Q. My husband has almost jokingly threatened to commit suicide several times because of pressure he is under. I don’t think he’s serious, but how do I know? Is there anything I can do?
A. There is no way for you to validate the seriousness of his suicidal impulses. He may say he is suicidal when he is really feeling hopeless. In this case, it is a cry for help. You cannot be his therapist, but you can help him by discussing his feelings, helping him make a plan that would alleviate his hopelessness and some of the pressure, and insist that he meet with a mental health professional.
When your husband is feeling suicidal there are several things you should not do:
• Never say, “Just go ahead and do it. I’m tired of your complaining.” He is complaining because he is in pain, not to disturb you.
• Never try to encourage him to “count his blessings.” Most depressed people understand that there are wonderful parts of their lives. Serious depression is an illness; it is not a self-imposed condition any more than are diabetes or hypertension.
• Never compare him to others. For example, I had a patient tell his wife “I don’t know why you complain, your sister has a much worse life than you do.”
Even though you cannot solve your husband’s problems, you can go with him to a mental health professional and perhaps learn ways to help alleviate some of his stressors. He may just need to talk with someone or he may need medication. However, if he makes an active threat or you feel his condition is becoming more serious, call 911 or take him to the nearest emergency room immediately.
Q. My boyfriend, who served several tours of duty, has been diagnosed with PTSD. He’s had many friends who have killed themselves either intentionally or by accident. I’ve read that PTSD is a big risk factor for suicide. Is this true?
A. The information you read is correct. According to the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM 5), which is the diagnostic manual used by mental health professionals, some people with Post-traumatic Stress Disorder (PTSD) are at an increased risk for suicide. There are four major markers to examine when making a suicide risk assessment:
• The PTSD has lasted longer than a year. Many people will experience the disorder and recover within a few months. If his PTSD has been diagnosed over a year ago, you have more reason for concern.
• If he was abused or exposed to childhood trauma it increases the risk of self-harming behaviors. Certainly not everyone who experiences child abuse or family dysfunction is suicidal, but it is a statistical risk factor.
• There is a depression component associated with suicide that is often gender specific. When men become depressed, it often presents as uncontrollable rage. If he is having periods of intense anger, it is another sign that he could be at risk.
• If he is self-medicating with alcohol, marijuana or pain medication, then you should be even more concerned. This does not mean that he cannot drink moderately or take pain medication as directed. However, he should not be using substances to control his feelings or to detach from life.
Do not be afraid to talk to him. If you keep communicating and he knows you are a support system for him, then his chances of self-harm are greatly reduced.
If he has not already done so, he should contact the local Veteran’s Affairs Hospital. They have established several worthwhile programs for individuals to receive assistance as they return to civilian life.
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Nancy Ryburn holds a doctorate degree in psychology from Yeshiva University in New York City. She teaches psychology at Southeast Arkansas College. E-mail your questions to firstname.lastname@example.org or send them to Dr. Ryburn, SEARK, 1900 Hazel Street, Pine Bluff, AR 71603. The questions could appear in a future column. There will be no identifying information and all correspondence remains confidential.