What research tells us about the critical stages of suicidal risk
I have been working on this blog for weeks now. I was going to say I have been trying to write it and failed, but that is just the part of my ‘monkey’ brain telling me I am not good enough to write it! Yet, there are so many reasons why I want to - for my clients; for every single person who is touched by the title and reads on; and for myself.
The more I read about suicide the more I understand - and that feels important to me. I am grateful to Dr Susie Bennett, a male suicide researcher at the Suicide Research Lab at Glasgow University for asking the difficult questions and for so clearly bringing together "Theories of Suicide" on her Instagram page that provided me with the material on which to base these blogs.
There is so much stigma and misunderstanding around the subject of suicide. It's really hard to say why any one person thinks about it or goes through with it, but understanding more can make a real difference in how we approach and support those who are struggling.
As this is such a huge and complex subject, I’m going to break the blog down into separate parts, addressing some of the key theories around suicide. I’ve decided to start by talking about risk, because I think that it might help to separate background risk from suicidal thoughts and making an attempt.
Rory O’Connor, one of the world’s leading suicide experts, talks about three critical stages of suicidality and emphasises that the factors leading to thoughts of suicide differ from those that lead to suicidal behaviour.
1. Background Risk
Let's start by looking at the various factors that can influence suicidal risk:
Biological or Genetic Factors: Some people might be more prone to stress due to their biology or genetics, including the role of serotonin.
Personality Traits: Traits like perfectionism can make individuals more sensitive to failure. Will Storr explores this in-depth in his article and book, Selfie: How the West Became Obsessed.
Environmental and Social Factors: Living in poverty, facing political unrest, or experiencing discrimination can all increase underlying risk.
Adverse Childhood Experiences (ACEs): Challenging childhood experiences, such as physical, emotional or sexual abuse; living with someone who misused substances, has been imprisoned or has a serious mental illness; exposure to domestic violence or losing a parent, can have long-lasting impacts. A 2014 UK study found that 47% of people experienced at least one ACE, with 9% having four or more. An American study reported a 2 to 5 times increased risk with any ACE and an even higher risk with multiple ACEs.
It's crucial to remember that these are risk factors, not guarantees that someone will attempt suicide. Other life events, like overwhelming work or family issues, can also contribute to feelings of being trapped and lead to suicidal thoughts.
2. Thoughts of Suicide
According to O’Connor, suicidal thoughts often stem from feelings of defeat and entrapment. When someone feels overwhelmed by failure, loss, or humiliation, they might feel there’s no way out.
While supportive relationships, future plans, and clear personal goals can help counter these feelings, isolation, lack of support, or feeling like a burden can exacerbate them.
3. Making an Attempt
O’Connor goes on to explain the factors that can increase the likelihood that someone will act on their suicidal thoughts:
Not fearing death or having a high pain tolerance
A history of self-harm or previous suicide attempts
Losing a close friend or loved one to suicide
Making specific plans and having the means to carry them out
Exposure to media that glorifies suicide
Impulsive behaviour
Managing Risk
O’Connor highlights the importance of creating a personalised safety plan for those feeling suicidal. This plan should include practical steps like:
Making their environment safer by removing means to harm themselves
Deciding who to call for support
Finding distractions, like listening to uplifting music
Bringing their mind to the present by doing things like running a hand under cold water or plunging it into icy water
There are a number of online resources to help people in writing a safety plan and Charities such as PapyrusUk operate a HopeLink that can support young people in keeping a safety plan up to date. There are also apps such as StayAlive and ZeroSuicide where you can store a safety plan on your phone.
When researching suicide and risk for my PostGrad, I found Rory O’Connor’s book When it is Darkest: Why people die by suicide and what we can do to prevent it really helpful not only in explaining the reasons, but also in giving me the confidence to support clients when they are at their darkest.
If you have been impacted by the content of this blog, reach out to someone you trust for support. If you or someone you care about is in a crisis, there is a list of helplines in the Support Directory on my website.
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