Stressful life events have also been shown to increase risk for suicidal thinking or attempt in some studies. Childhood abuse and early parental loss are among the greatest stressors. In some cases, stressful events probably interact with the other risk factors to precipitate suicide attempts.
For people who are feeling suicidal, the first step is to do what J. K. Rowling did: Tell someone. She called her general practitioner. The doctor (or therapist) then needs to determine the nature of the problem and the extent of the danger. In some cases hospitalization is clearly the right thing to ensure the patient is safe. Often, however, the situation can be managed, as it was for Rowling, in the outpatient setting.
Providers need to be clear with a patient that suicide is wrong, and that theirs is a life worth living. Providers need to make clear how devastating suicide would be to the people who care about the patient. And they need to emphasize that no matter how bad the patient feels, she has to battle to make the right choice, to not give in to suicidal urges.
"It is our choices that determine who we are," Professor Dumbledore tells Harry Potter.
Providers need also to mobilize the help of family and friends who care about the patient. I had a patient who was living alone and became intensely suicidal. He had not told anyone about his dangerous state of mind. We called his sister, who decided to take two months off from work and drive 1,000 miles to stay with him until he felt better. He did eventually, and she was able to return home.
The other key is to treat the underlying conditions, such as depression or bipolar disorder. One patient felt suicidal every day for 30 years, from the time she was a teenager. Then, a week or two after a psychiatrist prescribed lamotrigine, those thoughts vanished, never to return.
Kudos to J.K. Rowling for talking openly about her experiences. This is heartening to stigma busters everywhere, such as the American Foundation for Suicide Prevention (AFSP), for which I serve on the Scientific Review Board. AFSP sponsors Out of the Darkness Community Walks to raise awareness, as well as money for suicide prevention research. Help AFSP drive away the Dementors!
If only we could wave a magic wand.
Dr. James Potash is an associate professor of psychiatry and co-director of the Mood Disorders Program at the Johns Hopkins School of Medicine in Baltimore. If you have questions or comments, please e-mail at firstname.lastname@example.org. To participate in our genetic and clinical studies, call 877-MOODS-JH.