NEW ALBANY, Ind. (AP) — After 11 years of reflection, Mike Mudd Sr. still can't understand why his brother Stephen took his life on that first day of spring 2003.
Yes, Stephen had problems. Alcohol had long been a factor in some of the difficulties. On occasion, Mudd said his younger brother didn't feel very good about himself, as if Stephen thought he was unworthy of love.
Not once, though, did he mention to Mudd that he ever wanted to die. Nor did he exhibit any of the other warning signs in front of his brother.
How these feelings morphed into Stephen, at only 49 years old, committing suicide at the bottom of his Virginia driveway is something that the Clarksville resident can't comprehend.
"The one question I always have is what propels you to get to that point in your life where you choose to take your own life. How do you get there? How does that happen?" Mudd told the News and Tribune (http://bit.ly/1hTHCza ). "And that's what we'll never know."
Mudd, 64, isn't alone in his wondering.
Every year, about 38,000 people in the United States commit suicide. More than 100 men and women die this way each day, leaving behind friends and family members to ask why and ponder if they could have done something to prevent their deaths.
"The thing I can't grasp and can't get over and I can't get through is the fact that I couldn't do anything to stop him, and as his older brother, I should have been able to have done something," Mudd said. "That will haunt me to the grave."
Affecting people of all social and economic classes, the consequences of suicide can be felt as much in small towns as they can in big cities. Right here in Clark and Floyd counties, 126 people took their own lives between 2006 through 2010, according to the Indiana State Department of Health's Suicide in Indiana report. During the same period of time, 530 patients in these counties visited emergency departments due to suicide attempts. Underreporting by survivors caused by stigma and shame can skew the real numbers. Many believe the true figure to be much higher.
Studying data can tell both a lot and surprisingly little. Through it, researchers have discovered that men are four times more likely to die by suicide than women, yet 75 percent of all nonfatal suicide attempts are committed by females. Ninety percent of those who took their own lives in 2010 were white, with the rates greatest among Americans 85 and older.
Most significant, perhaps, is that research documented by the American Foundation of Suicide Prevention, or AFSP, shows the connection between suicide and mental illness.
Of those that took their own lives, 90 percent had a mental illness at the time of their death. While there's no single cause to the complex issue, depression remains the most common psychological disorder associated with suicide. More than two-thirds of those who kill themselves are considered depressed. Other mood and personality disorders as well as substance use disorders also may play a role.
Still the numbers can't explain the reasons why people make the decision to do it. Nor can the data alone necessarily tell the tale of how to prevent it.
That's where local mental health, government and nonprofit organizations come in.
As the Clinical Director for LifeSpring Health Systems, Marta Myszak has studied and treated mental health issues in Southern Indiana, including depression and suicidal thoughts. Through the years, she and others in the medical community have gathered information that could warn friends and family members someone close to them may be thinking about taking their own life.
These warning signs may include one or more of the following: changes in eating and/or sleeping habits; social withdraw; becoming less active in beloved activities; neglect in self-care; increased substance use; overly emotional behavior such as excessive crying or rowdiness; and tying up loose ends.
Not all of those who die by suicide communicate their intentions to self-harm. But nearly two-thirds of all cases do exhibit some signs, according to the AFSP. The knowledge of these signs can allow medical help to be found before an attempt can be made.
"Every situation is different," Myszak said. "Anytime anyone is talking about suicide, you need to take it seriously. But people who don't talk about it do it more often. That's been my experience."
Myszak said the best thing to do should a loved one exhibit these warnings is straight out ask the person his or her intentions. Don't worry about putting the idea into their head. Research has shown that simply isn't the case.
"If you suspect someone is thinking about suicide, you need to ask," she said. "And if they are, don't just walk away from it. Take action. Let somebody else know. Get them some help. They may not want it. In fact, they'll probably be resistant to the idea. But you need to get them some help."
In the area, that help may just be a phone call away.
Across the Ohio River in Louisville, trained counselors with the private, nonprofit Seven Counties Services are ready to answer questions and provide support to callers in crisis 24 hours a day, seven days a week. Of the 60,000 calls to their Hope Now hotline each year, about 40 percent come from people they consider at risk for suicide. The National Suicide Prevention Hotline also routes nearby callers from their nationwide phone line to the center.
"We don't charge for anything we do. Our phone services are all free and everything they tell us is confidential," said Geneva Robinson, clinical supervisor for the Hope Now Hotline. "The only time we would break confidentiality would be in what we call active rescue situation. That's where somebody is either at imminent risk — meaning we know if we don't take action now, someone is going to end up dying — or has already taken an overdose or done something to hurt themselves."
Counselors, Robinson said, listen to the callers without judgment and learn their unique stories. Then they help the person prioritize what they want to start working on in order to begin to feel better. Referrals can be given for mental health professionals, as well as recommendations for financial assistance and other social programs that could help alleviate some of the stress of daily life.
"We have no judgment," Robinson said. "We're just there to support that person and to let them know they deserve to be healthy and that there are resources that we can connect them with that can make a difference."
In addition, the hotline answers questions from family and friends concerned about loved ones.
"We can help them understand warning signs and risk factors. We can talk to them about their fears, about how to approach the topic, and we can provide education and materials so they can better help the person they care about," Robinson said.
Information from: News and Tribune, Jeffersonville, Ind., http://www.newsandtribune.com