QPR Suicide Prevention Training: How to Recognize the Signs

Christina Iglesias

Trigger warning: Suicide, Suicidal ideation


In 2017, 47,173 Americans died by suicide. According to recent federal studies, suicide is the 10th leading cause of death in the U.S. and the second leading cause of death among young Americans ages 15-24. While society deems it taboo, generating discourse around suicide is crucial in destigmatizing mental illness and other risk factors that may lead to suicide. 

Villanova University’s Office of Health Promotions recently conducted its first suicide prevention training called QPR. QPR stands for Question, Persuade, Refer—the three steps individuals can take to help intervene and prevent suicide. Similar to CPR, QPR can save a person’s life. The training is designed to teach people to recognize the warning signs of a suicide crisis. All students, regardless of their suicide-related knowledge levels, are encouraged to complete the training to normalize the discussion of mental health on campus and eliminate stigma surrounding suicide. 

There are multiple risk factors that influence suicidal ideation. Risk factors may include alcohol and substance abuse, physical and mental abuse, depression and other mental illnesses, relationship conflicts, perfectionism and previous suicide attempts. Suicide is most common among white men between 15-24 years old. However, suicide affects people of different genders, ages, and ethnicities. Groups with increasing risks include young African American men, older European American men, people in transition, people with failing health, and people with impending legal consequences. 

Symptoms of suicidal ideation may take on various forms. Individuals who experience feelings of hopelessness and worthlessness, have difficulty concentrating or are constantly sad or irritable may be struggling with suicide. Physical symptoms may include a change in someone’s appetite, weight, sleep or sex patterns, as well as a loss of energy and lack of self-care. Physical symptoms may even include digestive issues or chronic pain that does not respond to medical treatment. Warning signs can be detected on social media, in groups and in one-on-one interactions. Regardless of the site of interaction, it is important to recognize how individuals express these clues.  

Suicide warning signs include direct verbal cues, indirect verbal cues, behavioral clues, and situational clues. Direct verbal cues explicitly communicate that someone is planning to end their life. Direct verbal cues include statements like “I have decided to kill myself” or “ I wish I was dead.” On the other hand, indirect verbal cues include statements like “I wish I could sleep and never wake up” or “I can’t go on”—both of which are admissions of contemplation. Behavioral cues communicate a change in behavior or the presence of new behaviors that suggest someone is suicidal. Examples include giving away possessions, being extra moody consistently or putting one’s personal affairs in order. Situational cues are environmental factors that may push someone toward thoughts of suicide. Factors include the death of a loved one, the loss of a relationship or the loss of financial security. If you notice these signs in an individual, be direct and ask if they are considering suicide.  

According to QPR, questioning is the first step in helping someone who might be suicidal. Before your talk, prepare a list of resources, including crises hotlines and local emergency rooms, that the individual can refer to immediately. While it may feel uncomfortable, it is best to be direct when asking someone if they considering suicide. A direct approach prevents someone from providing vague answers that avoid their admission of being suicidal. For example, do not phrase the question as “Are you having thoughts of hurting yourself?” Instead, ask “Are you thinking of killing yourself?” to avoid miscommunication. You could start with an indirect approach; however, you must be direct afterward. Keep in mind to ask the question in an engaging way rather than in a judgmental way. Find a private space to talk and give yourself time speak. Welcome silence even if it is awkward. Be present and listen to someone before you begin to persuade the individual to find help.

After direct questioning, QPR suggests to persuade someone to stay alive. If an individual admits to suicidal ideation, pay attention to their reasoning. Try to provide hope to them, informing them that their problems are solvable. Offer to help them find help, and then have them promise to stay alive until they receive help. If they are resistant, be persistent. Do not avoid being persistent in fear that the individual will be upset with you.

The final step in QPR is to refer an individual to seek help. The best action is to take a person to a mental health professional immediately. Refer to local crises hotlines and services that are easily accessible. The next best action is to have them commit to getting help and then making specific arrangements to receive that help. The third best option is to have them promise to not attempt or complete suicide. Throughout the referral process, always try to build hope into the conversation. Planting seeds of hope in someone is extremely powerful.

While discussing suicide may feel uncomfortable, it could save a life. People who are experiencing suicidal ideation are almost always relieved to voice their feelings aloud. Do not wait to take initiative if you think someone needs help. Be proactive. Perhaps attend a QPR training to learn more about suicide prevention. Encourage your friends to join you in becoming merchants of hope for people who struggle with their mental health. Only when we empower ourselves through knowledge will we be able to end stigma and get people the help they need. 






*To find out more information on attending a QPR training, visit the University’s Counseling Center website.