“Suicidal thoughts are a red flag when you need to drop everything and go to the doctor”

“I’ll jump off the roof and die, I’m sure everyone will feel better,” the girl said in a trembling voice as she entered the psychologist’s office.

Suicidal thoughts are a fairly serious risk factor; in most cases they do not lead to suicide, but their presence is frightening.

You can live a completely wonderful life, have a family, a good car, a loving person, but one day you feel an irresistible desire and, unexpectedly for those around you, break down.

Thoughts about suicide can be episodic or obsessive, unformed or in the form of detailed planning.

Such thoughts bring a lot of discomfort into a person’s life. Possible sleep and appetite disturbances. These thoughts are mentally and physically exhausting.

The sages say that everything in the world has a reason. And suicidal thoughts are no exception. This kind of thoughts can be a consequence of mental disorders of organic origin, as well as a consequence of traumatic or shock situations.

What are the thoughts of suicide?

• The world is terrible, full of evil, there are very few good people;
• My situation is hopeless;
• Life is scary;
• I won't be able to achieve that in life;
• I will never be happy;
• Non-existence is a good break from life;
• Suicide is the only way out;
• By committing suicide, I will unite with my loved one who is already THERE.

Have you ever felt the urge to commit suicide? Perhaps you have heard such a desire from your loved ones or friends?

“I want to die” is often said in a situation of hopelessness, despair, or unexpected news. “I’m leaving you,” “your mother has died,” “you’re fired,” it’s so difficult to agree with this and it’s difficult to live and feel all those feelings that come at the moment of news.

Symptoms

Suicidal thoughts are accompanied by a number of symptoms such as:

• Loss of appetite or, conversely, gluttony
• Insomnia
• Physical and mental fatigue

Suicidal ideation most often involves two or more types of thought patterns, such as:

1. Obsessive fixation on the thought of planning an act of suicide.

2. The belief that there is no hope, and the only way to get rid of pain is by dying.

3. The belief that existence is meaningless or uncontrollable.

4. The feeling that thoughts are as if in a fog and it is difficult to concentrate on what is happening.

To date, quite a lot of calls related to suicidal thoughts have been recorded in Russia. In the latest study by the Institute of Public Opinion Questionnaire, 39% of Russians have ever had thoughts of suicide. Children are least likely to experience suicidal thoughts. A study has shown that thoughts of suicide are more common in women than in men.

In children, suicidal thoughts in a child (before the teenage crisis) are rare, because children have an instinctive fear of death. Here he either watched enough films with suicide attempts, or somewhere he heard conversations about such things. Less often, a child wants to die because of the death of one of his loved ones, believing that in this way he will be reunited with them.

Ideas to commit suicide are common among teenagers. This is due to the age crisis and hormonal surge.

As you can see, the statistics are quite critical.

I have suicidal thoughts among people of different ages, status and gender, and do not depend on their financial status. The appearance of such thoughts is difficult to predict; they are often a reaction of the psyche to various kinds of stress and are not satisfied with the quality of life.

How to help yourself deal with thoughts

Analyze why thoughts of suicide occur. Think how much grief your decision will bring to your loved ones.

Be sure to do something. Throw yourself into work or play sports. Make a schedule where every minute is busy. Leave only time for proper sleep.

Change your life:

• move to another city;
• change jobs;
• get additional education.

New experiences distract from negative thoughts.

Pay attention to the spiritual:

• visit your church;
• talk to the priest;
• help the monks with heavy physical activities.

For some, this helped them reconsider their value system.

A positive attitude can help combat suicidal thoughts.

Of course, it will not appear immediately, it will take time, but if you put in every effort, you will definitely succeed:

1. Believe in yourself.
2. Do things that make you feel strong and successful.
3. Don't think about the people who hurt you - they are in the past.
4. And most importantly, free yourself from the opinions of others - this is your life and you have the right to take control of it.

Causes

The thought of suicide is like a beacon that what is happening is not suitable and the only right decision at this moment seems to be death.

Our psyche is structured in such a way that we react to every event in one way or another. The appearance of obsessive ideas about leaving life is the result of the fact that a person does not find a way out. The psyche perceives the critical situations described earlier as irreversible, as a result of which the purpose of life disappears. And the more traumatic the event that led to such a desire, the more difficult it is to cope. Thoughts are the same reaction as words or body movements. The topic of suicide is quite delicate and it is best to explore it accompanied by a psychologist. But it is not always possible and resources to reach a specialist, which is why today we will talk about methods of introspection and self-help when thoughts of suicide arise.

The process of experiencing certain life difficulties can provoke suicidal feelings, for example:

• mental health problems;
• bullying or restriction of rights on any grounds by others;
• domestic abuse;
• death of loved ones;
• separation from a partner;
• long-term physical pain or illness;
• inability to accept drastic changes in life, such as becoming disabled, expelled from school, or fired;
• money problems or loss of housing;
• rejection or feelings of loneliness;
• imprisonment;
• feeling like a failure.

Talk about the situation

There is an opinion that the mention of suicide can make a person think about it, but this is a myth. The benefits and risks of asking research participants about suicide: A meta-analysis of the impact of exposure to suicide-related content. . If you talk openly with your friend, it will be easier for him to see other options to solve the problem.

Find a comfortable environment

The conversation will likely be very difficult, especially for your friend. Please note that he may feel guilty and ashamed about his intention. Start a conversation where there will be no distractions. Ideally, in a calm, familiar environment.

Touch on the topic of suicide

Start with these questions:

• How do you cope with everything that has befallen you?
• Do you ever feel like you just want to give up?
• Do you often think about death?
• Are you thinking about hurting yourself?
• Have you tried this before?

Speak openly and clearly

Avoid general phrases that may seem accusing (“You keep saying that life has become impossible”). Be more specific, for example: “Over the past few months, I've noticed that you no longer feel happy about the things that used to make you feel good. You stopped spending time with your children." Show that you started this conversation to show you care.

Perhaps at first the interlocutor will act bewildered or laugh at your words. However, if you notice serious red flags, don't let him move the conversation to another topic.

Don't judge

It may seem to you that your friend is wrong in his assessment of events, that everything is not so scary for him. Remind yourself that you cannot fully understand what is going on inside him.

Forget about the widespread opinion in society that suicide is a way out of selfish, crazy or immoral people. Suicidal ideation is the result of a medical condition that is treatable and for which your friend is not to blame.

Don't use phrases that can hurt

Your point of view will not necessarily help a person look at his problems differently. It may seem like you just don't take them seriously. Therefore, do not say phrases like “It’s not that bad.”

Also avoid statements that make you feel guilty, such as, “You have so many reasons to live,” or “Think about how your death will upset your family and friends.” Instead, be compassionate and say, “It must be really hard for you to be having these thoughts.”

Listen and show empathy

This conversation should make your friend feel loved and supported. Try to put yourself in his place and listen without criticism. Look the other person in the eye and show your openness through your body language.

Words of support and encouragement are important, but let the other person talk first. Don't interrupt him. After he has spoken, express your point of view. Mention that suicide is a permanent solution to a temporary problem. Assure that you and other loved ones will help you find alternative solutions to the situation.

Let your friend know that you love him and that he is an important part of your life. Emotional support at such a time is a very important incentive to live on.

Where to contact

If you have thoughts of suicide, make an appointment with a psychologist or psychiatrist in your city. If this is not possible, call the hotline of the psychological assistance center in your city. Your call will be completely anonymous, and you don’t have to worry about anyone finding out about your suicidal thoughts. You will not be asked to change your mind about dying or not to think about suicide. They will listen to you, support you, share your feelings and thoughts, this will reduce the level of tension and anxiety when such thoughts arise.

Perhaps in the process of dialogue you will become more clear about what pain you want to “kill” by committing suicide. Or maybe you want to attract someone’s attention or someone you want to punish with your death.

Seek outside help

You are not a therapist and you don't have to be one. Your task is to show concern for your friend and be there for him. Most likely, for the desire to live to return, you will need professional help.

Suggest seeing a therapist

If a person has depression, regular communication with a therapist to discuss suicidal thoughts and their triggers can prevent a suicide attempt. This is especially important for those who have attempted suicide before. These people have an increased risk of reattempting, and psychotherapy reduces Cognitive Therapy for the Prevention of Suicide Attempts. it is almost 50%.

Call an ambulance or support hotline

If a friend continues to talk about suicide and even hints that he will commit suicide in the near future, do not try to cope alone. He needs qualified medical assistance. Call an ambulance, according to the law, Article 29 of the Federal Law of the Russian Federation, a person can be hospitalized if he is going to harm himself.

If there is no immediate threat to life, but the desire to commit suicide still persists, call one of the psychological help hotlines. They can help both those who are thinking about suicide and their loved ones.

Enlist the support of others close to you

Love and care can help a person look at his life differently. Moreover, if people from your inner circle know what words and sentiments to pay attention to, they will not miss alarm bells. Naturally, talk only to those you completely trust and who can really help.

Don't forget to take care of yourself too

Helping someone else cope with such a serious problem is very difficult. This causes stress for loved ones and takes a lot of energy. Therefore, monitor your own emotional and physical state. Don't keep everything to yourself, discuss your feelings with people you trust. This will help you get through the situation easier.

Forced treatment

In accordance with the current legislation of our country, compulsory treatment is allowed after a suicide attempt. if relatives try, they are advised to call an ambulance. The patient is hospitalized in a hospital. He is undergoing treatment in the psychosomatic department.

During the first few days, relatives and friends are not allowed to see the patient. After the patient regains consciousness and recovers a little, he can be visited in the presence of a medical professional. First, the doctor gives recommendations to relatives on how to behave with the patient. After a certain time, the clinic staff will establish contact with the patient and instill in him a desire for life, thanks to the use of special psychotherapeutic techniques. Compulsory treatment after suicide is recommended to be carried out without fail, which will eliminate the possibility of relapse.

Suicidal ideation in terminally ill people

Contents Who is at risk?

What can be a harbinger of suicidal thoughts?

“Bad” signals - what are they? What to pay attention to.

What to do if there are signs of suicidal thoughts?

Bad option: a seriously ill person attempted suicide. What to do?

Does it happen that “nothing was foreshadowed”, but a person attempted suicide?

According to alarming statistics: with a high frequency of depression in palliative patients (and this is one third of all terminally ill people), the proportion of suicide attempts in the terminal stages is 86% (source: “Depression in somatic and mental illnesses” by A.B. Smulevich). Humanly speaking, this is understandable. We all know that someday we will finish our earthly journey, but when the doctor “starts the countdown” by transferring the patient to palliative care, this abstract “someday” takes on the concrete outlines of days, weeks, months.

During this period, patients especially need the help of specialists who can reassure and support the natural desire for any person to live as long as possible. But the attention and support of loved ones and those caring for him are no less important. For those who are close to a terminally ill person, we have compiled a short guide on how to recognize suicidal thoughts or intentions in them and help them cope with them.

Nadezhda Lustenko , a psychotherapist at the Moscow Multidisciplinary Center for Palliative Care,
helped compile it Who is at risk?

• People suffering from a concomitant mental disorder - primarily depression;
• People with certain personal characteristics: hot temper, a tendency to impulsive actions, violence or total control;
• People who are addicted to alcohol or drugs;
• People with a family history of suicide attempts in relatives;
• People who have experienced the severe loss of loved ones.
  Anxiety and depressionHow to Help a Patient Cope with Disorders Bruce Cleminson

  Symptomatic treatment

A serious, incurable illness is in itself a factor that can cause thoughts of suicide.

Depression is a serious mental illness. It has many different symptoms, which can manifest differently in each individual case. In mild forms of depressive states, people are characterized by depression, apathy, isolation, and a persistently bad mood. If a strong feeling of melancholy or anxiety does not leave a person for more than two days, you need to pay attention to this and take action. Symptoms usually appear gradually and develop over a long period of time.

Clinical depression is a rapidly increasing set of symptoms that appears suddenly or gradually develops from a mild form. In addition to psychological discomfort, physiological discomfort is also added. In this case, such a “traditional” marker as a depressed mood may be absent. Sometimes this misleads the patient’s loved ones and they miss the moment when the person can no longer cope without qualified help. Experts call this type of disease “smiling” or masked depression.

Symptoms of clinical depression:

Sudden decline in mood

. The person feels useless and helpless. He suffers from feelings of guilt, self-abasement and various fears.

Behavior change

. In a normal situation, a person begins to behave inappropriately - cry, get angry, show aggression.

Loss of interest in the world.

The emotional reaction to something disappears or sharply decreases. Sometimes visual, auditory, and taste perception worsens.

Physical manifestations.

Appetite decreases, sleep is disturbed, weakness, pain in muscles and joints occurs.

In severe clinical depression, mental disturbances may occur, including hallucinations and delusions.

Severe somatic manifestations: pain, partial or complete loss of mobility, shortness of breath.
What can be a harbinger of suicidal thoughts?

• Insensitivity to treatment - therapy, procedures, medications do not help;
• Diseases or operations that mutilate the appearance (mainly the face and neck), ostomy;
• Insomnia. Especially long-term;
• Social isolation - loneliness.

“Bad” signals - what are they? What to pay attention to.

• Depressed, depressed mood.
• Behavior change. Even for the better. If a withdrawn person begins to show unusual gaiety, you should be wary.
• A person begins to “play” with drugs - take medications at his own discretion or refuse them altogether.
• Conversations about unwillingness to live, including those of a passive nature (for example, “I wish I could fall asleep and not wake up”)

Important You should be extremely wary of any statements a person makes about not wanting to live.
A smile or apparent criticism should not reassure. What to do if there are signs of suicidal thoughts?

• Be attentive to the words of a seriously ill person about dying. It should not be assumed that he is driven only by a desire to attract attention. It happens that this is the only way for him to show how much he suffers. To some extent, this is indeed attention-seeking, but not in the sense of posing or manipulating others. Rather, it means that the person is not receiving enough care or medical attention. And if action is not taken, he may move from statements to actions.
• Talk about this in a confidential conversation. Ask a direct question whether the person has thoughts about not wanting to live.

It’s not easy to decide on this - we’re not used to talking about the end of life. By postponing, fearing an honest conversation on this topic, we ourselves are often unable to figure out what is stopping us: concern for a loved one or our own fear of death. And yet, such a question can become a kind of “permission” for a seriously ill person to speak out, put into words what has been “boiling up” for a long time, ease the soul and finally become heard.

Give your loved one a chance to express their feelings. Even if there are relatives nearby, the disease “drives” him into loneliness.

He tries to be strong, and often everyone around him convinces him that everything will be fine and that he must hold on. Talking about how bad he feels, he is afraid of upsetting his family, afraid of becoming a burden for them. In this state, the person becomes even worse.

Webinar: “Communication with a dying person” Nursing expert Lena Andrev on the peculiarities of communication with a dying person. Lena Andrev

Communication

You may not have anything to say back to phrases like “you don’t know what it’s like for me” or “I’m a wreck and dying.” Your task is to listen, observing three rules: do not devalue, do not argue and do not lie. Just be there, take your loved one by the hand, listen to him and tell him that you love him and it is important for you that he be with you as long as possible.

Don’t be afraid to provoke a person into action with questions. Most often, people want to be convinced to live, because this is a natural desire for any of us.

• Seek help from a psychiatrist . He will assess the person’s condition from a professional point of view: dangerous symptoms that are obvious to the doctor may not be noticed by relatives. There are two types of patient monitoring: dispensary and consultative-therapeutic. Both types assume that the patient is at home, but in the first case, the doctor checks the patient’s condition at certain intervals, and in the second, he only provides consultations upon request. Depending on the severity of the disorder, the psychiatrist may refer the person to a psychotherapist or prescribe medication.

We can talk about hospitalization only if a person is dangerous to himself or others.

Important Talking about unwillingness to live is a “cry for help” from a seriously ill person. They should never be ignored.

Olga Osetrova, chief physician of the Samara hospice, says:

Vitaly came to us after a suicide attempt. A 70-year-old man had liver cancer and developed severe jaundice and very severe itching. It was the itching, which doctors could not cope with, that became the reason for the tragic decision to end his life. Vitaly scratched himself until he bled, did not sleep for days, and suffered from unbearable pain. However, he refused his relatives’ offer to go to a hospice. One day, when his wife went out for a walk with the dog, Vitaly decided to hang himself. He was saved by a miracle - the dog, as if sensing something, went down with its owner to the first floor, but then persistently pulled her back.

After everything that happened, the man no longer objected to the hospice, and we were able to help him - the itching was relieved. Finally, Vitaly was able to rest. Afterwards, having come to his senses, he recalled this story with horror. Unfortunately, this is typical for many palliative patients who do not receive care on time.

Bad option: a seriously ill person attempted suicide.
What to do? In this case, contacting a doctor is mandatory. All patients following a suicide attempt should be assessed by a psychiatrist. He will make a diagnosis and determine further treatment tactics. If you refuse an examination, Article 29 of the Law of the Russian Federation No. 3185-1 “On psychiatric care and guarantees of the rights of citizens during its provision” comes into force, providing for a psychiatric examination on an involuntary basis.

Important Concealing information about a suicide attempt by relatives from medical workers is considered from the point of view of the law as “leaving in danger” (Article 125 of the Criminal Code of the Russian Federation).
Does it happen that “nothing was foreshadowed”, but a person attempted suicide?
Unfortunately yes. There are very closed people whose intentions to die cannot be noticed even with careful observation either at home or in the hospital. But this rarely happens. In most cases, if there are caring, attentive people next to a seriously ill person, if he receives a sufficient amount of painkillers, and doctors do everything possible to relieve other, severe symptoms, the tragedy can be prevented. This means going through life’s journey to the end without pain, fear and loneliness.

Olga Osetrova, chief physician of the Samara hospice, says:

I met Elena in one of the palliative care departments that I sometimes visit. She was 40 years old. Initially, she was brought to the hospital with severe bleeding, from there she was sent to the oncology center, where she was diagnosed with advanced cervical cancer. Elena was admitted to the palliative department, without, however, being told about the real state of affairs. They even reassured her: they said that she would soon recover, although the doctors understood everything perfectly.

Lena ended up in the ward with three other women. One was unconscious, the second was “out of her mind.” Both, like Lena, had gynecological cancer.

When I first entered their room, Lena had already been there for several days. She looked scared. We started talking, and suddenly she asked me:

—Are you a believer? I've saved up five Relanium tablets here. I want to save 10 and finish it all. Tell me, is this a sin? Even though they tell me that everything will be fine, I know that I will soon die. And I don't want to become like these women.

“I think it’s a sin,” I answered, “but you and I can pray together that the Lord will not allow this.”

Then we talked with Elena several more times. I left her my phone number, and she called when she felt the need to talk, talk about her fears and experiences. Most of all, Lena was afraid of “becoming like those women,” and it was very important for her to live her fear not alone, talk about it, rely on someone’s support and find strength in her to live.

She died three weeks later. “Like those women” she did not.

Prepared by Evgenia Rezvan

The material was prepared using a grant from the President of the Russian Federation for the development of civil society provided by the Presidential Grants Foundation.

Diagnostics

If you have suicidal thoughts, first of all you can take a test yourself to understand how dangerous they are and whether the situation is advanced. The Beck Suicidal Ideation Scale provides fairly accurate results. Its author is a famous American psychotherapist, professor of psychiatry, creator of cognitive psychotherapy, and a leading expert in the treatment of depression.

Each question has several alternative answers. You need to select only one and enter the score indicated next to it.

Interpretation of results:

• 0-9 points - normal state, suicidal thoughts - an accident;
• 10-18 - moderate depression, the risk of suicide is minimal;
• 19-29 - moderate depression, thoughts, although they are passive, already significantly reduce the quality of life;
• 30-63 - severe depression, ideation can lead to a suicide attempt.

If the Beck Scale scores more than 19 points, psychotherapeutic treatment is simply necessary.

Treatment of child suicide anonymously in Moscow

For suicidal tendencies in children, it is recommended to seek professional medical help. By providing timely psychological assistance, suicide is prevented and the child’s life is preserved. The Moscow clinic employs highly qualified psychologists and psychotherapists who initially diagnose the child’s condition. Thanks to the use of special techniques, they find out the causes of suicidal tendencies and develop an effective treatment regimen that is aimed at eliminating them.

During the diagnosis, neuropsychic disorders, mental disorders and psychosomatic diseases are determined, against the background of which suicidal thoughts appear. Their treatment requires taking medications and using psychocorrection.

Treatment of children is carried out in a hospital setting, which eliminates the possibility of suicide. The clinic employs qualified and communicative staff who provide 24-hour patient support. To treat a child, universal psychocorrectional techniques, individual and group lessons are used. If necessary, drug therapy is used. The choice of treatment method is made by the doctor in accordance with the individual characteristics of the patient and the severity of the pathology.

Emotional and mental symptoms

Pay attention to the thinking model of your relative or friend. Signs such as:

• obsessive thoughts;
• lack of hope for the future;
• pronounced problems with concentration;
• frequent mention of words such as “my existence is meaningless”, “I no longer control my life”, etc.

Suicidal tendencies can also be determined by psycho-emotional state. Suicide is often preceded by the following symptoms:

• great feelings of shame, humiliation or guilt;
• feeling like a burden to loved ones;
• rage, aggression, desire for revenge;
• sudden mood changes;
• serious concern about something;
• excessive irritability;
• feeling of loneliness even among family and friends;

Potential suicides, when on the verge, often use specific words or expressions:

• “I’m tired of living”;
• “I can’t live like this anymore”;
• "nobody needs me";
• “I don’t see any point in living further”;
• “if I disappear, it will only be better for everyone”;
• "no body understands me";
• “I just want the pain to stop.”

Such phrases, often heard from a loved one, should be a reason to immediately seek help from a specialist, since it is very difficult to cope with such conditions without a psychologist.

If you notice that a person has changed dramatically, has become cheerful, do not stop watching him. Sometimes this is a dangerous symptom that he has come to terms with the idea of ​​suicide and is ready to carry out his plans.

What behavioral signs indicate readiness for suicide?

Quite often, when planning to commit suicide, patients strive to complete all their affairs as quickly as possible. This may manifest itself as follows:

1. The emergence of a desire to give away one's property.
2. Drawing up a will.
3. An unexpected farewell to loved ones that has no justified reason (that is, no one is leaving), etc.

Another sign is reckless behavior bordering on life-threatening. For example, your friend, who has always driven a car carefully, suddenly deliberately puts himself at risk: he drives at high speed, gets behind the wheel while drunk. This can also manifest itself as a sudden love for extreme forms of entertainment.

A sign that a person is on the edge may be the unexpected acquisition of weapons or powerful medications.

If you feel that your friend or relative needs help, but he refuses to communicate and asks to be left alone, do not allow social isolation and immediately contact specialists.

Also pay attention to:

1. A sharp decline in your favorite hobby.
2. Rare trips outside, self-isolation.
3. Uncharacteristic apathy (loss of energy, decreased libido, difficulty making decisions).

Independent struggle

To organize the most effective treatment of suicidal conditions, it is recommended to use the following methods:

1. Organize communication with new people. To radically change your lifestyle, it is important not only to eradicate bad habits, but also to expand your social circle. A new and fresh look at old problems will help improve your psychological state, as well as jointly organize an effective fight
2. A change of scenery. Traveling is one of the best types of self-therapy, allowing you to get new positive emotions, start an affair or communicate with new people.
3. Change your place of work. It is optimal to resolve this issue without material losses. Sometimes a person cannot really assess his own abilities and does not continue to develop himself
4. Change your place of residence. To start life with a new leaf, changing the city, region, region will also be beneficial. Although a person may experience stress as a result of moving, such a decision often has a beneficial effect
5. Self-hypnosis. This will require internal moral strength to set the right attitude for yourself. Training experts recommend fighting such emotional manifestations as anger, cruelty, and hatred.

However, such methods are, as a rule, additional methods that support the work of specialists or medication treatment.