Typical warning signs of suicide or suicidal thoughts include:

• Talking about suicide, including making such statements as "I'm going to kill myself," "I wish I was dead" or "I wish I hadn't been born"
• Securing the means to commit suicide, such as getting a gun or stockpiling pills
• Withdrawing from social contact and wanting to be left alone
• Dramatic mood swings, such as being emotionally high one day and deeply discouraged the next
• Being preoccupied with death, dying or violence
• Feeling trapped or hopeless about a situation
• Increased use of alcohol or drugs
• Changing normal routine, including eating or sleeping patterns
• Engaging in risky or self-destructive behavior, such as using drugs or driving recklessly
• Giving away belongings or getting affairs in order
• Saying goodbye to people as if they won't be seen again
• Developing personality changes, such as becoming very outgoing after being shy

Warning signs aren't always obvious, though. You may try to keep your suicidal thoughts and feelings secret.

Types of suicidal behavior
Suicide is actually a complex set of behaviors that exists on a continuum, from ideas to actions, including:

• Suicidal ideation. Having thoughts of harming or killing yourself.
• Suicidal behavior. Engaging in acts intended to cause your death, or acts that while unlikely to cause your death indicate that you're self-destructive or suicidal. These may include overdosing, reckless driving or excessive drinking.
• Suicide attempt. This is a nonfatal, self-inflicted destructive act that was intended to cause your own death.
• Parasuicide. This is an act that may resemble suicidal behavior but that isn't intended to cause your death. Such acts may include deliberately injuring yourself, such as cutting. Some people find these acts emotionally soothing. These acts may result in accidental death.
• Completed suicide. This is taking your own life.

It's important to understand the types of suicidal thoughts, behaviors and intent in order to get the appropriate type of treatment.

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Suicide and suicidal thoughts have numerous causes. Most often, suicidal thoughts are the result of an inability to cope when you're faced with what seems to be an overwhelming life situation — financial problems, a personal crisis, emotional turmoil and despair, for instance. If you don't have hope for the future, you may think suicide is a solution when, in fact, it's not. You may experience a sort of tunnel vision, where in the middle of a crisis you believe suicide is the only way out.

Emerging evidence suggests that there may also be a genetic link to suicide. People who complete suicide or who have suicidal thoughts or behavior are more likely to have a family history of suicide. While more research is needed to fully understand a possible genetic component, it's thought that there may be a genetic link to impulsive behavior that could lead to suicide.

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Because of its devastating toll, suicide is considered one of the biggest public health problems worldwide. In the United States, suicide is the 11th-leading cause of death, with 32,000 suicides a year, or about 89 a day. Among Americans ages 10 to 24, it's the third-leading cause of death, accounting for about 4,600 deaths a year.

There are many more suicide attempts than actual suicides, and hundreds of thousands of people are treated every year for self-inflicted injuries. Overall, there's one completed suicide for every 25 attempts.

Men are more likely than women to complete suicide because they typically use more lethal means, such as a firearm. Women are more likely to attempt suicide, though. Males over age 75 have the highest suicide rate.

Factors that increase the risk of suicide include:

• A prior suicide attempt
• Having a psychiatric disorder, such as depression, bipolar disorder, schizophrenia or personality disorders
• Being intoxicated by alcohol
• A family history of mental disorders or substance abuse
• A family history of suicide
• A family history of violence, including physical or sexual abuse
• Having firearms in the home
• A significant medical illness, such as cancer or chronic pain
• Social isolation, or feeling alone
• Legal or disciplinary problems, especially among children and young adults ages 10 to 24
• School problems
• Having never been married
• Feeling hopeless
• Impulsive or reckless behavior
• Having limited life activities because of health problems caused by combat

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It's perfectly normal to occasionally feel sad, upset or unhappy with situations in your life. But if these feelings are intense, linger for weeks, months or even years, or leave you thinking about suicide or harming yourself or someone else, seek medical help as soon as possible. Suicidal thinking usually doesn't get better on its own, and it may lead you to take drastic steps to cope with your pain.

If you don't feel at immediate risk of acting on feelings of suicide or self-harm, contact your primary care doctor or other health care provider or mental health provider. If you're reluctant to seek treatment, try to work up the courage to confide in someone else about your feelings, whether it's a friend or loved one, a health care professional, a faith leader, or someone else you trust. They can help you take the first steps to successful treatment.

If you're considering suicide or self-harm now and have the means available, reach out to someone immediately for help. The best choice is to call 911 or your local emergency services number. If you simply don't want to do that, for whatever reason, you have other choices for reaching out to someone to stay safe:

• Contact a family member or friend
• Contact a doctor, mental health provider or other health care professional
• Contact a minister, spiritual leader or someone in your faith community
• Go to your local hospital emergency room
• Call a crisis center or hot line

Helping a loved one with suicidal thoughts
If you have a loved one you think may be considering suicide, have an open and honest discussion about your concerns. You may not be able to force someone to seek professional care, but you can offer encouragement and support. You can also help your loved one find a qualified doctor or mental health provider and make an appointment. You may even be able to go to an appointment with him or her.

If you have a loved one who has harmed himself or herself, or is seriously considering doing so, take him or her to the hospital or call for emergency help.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Current U.S. health guidelines don't recommend screening the general public to see if someone is having suicidal thoughts or behavior. But if your health care provider believes you may be at risk of suicide or that you have suicidal thoughts, he or she may ask you about it in more detail. This will help ensure that you're getting the proper treatment.

When you see a health care provider for the first time, whether on an emergency basis or not, you'll have a detailed evaluation. This evaluation will help determine the nature of your suicidal thoughts and behavior. Such assessments generally include discussion about:

• Specific plans you may have for suicide
• Your past suicidal or self-injurious behavior
• Review of previous treatment and diagnoses
• Your family history of suicide or mental illness
• Your current living situation and circumstances
• Stressors in your life, such as work, finances or relationship problems
• Changes in your mood or behavior
• Your use of alcohol or substances

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Suicide and suicidal thoughts have many potential complications. The most obvious and tragic, of course, is death.

But suicide and attempted suicide exact a toll in other ways, too — both for those who want to take their own life and their loved ones. You may be so consumed by suicidal thoughts that you can't function in your daily life, for instance. And while many suicide attempts are impulsive acts during a moment of crisis, they can leave you with permanent serious or debilitating injuries, such as organ failure or brain damage.

For those left behind after a suicide — people known as survivors of suicide — grief, anger, depression and guilt are common.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Treatment of suicidal thoughts and behavior depends on your specific situation, including your level of suicide risk.

Emergency situations
If you're in a crisis or emergency situation, the first goal is to keep you safe from harming yourself. You will first have a psychiatric evaluation. Psychiatric hospitalization may be recommended if:

• You've made a near-lethal or violent suicide attempt
• You're in a psychotic state
• You lack a strong support system that could help keep you safe
• You're acting impulsively or recklessly
• You have strong or persistent urges to take your life

While in the hospital, you'll receive necessary medical care. You'll also receive treatment for any mental health disorders you may have, such as depression, schizophrenia or bipolar disorder. This treatment may include medications, psychotherapy or electroconvulsive therapy (ECT).

Nonemergency situations
If you have suicidal thoughts but aren't in a crisis situation, your care may be able to take place on an outpatient basis. This treatment may include:

• Psychotherapy. In psychotherapy, also called counseling or talk therapy, you explore the issues that make you feel suicidal. You and your therapist can work together to develop treatment plans and goals. If you were already in therapy, you and your mental health provider may meet more frequently until your thoughts of suicide are better managed.
• Medications. Antidepressants, antipsychotic medications, anti-anxiety medications and other medications for mental illness can help reduce symptoms, which can help you feel less suicidal.
• Addiction treatment. Alcohol and substance abuse can worsen thoughts of suicide and make you feel impulsive enough to act on your thoughts. Treatment for drug or alcohol addiction can include detoxification, addiction treatment programs and self-help group meetings.
• Family support and education. Your loved ones can be both a source of support and conflict. Involving them in treatment can help them understand what you're going through, give them better coping skills, and improve family communication and relationships.

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Prevention of suicide involves both individuals and communities. Suicide prevention strategies include:

• Learning the warning signs of suicide and suicidal behavior
• Honest discussion with someone who may be suicidal
• Increasing access to mental health care
• Learning skills such as resilience and assertiveness
• Anger management
• Conflict resolution
• Improved awareness among primary care doctors of suicide risks and warning signs
• Restricting access to lethal weapons of suicide, such as not keeping guns in your home
• Better treatment of depression and other mental illnesses
• Developing a strong network of friends and social support

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Don't try to manage suicidal thoughts or behavior entirely on your own. It's best to seek professional medical care. But you can become an active participant in your care. You can do some things for yourself that will build on your treatment plan. In addition to professional treatment, follow these self-care steps:

• Stick to your treatment plan. Don't skip therapy sessions, even if you don't feel like going.
• Take your medications as directed. Even if you're feeling well, resist any temptation to skip your medications. If you stop, your negative feelings and thoughts may come back. You could also experience withdrawal-like symptoms from abruptly stopping an antidepressant or other medication.
• Learn about your condition. Learning about your condition can empower you and motivate you to stick to your treatment plan. If you have depression, for instance, learn about its causes and treatments.
• Pay attention to warning signs. Work with your doctor or therapist to learn what might trigger your suicidal feelings. Make a plan so you know what to do if suicidal thoughts return. Contact your doctor or therapist if you notice any changes in how you feel. Consider involving family members or friends in watching for warning signs.
• Get active. Physical activity and exercise have been shown to reduce depression symptoms. Consider walking, jogging, swimming, gardening or taking up another form of exercise you enjoy.
• Avoid drugs and alcohol. Alcohol and illicit drugs can worsen suicidal thoughts. They can also make you feel less inhibited, which means you're more likely to act on your thoughts.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.