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The Trouble With Suicide and Extreme Emotional Distress

Updated on February 1, 2017

US Suicide Statistics

Suicide remains a major public health problem.  It is the 11th leading cause of death for all Americans.  Each year, more than 33,000 people take their own lives.  In addition, more than 376,000 are treated in emeremergency departments for self-infli
Suicide remains a major public health problem. It is the 11th leading cause of death for all Americans. Each year, more than 33,000 people take their own lives. In addition, more than 376,000 are treated in emeremergency departments for self-infli


If you, or someone you know, is in suicidal crisis or emotional distress

please call 1-800-273-TALK (8255).


Call for any of the following reasons:

  • Suicidal thoughts
  • Information on suicide
  • Information on mental health/illness
  • Substance abuse/addiction
  • To help a friend or loved one
  • Relationship problems
  • Abuse/violence
  • Economic problems
  • Sexual orientation issues
  • Physical illness
  • Loneliness
  • Family problems

Who should call?

  • Anyone who feels sad, hopeless, or suicidal.
  • Family and friends who are concerned about a loved one.
  • Anyone interested in mental health treatment and service referrals.

Worldwide Suicide Statistics

Already in this new century there have been more than 5 million suicide deaths worldwide. Each year approximately one million people in the world die by suicide. This toll is higher than the total number of world deaths each year from war and homicid
Already in this new century there have been more than 5 million suicide deaths worldwide. Each year approximately one million people in the world die by suicide. This toll is higher than the total number of world deaths each year from war and homicid

Suicide Crisis

A suicide crisis is different from suicide risk. A suicide crisis is an occurrence that signals immediate danger of suicide. A person in a suicide crisis is in immediate danger of carrying out a life threatening behavior that is intended to result in loss of their life. Suicide risk is a broader term that refers to factors that are associated with suicide risk, but do not necessarily indicate immediate risk of suicide.

An emergency response is appropriate when a person is in a suicide crisis. Calling the national suicide hotline, 911 or other emergency number is appropriate.

Driving the person to the emergency room and sitting with them through the admission process is also appropriate if they are agreeable. By staying with the person through the admission process you can ensure that he or she doesn't leave, and you can share pertinent information that the person in crisis might omit. This will help the professional make a more accurate assessment of risk and needs.

DO NOT leave the person alone.

DO remove knives, guns, sharp objects, prescription and over the counter medications and any other objects that can be used for suicide.


Precipitating Event: A recent event that is especially distressing, such as a loss.

Intense Emotional State in Addition to Depression: Feeling desperate with an urgent need for relief, rage, strong emotional pain or inner tension, anxiety, guilt, hopelessness, sudden and severe sense of abandonment.

Changes in Behavior:

  • Speech that suggests the person is close to suicide, such as, "My family would be better off without me," threatening, talking about or making plans for suicide, or comments that sound like the person is saying goodbye or going away.
  • Actions: buying a gun or asking to borrow one, giving away prized possessions, getting one's affairs in order.
  • Worsened Functioning at home, work, school or socially; increased use of alcohol or drugs; other self destructive behavior; loss of control, rage explosions.

Recognizing Depression

Depression is present if at least five or more of the following symptoms are present during a two-week period; at least one of the symptoms must be either depressed mood or loss of interest or pleasure in usual activities.

  • Depressed mood
  • Loss of interest or pleasure in usual activities
  • Change in appetite or weight
  • Change in sleeping patterns
  • Speaking and/or moving with unusual speed or slowness
  • Loss of interest or pleasure in usual activities
  • Decrease in sexual drive
  • Fatigue or loss of energy
  • Feelings of worthlessness, self-reproach or guilt
  • Diminished ability to think or concentrate, slowed thinking or indecisiveness
  • Thoughts of death, suicide, or wishes to be dead

Suicide Risk Factors

Risk factors alone do not predict suicide. A person with these risk factors may not think about or attempt suicide. However, a person who has one or more of these risk factors, does not have any protective factors and is showing signs of suicide crisis can be considered to be at heightened, if not immediate risk for suicide. Some risk factors can be reduced in order to reduce risk, such as taking prescribed medications stopping alcohol use, or talking to a therapist. Some factors cannot change; such as a previous attempt, a trauma history or a family history of suicide or depression.

Psychiatric Disorders: 90% of people who die from suicide have one or more psychiatric disorders that are recognizable and treatable.

  • Depression - Although most people with depression are not suicidal, most suicidal people are depressed. The most common combination is depression with alcohol and drug abuse.
  • Bipolar Disorder
  • Drug or alcohol abuse and dependence
  • Schizophrenia
  • Post Traumatic Stress Disorder (PTSD)
  • Eating Disorders
  • Personality Disorders - especially borderline and antisocial

Previous Suicide Attempt: Between 20 - 50% of people who die from suicide had previously attempted suicide. A person with a history of a past suicide attempt has a much higher risk of actually dying from suicide.

Genetic Predisposition: A family history of suicide, suicide attempts, depression or other psychiatric illnesses is a risk factor.

Neurotransmitters: Low levels of serotonin in the brain is associated with increased incidence of attempted and completed suicide in psychiatric patients. Serotonin is the neurotransmitter associated with depression. Antidepressants help correct the serotonin level.

Impulsivity: An impulsive person is more likely to act on feelings without thinking, and is more likely to act on suicidal impulses. Impulsivity is often associated with Attention Deficit Hyperactivity Disorder (ADHD), bipolar disorder, and substance use disorders.

Demographics: Men are three to five times more likely to commit suicide than women. Elderly Caucasian men have the highest suicide rates.

Risk Reduction and Protective Factors

Preventing suicide involves reducing risks and increasing protective factors. Efforts to help remove harmful objects, stop substance use, make treatment accessible and affordable, take medications as prescribed can decrease an individual's risk for suicide and decrease a community's rate of suicide. Since resistance to suicide is not permanent, efforts to reduce risk and maintain protection from suicide need to be ongoing as well.

Protective factors can include simply the absence of some risk factors, such as a person's genetic or biological characteristics, no previous suicide attempts, a pattern of thinking before acting, and a more positive and hopeful outlook on life in general. Other protective factors include:

  • availability of quality care for mental, physical and substance abuse disorders
  • access to care (transportation, insurance, financial support, handicap access, etc.)
  • restricted access to guns, knives, medications and other means of suicide
  • family and community support
  • ongoing medical, mental health and sober social support
  • skills in coping, problem solving, communication, feeling expression, healthy relationships
  • cultural and religious beliefs that discourage suicide and value life.

The Terry Wise Story: A Suicide Attempt Survivor

"Suicide doesn’t stand alone. It doesn’t just happen as the result of nothing out of nowhere. All the things that have been on simmer in your life come to a full boil."

Terry Wise

A longer version of this video is available and strongly recommended. When viewing on You Tube, hover over the top right corner of the screen and click on the link for the longer version.

Know the Facts: What's Your Suicide IQ?

view quiz statistics


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    • lorlie6 profile image

      Laurel Rogers 3 years ago from Bishop, Ca

      I see your point now, kimbho 39-yes, anger is indeed a form of emotional distress!!!!!

    • kimh039 profile image

      Kim Harris 3 years ago

      Thanks for your thoughts lorlie6, and it's good to "see" you again. Anger comes under intense emotional states under signs of a suicide crisis, such as rage, abandonment fears, pain of rejection. I generally look at pain and fear that underlies anger, such as the pain of feeling unwanted, unloved and unappreciated and the fear of losing face or being alone. I think your comment will serve to highlight the role of anger and the seriousness of the issue. Thanks for taking the time to post your thoughts.

    • lorlie6 profile image

      Laurel Rogers 3 years ago from Bishop, Ca

      kimho39, I find your Hub very interesting and informative, however I did not feel you touched upon anger being one of the sources of suicidal ideation. This is often seen as '...they'll be sorry when I'm dead' sort of thinking, yet it is a considerably serious issue. Often people feel life has dealt them so many crises that they find themselves in a furious mind set. I believe they feel not only hopelessness but concentrate fully on the impossible unfairness of their lives.

      I am truly not criticizing this writing at all, I simply hope Hubbers consider such considerations.

    • kimh039 profile image

      Kim Harris 7 years ago

      You're welcome, Dim. Thanks for reading and commenting. I hope your friend is getting better. That would be terrifying for his family. I wonder if he's tried DBT groups. They're really good for self harming behavior. I hope all is well with you this new year.

    • Dim Flaxenwick profile image

      Dim Flaxenwick 7 years ago from Great Britain

      Thank you for so much detailed information.l have a friend who seems to swing from self-harm to attempted suicide and back again. It´s a nightmare for families with someone threatening suicide.

    • kimh039 profile image

      Kim Harris 7 years ago

      Thank you, Nell. It is sad, even when you don't know the person directly and you're just hearing about them. Thanks for your kind comments, Nell, and for stopping by to post them! Happy Holidays.

    • Nell Rose profile image

      Nell Rose 7 years ago from England

      Hi, this is a very detailed and conprehensive hub, and if it even helps one person then that is fantastic. I heard only the other day that someone in my town had jumped from the bridge over the river. it is so sad. very well written, rated up nell

    • kimh039 profile image

      Kim Harris 7 years ago

      Yeah. It's good to understand the difference between a suicide crisis and risk factors - and how to repond to each. Thanks for stopping by to read and comment katiem.

    • katiem2 profile image

      katiem2 7 years ago from I'm outta here

      Now I understand the truth about suicide and the risk. Thank you for a truthful and helpful look at the trouble with suicide and extreme emotional distress. There is some confusion about this issue which takes away from the importance of difference of each. Well done! Love and Peace :)

    • kimh039 profile image

      Kim Harris 7 years ago

      Wow. You think, De Geek? Thanks. Sometimes I think I've become very calloused and de-sensitized. I appreciate your kind words.

    • De Greek profile image

      De Greek 7 years ago from UK

      Only a truly caring person would take the trouble to write this hub. Well done :-)

    • kimh039 profile image

      Kim Harris 7 years ago

      Thanks Lambservant. I mentioned the family history as a risk factor that can't be changed but did not include it in the list of risk factors. Partly, I was concerned that a reader might think that just because a family member died of suicide that they are somehow doomed, destined or fated to die of suicide themselves. The family connection is in the presence of psychiatric disorders that have a genetic component as well as how a person learns to cope in his or her family, and that person's attitude about getting treatment for psychiatric conditions, as it is primarily untreated psychiatric disorders that pose the risk. A risk factor doesn't predict suicide, but if a person has a family history of suicide, an untreated psychiatric condition and a recent precipitating event, they do have significant risk. Also, a person who gets very agitated, aggressive or anxious when depressed and abuses substances has a significant risk. Thanks for pointing that out lambservant...and for taking the time to read and comment and add to the discussion.

    • profile image

      Lambservant 7 years ago

      Excellent and needed information. People should also know that family members of one who has committed suicide are at extreme high risk of committing suicide themselves.

    • kimh039 profile image

      Kim Harris 7 years ago

      I'm sure she did! Thanks dahoglund.

    • dahoglund profile image

      Don A. Hoglund 7 years ago from Wisconsin Rapids

      Good background. My wife used to answer phones for a womens crisis center in a small community. Although it was not about suicide I believe she got some such calls.

    • kimh039 profile image

      Kim Harris 7 years ago

      Notice: Advertising has been re-enabled on this hub based on moderator review. Thank you moderator!

    • kimh039 profile image

      Kim Harris 7 years ago

      Thanks alekhouse. Sorry to hear you've lost so many to suicide. I was glad to see some information and support for survivors. I have worked with people who have lost loved ones to suicide, and it takes a toll on the survivor - especially when they feel guilty and blame themselves, often for years after. Anyway! Thanks for stopping to read and comment alek.

    • alekhouse profile image

      Nancy Hinchliff 7 years ago from Essex Junction, Vermont

      Great hub, Kim. I've been very close to several people who committed suicide, including an ex-husband. It's a terrible thing for everyone involved. The helpful info that is out there, the better. Good job!

    • kimh039 profile image

      Kim Harris 7 years ago

      Thank you Vern:) Happy Holidays!

    • vrbmft profile image

      Vernon Bradley 7 years ago from Yucaipa, California

      Awesome! Thanks for the directions! I've seen that before and never clicked!! literally!! December is a very very interesting month. Reindeers have it tough. People making fun of them, asking them if their name is Rudolph, and why isn't your nose red like it supposed to be, and do you still believe in Santa. Man, I feel sorry for those animals. Therapist have a difficult time as well as everyone likes to cancel even tho I go over it a hundred times, "You sure you want to schedule for next week with the holidays and all?"

      "Oh yea," they say and then cancel. Man, what that does to my budget! I have to journal on resentment for six weeks after Christmas! Of course shepherds also might have it bad, everyone wanting to use them for live Manger scenes without paying them anything. There aren't any wise men left in the world, so they have it easy!! "Christmas" trees have an interesting month as well. Get chopped down, decorated to the hilt, and then burned. What a way to end your career! Gift wrap doesn't have it much better unless you befriend one of those compulsive folk who will fold you gently and save you in a box with a bunch of other gift wrap. But that gets old, literally. I'm not sure what I am commenting on here, but I think I will stop!!


      P. S. Yes, I write like this when I am sober!!

    • kimh039 profile image

      Kim Harris 7 years ago

      I'm glad you asked that Vern. It is absolutely a MYTH that rates are higher at Christmas time. In fact, rates are lowest in December. I was going to add that, but it seemed like pointing out that something is a myth can contribute to the myth, especially if you never heard the myth to begin with!

      The holidays are very difficult for a lot of people, and not all peace and joy for everyone, so maybe that's where the idea came from. I didn't find the reason suicide is lower in December, just that it is; and I was also thinking it might be because of increased interaction/decreased isolation and withdrawal.


      In edit mode, on top right near your profile pic is a "settings" button. click that. uncheck "this hub may be considered commercial" and set ad level to "none".

    • vrbmft profile image

      Vernon Bradley 7 years ago from Yucaipa, California

      Kim, thanks for the informative hub. People always say to me something along the lines of "I bet you're busy during the holidays." I really am not even tho I would like to be! But I am not sure I would want to be too busy with suicide issues. But I read somewhere, and am not sure how true or statistically true it is (if there is a difference) that most people do fairly well during the actual holiday season because most families reach out in some way even to those family members that ordinarily they shun. BUT it is after the holidays that the depression sets in and the suicide rate goes up. Have you heard that?

      Anywho, you always write such informative, solid, and accurate blogs. Tell me how to shut off the adds. Where is that switch?


    • kimh039 profile image

      Kim Harris 7 years ago

      You're very welcome Micky Dee......and I hope all the veterans notice the link above for vets. Apparently VA worked with the Suicide prevention line to make sure vets have access if needed. Veterans are especially vulnerable and high risk. Thanks for stopping to read, Micky.

    • Micky Dee profile image

      Micky Dee 7 years ago

      Thank you for creating this hub Kim. God bless!

    • kimh039 profile image

      Kim Harris 7 years ago

      What a beautiful story HBN, and thanks so much for sharing it. I'm especially glad yours has a happy ending. Your mom's crisis follows the theory: there was a precipitant, depression, and statements she made. Thank God you were listening and knew what to do.

      It didn't occur to me until after I published it that the topic would raise content flags so I turned off the ads. This one is strictly a public service announcement.

      Thanks for reading and commenting Happyboomernurse. I love your comments.

    • Happyboomernurse profile image

      Gail Sobotkin 7 years ago from South Carolina

      Hi Kimh039,

      Thanks so much for this comprehensive article. My mother, who had always suffered from depression, became even more depressed after my father died. I was aware that she was suicidal and several times I brought her to my own house until I could get mental health services in place for her to go back home. She would promise to follow through but after one or two visits to a therapist or support group she'd say, "They can't bring your father back so why should I keep going?"

      One night she called me and in the middle of a regular conversation said very matter of factly, "I just wanted to tell you that I love you. I've taken 2 bottles of pills and am going to sleep."

      I lived 2 hours away and told her I was going to call an ambulance which I did despite the fact that she begged me not to. Her stomach was pumped in the ER and she may well have died if I hadn't called the ambulance.

      Fortunately, she finally got the intensive in patient mental health treatment that she needed and when she was discharged from the hospital she did follow through with treatment and also started going to a Senior Citizen center where she met a very loving man.

      It's now 20 years later and they're both frail but still living together in an assisted living facility. Mom still suffers from manic depression and sometimes needs to go to a geriatric mental health unit for adjustments in her medication but it is a blessing that support services are available for her and that most of the time she's able to live with the man that she loves.

      Your article has the potential to save lives and I'm glad you published it.