Kate Spade. Anthony Bourdain. Jeremy Richman (father of a Sandy Hook victim). These tragic, high-profile deaths shine a light on the frightening, rising trend of suicides. According to the Centers for Disease Control and Prevention (CDC), the rate of suicide in the US has increased by 30% between 2000 and 2016, with nearly 45,000 people taking their own lives in 2016. For men it increased 21%, and for women a shocking 50%. More sobering statistics: The suicide rate for females is highest among those ages 45 to 64, and the highest increase in suicide is in men who are age 50 and over. We don’t have any definitive reasons why middle age is such a vulnerable time, but multiple factors likely play a role—excessive stress at midlife, financial challenges and better reporting of suicide numbers. 

Losing a loved one is always devastating, but in the case of suicide it’s even more so because it theoretically didn’t have to happen. Survivors of ­suicide—the partners, family members and friends left behind—often are tormented by guilt about what they might or should have done: If I had seen the signs more clearly, acted faster, would he/she still be alive? The answer may be no—suicides can and do occur without warning—but in many cases, there are red flags. And there are steps you can take to keep someone from suicide.

Risk Factors in Plain Sight

Not surprisingly, some estimates suggest that up to 90% of suicides occur in people suffering from psychiatric issues. They may have bipolar disorder, schizophrenia, dementia, anxiety disorder or post-traumatic stress disorder or they may abuse substances, ­particularly alcohol. If you know a loved one who suffers from any of these, you likely already understand the importance of watchfulness. Likewise, if someone you know suddenly becomes overwhelmed by a death, job loss or a chronic or terminal illness, you should be on alert for trouble. 

But what about those problems you can’t see? Many psychiatric issues are ­undiagnosed—it’s estimated that only half of Americans experiencing major depression receive treatment, yet research consistently shows a strong link between depression and suicide. There are many other risk factors, as well, that may be hidden from your view. Examples…

Being a victim of trauma or abuse—experiences some people may never share—increases the odds of suicide.

Taking a medication—one that you don’t know someone is on or that you are not familiar with—that puts a person at risk. More than 200 commonly used prescription medications have been linked to increased suicide risk. 

According to a recent study, more than one-third of Americans take medications that may increase their risk for depression, and close to one-quarter take drugs that list suicidal symptoms as a side effect. As you might expect, medications to treat mental health issues, such as some types of antidepressants and sedatives, can fall into this category. But so do some birth control pills, steroids, beta-blockers, anticonvulsants, proton pump inhibitors, some antibiotics (including fluoroquinolones) and medications for acne, asthma, allergy and smoking cessation. 

Before someone you love starts a new drug, have him/her ask the doctor about risks or side effects and double-check with the pharmacist. If suicide is a potential side effect, have a discussion with the doctor about getting a different prescription. If suicidal thoughts are a possibility, be on the lookout for out-of-character behavior, including withdrawing from routine ­activities or changes in sleeping and eating patterns.

Watch for Red Flags

When someone is suicidal, it’s unusual if there aren’t any warning signs, but it can be difficult to see them. ­Everyone is busy with his own life and may not pick up on red flags. It may be months between visits with a friend, sibling or college-age child, making it hard to see a trend. The person considering suicide also is likely to hide his thoughts because of the stigma and shame associated with them. Someone who commits suicide may even have seemed “fine” the day before. 

That’s why it’s important to recognize clues that are a cry for help. The consensus-based list of warning signs, according to Suicidal Awareness Voices of Education are (in order of risk)…

  • Talking about wanting to die or to kill oneself
  • Looking for a way to kill oneself 
  • Talking about feeling hopeless or having no purpose
  • Talking about feeling trapped or being in unbearable pain
  • Talking about being a burden to others
  • Increasing the use of alcohol or drugs
  • Acting anxious, agitated or reckless
  • Sleeping too little or too much
  • Withdrawing or feeling isolated
  • Showing rage or talking about seeking revenge
  • Displaying extreme mood swings.

The Conversation You Must Have

If you see any of the red flags listed, you’re going to need to talk with the person. A common misconception is that just mentioning suicide can put the idea into someone’s head, but that couldn’t be further from the truth. Your willingness to talk actually can prevent a death. It’s certainly not an easy conversation to have, but providing support and connectedness with others during a difficult time are what therapists call “protective factors” because they make someone less likely to engage in suicidal behaviors. Still, what you say and how you say it can help or hurt the situation…

Avoid making the person feel guilty about his thoughts. Saying, “You wouldn’t be thinking about hurting yourself, would you?” sends the message that you really don’t want to hear what’s going on with that person, and his response likely will be to shut down. Nor should you minimize what the person is going through by referring to it as a “rough patch” or saying “Things aren’t that bad” or “You have everything to live for.” These statements reinforce the idea that the person is weak, increase feelings of guilt and hopelessness and make him think that he can’t tell anyone how he feels.

Bring up your concerns honestly and openly. Say, “I’m genuinely worried about you. Can we talk?” Start by asking, “Do you feel so bad that you think about committing suicide?” If the ­answer is “yes” or “sometimes,” follow that with, “Do you have a plan to kill yourself?” With each successive “yes” or “maybe,” gather as much information as you can while keeping the conversation going—“Have you thought about what method you would use?” “When are you thinking about doing this?”

Note: Even though it may be uncomfortable, it’s important to use the word “suicide” in the conversation. This person’s brain is focused on death and dying, and that’s what you need to ­connect with. Talking about it in a nonjudgmental, nonconfrontational way is more likely to make him accept help. 

Surely, you’ll be frightened if presented with affirmative answers or actual plans. Know, however, that there are immediate steps you can take to help…

Acknowledge what the person has said to you. Say, “I’m glad you shared that with me.” Other helpful statements: “You don’t have to go through this alone” or “Treatment does work.” 

Ask who else he has talked to. If your loved one has not already reached out to a doctor or a crisis hotline, suggest doing it together—“I’m worried about what you’re saying. Let’s call the National Suicide Prevention Lifeline at 800-273-TALK (8255) right now.” 

Do some research together. Go online and look at the suicide warning signs together, just as you would do for any sort of ache or pain, to help minimize the stigma of mental illness. Hopefully, this exercise will convince the person that it’s time to get help. 

Make an appointment. If the ­person doesn’t seem to be in imminent danger, reassure him that suicidal feelings are treatable. Together, call and set up a time for the person to see a mental health professional as soon as possible. Be tenacious about following up. If necessary, make the appointment yourself, and go to the appointment with him. 

Recognize an emergency situation. If you suspect imminent danger, call 911 or take your loved one to a hospital emergency room. Don’t leave someone alone if he seems to be at high risk. If he storms out or locks himself in a room, you may have to call for help. 

Important to know: Firearms are the most commonly used method of suicide among men in the US, and poisoning (including pills) is the most common method among women in the US, so also explain that you are removing ­access to these—or another method the person might have told you about.

Inserting yourself into someone else’s life this way is difficult, but—when it comes to suicide prevention—it’s necessary. Never worry about being intrusive or overbearing. Finding support, staying connected and limiting isolation can help save a life.