicide for years, and had researched methods. She was in a bad relationship.
“I wasn’t really eating, I wasn’t really sleeping,” she says. “It just wasn’t good.”
At the age of 23, after a bitter argument with her partner, she made an attempt. She doesn’t want to describe how — she doesn’t want to give anyone any ideas — but after two years of suicidality, the effort itself was a sudden decision. She didn’t use any of the methods she’d researched.
“I was just feeling really hopeless,” she says. “I wanted to go, and I wanted to be done.”
Paramedics called by her partner saved her. For Currington, it was the hotline. Stage says using a hotline just didn’t enter her mind at the time. She says maybe her best friends could have stopped her, but they all lived far away.
Friends aren’t at fault for not interceding — it’s hard to know.
“People who are close to someone who’s suicidal don’t necessarily get the full picture,” says psychologist Cerel. That said, if someone is talking about suicide, Cerel says it’s a good idea to encourage them to seek help.
While there may be no clear, proven way to identify people just before an attempt, there are some proven long-term prevention strategies. Means restriction, for one. Keeping guns away from people who are thinking of suicide. Getting treatment for depression. Changing pill packaging and prescription sizes to make access difficult. And reaching out.
“It’s definitely OK to ask people if they’re thinking about killing themselves or even to use the suicide word,” says Cerel. “Asking people, ‘Are you feeling suicidal or are you feeling like you want to kill yourself,’ gives them permission to talk about it.”
As for hotlines like the one Currington used, “the research we have says that suicide hotlines are utilized, and for the people that call them they are very helpful,” she says.
Both Currington and Stage are dedicated to prevention. Currington talks at storytelling shows as a way of saying it’s OK to talk about suicidality, and important to seek help. Stage has a website, Live Through This, a series of photographic portraits of suicide attempt survivors, along with their stories. Her idea is that silence is dangerous, and that talking about suicide may destigmatize it.
There are also online projects, though no published results yet. Facebook, for example, will send information and resources to friends worried about a post. And some researchers are looking for concrete biomarkers like stress hormones, or brain scans that might reveal structural or chemical changes.
Still, on the front line, there’s a certain degree of burnout. In a recent survey in the journal Depression and Anxiety, 54 percent of emergency room doctors and nurses said only “some or few” suicides could be prevented.
Currington, Stage, Cerel and other researchers and mental health workers say it’s a matter of doing more.
“We have to keep trying,” Stage says.
Their bottom line: Because suicides are so variable and unpredictable, many different programs are needed. Psychiatric treatment. So-called means restriction. Public information campaigns. Hotlines. And — more research.
The National Suicide Prevention Lifeline is available 24/7 at 1-800-273-8255.
Joanne Silberner is a freelance reporter and artist-in-residence at the University of Washington. She tweets @jsilberner.
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