Access to care, including mental health hotlines or therapy, is important for suicide prevention.
Suicide is a serious public health concern. More than 700,000 people die due to suicide every year, according to the World Health Organization. In the United States, 12.2 million adults ages 18 or older had serious thoughts about suicide in 2020, and 1.2 million Americans attempted suicide, according to the Substance Abuse and Mental Health Services Administration.
Fortunately, suicide is preventable. The most effective types of suicide prevention focus on learning the warning signs, reducing stigma and providing support to those who are at risk.
What are the warning signs of suicidal behavior?
There are several warning signs that someone may be considering suicide.
"The first two are helplessness and hopelessness, as if their life doesn't have meaning, or what they do doesn't make a difference," says Dr. Frank Drummond, national medical director for Behavioral Health at HCA Healthcare. "You might hear them make statements like, 'No one would care if I wasn't here anymore,' or 'What's the point of going to work,' or 'What's the point of taking a shower?'"
However, suicidality — the risk of suicide, which is usually indicated by suicidal ideation or intent — can also be a symptom of depression, Dr. Drummond says. Other symptoms of depression can include:
- Increased or decreased sleep
- Loss of interest in usual activities
- Crying spells
- Withdrawal from loved ones and community
Who is at risk?
Suicide rates vary based on a number of different factors, including age and ethnicity, Dr. Drummond says. Where you live can also play a role in determining your risk. For instance, people who live in the Southeast have a lower rate of suicide than people who live in the Midwest. Non-Hispanic American Indians or Alaska Natives and non-Hispanic white populations have higher rates of suicide, as do people who live in rural areas. Social determinants of health, which are the nonmedical factors that affect health outcomes, can also impact suicide risk. These can include homelessness, unemployment or financial distress.
In addition to depression, mental health conditions such as substance use problems, bipolar disorder or anxiety disorders can increase suicide risk, according to the American Foundation for Suicide Prevention. Previous suicide attempts or a family history of suicide can also increase risk.
Types of suicide prevention
Suicide prevention can take a number of different forms, focusing on economic, social or medical factors, says Dr. Drummond. "Strengthening economic supports is important in communities," he notes. "A big determinant is homelessness, so a focus on the homeless population and what services — including housing stabilization policies — are available to them can really change the rates of suicide."
Another important factor is access to care, including awareness of suicide or mental health hotlines and how to access them. For example, anyone in the United States can now call or text 988 to reach the Suicide & Crisis Lifeline, which offers free, confidential suicide and crisis counseling. There is also a live chat feature at www.988lifeline.org.
"Points of access to care tend to be emergency rooms in a lot of cases," Dr. Drummond says. "These emergency rooms need to make sure they have all the resources they need to help someone who's having thoughts of suicide, including the appropriate level of assessment needed at the time of crisis and the right type of treatment."
Peer support, after-care programs, and instruction in coping and problem-solving can also help with suicide prevention.
How to support a loved one who is having suicidal thoughts
While it can be uncomfortable to talk about suicide and suicidal thoughts, contrary to some beliefs, talking about suicide does not increase the chances that someone will commit suicide. It's important to understand that no one who is having these feelings wants to feel like that, Dr. Drummond says, and it is OK to ask them directly if they are having any thoughts about hurting themselves.
"If you want to be a little less direct, 'Have you had any thoughts of hopelessness?' can be a lead-in question, or 'You seem different, I notice you're not socializing as much, has something changed? Are you feeling OK?' can be an indirect lead-in, if that feels more comfortable," Dr. Drummond says.
Loved ones should always seek help if someone they care about is having thoughts of suicide, but the appropriate level of help can vary. "That might be an emergency room if the person doesn't feel safe, or if the situation doesn't seem safe, including when there's access to firearms, or a lack of family or connections that would reinforce or strengthen their ability to get through this episode," Dr. Drummond says. "If the person does seem safe or doesn't seem at risk of hurting themselves, definitely seeking out psychotherapy, supportive therapy or at least talking to someone about what kind of support might help."
If you are the caregiver or a loved one of someone who is having suicidal thoughts, it's equally important to make sure you are taking care of yourself and your own mental health. "Talking about the experience and having a safe person to talk to about what it's been like is important," Dr. Drummond says. "It's not uncommon for someone to seek out therapy for themselves because of the experience that they've had caring for a loved one with any mental illness."
Suicidal thoughts are a symptom of an underlying problem, but they can improve over time with support and treatment. Recognizing the warning signs in yourself or a loved one is an important first step toward prevention, but "the bottom line is to talk about it," according to Dr. Drummond.
If you or someone you know is in crisis, contact the 988 Suicide & Crisis Lifeline, or call 911 in the event of an emergency.