Suicide can be prevented.

While some suicides occur without any outward warning, most do not. The most effective way to prevent suicide among loved ones is to learn how to recognize the signs of someone at risk, take those signs seriously and know how to respond to them. The depressions and emotional crises that so often precede suicide are -- in most cases -- both recognizable and treatable. By helping a loved one obtain necessary treatment, and by giving your own personal support, you can make a difference.

What to do if you suspect a loved one may be contemplating suicide.

What should you do?

1. Know the danger signals

n Previous suicide attempts: Between 20 and 50 percent of people who kill themselves had previously attempted suicide. Those who have made serious suicide attempts are at much higher risk for actually taking their lives.

n Talking about death or suicide: People who commit suicide often talk about it directly or indirectly. Be alert to such statements like “My family would be better off without me.” Sometimes those contemplating suicide talk as if they are saying goodbye or going away.

n Planning for suicide: Suicidal individuals often arrange to put their affairs in order. They may give away articles they value, pay off debts or a mortgage on a house, or change a will.

n Depression: Although most depressed people are not suicidal, most suicidal people are depressed. Serious depression can be manifested in obvious sadness, but often it is rather expressed as a loss of pleasure or withdrawal from activities that had been enjoyable.

Be particularly concerned about depressed persons if at least five of the following symptoms have been present nearly every day for at least two weeks:

n depressed mood

n change in appetite or weight

n change in sleeping patterns

n speaking and/or moving with unusual speed or slowness

n loss of interest or pleasure in usual activities

n decrease in sexual drive

n fatigue or loss of energy

n feelings of worthlessness, self-reproach, or guilt

n diminished ability to think or concentrate, slowed thinking or indecisiveness

n thoughts of death, suicide, or wishes to be dead.

Depressed individuals who are extremely anxious, agitated, or enraged are at greater risk for suicide. So are depressed individuals who are isolated, who are alcohol or drug abusers, or who have a history of physical or emotional illness.

2. Take it seriously

n 3/4 of all suicides give some warning of their intentions to a friend or family member.

n All suicide threats and attempts must be taken seriously, even those of teenagers among whom such threats are more common.

3. Be willing to listen

n Take the initiative to ask what is the matter, and persist to overcome any reluctance to talk about it.

n Even if professional help is indicated, the person you care for is more apt to follow such a recommendation if you have listened to him or her.

n If your friend or relative is depressed, don’t be afraid to ask whether he or she is considering suicide, or even if they have a particular plan or method in mind.

n Do not attempt to argue anyone out of suicide. Rather, let the person know you care and understand, that he or she is not alone, that suicidal feelings are temporary, that depression can be treated, and that problems can be solved. Avoid the temptation to say “you have so much to live for” or “your suicide will hurt your family.”

4. Be actively involved in seeking professional help

n Encourage the person to see a physician or mental health professional immediately. Since suicidal people often don’t believe they can be helped, you may have to do more. For example, a suicidal college student resisted seeing a psychiatrist until his roommate offered to accompany him on the visit. A 17-year-old accompanied her 16-year-old suicidal sister to a psychiatrist because the parents refused to become involved.

n You can make a difference by helping those in need find a knowledgeable mental health professional or a reputable treatment facility.

5. In an acute crisis, take the person to an emergency room or walk-in clinic at a psychiatric hospital

n Do not leave the person alone until help is available.

n Remove from the vicinity of the potentially suicidal person any firearms, drugs, razors or scissors that could be used as aids to suicide.

n Medication and/or hospitalization may be indicated and may be necessary at least until the crisis abates.

n If a psychiatric facility is unavailable, go to the nearest hospital or clinic.

n If the above options are unavailable, call your local emergency number (911). Chances are the dispatcher can help you locate immediate psychiatric treatment.

6. Follow up on your loved one’s treatment

n Suicidal patients are often hesitant to seek help and may run away after an initial contact unless there is support for their continuing with treatment.

n If medication is prescribed, take an active role to make sure the patient follows his or her prescription, and be sure to notify the physician about any unexpected side effects. Often, alternative medications can be prescribed.

_American Suicide Foundation, New York, NY.