I know someone who I think has tried to attempt suicide. What are the risk factors that increase the likelihood of someone attempting suicide, and what can be done to help ensure they don’t attempt suicide again (or ever in the first place)?

Suicide attempts are usually preceded by a mood disorder, like depression, or a psychotic illness, like schizophrenia, often in combination with substance abuse. Both types of illnesses can cause distressing levels of sadness, anxiety, insomnia and hopelessness that can lead someone to suicide.

There are, however, many other risk factors that, when combined, can greatly elevate one's likelihood of a suicide attempt. These other risk factors include:

- Female gender (while women are three times as likely to attempt suicide, men are four times as likely to die in their attempts)
- History of previous suicide attempts (this risk is highest in the first year following an attempt)
- Alcohol or drug abuse
- Family history of suicide attempts
- History of impulsive or aggressive behaviors
- Insomnia
- Anxiety
- Being single, widowed or divorced
- Age (risk increases over age 65 and in adolescence/young adulthood).

While no one factor can accurately predict suicide, a combination of these factors along with other stressful life circumstances such as problems with work, school or family can lead to someone feeling hopeless enough to want to "escape" by killing themselves.

Following a suicide attempt, particularly in the first year after it, individuals are at an elevated risk for another attempt. Despite assurances that they will "never do it again," one cannot take this promise on face value. The best way to dramatically reduce the risk for a future suicide attempt is to ensure that the individual is receiving appropriate treatment, usually a combination of both medications and psychotherapy.

Occasionally, however, suicide attempts are impulsive reactions to changes in mood or adversities encountered on a day-to-day basis, despite the fact that the individual is receiving appropriate treatment. To help minimize the likelihood of an impulsive attempt, firearms should be removed from the home and the amounts of prescription medication in the home should be closely monitored. Additionally, sobriety should be stressed as intoxication often precedes impulsive suicide attempts.

Individuals are often more likely to express suicidal thoughts to family or friends than to their mental health provider, so loved ones should not assume that the doctor knows about these thoughts. Any concerns that the individual may be contemplating suicide again should be communicated immediately to the treating physician.

If the threat for self-harm seems imminent, the individual should be taken without delay to the nearest emergency room for an evaluation. If she or he is unwilling to go, 911 should be called to evaluate and ensure the individual's safety.