Why do people kill themselves? It's a question at the heart of suicide prevention: If we know the circumstances surrounding the act, we can better know how to stop it.
One myth, for example, is that suicide isn't impulsive, and people will simply resort to other methods if some lethal means — like guns — aren't available to them.
But Jill Harkavy-Friedman, vice president of research for the American Foundation for Suicide Prevention, told me years of research show that suicides tend to be fairly impulsive acts during short-term crises, and they can be caused by multiple factors that sometimes may not be perfectly clear to the public or even friends and family.
One of the key factors, Harkavy-Friedman said, is access to lethal means, such as guns. Citing research from Israel, she argued that people considering suicide are often in a fairly stubborn, albeit temporarily so, mindset. So if the method of suicide they want to use isn't available, they might give up on the act altogether — and survive. That helps explain why, for example, access to guns closely correlates with the number of suicides.
"Time is really key to preventing suicide in a suicidal person," she said. "First, the crisis won't last, so it will seem less dire and less hopeless with time. Second, it opens the opportunity for someone to help or for the suicidal person to reach out to someone to help. That's why limiting access to lethal means is so powerful."
I spoke to Harkavy-Friedman by phone to learn more about the causes of suicide. A transcript of the conversation follows, edited for length and clarity.
Most suicides are impulsive, but a lot of long-term factors can contribute to the trigger event
German Lopez: How impulsive are suicide attempts?
Jill Harkavy-Friedman: When we talk about suicide, it's important to understand the process. It's not that people suddenly become suicidal. But it's a complicated behavior that comes from both longer-term and underlying factors that can contribute to it, like mental health conditions, past suicide attempts, physical or chronic illness or pain, traumatic brain injury, and abuse as a child. There are those underlying factors, although they don't necessarily mean you're going to kill yourself.
Then there are more acute factors, like chronic stress and more recent stressors.
Many factors come together. Then the person has to have access to lethal means.
The main feelings are usually ambivalence, and an idea that there's no alternative, because the thinking is inflexible. So you get this idea, and you believe there are no other options.
But when they're thinking more healthily, people know there are other options, or they might have to learn through treatment to come up with other options.
In a person who is likely to engage in suicidal behavior, that moment can happen very quickly. It can happen within five minutes of deciding to attempt, or an hour, or three hours, or 10 hours.
But we also know from people who made near-lethal suicide attempts and survive that even in the midst of it, they wish they hadn't done it.
German Lopez:You mentioned five minutes to 10 hours. That seems like a really quick turnaround.
Jill Harkavy-Friedman: Yes. There are studies that show the majority of suicide attempts are within three hours [of people deciding to kill themselves].
Many warning signs can pop up over a person's life — and it's important to not be dismissive
German Lopez: So to understand that correctly, somebody has some sort of short-term crisis, and within five minutes they'll attempt?
Jill Harkavy-Friedman: Right. They may be thinking about it in some way for a long time. There could be what we think of as a triggering event, whether it's losing a job or being bullied. But we should also go to all the other stuff that's going on underneath.
After people die, when you go back, look at what happened, and conduct what's called a psychological autopsy, you almost always find signs that the person was in the throes of a mental health condition — although they may not have known it, and they may not have been diagnosed.
There also could have been substances involved at the time of death, which can increase the likelihood of risky behavior and decrease the ability of people to stop themselves if they're going to do something bad.
In hindsight, you realize things were different for that person. It comes from looking more carefully, rather than it being out in the open. But sometimes you'll know that somebody is at risk, and we do the best we can to try to help them through that; it's not like we never know.
There are many things that we can educate people to look for: changes in mood, changes in drinking or drug use, or changes in appetite, weight, sleep, grades, or work. All of those things can be signs.
But we tend to be very forgiving. We'll say that someone is in a bad mood, or they're teenagers.
So it's hard. We have to start thinking about several things together to see if someone is really at risk.
Removing access to lethal means, like guns, can make a huge difference
Jill Harkavy-Friedman: Time is really key to preventing suicide in a suicidal person. First, the crisis won't last, so it will seem less dire and less hopeless with time. Second, it opens the opportunity for someone to help or for the suicidal person to reach out to someone to help. That's why limiting access to lethal means is so powerful.
There was an interesting study done in Israel. They were having trouble with suicide in the military. It used to be that Israeli soldiers carried their weapons with them at all times. So they had soldiers leave their weapons on base over the weekend when they went home. They had a 40-percent drop in suicide rates.
It also showed that if we keep the method of suicide away from a person when they consider it, in that moment they will not switch to another method. It doesn't mean they never will. But in that moment, their thinking is very inflexible and rigid. So it's not like they say, "Oh, this isn't going to work. I'm going to try something else." They generally can't adjust their thinking, and they don't switch methods.
Limiting access to lethal means won't stop all suicides, but it can make a significant dent in the problem.
It's important to look at a comprehensive set of factors, instead of blaming one thing
German Lopez:How important is it to look at a set of comprehensive, long-term factors instead of the acute factors?
Jill Harkavy-Friedman: There's no single cause of suicide. There's many factors — biological and psychological functions — coming together. There will usually be one or more triggers or stressors. And then there's access to lethal means. You can't just say one thing causes it; you have to look at what's going on as a whole with that person.
One thing to remember also is that if you have a crisis and then feel better, you're still usually more sensitive for quite some time.
I think about it like breaking a bone. The bone heals within six weeks. But you still have pain and discomfort for at least a year. Depression works that way, too.
So if there are changes so you're out of depression, you're still at risk for depression within months. That takes time and treatment to address.
If you are considering suicide, please seek help through the national suicide prevention lifeline at 1-800-273-8255.