Suicide prevention is a collection of efforts to reduce the risk of suicide. Suicide is often preventable, and the efforts to prevent it may occur at the individual, relationship, community, and society level. Suicide is a serious public health problem that can have long-lasting effects on individuals, families, and communities. Preventing suicide requires strategies at all levels of society. This includes prevention and protective strategies for individuals, families, and communities. Suicide can be prevented by learning the warning signs, promoting prevention and resilience, and committing to social change.
Beyond direct interventions to stop an impending suicide, methods may include: Treating mental illness Improving coping strategies of people who are at risk Reducing risk factors for suicide, such as substance misuse, poverty and social vulnerability Giving people hope for a better life after current problems are resolved Calling a suicide hotline
General efforts include measures within the realms of medicine, mental health, and public health. Because protective factors such as social support and social engagement — as well as environmental risk factors such as access to lethal means — play a role in suicide, suicide is not solely a medical or mental health issue.Compare: Suicide is known as the 10th leading cause of death in the United States.
Suicide prevention involves using a range of strategies designed to reduce the risk of suicide and support individuals in crisis. According to the National Institute of Mental Health (NIMH), key approaches include increasing access to mental health care, creating supportive environments, and raising awareness about warning signs such as withdrawal, mood changes, and talking about death or feeling hopeless. Community-based programs, crisis hotlines like the 988 Suicide & Crisis Lifeline, and school-based interventions have been shown to make a difference. Research also suggests that reducing access to lethal means can significantly lower suicide rates.
Detection and assessment of a risk of suicide Warning signs
Warning signs of suicide can allow individuals to direct people who may be considering suicide to get help.
Behaviors that may be warning signs include: Talking about wanting to die or wanting to kill themselves Suicidal ideation: thinking, talking, or writing about suicide, planning for suicide Substance abuse Feelings of purposelessness Anxiety, agitation, being unable to sleep, or sleeping all the time Feelings of being trapped Feelings of hopelessness Social withdrawal Displaying extreme mood swings, suddenly changing from sad to very calm or happy Recklessness or impulsiveness, taking risks that could lead to death, such as driving extremely fast Mood changes, including depression Feelings of uselessness Settling outstanding affairs, giving away prized or valuable possessions, or making amends when they are otherwise not expected to die (as an example, this behavior would be typical in a terminal cancer patient but not a healthy young adult) Strong feelings of pain, either emotional or physical Considering oneself burdensome Increased use of drugs, including alcohol
Direct talk for assessment An effective way to assess suicidal thoughts is to talk with the person directly, to ask about depression, and assess suicide plans as to how and when it might be attempted.Preventing Suicide – A Resource for Primary Health Care Workers World Health Organization, Geneva, 2000. Contrary to popular misconceptions, talking with people about suicide does not plant the idea in their heads. However, such discussions and questions should be asked with care, concern and compassion. The tactic is to reduce sadness and provide assurance that other people care. The WHO advises to not say everything will be all right nor make the problem seem trivial, nor give false assurances about serious issues. The discussions should be gradual and specifically executed when the person is comfortable about discussing their feelings. ICARE (Identify the thought, Connect with it, Assess evidence for it, Restructure the thought in positive light, Express or provide room for expressing feelings from the restructured thought) is a model of approach used here.
Risk factors All people can be at risk of suicide. Risk factors that contribute to someone feeling suicidal or making a suicide attempt may include: Depression, other mental disorders, or substance abuse disorder Certain medical conditions Chronic pain A prior suicide attempt Childhood trauma Betrayal and abandonment Financial troubles or poverty Family history of a mental disorder or substance abuse Family history of suicide Family violence, including physical or sexual abuse Psychiatric Abuse Benzodiazepines Having guns or other firearms in the home with ammunition Having recently been released from prison, jail or mental asylum Self-harm Being exposed to others' suicidal behavior, such as that of family members, peers, or celebrities Food insecurity There may be an association between long-term PM2.5 exposure and depression, and a possible association between short-term PM10 exposure and suicide. Having a lower GPA at age 16
Strategies for detection and assessment
The traditional approach has been to identify the risk factors that increase suicide or self-harm, though meta-analysis studies suggest that suicide risk assessment might not be useful and recommend immediate hospitalization of the person with suicidal feelings as the healthy choice. In 2001, the U.S. Department of Health and Human Services, published the National Strategy for Suicide Prevention, establishing a framework for suicide prevention in the U.S. The document, and its 2012 revision, calls for a public health approach to suicide prevention, focusing on identifying patterns of suicide and suicidal ideation throughout a group or population (as opposed to exploring the history and health conditions that could lead to suicide in a single individual). The ability to recognize warning signs of suicide allows individuals who may be concerned about someone they know to direct them to help.
Suicide gesture and suicidal desire (a vague wish for death without any actual intent to kill oneself) are potentially self-injurious behaviors that a person may use to attain some other ends, like to seek help, punish others, or to receive attention. This behavior has the potential to aid an individual's capability for suicide and can be considered as a suicide warning, when the person shows intent through verbal and behavioral signs.
Screening The U.S. Surgeon General has suggested that screening to detect those at risk of suicide may be one of the most effective means of preventing suicide in children and adolescents.Office of the Surgeon General:The Surgeon General's Call To Action To Prevent Suicide 1999 There are various screening tools in the form of self-report questionnaires to help identify those at risk such as the Beck Hopelessness Scale and Is Path Warm?. A number of these self-report questionnaires have been tested and found to be effective for use among adolescents and young adults.Rory C. O'Connor, Stephen Platt, Jacki Gordon: International Handbook of Suicide Prevention: Research, Policy and Practice, p. 510 There is however a high rate of false-positive identification and those deemed to be at risk should ideally have a follow-up clinical interview.Rory C. O'Connor, Stephen Platt, Jacki Gordon, International Handbook of Suicide Prevention: Research, Policy and Practice, p.361; Wiley-Blackwell (2011), The predictive quality of these screening questionnaires has not been conclusively validated so it is not possible to determine if those identified at risk of suicide will actually die by suicide.Alan F. Schatzberg: The American Psychiatric Publishing textbook of mood disorders, p. 503: American Psychiatric Publishing; (2005) Asking about or screening for suicide does not create or increase the risk.
In approximately 75 percent of suicides, the individuals had seen a physician within the year before their death, including 45 to 66 percent within the prior month. Approximately 33 to 41 percent of those who died by suicide had contact with mental health services in the prior year, including 20 percent within the prior month. These studies suggest an increased need for effective screening. Many suicide risk assessment measures are not sufficiently validated, and do not include all three core suicidality attributes (i.e., suicidal affect, behavior, and cognition). A study published by the University of New South Wales has concluded that asking about suicidal thoughts cannot be used as a reliable predictor of suicide risk.
Underlying condition The conservative estimate is that 10% of individuals with psychiatric disorders may have an undiagnosed medical condition causing their symptoms, with some estimates stating that upwards of 50% may have an undiagnosed medical condition which, if not causing, is exacerbating their psychiatric symptoms. Illegal drugs and prescribed medications may also produce psychiatric symptoms. Effective diagnosis and, if necessary, medical testing, which may include neuroimaging to diagnose and treat any such medical conditions or medication side effects, may reduce the risk of suicidal ideation as a result of psychiatric symptoms. Most often including depression, which are present in up to 90–95% of cases.Patricia D. Barry, Suzette Farmer; Mental health & mental illness, p. 282, Lippincott Williams & Wilkins;(2002) The classification of a case as psychiatric frequently implies more rigid treatments.
Methods of intervention Restriction of lethal means
Restriction of dangerous means — reducing the odds that a person attempting suicide will use highly lethal means — is an important component of suicide prevention. This practice is also called "means restriction". It has been demonstrated that restricting lethal means can help reduce suicide rates, as delaying action until the desire to die has passed. In general, strong evidence supports the effectiveness of means restriction in preventing suicides. There is also strong evidence that restricted access at so-called suicide hotspots, such as bridges and cliffs, reduces suicides, whereas other interventions such as placing signs or increasing surveillance at these sites appears less effective.
One of the most famous historical examples of means reduction is that of coal gas in the United Kingdom. Until the 1950s, the most common means of suicide in the UK was poisoning by gas inhalation. In 1958, natural gas (virtually free of carbon monoxide) was introduced, and over the next decade, comprised over 50% of gas used. As carbon monoxide in gas decreased, suicides also decreased. The decrease was driven entirely by dramatic decreases in the number of suicides by carbon monoxide poisoning. A 2020 Cochrane review on means restrictions for jumping found tentative evidence of reductions in frequency.
In the United States, firearm access is associated with increased suicide completion. About 85% of suicide attempts with a gun result in death, while most other widely used suicide attempt methods result in death less than 5% of the time. Matthew Miller, M.D., Sc.D. conducted research comparing the number of suicides in states with the highest rates of gun ownership, to the number of suicides in states with the lowest rates of gun ownership. He found that men were 3.7 times more likely to die by firearm suicide and women were 7.9 times more likely to die by firearm suicide living in states with high rates of gun ownership. There was no difference in non-firearm suicides. Although restrictions on access to firearms have reduced firearm suicide rates in other countries, such restrictions are difficult in the United States because the Second Amendment to the United States Constitution limits restrictions on weapons.