September is National Suicide Prevention Month. As with most conditions, awareness is key, but mental health issues are invisible diseases. Many people living with chronic pain – another invisible illness – also suffer from mental health challenges, with both often going untreated. In fact, those with chronic pain experience mood disorders such as depression and anxiety disproportionately.

An estimated 800,000 people attempt suicide every year, with those in chronic pain more likely to attempt and complete suicide than those without chronic pain, even without a history of depression. National Suicide Prevention Month is not just about building awareness of how many people suicide affects each year. It’s also about recognizing red flags and actively getting involve to prevent suicide.

Contrary to popular belief, the potential for suicide is not necessarily easy to predict. Many people are astonished when a loved one attempts or commits suicide. Upon reflection, they may be able to see the red flags that may have given them clues. These clues are essential to suicide prevention. Patients with chronic pain and their caregivers can be on the lookout for the following red flags.

Talking about feeling hopeless

Those who attempt or commit suicide feel as if they have nothing to live for. Even family and friends are not enough to sustain them. While everyone may experience momentary feelings of hopelessness, especially during grief or after a traumatic event, those who are at risk for suicide talk about this feeling regularly and will not be convinced otherwise.

Hyperfocus on being in pain

It is easy to understand that a person suffering from chronic pain may be focused on their pain during their worst days. Sometimes it is all a patient can do to feed themselves or perform basic functions. A person at risk for suicide is often hyperfocused on their pain at all times. Some research indicates that hyperfocus can actually increase a patient’s perception of pain, even if the pain is the same.

Extreme mood swings

Anyone can experience mood swings for a number of different reasons, but people at risk for suicide experience extreme emotional swings, sometimes very rapidly. They may move from an elated, euphoric state to a deep depression over the course of just a few hours. Extreme mood swings indicate unbalanced thinking and can contribute to an increasingly negative outlook that doesn’t necessarily reflect reality.

Change in sleeping and eating habits

Sleeping habits at both ends of the spectrum – insomnia and utter fatigue – are a red flag for a person at risk for suicide. Likewise, a person who experiences changes in eating habits, from eating constantly to not at all or vice versa, may also be struggling.

Feeling trapped or like they are a burden

Chronic pain patients may rely heavily on another person to do everyday tasks that they previously performed with ease. Over time, this feeling of being helpless, trapped, or a burden can wear on a person, causing them to contemplate suicide as a way to relieve the other person of their caregiving duties.

Increased use of drugs or alcohol

Increased drug and alcohol use may be a way for a person contemplating suicide to numb themselves to whatever they are feeling physically, mentally, and emotionally. Chronic pain patients who have been prescribed opioids are playing with fire when they combine their prescriptions with any other drugs or alcohol. This combination may end up being deadly, either accidentally or on purpose.

Saying goodbye or “getting their affairs in order”

A person who sets up a will, writes goodbye letters or seeks friends and family out to say goodbye in person, or otherwise handles anything that might be confusing in the wake of their death is a person who is seriously considering and possibly planning suicide. This may be the final stage before an attempt.

Talking about wanting to die or researching ways to kill themselves

If anyone talks about wanting to die or begins to conduct research on how to kill themselves, take this red flag very seriously. This may be the last chance to intervene before a suicide attempt. It is important that patients and caregivers recognize that the idea of suicide has moved from a hazy possibility to a concrete reality the moment a person begins looking at their options. Do not hesitate to step in.

Any one of these factors can be considered a red flag and should be taken seriously. Caregivers and patients may recognize and intervene in different ways.

Caregiver interventions

The following are some ways that a caregiver can intervene if they suspect their friend or family member may be contemplating suicide.

  • Share your concerns: Talk to the patient in a non-threatening way about your concerns. Start by indicating the changes you’ve noticed, and ask how they are doing. Keep the conversation light at first and encourage them to talk openly. Withhold judgment and just listen.
  • Offer support: Call a crisis line, encourage positive changes in lifestyle, remove potential means of suicide (pills, knives, razors, etc.), and let the patient know you are with them for the long haul.
  • Develop a crisis plan: Help the patient recognize their suicidal thoughts and develop a safety plan if they begin to feel pulled towards an attempt. This can include concrete steps such as calling a friend or taking a walk, giving themselves time to think it through.

Many caregivers hesitate to intervene, feeling like they will embarrass or offend the patient. Embarrassment and anger are a small price to pay for saving someone’s life. If you are a caregiver and feel like the threat of suicide is imminent, don’t hesitate.

Patient interventions

Many patients who experience suicidal thoughts recognize that they are in trouble but don’t know how to ask for help. Mental health issues remain taboo in the U.S., and suicide is often talked about in whispers, if at all. Patients may have limited resources where they are, or they may not want to cause any more trouble than they already have.

Fortunately, it is possible to get help at any hour of the day or night, anonymously if necessary. Patients experiencing suicidal thoughts or impulses can contact the National Suicide Prevention hotline 24 hours a day, seven days a week. This number is available for emergency crisis intervention or just talking through difficult feelings or thoughts.

As much as possible, patients need to allow themselves to reach out and ask for help. Recognizing the existence of red flags is the first step. The next is to give themselves permission to seek assistance.

National Suicide Prevention Month focuses on making every day matter. How do you make every day matter for yourself and your friends and family?

Image by Raffaele Esposito via Flickr


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