Mental Health Conditions and Suicide

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         Mental Health Conditions and Suicide

                For far too long, we have been placing our minds on the back burner.  Scientific studies have sped along, figuring out causes and cures for many “physical ” illnesses and diseases.  This is a wonderful thing.  We now have sound treatments for heart diseases, kidney disease, cancer, and many other physical conditions.  However, we have left the one organ out that controls all of the other organs.  This is the brain.  I’m not speaking about treating brain tumors and other “physical” conditions.  I’m speaking of something far more elusive; the mind.

            Much has been talked about in the realm of situational and environmental causes for mind, better known as, mental illnesses. However, not much light has been shed onto the biological factors and genetic causes for these conditions.  In this blog site, we will explore the ‘science behind’ mental health conditions and suicide.  

            The question is not why we are looking into these conditions.  It’s why has it taken us so long to do so?

Schools Need a Curriculum Adjustment

It’s way past time we have serious discussions on mental health in our schools.  Although important strides have been made, they are not enough.  Our education system is not truly educating our children on mental health conditions.  Bills have been passed, and programs have been added.  These include teacher trainings on mental health, supplemental social and emotional learning for students, extra mental health specialists to support students, and in a few high schools, peer centered support groups.  It’s not enough.

You might think this sounds great and wonder why it isn’t enough.  The reason is that although these are great first steps, none of them truly educate our students on mental health conditions.  We educate our students in physical health through required PE and health classes.  Physical education is deemed important enough to have state standards and required classes beginning in kindergarten and going into high school.  Yet, mental health isn’t treated in the same way.  With the exception of only a couple of states, there are no mental health standards built into the curriculum for students K-12.  This is shameful.

There is still much stigma associated with mental health conditions and suicide.  In order to truly combat the stigma, mental health education needs to begin early in elementary school so we can target conditions and treat them more effectively before they advance to a dangerous level.  According to the American Psychiatric Association, 50% of mental illness begins by 14 years of age and 75% by age 24.  (Per Johns Hopkins Medicine, approximately 26% of people aged 18 and older live with a mental health condition in a given year.)  This means that we need to begin early, with our children.  

We realize how hard educators work. They don’t need any extra duties.  We also realize social, emotional learning  is being added to school programs.  However, what it looks like from one district to the next, one state to the next, is vague and inconsistent.  Project AWARE is a step in the right direction, but it’s not enough on its own. 

What we need is a curriculum adjustment – not only another teacher training or an add-on for students, but a standards-based curriculum adjustment. This is so our children can learn about mental health conditions, just like they learn about physical health conditions.  Mental health standards need to be part of state educational standards.  Mental health lessons need to be taught throughout the year, each year to our students.

There needs to be consistent, age appropriate, discussions on a continual basis built into the curriculum.  This can be done through whatever subject is deemed appropriate, with minimal time allotted on a weekly basis.  

In high school, there needs to be a required class to be taken each year. This class could be for a half credit to go toward graduation. In this way, students could earn their units for graduation and not affect the school’s graduation rate.

The reason for providing continuity in mental health education from kindergarten through high school is to normalize mental health, just like we do with physical health.

Discussion on self-harm and suicide, should be a part of the instruction from late elementary school on up. Of course, as in all of the curriculum, this would need to be age appropriate.

Normalizing mental health conditions and suicidal ideation would remove the stigma attached to them. Physical health conditions are normalized.  Mental health conditions should be normalized as well. 

Many children and adolescents are hiding the fact that they have anxiety and depression.  No one has helped them to truly understand that they are not alone.  In fact, a large number of children and teens live with these feelings.  Because they don’t know that many others suffer from anxiety and depression, they don’t reach out for help.  They are ashamed and afraid of what their classmates might have to say about them if they admit to having these feelings.  So, they stay silent.  They don’t feel normal.

We must remove the stigma.  Stigma only leads to silence.  Silence leads to despair. And despair leads to very unhappy and unproductive lives, as well as serious risk of self-harm and suicide.

Mental Health Moonshot Initiative

48,344 people died by suicide in the United States in 2018, according to the CDC.  

Of those individuals, 90% had a diagnosable mental health condition at the time of their death.

The daily average?  132 Americans died by suicide every day, with 119 having a diagnosable mental health condition at the time of their death.

Looking at NIH data from 2008, when they began publicizing this data, funding for mental health conditions and suicide is far lower than that of other illnesses. Comparatively speaking, we are nowhere near the funding in areas such as cancer, heart disease, kidney disease, diabetes, and many other diseases that are deemed ’physical’. This is inexcusable.

According to NIMH/NIH data gathered in 2021, Suicide was the second leading cause of death among individuals between the ages of 10 and 34, only followed by accidental death. It is the fourth leading cause of death among individuals between the ages of 35 and 44.  It is believed that suicide is under-reported due to the stigma associated with it, which means that many of the accidental deaths are undoubtedly deaths by suicide.

With this in mind, why are mental health conditions not treated as important as other conditions?  We fund research to tackle things like asthma, allergies, diabetes, etc. in early childhood.  However, for the quarter of our population suffering from a mental health condition, we do extremely little.  

I just read a post from a parent whose adult son passed away due to suicide.  She’s a member of an online support group for those who have lost loved ones to suicide.  

(Note – There are over 20,000 registered members in this support group, not to mention those non-members who visit each day as a way to search for help and support.)

Below, is a partial post from the bereaved mother discussing our current state of mental health care:

“He was just 25. When someone goes through chemo, they want to know that you have someone to help you at home. I wish it was the same for mental illness.”

Unfortunately, this is one out of thousands and thousands of mothers who are struggling with the loss of their dear child, a child they love more than anything in the world.  No matter how many children a mother has, the loss of one of her children, is the entire world. These mothers, plus fathers, sisters, brothers, spouses, and friends’ lives have been forever changed.  So many are effected by one suicide. It’s astounding, the grief and despair that loved ones have.  They are catapulted into a life of constant questioning, doubt, and guilt.  

Our question – Why does this happen when we may be able to find cures and effective treatments for mental health conditions, more accurately termed as brain diseases? Right now, our medical community is throwing darts at a dartboard to see if a medication, or a cocktail of medications, will hit the mark.  If this doesn’t work, okay, we’ll throw some more darts at the target and see if they land a little closer to the bulls eye!  This is archaic, and flat out wrong.

So, what can we do now???

We need to have a Mental Health Moonshot Initiative, just like we did with cancer research.  That’s made a huge difference for those with cancer, and it could do the same for those suffering from a mental health condition.

In addition, we need a congressional bill with a line item that is specifically to fund for research into the biological causes of mental health conditions so we can find cures and proper treatments.  So many of our loved ones have passed away by suicide due to having a brain disease (mental health condition). And many others are struggling. Remember that in one year, 43,510 people lost their lives due to diagnosable mental illness. Where was the public outcry then? Where is it now?

You can help. Please contact your legislators and be heard.  Our “Science Behind Suicide and Mental Health Conditions” group has now reached out and met with several of our legislators. We are continuing to reach out, but we need each of you to do the same.  Please help us fight for all of our loved ones.

What is the real cost of prevention?

DOES PREVENTION REALLY SAVE MONEY?

Some economists say that prevention isn’t cost effective. However there are actually three types of prevention a nuance that most policy makers and economists miss.

  1. Primary prevention- preventing a disease or problem in the first place.
  2. Secondary prevention – has to do with preventing progression or impact of an existing disease.
  3. Tertiary prevention is softening the impact a disease may have on a person’s life.

Research is now showing that many who suffer from mental illness have a genetic predisposition to certain conditions such as bipolar, depression, anxiety and a increased risk for suicidal thoughts.

So there is some evidence from new studies that is finding isolated genes that are responsible for such conditions. What if we could find out with a simple blood test ? We could know from early on and utilize all 3 prevention types to reduce our potential risks.

Current treatment for mental health is difficult and climbing an uphill battle. Many find out they or their loved one suffers from mental illness when it’s already at a pretty advanced level. What if we could know in infancy or childhood? Think of the difference that would make. Just like if diabetes runs in your family you teach your offspring ways to minimize their risk factors.

We can do the same for mental illness.

Here are the statistics

There is one death by suicide in the US every 11 minutes (CDC)

There is one completed suicide for every estimated suicide attempt (CDC)

Suicide is the 2nd leading cause of death in the world for those aged 15- 24 years old.(CDC)

Suicide is the 4 th leading cause of death for adults 18-65. (CDC)

The financial toll on society is also costly. Suicide and Suicide attempts cost the nation over 70 billion per year in lifetime medical and work loss costs alone.(CDC)

The average costs of out of pocket expenses is 287 a month per person.

IN 2019 12 MILLION ADULTS AGED 18 and older reported having serious thoughts of suicide, and 3.5 million adults made suicide plans, 1.2 million adults made plans and attempted suicide, 217,000 adults made no plans and attempted suicide (NIMH)

So now let talk about not just the person suffering from mental health but everyone else around them.

“SUICIDE is like a pebble in a pond. The waves ripple outward. The reach of the pebble’s waves is much greater than the size of the pebble itself.”

Ultimately, in the way that a pond is changed because of a pebble, an entire community can be changed by a suicide. ” According to a 2016 study it is estimated that 115 people are exposed to a single suicide, with one in five reporting that this experience had a devastating impact or caused a major life disruption. “

Many people are afraid to talk about suicide because of stigma, but stigma only leads to silence. Silence about suicide DOES NOT contain the ripple effects.

Preventing mental, emotional, and behavioral disorders among young people is one of the soundest investments a society could make. Benefits include higher productivity, lower treatment costs, less suffering and premature mortality and more cohesive families and of course happier, better adjusted, more successful young people. Given the evidence that these actions can be taken to achieve these benefits, the case for action is compelling.

Cost – benefit analysis and cost effectiveness analysis are two methods used to assess whether an intervention is desirable from an economic standpoint.

” Prevention, by definition, is undertaken to avoid harmful out comes. MEB ( mental, emotional and behavioral) disorders among young people account for considerable costs to healthcare, child welfare, education, juvenile justice, and criminal justice systems, as well as enormous additional costs in terms of the suffering of individuals, families and others affected.” ( NCBI)

“These health consequences represent an enormous burden during childhood and are also correlated with significantly increased risks to health and reduced productivity in adulthood. Mental disorders lead to lost productivity and functioning not 9nly for the children, but also for the parents and caregivers.” ( NCBI)

The stress and unpredictability of having a child with a serious MEB can interfere with parents work lives, or a disruptive child in a classroom can interfere with other students learning. There may also be significant costs to the work or educational productivity of siblings.

In closing it is important to note that the significant society benefits of preventing mental, emotional and behavioral problems among young people may warrant intervention even when there is no specific cost effectiveness data available, particularly if there is evidence that an effective intervention is available.

WAITING FOR FUTURE COST EFFECTIVENESS ANALYSIS TO BECOME AVAILABLE, WHICH MIGHT TAKE YEARS TO DEVELOP, WOULD PUT MANY PEOPLE AT UNNECESSARY RISK.

So what are we waiting for?

YOU

LET’S END THE SILENCE DEMAND TO BE HEARD


Blood Tests for Depression and Bipolar Disorder

The following research was supported by the National Institutes of Health. Far more funding is needed in the areas of mental health conditions and suicide.

A new blood test can distinguish the severity of a person’s depression and their risk for developing severe depression at a later point. The test can also determine if a person is at risk for developing bipolar disorder. Researchers say the blood test can also assist in tailoring individual options for therapeutic interventions.

At this point in time, our psychiatric experts diagnose and treat mental illnesses by trial and error.  It’s like throwing meds at a person until you see which one makes the mark.  (a dart board, so to speak)

No fault to the psychiatrists. This is all they have to go on at this time.

However, a breakthrough study led by Indiana University School of Medicine researchers sheds new light onto the biological basis of mood disorders, and offers a promising blood test aimed at a medical approach to treatment.  This work builds on previous research into blood biomarkers that track suicidality as well as pain, post-traumatic stress disorder and Alzheimer’s disease.

The team’s work describes the development of a blood test, composed of RNA biomarkers, that can distinguish how severe a patient’s depression is, the risk of them developing severe depression in the future, and the risk of future bipolar disorder (manic-depressive illness). The test also describes specific and tailored medication choices for patients.  This is great news.

This is a comprehensive study over a four-year period of time.  From these studies?

Blood biomarkers are emerging as important tools in identifying disorders where, in the past, we have only had subjective self-reporting or reporting from health care professionals. Those subjective reports are not reliable.  Blood tests are.

“Blood biomarkers offer real-world clinical practice advantages. The brain cannot be easily biopsied in live individuals, so we’ve worked hard over the years to identify blood biomarkers for neuropsychiatric disorders,” says Alexander B. Niculescu, MD, PhD, Professor of Psychiatry at IU School of Medicine.

Niculescu also noted that mood disorders are underlined by circadian clock genes–the genes that regulate seasonal, day-night and sleep-wake cycles.  That explains why some patients get worse with “seasonal changes, and the sleep alterations that occur in mood disorders.”

A Blood Test For Depression and Bipolar Disorder

Language and Stigma

Have you ever thought about the words used in everyday life that encourage stigma? Have you noticed how media sometimes perpetuates this? Think of some popular TV shows, especially situation comedies, and I’m sure you’ll be able to come up with a few examples. Think of phrases like, “What a psycho!”, or “She must be having one of her (eye-roll) schizo moments”, followed by a laugh track. If you really deal with psychosis or schizophrenia, would you ever want anyone to know it, or would you try to hide it? Remember, your condition is followed by a laugh track.

Or think of the misuse of terms such as OCD and anorexia. Being neat and clean is not the same thing as having a real obsessive-compulsive disorder, yet we hear phrases like “My friend is sooo OCD, I’m afraid to walk into his house. I might track in a piece of dirt!” Regarding anorexia, every thin person doesn’t live with anorexia nervosa, yet we hear such things as, “She’s so anorexic!” in reference to a genuinely slender girl with no eating disorder at all. This misuse of terms makes light of the people who are living with real conditions that effect their everyday lives.

Sometimes people reference suicide. They might say, “I was so embarrassed, I thought I would kill myself!” This is extremely insensitive to all those living with real suicidal ideation and to the families of those whose loved one has passed away due to suicide. Yet, we still hear it.

Another term that is sometimes used to describe that a person has died by suicide is ‘committed’. This outdated term that a person ‘commits’ suicide insinuates that the person has committed a crime. This is not the case, yet many still use this term. The correct terminology is ‘died by suicide’.

We now know that suicide is the outcome of a complex set of factors reflected in the neurobiology of a suicidal person. The current data shows that mental disorders are present in over 90 percent of suicides in Western society, and many of these disorders are associated with biological changes. In addition, many other factors correlated with suicidality have well-described biological aspects. These include predisposing personality traits such as aggression and impulsivity, effects of acute and chronic stress, impact of trauma, gender, substance or alcohol abuse, and age. https://www.nap.edu/catolog/10398/reducing-suicide-a-national-imperitive

From this information, there is no question that the language is way overdue for a change. I know of some individuals who say, ‘died by suicide’ due to anxiety and depression. This would seem to be the case for many who have died by suicide.

Not only can correct language reduce stigma, but it has the potential to save lives. Remember what I mentioned about hiding a mental health condition? This is due to shaming and stigma. If the stigma is lifted, many will seek help who would not have otherwise. Many lives can be saved by simply changing the language we use, day in and day out.

A Call for Help – What You Can Do

I have a request for all of you. We are experiencing a crisis when it comes to mental health conditions and suicide. There are so many discoveries coming to surface, but we need much more funding to push forward. According to the NIH data I have researched on funding for all diseases and conditions, it’s obvious that mental health conditions and suicide are far down on the list of what is currently being funded.

This is a shame, considering one in four people suffer from a mental health condition, and considering that suicide is the 2nd leading cause of death in our young people from ages 10-35, only following accidental deaths. Many reports state that suicide is under reported because of the stigma related to it. If this is the case, which I believe to be so, then suicide numbers are far higher than reported. The fact that our funding for research is so low is flat out inexcusable.

We are already finding biomarkers for mental health conditions, and the research is showing the likelihood of biomarkers for suicide. There have been many studies conducted on genetics, epigenetics, and neuroinflammation, and how these can cause a predisposition for mental health conditions and suicidal ideation. In order to discover treatments for these conditions, we need to conduct more research. In order to do this, we need more funding!

How can you help? Please contact your local legislators to let them know that you are advocating for more funding to go into research for the biological causes of mental health conditions and suicide. With all of us working together, we could make a huge impact. It’s amazing what we can do when we all work together!

Mental Health Overview

Whether we call it a mental health condition/disorder, emotional dysregulation, or mind/brain disease, it’s all the same. And one in a quarter of us suffer from these problems. (I would say, probably more.). Some of us are depressed. Some of us suffer from anxiety. Some have OCD. And some have psychotic events causing dissociation, schizophrenia, borderline personality, and bi-polar disorder. There’s mounting evidence that many of us are suffering from some type of mental health condition.

I’ve been researching the scientific causes for mental health conditions and suicide, and decided to give a general overview of some of the major categories. Here goes:

“Mental illness, also called mental health disorders, refers to a wide range of mental health conditions — disorders that affect your mood, thinking and behavior. Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviors. Many people have mental health concerns from time to time. But a mental health concern becomes a mental illness when ongoing signs and symptoms cause frequent stress and affect your ability to function.” (https://www.mayoclinic.org/diseases-conditions/mental-illness/symptoms-causes/syc-20374968)

I, myself, have suffered from depression and anxiety disorders. I have no doubt there is a genetic link. Several in my family have suffered. You may have a genetic link as well. Research, better treatment, and education are the ways to more successful tomorrows for our loved ones.

For Those of Us Struggling

For those of us struggling with a mental health disorder, or who have a family member with a mental health disorder, or those who have a loved one who has passed away due to suicide, not enough can be said or done to make things right.  The numbers keep rising, yet the research is still painfully slow in finding the causes and treatments for mental health diseases and suicide.

If you don’t suffer from a mental health disorder, count yourself fortunate.  If you do, you are definitely not alone. Unfortunately, our culture has made us feel alone, unusual, and sometimes the target of jokes and bullying. All the while, a great deal of the underlying causes are biological in origin.

Who would make fun of a person dying from heart disease?  Who would laugh at a child suffering from cancer?  No one.  Yet, mental illnesses have never been treated with the same dignity as other diseases.  How shameful our culture is.  How horrific these countless tragedies are to our innocent children, teens, adults, and the aging population.

Stigma and shame have led many to hide and not receive any kind of help.  Would you want to be embarrassed by your peers, cut from a list of job candidates, or denied decent insurance coverage, all because of a mental health condition?  

So hiding becomes a way of life for so many.  Is there any wonder why so many people are suffering?  Is there any wonder why so many people are dying by suicide?

As for those who do seek medical help, some have successful outcomes.  Yet for many, the treatments are, quite frankly, sub-par.  And these individuals are left floundering, jumping from one pill to the next, sometimes taking dangerous cocktails of meds. 

I say these things not to knock the psychiatric community.  They are merely doing their jobs. According to the limited research at hand, they are doing the best they can.  And that’s the point. The research isn’t there, or not nearly enough of it.  This, again, is because mental health conditions have been seen as not as important as ‘real’ medical conditions  Well, they are important, and they “are real”.  They are biological in nature for many, and they have the added layer of being environmental.  Add stigma to the mix, and we have a recipe for disaster.

With all of this said, I do see the tides shifting a bit.  Or maybe it’s wishful thinking on my part.  I hope not.  Organizations such as the National Institute of Mental Health (NIMH) and others are seeing the need to support research into the biological causes of mental health conditions.  Support groups, such as the Alliance of Hope (AOH) are making a huge impact on those who have lost loved ones to suicide. They are also working hard to remove stigma from mental health disorders and suicide.

We need to all keep working together.  We need to speak out until we are heard so that lives may be enjoyed and so that lives may be saved.

Suicide is Not a Selfish Act

I heard someone say today that suicide was a selfish act. What do you think? Is it a choice? Do you really think that someone would intentionally take his or her own life out of being selfish? If you do, I’m so sorry you feel that way. If you do, I hope I can change your mind.

Suicide certainly leaves a wake of devastation for those who are impacted. Survivors of suicide loss are at increased risk for depressionaddiction, and the emergence of suicidal ideation themselves. Even though suicide causes massive collateral damage, can it really be considered selfish? The answer is a resounding “No”.

According to https://www.psychologytoday.com/us/contributors/shauna-h-springer-phd,:

The suicidal mode is an altered state of consciousness. When a person is battling with their demons and feeling hopeless, their thinking is often significantly distorted. They do not see reality the way they would if they were not in suicidal crisis. Their thoughts loop on the theme of how they are a burden to those they love. Their brains actively make a case for how others will not really miss them or that in the long run, those they love would be better off without them somehow. (Of course, their loved ones don’t agree with this).

An analogy might be helpful here. Take the case of a person who is in the grips of anorexia. (I, myself, had anorexia before anyone ever knew it existed.) I was dangerously underweight. However, I didn’t see myself that way at all. I could still see that overweight little girl who was so tired of being overweight. I had a distorted perception of reality. In a similar way, those who are in a very dangerous crisis of suicidal despair often have distorted perceptions of reality. They see themselves as a burden, the same way that an individual struggling with anorexia sees him or herself as being overweight.  

Further, those who are in the grips of the suicidal mode (or suicidal trance) often become mentally detached from those they love. With that being said, each suicide attempt is different. In each one’s story, it’s clear that interpersonal detachment is a core part of the suicidal mode. People’s demons become like the domestic abuser whose first move is to isolate his or her partner from the influence of those who love them. Demons will ambush those who suffer in silence, but those who break this dangerous code of silence before the suicidal crisis begins, often can regain their hope and will to live.

Finally, those who survive suicide attempts often look back on their crisis from a different perspective. They often understand how suicide would devastate their loved ones, where they did not see this in the throws of their earlier suicidal mode (trance). Those who come through a dark time and regain a sense of hope and purpose have stories that can save lives. Those who are suffering need to hear stories of hope and recovery. Attempt survivors can use their experience of being in the grips of suicide to argue that hope awaits us, even in the midst of some of our darkest days. Their stories can break the power of shame and stigma.

(I would like to share what an individual who survived a suicide attempt had to say to a blog author from”Psychology Today”.)

     I am a suicide survivor who attempted to take my own young life, at age 23, with an overdose of antidepressant and anti-anxiety medications. Fortunately, my sister found me unconscious and was able to call an ambulance in time. After 2 years of therapy with a great psychiatrist, I recovered and, now, 30 years later, am still eternally grateful to my sister.What I remember most about deciding to end my life is that it was an unpredictable, lightning-fast decision, preceded by an upsetting event, during a time in my life when I was both depressed and anxious. I remember feeling pure relief when I made the decision to end all the pain. You mentioned the word “tunneling,” and that is a perfect word to describe my thought process. I blocked out all thoughts of how my actions would affect my loving parents, family, and friends. This wasn’t purposeful—it was simply what occurred. It was, as you said, an altered state of consciousness, and the lens through which I saw my life at that moment was so different from how I had previously, or would see it in the future. I didn’t intend to hurt anyone; I wanted to unburden my family and finally escape the pain. I felt hopeless in the truest sense of the word. And, no one saw it coming, including me just a few hours earlier. That is how unpredictable and instantly gripping I believe [suicidal thoughts can be].

Duration of Suicidal Crises

This article is discussing the duration of suicidal crises of those who may or may not suffer from a mental health condition. We are a long way in finding answers in how to help and respond to these types of tragedies.

While some suicides are deliberative and involve careful planning, many appear to have been hastily decided-upon and to involve little or no planning. Chronic, underlying risk factors such as substance abuse and depression are also often present, but the acute period of heightened risk for suicidal behavior is often only minutes or hours long (Hawton 2007).

The following studies are interviews from those people hospitalized after a suicide attempt.

The Houston study interviewed 153 survivors of nearly-lethal suicide attempts, the the 13-34 age range. Survivors of these attempts were thought to be more like suicide completers due to the medical severity of their injuries or the lethality of the methods used. They were asked: “How much time passed between the time you decided to complete suicide and when you actually attempted suicide?” One in four deliberated for less than 5 minutes!  (Simon 2005).

Duration of Suicidal Deliberation:

24% said less than 5 minutes

24% said 5-19 minutes

23% said 20 minutes to 1 hour

16% said 2-8 hours

13% said 1 or more days

A study from Deisenhammer asked people who were seen in a hospital following a suicide attempt how long before their suicidal act they first started thinking about attempting it. 48% said within 10 minutes of making the attempt. An Australian study of emergency department visits found 40% of attempters took action within 5 minutes of deciding to attempt (Williams 1980). The authors summarized seven earlier studies that found one-third to four-fifths of attempts were impulsive.

In an Australian study of survivors of self-inflicted gunshot wounds, 21 of 33 subjects (64%) stated that their attempt was due to an interpersonal conflict with a partner or family member (deMoore 1994). Most survivors were young men who did not suffer from major depression or psychosis, and the act was almost always described as impulsive. A similar study in Texas with 30 firearm attempters found 60% had experienced an interpersonal conflict during the 24 hours preceding their attempt (Peterson 1985).

At least one-third of suicide decedents under age 18 experienced a crisis within 24 hours of taking their life, according to NVISS data drawn from police and coroner/medical examiner reports. The proportion with a crisis declined with age. In some cases the crises were not just same-day but virtually same-moment (such as shooting themselves in the midst of an argument).

Interviews with 268 patients hospitalized for a poisoning suicide attempts in Sri Lanka found that just over half took the poison after less than 30 minutes of thought, often directly following an argument (Eddelston 2006). While most of these patients survived their attempts, 13 died. Like the nonfatal attempters, over half of those who died deliberated less than 30 minutes.