The United States is the only industrialized country where suicides have been continually on the rise, and many believe the numbers are still underestimated due to how deaths by suicide are classified. To be ruled suicide, the intent to die must have been communicated. This makes deaths such as those by overdose difficult to properly account for because it is difficult to tell if the overdose was accidental or intentional.

Currently, suicide is the 10th leading cause of death in the country. The rate of death by suicide is two and a half times higher than that of homicides and has seen a steady increase since 1999. The group that has seen the highest increase is white, middle-aged males, a statistic that is also reflected locally.

So far this year there have been six suicides in Indiana County. Last year 18 were recorded. Of the six, five have been males, and the victims have ranged in age from 14 to 83.

“Just like nationally, though, we believe the number may be higher due to circumstances such as overdoses,” said Dr. Ralph May, a psychologist at the Community Guidance Center.

May and Dr. Joseph Buzogany of Indiana Regional Medical Center presented “Mental Notes: Suicide Prevention” Wednesday night at the Rustic Lodge in White Township.

Indiana County fits the bill for other national statistics as well. Studies have shown that suicide rates in rural areas are higher than in urban areas. Reasons include increased chances of isolation and easier access to firearms, which is one of the most common methods of suicide.

More overarching factors are seen in most people who express suicidal ideation. Factors such as drug or alcohol addiction and untreated mental health issues have a heavy affect on those who are contemplating suicide, May said.

There are several methods and risk assessments that doctors use when a patient expresses thoughts of suicide. These assessments allow doctors to analyze patients’ responses to questions and judge what sort of treatment and steps to take to help them.

Buzogany, a psychiatrist with IRMC, spoke on treatments for patients.

“It’s important to ask people if they’re suicidal. I always ask my patients if they feel suicidal or homicidal on every visit, even if they walk in looking happy. Some always tell me ‘no’ every time and ask me why I ask them the same question at every appointment and I always tell them ‘because some people say yes.’ So it doesn’t matter what they look like outwardly, I always ask.”

May also stressed the importance of routinely talking about suicide.

“If you notice someone acting down or talking in a way that seems off, ask them outright if they’ve thought about suicide. Sometimes people just need the prompt to talk about it. And when they do talk, listen,” May said.

Many times people who are having these thoughts will keep them to themselves out of embarrassment or fear of being “locked away,” May said.

May and Buzogany agree that these questions should be standard protocol for any doctor’s visit, even if the person seems healthy.

“It’s important to make it something people talk about and aren’t afraid to get help for,” said May.

Talk turned to other methods of prevention as well as noticing signs in those around you. While suicide is complex and not all people show signs of ideation, a majority of the cases do, May said. The most common examples are feelings of hopelessness and worthlessness, that life is no longer worth living.

“One very telling sign is acting as though they are perceived as a burden,” said May. “If they’re saying things like ‘things would be better off if I wasn’t here’ or ‘it would be better if I were just gone,’ it’s a good chance they’re at least thinking about it. Talk like this very common in those who are suicidal. Ask and pay attention when people are talking like this.”

Buzogany also talked about a certain mindset that those who are suicidal tend to get stuck in.

“No one would rather be dead if there was an alternative. When someone is truly suicidal, the chemicals in their brain have convinced them that there is absolutely no alternative and even the good things that happen to them do not matter. It’s important to recognize when someone is in this state and buy as much time as we can to get them help to work on it,” Buzogany said.

The presentation included resources that are available in Indiana County. The Suicide Task Force offers services as well as classes and workshops to help people recognize a crisis situation. One such training is QPR, a topic that was touched on in the presentation. QPR stands for Question, Persuade and Refer, three steps that can help save someone from committing suicide. These steps can help a person identify a crisis, question the person, persuade them to seek help, offer hope and then help refer them to the proper resources. Training is available for QPR through the task force and more information and scheduling are available by calling Brandy King at (724) 463-8200.

A 24/7 crisis hotline can be reached at 1-877-333-2470.

However, both May and Buzogany stressed that in an emergency situation where someone is actively attempting harm, it is imperative for you to leave the situation and call 911 immediately.

“Do not engage with someone in this type of emergency situation,” Buzogany said. “Anyone who is in the mental state to harm themselves with a loaded weapon may turn it on others. It’s important to keep yourself safe as well as get the proper authorities involved.”

For more information on the services provided by the task force, including information on upcoming events and seminars, visit