After two high-profile deaths, calls and texts to crisis hotlines have risen by 65 percent. The deaths have many people talking about suicide. Were there warning signs family and friends could have missed?

The American Foundation for Suicide Prevention says there is never a single cause for suicide. In a statement on its website after the death of fashion designer Kate Spade on June 5, the foundation said “suicide is the result of many factors that come together, such as an underlying mental health condition, life stressors and access to lethal means.”

Amanda B. Hettinger, M.D., psychiatrist with Norton Women’s Mental Health Services, echoes the sentiments of the foundation, saying that suicide is a complicated and tragic outcome.

The American Foundation for Suicide Prevention offers information on the warning signs and risk factors. Dr. Hettinger encourages everyone to know the signs.

Warning signs

A person talks about:

• Killing themself
• Feeling hopeless
• Having no reason to live
• Being a burden to others
• Feeling trapped
• Unbearable pain

Behaviors that may signal risk, especially if related to a painful event, loss or change:

• Increased use of alcohol or drugs
• Looking for a way to end their life, such as searching online for methods
• Withdrawing from activities
• Isolating themself from family and friends
• Sleeping too much or too little
• Visiting or calling people to say goodbye
• Giving away prized possessions
• Aggression
• Fatigue

People who are considering suicide often display one or more of the following moods:

• Depression
• Anxiety
• Loss of interest
• Irritability
• Humiliation/shame
• Agitation/anger
• Relief/sudden improvement

Three key risk factors associated with suicide include health, environment and history:

Health factors include:

• Mental health conditions
  • Depression
  • Substance abuse
  • Bipolar disorder
  • Schizophrenia
  • Personality traits of aggression, mood changes and poor relationships
  • Conduct disorder
  • Anxiety disorder
• Serious physical health conditions, including pain
• Traumatic brain injury

Environmental factors include:

• Access to lethal means, including firearms and drugs
• Prolonged stress, such as harassment, bullying, relationship problems or unemployment
• Stressful life events, such as rejection, divorce, financial crisis, life transitions or loss
• Exposure to another person’s suicide or to graphic or sensationalized accounts of suicide

Historical factors include:

• Previous suicide attempts
• Family history of suicide
• Childhood abuse, neglect or trauma