TheTruthAboutSelfHarm

By:EmberJones
Advisor:MindiHarman
03March2015

INTRODUCTION

In201341,149deathsbysuicidewerereportedmakingsuicidethetenthleadingcauseof
deathintheUnitedStates.Thatmeanssomeonediesfromsuicideevery12.8minutes.Thats
approximately41,000deathsbysuicideperyear.Althoughtherearemanythousandsofdeaths
bysuicideeachyearthereisNOoneleadingcauseofsuicide.Infacttherearevariousdifferent
reasonswhypeopleselfharmorcommitsuicideandeveryonehastheirownreason.Threemain
reasonspeoplecommitsuicidearementalissues,medicalconditions,andtraumaticevents.
Researchershavefoundthatmentalillnesssuchasdepressioncanleadtoselfharmingand
eventuallysuicide.Infact77%ofpeoplehaveseenaprimarycareproviderregardingtheir
mentalhealthwithinayearofdeathbysuicide.Thirtypercentofpeoplewhocommittedsuicide
receivedsomesortofmentalhealthcarewithinthelastyearoftheirlife.Infact,morethan90%
ofallsuicidesarepeoplewithpreviousmentaldisorders.(
www.Afsp.org
)Althoughnotall
peoplewhodocommitsuicidehaveamentalillness.Infactpatientswithaseriousmedical
conditionareatahigherriskforsuicide.Onereasonbeingthattheyfeellossofcontrolover
theirlife,andfeeltheyshouldbeabletochoosetheirtimeofdeath.Othercontributingfactorsto
patientswithseriousmedicalconditionsarechronicpain,fatigue,insomnia,andadverseeffects
fromprescribedmedications.Mentalandseriousmedicalconditionsarenottheonly
contributingfactorstopeoplewhocommitsuicideorselfharm.Inmoderntimeswiththe
popularityoftheinternetglorificationofsuicidesamongcelebritiesandothershasleadtoan
increaseinsuicidesamongadolescents.Studieshavealsofoundthatbeingbulliedhasleadtoan
increaseinsuicides.Bullyingdoesntjusthappenontheplaygroundorinthehallwaysit

happensovertheinternet24/7.Bullyingisverydamagingtopeoplementallyandsociallyand
hasleadtomanysuicidesinrecentyears.(
www.Afsp.org
)
SELFHARM
Twentypercentofpeoplewhodiebysuicidehavemadepriorattempts.Infactonly
710%ofpeoplewhohaveattemptedsuicidesucceed.Womenareestimatedtomake100or
moreattemptspercompletedsuicidethanmen.(
www.Afsp.org
)Asuicideattemptcanbegin
withselfharminmanyforms.Oneformofselfharmiscuttingarms,legs,orplacesthatcanbe
easilyhiddenbylongsleevesandpants.Otherformsofselfharmincludescratchingorpinching
skinuntilbleeding,rippingoftheskinusinganysortofsharpobject,carvingofwordsor
symbolsintotheskin,reopeningofwounds,burningoftheskin,hairpulling,starvation,purging,
breakingofbones,anddrugusage.Therearevarioussymptomsthatpeoplewhoselfharmwill
showsuchasscars,burns,frequentfreshwounds,frequentbruising,hairloss,brokenbones,
keepingsharpobjectsonhand,isolation,claimingfrequentaccidentssuchasfalling,lossof
appetite,lossofinterestinactivities,andinsomnia.Manypeopleselfharminmanyways
resultinginattemptedsuicideoraccidentalsuicide.Selfharmingisfoundtobemorecommon
amongadolescentsandyoungadultsandcanevenbecomeanaddictivebehavior.Infactonein
threepeoplewhoselfharmwilldoitagainintheirlifetime.Peoplewhoselfharmareactually
50%morelikelytocommitsuicide.(
www.Afsp.org
)Themoresomeoneselfharmstheworse
itgets.Mostpeoplestartwithsmallcutsorbruises,andgraduallyprogressintomoresevere
formsofselfharm,leadingtoanincreasedriskofaccidentalsuicide.Selfharmingcancause
thingssuchasscarring,numbness,nervedamage,andinseverecasesevenparalysis.Self
harmingisoftenusedasaquickescapefromlifesproblems.Itcanmakesomepeoplefeel

moreincontroloftheirownpain.Othersdoittosimplytofeelsomethingotherthanthe
numbnessofdepression.Selfharmingisaveryseriousissue.Ifyouorsomeoneyouknowisor
hasshownsignsofselfharm,thereissomethingyoucandotohelp.Youcancontactfamily,
contactlocalmentalhealthresources,orevensimplyreachouttoshowthemthatyoucare.
DEPRESSION
Depressionisoneofthemostcommonmentalillnessesamongpeoplewhoselfharmor
commitsuicide.Depressioncanaffectmanyaspectsoflifesuchasthewayyoufeel,behaveand
think.Depressioncanalsoleadtovariousphysicalandemotionalproblems.Depressionusually
happensduetoalackofserotonininthebrain.Depressionmayrequirelongtermtreatmentsuch
asmedication,psychologicalcounseling,andothertreatments.Symptomsofdepressionmay
includesadnessoremptiness,angryoutbursts,irritabilityandfrustration,lossofinterestin
favoriteactivities,insomnia,lackofenergy,changeinappetite,anxietyorexcessiveworry,
slowedthinking,worthlessnessorguilt,failureandblame.(
www.mayoclinic.org
)Other
symptomsincludetroubleconcentrating,thinking,makingdecisionsorrememberingthings,
thoughtsofdeathorsuicide,andunexplainedphysicalproblemssuchasheadaches.Forsome
peopleitisobviousthattheyhavedepression,andothersdontunderstandwhytheyfeeltheway
theydo.Thereareevenvariousdifferenttypesofdepressionsuchasanxiousdistresswhich
leadstounusualrestlessness,worryandlossofcontrol.Anothertypeofdepressioniscalled
mixedfeatureswhichincludessymptomsofsimultaneousdepressionandmania,elevatedself
esteem,talkingalot,andracingthoughtsorideas.Onemoretypeofdepressionismelancholic
featureswhichincludessymptomsofseveredepression,andanextremelackofpleasurein
favoriteactivities,wakingupearly,worsenedmoodinthemorning,changesinappetite,guilt,

agitation,andsluggishness.Atypicalfeaturesisatypeofdepressionwithsymptomsofthe
abilitytobecheeredbyhappyevents,increaseinappetite,littleneedforsleep(insomnia),
sensitivitytorejection,andheavyfeelingsinlimbs.Anothertypeofdepressionispsychotic
featureswithsymptomsofdepressionaccompaniedbydelusionsorhallucinations,andmay
involvefeelingsofpersonalinadequacyorexpressionofnegativethemesinpersonality.
Catatoniaisaformofdepressionwithsymptomsthatincludeuncontrollableandpurposeless
movementinmotoractivity,orfixedorinflexibleposture.Peripartumonset,alsoknownas
postpartumdepression,occursinsomewomenduringpregnancyandinthemonthsafter
delivery.Seasonalpatternsofdepressionhappenrelatingtothechangeofseasonsandthe
diminishedlightexposure.Peoplecanhaveoneormoreformsofdepressionthroughouttheir
lifetime.(
www.mayoclinic.org
)
Thereareavarietyofdifferentmethodsusedtotreatdepressionsuchasmedication,
counseling,orpsychotherapy.Althoughsomepeopledontrespondtostandardtreatments,
nondrugapproachescanbeusedalongsidewithothertreatmentmethods.Therearethreemain
typesoftalktherapyfordepressionincludingcognitivebehavioraltherapywhichisusedtohelp
peopleseehowtheirbehaviorsandthewaytheythinkaboutthingsplayaroleintheir
depression.Anothertypeoftalktherapyisinterpersonaltherapywhichfocusesonrelationships
withothersandhowtheyaffectindividuals.Thethirdtypeoftalktherapyisproblemsolving
therapywhichfocusesonspecificproblemsfacedandhelpstofindsolutions.Therearealso
variousdifferentmedicationsusedtotreatdepression.Ifonedoesnotworkyourdoctorwill
usuallychangeyourmedicationordosageandsometimesevenputyouonmorethanone
mediationatatime.SomeexamplesofmedicationsthatareusedtotreatdepressionareSSRIs

(selectiveserotoninreuptakeinhibitors),serotonergicantidepressants,SNRIs(serotoninand
norepinephrinereuptakeinhibitors),TCAs(tricyclicantidepressants),andMAOIs(monoamine
oxidaseinhibitors).TCAsandMAOIswereinfactsomeofthefirstmedicationseverusedto
treatdepression.Allantidepressantshaveawarningaboutanincreaseinriskofsuicide.There
arealsootheralternativetreatmentsfordepressionbecauseeveryonewithdepressionhastheir
ownstory,andtheirownpersonalizedtreatmentprogramthattheyhavemadewiththeirfamily
physicianormentalhealthphysician.(
www.webmd.com
)
POSTTRAUMATICSTRESSDISORDER
Posttraumaticstressdisorderisanothermentalhealthillnessthathasbeencloselyrelated
topeoplewhoselfharmandcommitsuicide.Posttraumaticstressdisorder,alsoknownas
PTSD,wasntreallydiscovereduntilsoldiersstartedcomingbackfromtheVietnamWar.
MultiplesoldiersstartedexperiencingsymptomsofPTSDanditwassoonrecognizedasa
mentalillness.Peoplewithposttraumaticstressdisorderexperiencevariousdifferent
symptoms,therearethreecategoriesofsymptomsthatpatientswithPTSDcouldexperience.
Reexperiencingsymptomsconsistofflashbacksofthetraumaticeventorevents,sweatingor
experiencingaracingheart,nightmaresandfrighteningthoughts.Avoidancesymptomsconsist
of,feelingemotionallynumb,strongguilt,worry,depression,lossofinterestinactivities,having
troublerememberingthetraumaticevent(s)theyexperienced,andeventryingtostayawayfrom
events,placesorobjectsthatremindthemofthetraumaticevent(s)they
experienced.(
www.webmd.com
)Hyperarousalsymptomsconsistofbeingeasilystartled,feeling
tenseoronedge,havingdifficultysleeping,andhavingangryoutbursts.Peoplewithpost
traumaticstressdisordercanexperienceuptoanynumberofthesesymptomsinanycategoryat

anygiventime.Anyoneatanyagecangetposttraumaticstressdisorder,butjustbecauseyou
haveexperiencedatraumaticeventitdoesnotmeanthatyouwillgetPTSD,infactmostpeople
wont.PeoplewhohavePTSDexperiencesymptomsforatleastsixmonths,ifnotlonger,
beforebeingdiagnosed.PeoplecangetPTSDfromavarietyoftraumaticeventssuchascombat
exposure,experiencingintenseorlonglastingtrauma,havingexperiencedtraumaearlyinlife,
havingajobwithincreasedriskofbeingexposedtoatraumaticevent,havingothermental
healthissuessuchasanxietyanddepression,andhavingbiologicalrelativeswithabackground
ofmentalillnesses.ThemostcommontraumaticeventsamongpeoplewithPTSDarecombat
exposure,childhoodneglectandabuse,sexualassault,physicalassault,andexperiencingalife
threateningsituation.Peoplewithposttraumaticstressdisorderevenhaveanincreasedchance
ofgettinganothermentalillness.(
www.webmd.com
)
Therearevariousdifferenttreatmentsforpatientsdiagnosedwithposttraumaticstress
disorderbecauseeverypatient'ssituationisdifferent.Itoftentakesmanytriestofinda
treatmentthatworks.CognitivebehavioraltherapyandSSRImedicationshavebeenfoundtobe
mosteffectiveintreatingpatientswithPTSD.Therearemanydifferenttherapeuticmethods
usedtotreatposttraumaticstressdisorder.Cognitivetherapyteachespatientshowtochange
theirthoughtsaboutthetrauma(s)thatcausesthemstress.Exposuretherapyiswhenapatient
talksabouttheirtraumaticevent(s)inasafeenvironmentrepeatedlyuntiltheyhavelessfearof
thetrauma(s)theyhaveexperienced.Eyemovementdesensitizationandreprocessing(EMDR)
isatherapyinwhichapatientwillfocusondistractionslikehandmovementsandsoundswhile
talkingaboutthetraumaticevents(s)theyhaveexperienced.Therearealsomultiplealternative
formsoftherapybeingexperimentedtoseewhatcouldbemosteffectiveforpatientswithPTSD.

Itisalsofoundthatusingpositivecopingskillscanhelpwiththetreatmentofpatientswithpost
traumaticstressdisorder.Someindividualsusecopingskillslikeexercisingorbeingactive,
gettingregularamountsofsleep,havingawellbalanceddiet,art,writing,andotherhobbies
and/orintereststhatmakeindividualshappy.(
www.webmd.com
)
Researchershavefoundtheretobeacorrelationbetweenmanytypesoftraumaand
suicidalbehavior.Manydifferenttraumaticeventssuchasphysicalorsexualassault,childhood
neglectorabuse,caraccidents,andchronicmedicalconditions.(
www.Ptsd.va.gov
)Statisticsina
surveyof5,877individualsshowthat22%ofindividualswhohadexperiencedbeingsexually
assaultedhaveattemptedsuicideatsomepointintheirlifetime.(
www.rcpsych.ac.uk
)
Approximately23%ofpeoplewhoexperiencedphysicalassaultattemptedsuicideatsomepoint
intheirlifetime.Thisstudyalsoshowedthatthereisalargerincreaseinsuicideratesamong
peoplewhoexperiencedphysicalorsexualassaultandchildhoodneglect.Individualswith
PTSDarealsoatagreaterriskofsuicide,about27%ofpeoplediagnosedwithPTSDhave
attemptedsuicideatsomepointthroughouttheirlife.(
www.Ptsd.about.com
)
BIPOLARDISORDER
Bipolardisorderisanothermentalillnessthathasbeenlinkedtosuicidebecausemood
shiftscancausesuicidalthoughtsorbehaviors.Bipolardisorderisamanicneurologicaldisorder
thatcancauserandomshiftsinanindividual'smood.Therearevarioussymptomsthatpeople
withbipolardisorderexperience.Individualsdiagnosedwithbipolardisorderexperiencevery
intenseshiftsinemotions,thesearecalledmoodepisodes.Manicepisodesmayincludefeelings
ofbeingoverlyjoyful,.adepressiveepisodeinapatientshowsymptomsofhopelessnessand
sadness.Someindividualsexperienceamixtureofbothwhichiscalledamixedstate.Other

symptomsofmanicepisodesmayincludebeingextremelyirritable,talkingfast,racingthoughts,
beingeasilydistracted,behavioralchanges,anoticeableincreaseinactivities,beingoverly
restless,insomnia,compulsivebehavior,engaginginhighriskbehavior,andevenhaving
unrealisticbeliefs.Symptomsofadepressiveepisodemayincludemoodchangessuchas
feelingsadorhopelessforalongperiodoftime,orhavingalossofinterestinyourmost
enjoyableactivities.Behavioralchangesincludefeelingtiredorsloweddown,havingtrouble
concentrating,makingpoordecisions,havingtroublerememberingthings,feelingrestless,easily
irritable,changesineating,sleepingorotherhabits,andevensuicidalbehavior.
(
www.nimh.nih.gov
)
Bipolardisordercanevensometimesbepresentinindividualswhenmoodswingsarent
veryextremeatall,thisiscalledhypomania(alesssevereformofmania).Duringahypomanic
episodepatientsmayfeelverygood,behighlyproductive,andevenseemtofunctionwell.
Individualswhoexperiencethismayfeelasifnothingiswrong,butfamilyandfriendsmay
recognizechangesinone'sbehavior.Withouttreatmenthypomaniacanbecomeseveremaniaor
depression,sometimespatientswithseveremanicepisodesanddepressionmayalsoexperience
psychoticsymptomssuchashallucinationsand/ordelusions.Symptomsofpsychoticbehavior
canincludebelievingyouaresomeoneyouarenot,suchasacelebrity,believingyouhave
specialpowers,andevenbelievingyoucommittedacrimewhenyoudidnot.Peoplewho
experiencethistypeofpsychosisareoftenmisdiagnosedwithschizophreniawhichisanother
mentalillness.Patientswithbipolardisordersometimeshaveabackgroundofalcoholor
substanceabuse.Therearewaystotreatpeoplewithbipolardisorder,butitisanincurable
mentalillnessandsymptomstypicallyreturnovertime.Treatmentistypicallymosteffective

amongpatientswhocontinuetoseektreatmentandareopentochangingtreatmentplans
includingmedications.Keepingtrackofmoodwingscanalsohelptopersonalizethetreatment
plan.Therearemanydifferentmedicationstotreatmoodswings,butitoftentakesmany
differenttriestofindtherightone.Mostcommonmedicationsusedtotreatbipolardisorder
includemoodstabilizers,atypicalantipsychotics,andantidepressants.(
www.nimh.nih.gov
)
Therearealsovariousdifferenttreatmentstotreatindividualswithbipolardisorder.
Psychotherapycanbehelpfultosomepatientsitcanhelptoprovidethemwithsupportand
guidancetheyneed.Cognitivebehavioraltherapycanhelppatientswithbipolardisorderlearn
tochangeharmfulpatterns,thoughtsorbehavior.Familyfocusedtherapycanhelpfamily
memberslearntorecognisenewepisodesandtohelpfindnewcopingstrategies,aswellas
helpingwithcommunicationbetweenfamilymembers.Interpersonalandsocialrhythmtherapy
canhelppatientswithbipolardisordertoimproverelationshipsandmanagetheirdailyroutines.
Regularroutinesandsleepingpatternscanhelptoreducesymptomsofmanicepisodes.
Psychoeducationteachespatientswithbipolardisorderabouttheirillnessandtreatmentoptions,
itcanalsohelpwithrecognizingsignsofimpendingmoodswingssothatearlytreatmentcanbe
sought.Thistreatmentisoftendoneingroupsandmaybehelpfulforfamilymembersand
caregiverstobetterhelpthosewithbipolardisorder.Therearealotofothertreatmentsusedto
treatbipolardisordersuchastheuseofsleepingmedicationsandherbalsupplements.Itis
extremelyimportanttoseektreatmentbecauseinsomecasesalongwithmoodswingspatients
mayexperiencesuicidalthoughtsand/orbehaviors.Everyonediagnosedwithbipolardisorder
willhaveadifferentplan,becausetherearevariousdifferentsymptomsthatpatientswithbipolar
disordermayexperience.(
www.nimh.nih.gov
)

CONCLUSION
Althoughtherearevariousdifferentreasonsastowhypeopleselfharmandcommit
suicide,thereisnooneleadingcausetodeathbysuicide.Therearevariousphysicalandmental
reasonswhypeoplecommitsuicidebuttherearealsoapercentageofpeoplewhocommit
suicidethatwewillneverknowthereasonwhy.Regardlessofthereasonthereissomethingwe
canalldotohelpthisissueweatheryouknowsomeonewhohasselfharmedornot.Asimple
gesturesuchassmilingatastrangerwalkingdownthestreetcansaveaperson'slife.Weareall
humanandneedtofeelloveandcompassionanditiscrazytothinkthatlovecouldbethereason
betweenlifeanddeath.Ifyounoticeafamilymemberorclosefriendstarttoshowsignsofself
harmorattemptingsuicidetherearewaysyoucanreachouttohelp.Insomecasesithelpsto
justletyourlovedoneknowthattheyarecaredfor,butyoucanalsotakeafurtherapproachto
contactotherfamilymembersoryourlocalsuicidepreventioncenterifyouareworriedabout
yourlovedone.Ifyouaresomeonewhohasexperiencedselfharming,mentalillness,or
physicalillnessitisimportanttorememberthatyouarenotaloneandyoucanreachoutfor
help.(
www.helpguide.org
)
SuicidehasbecomeaveryseriousissueintheUnitedStatesinrecentyearsandvarious
nonprofitorganizationshavebeenstartedtogivesupporttothosewhoneedit.Thereare
variousdifferentoptionsyoucantrytogethelp.Inmostcasespeoplewhoselfharmorare
suicidalusuallywontreachoutforhelpbecausemostpeopledontknowhow.Peoplewho
commitsuicideoftentimesdontevenwanttodietheyjustseenootherescapetothepainsand
problemsoflife.Itcanbehardtotalkaboutselfharmorsuicidewithalovedonebecauseyou

10

mightbeworriedthattheywillgetupsetorangrywithyou,buttalkingaboutsuicideisthefirst
steptopreventingit.(
www.helpguide.org
)
Ifyouareunsureastohowtostarttheconversationyoucanstartjustbylettingthem
knowyouhavebeenconcernedaboutthemandbyaskingthemhowtheyaredoing.Itcanbe
difficulttoknowwhatquestionstoaskalovedonewhoissuicidalbutitsoktoaskthingslike
Whendidyoustartfeelingthisway?HowcanIhelptosupportyou?Orevenaskingiftheyhave
thoughtaboutseekingtreatment.Somefamilymembersmaybeindenialtothefactthataloved
onemaybesuicidal,butitisimportanttoremembernottoreactwithangerandtoletthemknow
thatyouarethereforthemnomatterhowshockingthemattermaybe.Ifalovedonereaches
outtoyousayingtheyaresuicidalitisalsoveryimportantthatyoutakethemseriously,orit
couldperhapsincreasetheirriskofselfharmorsuicideifyoudonotbelievethem.Incases
whereyouareworriedafriendorfamilymemberisgoingtoattemptsuicideitisoktocontact
authoritiessuchaspoliceoryourlocalsuicidepreventioncenter,evenifyourlovedonegets
madatyouitisbetterthanthemgettinghurt.Itcansometimesbehardtotellwhetherornot
someoneisataloworhighriskofsuicide.(
www.helpguide.org
)
Peoplewithalowriskofsuicideusuallyexperiencesuicidalthoughts,buttheyusually
wonthaveaplantocommitsuicide,andoftentimestheywilltrytoreachoutforhelp.A
moderateriskforsuicidemayincludesuicidalthoughts,avagueplan,andinsomecasesthey
mighthintatthethoughtofsuicide.Someonewhoisathighorsevereriskofsuicidewillhave
suicidalthoughts,theyalsowillhaveaspecificplanastohowtheywouldcommitsuicide,and
oftentimestheywillfrequentlytalkaboutsuicide.Questionsitmaybegoodtoaskfriendsor
lovedonesifyourareconcernedtheyareatriskofsuicideareDoyouhaveaplan?Whenor

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howwouldyoudoit?Doyouintendoncommittingsuicide?Thesequestionsmayhelpyouto
determinewhetheryourlovedoneisatriskofsuicideornot.Eventhoughtalkingtoalovedone
aboutsuicideorcontactingauthoritiescanbethefirststeptohelpingalovedonethereareother
waystohelpto.Otherwaysyoucanhelptopreventsuicidemayincludebutarenotlimitedto
helpingalovedonetoseekingprofessionalhelpsuchascounseling,helpthemtocontinuewith
treatment,encourageapositivelifestyle,makeasafetyplanwithyourlovedone,removeobjects
thatcanbeusedtoselfharmsuchaspills,knives,orfirearms,orsimplyevenjustcontinuingto
showloveandsupporttoyourfriendorfamilymember.Suicideisaveryseriousissueinthe
UnitedStates,butit'simportanttorememberthattherearethingswecanalldotohelpthis
problemnationwideevenifit'ssimplyeducatingyourselfaboutthisissue.(
www.helpguide.org
)

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WorksCitedPage

www.afsp.org
2015
CentersforDiseaseControlandPrevention(CDC)2013.March12,2015

www.rcpsych.ac.uk
2013
RoyalCollegeofPsychiatristsPublicEducationCommittee.Editor:Dr.PhilipTims,
Expert:Dr.GordonTurnbullApril7,2015

www.mayoclinic.org
2015
http://www.mayoclinic.org/diseaseconditions/depression/basics/symptoms/con2003297745k
http://www.mayoclinic.org/diseaseconditions/postpartumdepression/basics/symptoms/con2002
913035k
http://www.mayoclinic.org/diseaseconditions/atypicaldepression/basics/symptoms/con2003511
439k
http://www.mayoclinic.org/diseaseconditions/bipolardisorder/basics/symptoms/con200275444
7k
March12,2015

www.webmd.com
2015
Author:StephenRPaige,PhD,VisitingProfessorofPsychology,UniversityofNebraskaat
Omaha
www.ptsd.va.gov
March5,2015

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www.nimh.nih.gov
2015
TheNationalInstituteofMentalHealth(NIMH)ispartofNationalInstitutesofHealth(NIH),a
componentoftheU.S.DepartmentofHealthandHumanServices.April16,2015

www.helpguide.org
2015
http://www.helpguide.com.org/articles/suicidepreventionhelpingsomeonewhoissuicidal.ht
m
http://www.helpguide.com.org/articles/depression/helpingadepressedperson.htm
April20,
2015

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