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9 risk factors for suicide and 1 important question you can ask to hopefully know for sure.

There's something you should know about people with severe depression.

9 risk factors for suicide and 1 important question you can ask to hopefully know for sure.

Many of us feel inept when it comes to acknowledging suicide.

"It's so tragic."

"What a waste of a beautiful life."


"Why didn't he just talk to us about it?"

We are often at a loss for how to deal with the profoundly devastating topic of suicide. We can talk about it in a removed, social-ill, this-world-is-so-messed-up, throw-our-hands-up-in-helplessness kind of way when it comes up in passing — like when people are talking about how much they miss Robin Williams.

But we are poorly equipped to discuss it in any substantial way. Which is understandable. Most of us aren't trained in psychiatric services and are doing our best to muddle through our own difficulties in life. Figuring out how to solve America's suicide problem seems above our pay grade.

It's important for each of us to commit to getting better at talking about it.

When you have that one friend you can just sit and talk with about anything. Image by Garry Knight/Flickr.

The truth is that each of us could have a friend who's suicidal right now — today — and isn't telling us about it. They're not telling us about it because they know very well that they live in a world ill-equipped to help them without judging them.

The main thing that kept me from speaking up long ago when I toyed with the thought of ending my own life was: "If I admit I'm barely able to take each next breath right now, will I always be labeled as fragile or troubled forever for the rest of time?" Saying something is a decision to commit to someone else's memory that this messed-up mental stumble is happening. It takes bravery to talk about it, especially when you're in the thick of it.

Everyone and anyone could be at risk for suicide. Suicide doesn't have a "look." Moms, dads, 11-year-olds, pastors — the thought of ending it all can take root in anybody's mind. But there are some groups who are more prone to suicide than others. According to the CDC, lesbian, gay, and bisexual youth are four times more likely to attempt suicide than straight peers. And 25% of transgender young people surveyed report having made an attempt to take their own life. The thing that some well-meaning people don't know is that snapping out of it or learning how to enjoy life isn't an option for those who are truly depressed — it's not a mind-over-matter thing. At that particular moment in their lives, the afflicted person just can't.

The little things that can spark our spirit during normal times don't do the same thing for someone who's depressed. Image by Rick/Flickr.

Why does suicide start looking like a viable option?

John Gibson, a pastor whose name was recently released as part of the Ashley Madison hack (where people were outed for starting accounts with the intent to cheat on their spouses), committed suicide in August.

"He talked about depression. He talked about having his name on there, and he said he was just very, very sorry. What we know about him is that he poured his life into other people, and he offered grace and mercy and forgiveness to everyone else, but somehow he couldn't extend that to himself."
Christi Gibson, on her husband John's suicide letter

Jody Nelson, a clinical social worker in Lansing, Michigan, explains part of why a person can be drawn to suicide in the first place:

"A suicidal person will often see suicide as a neat, tidy, and self-contained solution to their emotional state of desperation. Suicide is never neat. Never tidy. And never truly self-contained. Suicidal people are not capable of seeing or predicting the ripples and waves their act will cause in lives around them. Yet their suicide will impact lives they aren't even aware they are touching via connections their own illness makes impossible for them to see."

He advises us to know the risk factors:

"Not all of these are going to mean impending suicide attempts, but the risk increases as they pile on each other."

1. Depression. Isolation. Losses.

2. Big life changes (and sometimes, just some small ones like going on or off certain meds).

3. Prior attempts. Substance abuse.

4. Irrational or erratic behaviors.

5. Financial difficulties.

6. Access to means.

7. Suicidal intention.

8. A family history of suicide.

9. Connections to others who have died by suicide.

Nelson says that if we see those signs, we should ask straight-up something like this question:

"Hey I've noticed you've been particularly down lately. Are you thinking about hurting yourself?"

It won't make someone who's not suicidal suddenly consider it. And it won't make someone who is thinking suicidal thoughts go through with it. What it will do, if they have been thinking about it, is break through a wall that's keeping the person isolated and suddenly alleviate some of that buildup they've been sitting alone with. A person struggling with depression and suicidal thoughts is often very grateful to find someone they can talk frankly with about their thoughts.

And if they say yes, listen and talk, but also get them to an emergency room. Go with them. Get them there. They will be connected to the right resources once they get there. Then follow up and keep an eye. Keep talking with them. But don't let them put it off — they will try to downplay it as not that serious. Who wouldn't?

Here's why it's important for us to talk about this right now, and publicly.

There's no shame in needing your friends. These guys know. Image by SmellyAvocado.

When we learn how to talk about suicide more productively and demonstrate publicly that we're trying to understand it a little better than we used to, we open doors in case someone in our circle is thinking about opening up.

We signal that we aren't going to judge our friends and loved ones — just love them. Sharing an article like this is one way to start sending that signal.

And when more people get the message that there's someone around they can talk to, maybe we'll see the suicide numbers drop significantly.

In the big picture, that would be amazing. But as anyone who's lost a loved one to suicide can tell you, saving one person and stopping those devastating ripple effects from starting is immeasurably valuable.

Since his first hit single "Keep Your Head Up" in 2011, award-winning multi-platinum recording artist Andy Grammer has made a name for himself as the king of the feel-good anthem. From "Good to Be Alive (Hallelujah)" to "Honey, I'm Good" to "Back Home" and more, his positive, upbeat songs have blared on beaches and at backyard barbecues every summer.

So what does a singer who loves to perform in front of live audiences and is known for uplifting music do during an unexpectedly challenging year of global pandemic lockdown?

He goes inward.

Grammer told Upworthy that losing the ability to perform during the pandemic forced him to look at where his self-worth came from. "I thought I would have scored better, to be honest," he says. "Like, 'Oh, I get it from all the important, right places!' And then it's taken all away in one moment, and you're like, 'Oh, nope, I was getting a lot from that.'

"It's kind of cool to break all the way down and then hopefully put myself back together in a way that's a little more solid," he says.

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Since his first hit single "Keep Your Head Up" in 2011, award-winning multi-platinum recording artist Andy Grammer has made a name for himself as the king of the feel-good anthem. From "Good to Be Alive (Hallelujah)" to "Honey, I'm Good" to "Back Home" and more, his positive, upbeat songs have blared on beaches and at backyard barbecues every summer.

So what does a singer who loves to perform in front of live audiences and is known for uplifting music do during an unexpectedly challenging year of global pandemic lockdown?

He goes inward.

Grammer told Upworthy that losing the ability to perform during the pandemic forced him to look at where his self-worth came from. "I thought I would have scored better, to be honest," he says. "Like, 'Oh, I get it from all the important, right places!' And then it's taken all away in one moment, and you're like, 'Oh, nope, I was getting a lot from that.'

"It's kind of cool to break all the way down and then hopefully put myself back together in a way that's a little more solid," he says.

Keep Reading Show less
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Each year, an estimated 1.8 million people in the United States are affected by cancer — most commonly cancers of the breast, lung, prostate, and blood cancers such as leukemia. While not everyone overcomes the disease, thanks to science, more people are surviving — and for longer — than ever before in history.

We asked three people whose lives have been impacted by cancer to share their stories – how their lives were changed by the disease, and how they're using that experience to change the future of cancer treatments with the hope that ultimately, in the fight against cancer, science will win. Here's what they had to say.

Celine Ryan, 55, engineer database programmer and mother of five from Detroit, MI

Photo courtesy of Celine Ryan

In September 2013, Celine Ryan woke up from a colonoscopy to some traumatic news. Her gastroenterologist showed her a picture of the cancerous mass they found during the procedure.

Ryan and her husband, Patrick, had scheduled a colonoscopy after discovering some unusual bleeding, so the suspicion she could have cancer was already there. Neither of them, however, were quite prepared for the results to be positive -- or for the treatment to begin so soon. Just two days after learning the news, Ryan had surgery to remove the tumor, part of her bladder, and 17 cancerous lymph nodes. Chemotherapy and radiation soon followed.

Ryan's treatment was rigorous – but in December 2014, she got the devastating news that the cancer, once confined to her colon, had spread to her lungs. Her prognosis, they said, was likely terminal.

But rather than give up hope, Ryan sought support from online research, fellow cancer patients and survivors, and her medical team. When she brought up immunotherapy to her oncologist, he quickly agreed it was the best course of action. Ryan's cancer, like a majority of colon and pancreatic cancers, had been caused by a defect on the gene KRAS, which can result in a very aggressive cancer that is virtually "undruggable." According to the medical literature, the relatively smooth protein structure of the KRAS gene meant that designing inhibitors to bind to surface grooves and treat the cancer has been historically difficult. Through her support systems, Ryan discovered an experimental immunotherapy trial at the National Institutes of Health (NIH) in Bethesda, MD., and called them immediately to see if she was eligible. After months of trying to determine whether she was a suitable candidate for the experimental treatment, Ryan was finally accepted.

The treatment, known as tumor-infiltrating lymphocyte therapy, or TIL, is a testament to how far modern science has evolved. With this therapy, doctors remove a tumor and harvest special immune cells that are found naturally in the tumor. Doctors then grow the cells in a lab over the next several weeks with a protein that promotes rapid TIL growth – and once the cells number into the billions, they are infused back into the patient's body to fight the cancer. On April 1, 2015, Ryan had her tumor removed at the NIH. Two months later, she went inpatient for four weeks to have the team "wash out" her immune system with chemotherapy and infuse the cells – all 148 billion of them – back into her body.

Six weeks after the infusion, Ryan and Patrick went back for a follow-up appointment – and the news they got was stunning: Not only had no new tumors developed, but the six existing tumors in her lungs had shrunk significantly. Less than a year after her cell infusion, in April 2016, the doctors told Ryan news that would have been impossible just a decade earlier: Thanks to the cell infusion, Ryan was now considered NED – no evaluable disease. Her body was cancer-free.

Ryan is still NED today and continuing annual follow-up appointments at the NIH, experiencing things she never dreamed she'd be able to live to see, such as her children's high school and college graduations. She's also donating her blood and cells to the NIH to help them research other potential cancer treatments. "It was an honor to do so," Ryan said of her experience. "I'm just thrilled, and I hope my experience can help a lot more people."

Patrice Lee, PhD, VP of Pharmacology, Toxicology and Exploratory Development at Pfizer

Photo courtesy of Patrice Lee

Patrice Lee got into scientific research in an unconventional way – through the late ocean explorer Jacques Cousteau.

Lee never met Cousteau but her dreams of working with him one day led her to pursue a career in science. Initially, Lee completed an undergraduate degree in marine biology; eventually, her interests changed and she decided to get a dual doctoral degree in physiology and toxicology at Duke University. She now works at Pfizer's R&D site in Boulder, CO (formerly Array BioPharma), leading a group of scientists who determine the safety and efficacy of new oncology drugs.

"Scientists focused on drug discovery and development in the pharmaceutical industry are deeply committed to inventing new therapies to meet unmet needs," Lee says, describing her field of work. "We're driven to achieve new medicines and vaccines as quickly as possible without sacrificing safety."

Among the drugs Lee has helped develop during her career, including cancer therapies, she says around a dozen are currently in development, while nine have received FDA approval — an incredible accomplishment as many scientists spend their careers without seeing their drug make it to market. Lee's team is particularly interested in therapies for brain metastases — something that Lee says is a largely unmet need in cancer research, and something her team is working on from a variety of angles. "Now that we've had rapid success with mRNA vaccine technology, we hope to explore what the future holds when applying this technology to cancers," Lee says.

But while evaluating potential cancer therapies is a professional passion of Lee's, it's also a mission that's deeply personal. "I'm also a breast cancer survivor," she says. "So I've been on the other side of things and have participated in a clinical trial."

However, seeing how melanoma therapies that she helped develop have affected other real-life cancer patients, she says, has been a highlight of her career. "We had one therapy that was approved for patients with BRAF-mutant metastatic melanoma," Lee recalls. "Our team in Boulder was graced by a visit from a patient that had benefited from these drugs that we developed. It was a very special moment for the entire team."

None of these therapies would be available, Lee says without rigorous science behind it: "Facts come from good science. Facts will drive the development of new drugs, and that's what will help patients."

Chiuying "Cynthia" Kuk (they/them) MS, 34, third-year medical student at Michigan State University College of Human Medicine

Photo courtesy of Cynthia Kuk

Cynthia Kuk was just 10 years old when they had a conversation that would change their life forever.

"My mother, who worked as a translator for the government at the time, had been diagnosed with breast cancer, and after her chemotherapy treatments she would get really sick," Kuk, who uses they/them pronouns, recalls. "When I asked my dad why mom was puking so much, he said it was because of the medicine she was taking that would help her get better."

Kuk's response was immediate: "That's so stupid! Why would a medicine make you feel worse instead of better? When I'm older, I want to create medicine that won't make people sick like that."

Nine years later, Kuk traveled from their native Hong Kong to the United States to do exactly that. Kuk enrolled in a small, liberal arts college for their Bachelor's degree, and then four years later started a PhD program in cancer research. Although Kuk's mother was in remission from her cancer at the time, Kuk's goal was the same as it had been as a 10-year-old watching her suffer through chemotherapy: to design a better cancer treatment, and change the landscape of cancer research forever.

Since then, Kuk's mission has changed slightly.

"My mom's cancer relapsed in 2008, and she ended up passing away about five years after that," Kuk says. "After my mom died, I started having this sense of urgency. Cancer research is such that you work for twenty years, and at the end of it you might have a fancy medication that could help people, but I wanted to help people now." With their mother still at the forefront of their mind, Kuk decided to quit their PhD program and enter medical school.

Now, Kuk plans to pursue a career in emergency medicine – not only because they are drawn to the excitement of the emergency room, but because the ER is a place where the most marginalized people tend to seek care.

"I have a special interest in the LGBTQ+ population, as I identify as queer and nonbinary," says Kuk. "A lot of people in this community and other marginalized communities access care through the ER and also tend to avoid medical care since there is a history of mistreatment and judgement from healthcare workers. How you carry yourself as a doctor, your compassion, that can make a huge difference in someone's care."

In addition to making a difference in the lives of LGBTQ+ patients, Kuk wants to make a difference in the lives of patients with cancer as well, like their mother had.

"We've diagnosed patients in the Emergency Department with cancer before," Kuk says. "I can't make cancer good news but how you deliver bad news and the compassion you show could make a world of difference to that patient and their family."

During their training, Kuk advocates for patients by delivering compassionate and inclusive care, whether they happen to have cancer or not. In addition to emphasizing their patient's pronouns and chosen names, they ask for inclusive social and sexual histories as well as using gender neutral language. In doing this, they hope to make medicine as a whole more accessible for people who have been historically pushed aside.

"I'm just one person, and I can't force everyone to respect you, if you're marginalized," Kuk says. "But I do want to push for a culture where people appreciate others who are different from them."