As soon as suicidal thoughts arise, tell someone nearby and hand over those first few minutes

32. As soon as suicidal thoughts arise, tell someone nearby and hand over those first few minutes

Cost: No cost involved. The hard part is actually speaking up at that moment and admitting you can’t be alone for a few hours.

In plain terms: Among 82 people who attempted suicide, 47.6% reported that only 10 minutes or less passed from the first appearance of suicidal thoughts to the actual attempt. What they had to endure was not a lifetime of mental anguish, but just those few minutes. Of the same group, 76.8% had some contact with others during that time, though they did not voice their feelings. Looking ahead, about 2% of people who ended up in the hospital due to self-harm died by suicide within a year, while roughly 7% did so after nine years or more; the vast majority did not follow that path.

Benefit: Interviews conducted within three days of admission with those 82 individuals showed that 47.6% (39 people) stated the interval between the first emergence of suicidal thoughts and the actual attempt was no more than 10 minutes. Those whose process took longer displayed significantly higher scores on measures of suicidal intent. However, impulse scores showed no correlation with the duration of this period. Additionally, 76.8% (63 people) reported having some sort of interaction with a partner, family member, or friend during those minutes. The authors conclude that the window for intervention is usually very brief, leaving limited room for professionals to step in; thus, it is crucial to spread awareness of warning signs and basic intervention methods to ordinary people. Another systematic review compiled findings from 90 follow-up studies. For those seeking medical care after self-harm, the median rate of repeated self-harm without resulting in death was 16% after one year, while the suicide mortality rate at that point stood at 2%. After nine years or more of follow-up, roughly 7% had died by suicide.

Evidence grade: B

Sources: Deisenhammer EA, Ing CM, Strauss R, Kemmler G, Hinterhuber H, Weiss EM (2009). The duration of the suicidal process: how much time is left for intervention between consideration and accomplishment of a suicide attempt? Journal of Clinical Psychiatry, 70(1), 19-24. <https://doi.org/10.4088/JCP.07m03904>; Owens D, Horrocks J, House A (2002). Fatal and non-fatal repetition of self-harm: systematic review. British Journal of Psychiatry, 181, 193-199. <https://doi.org/10.1192/bjp.181.3.193>

Notes: Grade B is assigned for two main reasons: the Deisenhammer study involved only 82 participants from a single hospital and relied on retrospective recollections; Owens’s review aggregated median figures from 90 studies employing different methods, rather than producing a single combined statistic. That same review also emphasizes that the suicide risk among self-harm patients remains hundreds of times higher than in the general population. Consequently, the statement “the vast majority did not follow that path” describes the overall trajectory of this group, not a guarantee for any individual; appropriate medical care must still be sought. For advice on removing lethal means and contacting the helpline 12356, see item 25 in this section. Steps to take when feeling down are outlined in item 19 of Section 3. Long-term consequences following survival are discussed in item 33 of this section. Finally, actions you can take if someone close to you expresses such thoughts are detailed in item 15 of Section 8.