Suicide Prevention Resources for People With Diabetes
By Matthew Garza
Mental health conditions, self-harm behaviors, and suicide are all too common in the diabetes community. Learn what the statistics mean; be sure to share these suicide prevention resources with anyone you know who may be struggling with suicidal thoughts.
This article includes helpful resources and statistics; however, if you are currently having suicidal thoughts and need immediate help, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or access the Crisis Text Line by texting “TALK” to 741741. Find more resources below.
Diabetes is challenging to manage, and the constant attention that it requires can have serious effects on a person’s mental and physical health.
People with diabetes are at greater risk for depression, which also puts them at a greater risk for suicide, suicidal ideation, and self-harm. Unfortunately, suicide risk is difficult to identify and screen; as a result, experts believe that rates of suicide and self-harm in people with diabetes are under-estimated.
Understanding and addressing such a sensitive problem requires coordinated, collaborative efforts from healthcare professionals, friends and family, community support, advocates, researchers, the government, and industry.
Depression, suicide, and self-harm risk in people with diabetes
The numbers around suicide and self-harm in people with diabetes are concerning. For example, the rate of “suicidal ideation” is as high as 15% in people with type 1 diabetes, compared to 9.4% in the general population. Suicidal ideation, often called suicidal thoughts or ideas, is a broad term used to describe a range of contemplations, wishes, and preoccupations with death and suicide. And unfortunately, suicide attempts are about three to four times more likely in people with type 1.
Suicide occurs in every age group, but adolescents and young adults, who are in a challenging transition period and taking on a greater role in the self-management of their diabetes, are at a particularly high risk. This group is about 61% more likely to report suicidal thoughts than their counterparts without diabetes.
A person’s risk for suicide or suicidal ideation and self-harm also increases in those who have both diabetes and mental health conditions like depression. People with either type of diabetes are two to three times more likely to have depression than those without, and depression prevalence is around 11% to 15% in these groups.
As said before, these rates are all likely underestimated. The World Health Organization notes that actual rates of suicide attempts may be 20 times higher than the number of recorded suicide deaths in people with diabetes.
Reasons why rates might be so much higher in people with diabetes include the mental burden of the daily and seemingly endless management of diabetes and its associated technology, as well as the life-saving, but also very dangerous, medication – insulin. Taking too much or not enough insulin may be done intentionally in people with diabetes who attempt to harm themselves. For example, if a person takes too much insulin it can lead to severe hypoglycemia, or if they stop taking their insulin they may end up in diabetic ketoacidosis. These results can be life threatening.
In addition, self-management of diabetes has the potential to lead to depression through questions of self-worth, strength of relationships, and fears for the future (complications, family, employment, etc.).
Making a distinction between suicidal ideation (suicidal thoughts or feelings) and self harm behaviors (doing something that physically harms oneself, not necessarily with a suicidal intent) is important, as they may have different root causes and may need to be treated differently. In people with diabetes, certain self harm behaviors may be easier to carry out due to easier access to resources like needles and insulin. Oftentimes, it is extremely difficult to correctly identify these behaviors in other people; however, what they may look like in people with diabetes may include:
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Not taking insulin (known as insulin omission)
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Over-bolusing
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Binge-eating to purposefully raise glucose levels
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Intentional hypoglycemia
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Self-injurious behaviors with diabetes supplies (i.e., needles)
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Purposefully not wearing diabetes devices or not checking glucose levels
The warning signs of suicide
Though many people who experience suicidal thoughts may not show any signs, there may be some clues based on their behavior. The US Department of Health and Human Services lists the following warning signs:
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Talking about wanting to die or to kill oneself
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Looking for a way to kill oneself
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Talking about feeling hopeless or having no reason to live
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Talking about feeling trapped or in unbearable pain
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Talking about being a burden to others
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Increasing substance use (alcohol, drugs, etc.)
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Acting anxious or agitated or behaving recklessly
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Sleeping too little or too much
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Withdrawing or expressing feelings of isolation
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Showing rage or talking about seeking revenge
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Displaying extreme mood swings
In a healthcare context, discussing self-harm behaviors and the topic of suicide is often uncomfortable, for both the person at risk and their healthcare team. However, in order to help people who may be struggling, talking about it is vital. For healthcare providers, proper screening techniques and asking simple questions can help open up the conversation and let people know they are not alone. Plus, it can facilitate a way to provide helpful resources like suicide hotlines or therapy.
Suicide and self-harm resources and support
At the ADA 82nd Scientific Sessions, Dr. Shideh Majidi, a pediatric endocrinologist at Children’s National Hospital in Washington DC, shared one strategy she uses, called safety planning. This is not a “contract,” but a specific plan that people can work through when they are experiencing suicidal thoughts. Each person can make a safety plan that works specifically for them (a sample is below – it’s important to have pleasurable activities and skills set in advance, so you can very easily employ them)
When I am upset or thinking about suicide, I will take the following steps:
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Perform a pleasurable activity or therapy skill (such as meditating, journaling, reading, gratitude exercises, physical activity, calling a friend, volunteering, etc.)
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Perform a different pleasurable activity or therapy skill
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Perform a different pleasurable activity or therapy skill
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Perform a different pleasurable activity or therapy skill
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REPEAT all of the above
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Call 1-800-273-TALK (8255) [and/or a therapist]
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If I feel that I cannot stay safe, I will call 911 or go to an emergency room
In addition, there are a number of resources specifically for people who may be struggling with depression, suicidal ideation, or self-harm:
National and international suicide hotlines:
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National Suicide Prevention Lifeline
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1-800-273-TALK (8255)
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1-888-628-9454 (Spanish Line)
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Crisis Text Line
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Text “TALK” to 741741
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Veterans Crisis Text Line
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1-800-273-8255 (Press 1)
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The Trevor Project Hotline (for LGBTQ+ community)
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1-866-488-7386
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Text “START” to 678678
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Chat from: https://www.thetrevorproject.org/get-help/
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List of International Suicide Hotlines
Therapy resources
Education and support
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Zero Suicide – Zero Suicide is a researched model for improving suicide care within health and behavioral health systems.
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RESCUE Collaborative Community – A multi-stakeholder forum that works to reduce rates of intended self-injury and suicidal acts by people with diabetes through an improved understanding of the risk factors while implementing strategies to address them.
Share these resources with anyone who may be at risk for depression, suicidal ideation, self-harm behaviors, or suicide. It’s vital that these issues continue to receive attention and research funding given the increased risk for people with diabetes.
