Suicide Awareness and Prevention

Lauren Manier and Megan Polanin, PhD, National Center for Health Research

Sunny Cui, Lauren Manier, and Megan Polanin, PhD, National Center for Health Research

Suicide is the 10th leading cause of death in the United States among all people over 10 years old, and rates are on the rise. Approximately 40,000 people in the US commit suicide every year,[1] which is 24% higher than in 1999[2] and about 9,000 more than those killed in car accidents.[3]

Understanding the warning signs and risk factors can help prevent suicides.

What are the Warning Signs?

These are the warning signs, according to the National Suicide Prevention Lifeline (1-800-273-8255):[4]

  • Sleeping too much or too little
  • Acting anxious or upset
  • Showing rage
  • Withdrawing or isolating
  • Extreme mood swings
  • Behaving recklessly
  • Increasing use of drugs and/or alcohol
  • Talking about seeking revenge
  • Talking about feeling hopeless, trapped, or a burden to others
  • Looking for a way to kill themselves (for example, buying a gun)
  • Talking about suicide or wanting to die

If you notice any of these signs in a loved one, you should seek help.

What Makes It More Likely that a Person Will Commit Suicide?

According to the World Health Organization (WHO), many personal traits and experiences make it more likely that an individual will try to commit suicide. They include:[5]

  • Severe depression
  • Other mood disorders (such as bipolar disorder, also called manic depression)
  • Anxiety disorders
  • Impulsivity
  • Sense of hopelessness
  • Family history of suicide
  • Knowing people who committed suicide or hearing about suicides
  • Serious medical illness
  • Personal loss
  • Conflicts with other people
  • Broken relationships
  • Legal or work-related problems
  • History of physical or sexual abuse
  • Sexual orientation
  • Schizophrenia

For example, when teenagers and young adults know someone who recently committed suicide, they are more likely to commit suicide. News coverage of suicides can also increase the number of other suicides, especially among adolescents.[6]

How to Get Help

There are many ways to get help for you or for a loved one. For immediate help, call the National Suicide Prevention Lifeline (1-800-273-8255) or text the Crisis Text Line at 741741 to connect with a trained crisis counselor.

For long-term help (not for a crisis), psychotherapy, or “talk therapy,” can make a big difference. It is best if the therapist is licensed in your state and specially trained to work with individuals struggling with depression. Therapy can help prevent people who are struggling with suicidal thoughts from hurting themselves. It can also help support individuals who have a friend or family member who has committed suicide. Therapy can help people increase hope and learn new, helpful strategies to deal with scary feelings in more healthy ways.[7]

Cognitive behavioral therapy (CBT) is shown to work for people who are depressed. CBT helps people identify negative or unhelpful thoughts that contribute to distressing feelings and unhealthy behaviors. For example, if you focus on the thought, “I just messed up again – I’m such a failure,” you will probably feel stressed and unhappy. CBT can help people recognize their negative, unhelpful thoughts that lead to distressing feelings. It then helps people develop better ways to cope with these thoughts and resulting feelings so that they don’t lead to unhealthy behaviors.

Dialectical behavior therapy (DBT) is a related type of therapy that helps people who are depressed by teaching them healthier ways to think about and cope with stressful situations. It includes strategies from CBT while also helping people to learn to accept their negative thoughts and distressing feelings. DBT does this by teaching mindfulness skills, which means awareness of what you are experiencing in the moment. For example, you might be feeling stressed about an upcoming test or event. DBT would help you be aware of how the stress feels in your body and any negative thoughts that come up (mindfulness) and then teach you relaxation skills (like deep breathing and meditation) to help relieve the stress. DBT helps people accept that stressful situations and negative thoughts are part of life, while also increasing their capacity to cope with them.[8][9]

If therapy doesn’t work well enough, some people may try medication. Medicines can help reduce feelings of depression, anxiety, and other unhealthy thoughts, but unfortunately these medications can also increase thoughts of suicide. In fact, there is a warning on all antidepressants that mention that risk. Antidepressants are especially likely to increase thoughts of suicide in adolescents and young adults, but people of any age can also become more suicidal when taking antidepressant medications. Children taking antidepressants should be very closely monitored for suicidal thoughts, worsening depression, or changes in attitude.[10]

Prevention

The National Institute for Mental Health (NIMH) recommends the following steps to help a loved one dealing with emotional pain and suicidal thoughts or intentions (which are more serious than thoughts):[8]

  • Ask: Confront your loved one in a caring and nonjudgmental way by saying: “I care about you, and I am worried. Are you thinking about hurting or killing yourself?” Research shows questioning does not increase suicides or the thought of suicide. As this can be a difficult thing to do, you might seek support from someone else who cares about the person.
  • Keep them safe: Ask the person if they have any weapons or other lethal items that are easily accessible. If they do, help this person figure out a plan for removing the weapons so that they cannot be accessed.
  • Be there: Be open to listening and learning what the person is experiencing, thinking, and feeling. Simply being with the person and listening is a great way to show that you care, and it might help your loved one open up to you.
  • Help them connect: Help your loved one find a mental health professional. Provide resources such as the National Suicide Prevention Lifeline (1-800-273-8255), where trained crisis workers are available to talk 24 hours a day, 7 days a week. You can even help put the number in this person’s phone or call with them so that they have extra support. To help them find a therapist, use SAMHSA’s (Substance Abuse and Mental Health Services Administration) Behavioral Health Treatment Services Locator, or call SAMHSA’s National Helpline (1-800-622-4357). Remember: If the situation is potentially life-threatening, call 911 or go to a hospital emergency room immediately.
  • Stay connected: Keep in touch with the person after they are connected with a mental health professional. Following up with people who are thinking about suicide decreases their risk of committing suicide.[8]

Age, Sex, Race and Suicide

Adolescents and young adults are the most likely to consider suicide, and suicide is the second leading cause of death for people who are 15-24 and 25-34.[11] In addition, suicide attempts are higher among gay or lesbian students in grade 9-12 than among heterosexual students, and LGBTQ youth are 8 times more likely to commit suicide than heterosexual children. This is likely due to feelings of isolation and rejection as these youth are oftentimes the targets of bullying.[12]

Race and ethnicity also affect suicide rates. Native Americans and Alaskan Natives have the highest suicide rates: as many as 12 people out of every 100,000 commit suicide. African Americans and Hispanics have the lowest suicide rates; approximately 5 people out of every 100,000 commit suicide.[13]

Men die from suicide at a much higher rate than women, but women make more suicide attempts. About 7% of women attempt suicide while around 4% of men attempt suicide.[14] However, 4 men commit suicide for every 1 woman that commits suicide. This difference is because men are more likely to attempt suicide using a more lethal method when compared to women.[15]

Urban vs. Rural Suicide Rates

Rural areas often have higher suicide rates than urban areas. Studies indicate that this isn’t primarily due to racial or ethnic differences.[16] For example, a Johns Hopkins University study found that suicide rates in rural Maryland communities were 35% higher than rates in urban areas in the state, primarily due to an increased use and availability of firearms in rural areas.[17]

Related Articles

Do Antidepressants Increase Suicide Attempts? Do They Have Other Risks?

Risk Factors and Warning Signs for Youth Suicide: Smoking, Drinking, Marijuana, Family Problems, Sexual Orientation, and School-Performance

All articles on our website have been approved by Dr. Diana Zuckerman and other senior staff.

  1. US Department for Health and Human Services. Center for Disease Control and Prevention. (2015). Suicide: At a Glance. Retrieved from https://www.cdc.gov/violenceprevention/pdf/suicide-datasheet-a.pdf. Accessed September 8, 2017.
  2. Curtin, S. C., Warner, M., and Hedegaard, H. (2016). Suicide rates for females and males by race and ethnicity: United States, 1999 and 2014. NCHS Health E-Stat. National Center for Health Statistics. Retrieved from https://www.cdc.gov/nchs/data/hestat/suicide/rates_1999_2014.pdf. Accessed September 8, 2017.
  3. US Department for Health and Human Services. Center for Disease Control and Prevention. (2016). Motor Vehicle Crash Deaths. Retrieved from https://www.cdc.gov/vitalsigns/motor-vehicle-safety/index.html. Accessed September 8, 2017.
  4. National Suicide Hotline. We Can Prevent Suicide. Retrieved from https://suicidepreventionlifeline.org/how-we-can-all-prevent-suicide/. Accessed September 8, 2017.
  5. DeLeo, D., Bertolote, J., and Lester, D. Self-directed violence. (2002). Chapter 7. In: Krug EG., Dahlberg LL., Mercy JA, Zwi A, Lozano R, eds. World report on violence and health. Geneva: World Health Organization. Accessed September 8, 2017.
  6. O’Carroll, P. W., Potter, L.B., Aronowitz, E., et. al. (1994). Suicide Contagion and the Reporting of Suicide: Recommendations from a National Workshop. Center for Disease Control and Prevention. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/00031539.htm. Accessed September, 8 2017.
  7. Issues Treated in Therapy: Suicide. (2017, August 11). Retrieved from https://www.goodtherapy.org/learn-about-therapy/issues/suicide. Accessed September 8, 2017.
  8. National Institute of Mental Health. (2017, March). Suicide Prevention. Retrieved from https://www.nimh.nih.gov/ health/topics/suicide-prevention/index.shtml. Accessed September 8, 2017.
  9. National Alliance on Mental Illness. (2017). Psychotherapy. Retrieved from https://www.nami.org/Learn-More/Treatment/Psychotherapy. Accessed September 8, 2017.
  10. National Institute for Mental Health. Antidepressant Medications for Children and Adolescents: Information for Parents and Caregivers. Retrieved from https://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/antidepressant-medications-for-children-and-adolescents-information-for-parents-and-caregivers.shtml. Accessed September 8, 2017.
  11. Center for Disease Control. (2015). 10 Leading Causes of Death, United States. Retrieved from https://webappa.cdc.gov/cgi-bin/broker.exe. Accessed September 8, 2017.
  12. US Department for Health and Human Services. Center for Disease Control and Prevention. (2011.) Sexual Identity, Sex of Sexual Contacts, and Health-Risk Behaviors Among Students in Grades 9-12. Youth Risk Behavior Surveillance, Selected Sites, United States, 2001-2009. Accessed September 8, 2017.
  13. Heller, N. R. (2014). Suicide and Suicidal Behavior. Columbia University Press, pp. 462-483. Accessed September 8, 2017.
  14. Liotta, M., Mento, C., & Settineri, S. (2015). Seriousness and lethality of attempted suicide: A systematic review. Accessed September 9, 2017.
  15. Zhang, J. et al. (2005). Gender differences in risk factors for attempted suicide among young adults: findings from the Third National Health and Nutrition Examination Survey. Annals of Epidemiology, 15:2. Accessed September 9, 2017.
  16. Mahon, G. (2017). Urban/Rural Inequalities in Suicide Rates in Georgia, 2008-2013: A county-level analysis. Georgia State University. Accessed September 8, 2017.
  17. Benham, B. (2017, August). Study: Suicide rates in rural areas higher than in urban areas due largely to use of firearms. Johns Hopkins University. Retrieved from https://hub.jhu.edu/2017/08/17/high-suicide-rates-guns-rural-communities/. Accessed September 9, 2017.