What is Suicide?

Suicide is the act of intentionally causing one's own death, often as a result of overwhelming emotional pain or distress. Research and data show suicide is a leading cause of death:

• Over 700,000 people die by suicide every year.¹
• Suicide is the 11th leading cause of death in the U.S.²
• In 2022, there were an estimated 1.6 million suicide attempts and 49,476 Americans died by suicide.²

Everyone can play a role in recognizing and preventing suicide. This page explores the risk factors, signs of suicidal ideation, and methods of prevention to help better understand and address this critical issue.

Suicide Risk Factors

Suicide can affect anyone and there is no one cause of suicide. Many facets of a person’s life can be a risk factor for suicide. Examples include personal, relational, and sociocultural factors.

Personal Risk Factors for Suicide³

• Lower levels of education (high school or less)
• Having a disability
• Being unemployed
• Financial stress
• Feeling overwhelming emotional or physical pain⁴
• Involvement with the criminal justice system
• Feelings of loneliness, hopelessness, worthlessness, and humiliation
• Desensitization to suffering and death
• Substance use⁵
• Biological and genetic factors
• Professional or academic stress
• Mental illness

Relational Risk Factors for Suicide³

• Experiencing or perpetrating violence
• Isolation or the lack of support network
• Conflicts with others at work or school
• Lack of an intimate partner
• Exposure to suicide by a family member, friend, or loved one

Sociocultural Risk Factors for Suicide⁵

• Lack of accessible or affordable healthcare
• Having immediate access to items that could be used to attempt suicide, also known as lethal means (e.g. firearms)
• Stigma around mental illness and mental healthcare
• Living in a rural area⁶

Some populations and groups more likely to be at risk for suicide. For instance, research shows that women are more likely to attempt suicide, but less likely to die by suicide than men.² In 2022, white males made up 68.46% of suicide deaths in the United States.⁷ Some of the other populations at risk for suicide due to traumatic experiences, discrimination, marginalization, oppression, victimization, mental health issues, substance use issues, and stigma in the United States are:

• Veterans⁸
• LBGTQ+⁹
• Older white men²
• Youth¹⁰
• Native Americans²

Defining Terms: Suicidal Ideation, Plans, and Attempts

A Note About Language

The words we use have immense power. They can support, heal, and connect, or they can cause harm and create stigma, even unintentionally. Research shows that stigma can especially cause harmful social and mental health repercussions for those impacted by suicide.¹¹ While language preference varies among individuals impacted by suicide, and while we acknowledge that language is an ever-evolving construct, the language in this article and across PsychHub.com reflects some of the best practices adopted by advocacy and other mental health organizations.¹¹ As such, the terms “attempted suicide” or “died by suicide” will be used versus “committed suicide” because the latter term can imply a criminal connotation that is not consistent with current legal stances and add unnecessary additional pain or stigma to impacted individuals.

Psych Hub is committed to staying up-to-date on using recommended and purposeful language to discuss the complexities of mental health, including suicide, in an effort to responsibly increase awareness and create an environment where people feel safe to seek the help they need.

What are Suicidal Tendencies?

It is important to know that suicidal behavior, or suicidal tendencies, are terms that are often used to describe the three components of suicide:

• Ideations are serious thoughts of suicide. These can be sudden, intermittent, or recurring thoughts about suicide and death.
• Plans involve having or developing specific plans, considering the method or how to attempt suicide, when to do it, and obtaining the means to carry out the plan.
• Attempts are the actual gestures one might make to follow through with taking action to attempt suicide.

Suicidal Ideation

Suicidal ideations are serious thoughts about suicide that can appear suddenly and either come and go or happen repeatedly. It’s important to understand that when someone is struggling with suicidal ideation, they are likely seeking to avoid the pain they are experiencing. These suicidal ideations are often expressed verbally. Suicidal ideation might sound like:

• “Everyone would be better off without me.”
• “If I were gone, no one would notice.”
• “I just wish all of this would stop.”
• “I wish I were dead.”

Asking someone if they wished they were dead or are thinking about suicide won’t put the idea in their head.12 In fact, the person may feel relieved to talk to someone and the conversation may lead to finding needed support.

If you or someone you know is having suicidal thoughts, call or text the 988 Suicide and Crisis Lifeline at 988 or chat at 988lifeline.org. If you or someone you know are in immediate danger, call 911.

Suicide Prevention

Talking openly about suicide and providing education about it can help people prepare to handle thoughts about suicide, should they occur. Open conversation about suicide may also improve their support system’s ability to assist and keep them safe.⁷

Certain factors can also help protect against suicidal thoughts and behaviors, such as⁵:

• Support from family, friends, and peers
• Social connections and a feeling of belonging with others
• Engagement in the community
• Access to community services and support
• Accessible and affordable mental health and physical healthcare

Keep in mind that suicidal thoughts and behaviors are due to a combination of factors and not a single risk factor or event. It’s important to resist attempting to simplify a complicated issue. One important part of prevention is learning about the numerous and varied risk factors that can increase someone’s vulnerability to suicide. Whether you are at work or with friends or family, when someone shares suicidal thoughts or behaviors with you, try to convey a message that suicide is preventable, and that hope and treatment are available.

Interventions and Programs for Suicide Prevention

Several evidence-based therapeutic interventions and programs can help individuals who have attempted or are at risk of attempting suicide. The term evidence-based means it’s a practice that has been studied by experts, the scientific data show the outcomes are effective, and many people’s conditions are improved through the program. The Suicide Prevention Resource Center considers relevant outcomes for intervention and programs to include “reductions in suicidal thoughts and behaviors or changes in suicide-related risk and protective factors.”¹⁴

Several effective evidence-based interventions and programs include:

Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP)

Cognitive Behavior Therapy for Suicide Prevention (CBT-SP) is a psychotherapy to prevent re-attempts of suicide. The focus of the 10-session treatment includes a risk-reduction and relapse prevention approach that identifies risk factors and stressors (e.g., relationship issues, school or work-related problems) prior to the suicide attempt. The intervention also focuses on developing a safety plan, building coping skills, psychoeducation, and family support.^{5, 15}

Dialectical Behavior Therapy (DBT)

DBT is a therapy for individuals at high risk for suicide and who may have difficulties with impulsivity and emotional regulation issues. DBT has several components including individual therapy, group skills training, between-session telephone coaching, and a therapist consultation team.^{5, 16}

The Collaborative Assessment and Management of Suicidality (CAMS)

CAMS is an approach that focuses on a clinician and individual working closely using focused assessment tools to identify the causes behind suicidal thoughts and develop person-centered treatment plans. CAMS is interactive and collaborative, focusing on creating trust and mutual respect.

Counseling on Access to Lethal Means (CALM)

CALM is a practical intervention aimed at increasing the time and distance between individuals at risk of suicide and the most common lethal methods, particularly firearms. CALM educates on the importance of means (the instrument or object that a person uses for self-harm), and helps clinicians, community members, and loved ones learn how to effectively intervene with those at risk, both before and during a crisis.⁵

Acceptance and Commitment Therapy (ACT)

ACT is a type of psychotherapy that teaches individuals how to approach distressing experiences differently rather than what to do in a particular moment. The therapy uses mindfulness and behavioral activation to improve psychological flexibility, or the ability to accept unwanted thoughts and feelings while committing to positive value-based action. There are six core principles of ACT: contact with the present moment, acceptance, defusion, self as context, values, and committed action. ACT can be provided in multiple settings including one-on-one therapy and group therapy.¹⁷

Zero Suicide

Built on the core belief that suicide deaths for people under the care of health and behavioral healthcare providers are preventable, Zero Suicide uses a practical, evidence-based, systems approach to improving patient safety and care. The framework is based on the principles of improving service access and quality (core values), creating a culture that sets goals to eliminate suicide attempts and deaths (systems management), and implementing evidence-based clinical care practices. While the Zero Suicide framework is incorporated at a systems level, understanding if your provider uses the framework can provide confidence that they are implementing an evidence-based approach that includes treatment to target and treat suicidal ideation and behaviors.¹⁸

How to Get Help In a Mental Health Crisis

If someone is experiencing a mental health crisis including suicidal ideation the Suicide and Crisis Lifeline is free, confidential, and available 24 hours a day, 7 days a week in the United States. Call or text 988 or chat at 988lifeline.org. Trained counselors are available to help ensure the person is safe, understand their distress, and find support and resources. Services are also available in Spanish and for the Deaf and hard-of-hearing people, LGBTIA+ youth and young adults, veterans, service members, and their loved ones. Click here to find out more: https://988lifeline.org/talk-to-someone-now/

Summary

Suicide can affect anyone, regardless of background or circumstances, and it is influenced by a complex mix of personal, relational, and sociocultural factors. Recognizing the signs of suicidal ideation, such as expressions of hopelessness or a desire to die, is crucial for prevention. Effective treatments like Dialectical Behavior Therapy (DBT), Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP), The Collaborative Assessment and Management of Suicidality (CAMS), Counseling on Access to Lethal Means (CALM), Acceptance and Commitment Therapy (ACT), and Zero Suicide can help reduce suicidal thoughts and behaviors. Finally, crisis help is available anytime by calling or texting the Suicide & Crisis Lifeline at 988. By fostering open conversations about suicide, building supportive communities, and ensuring access to evidence-based mental health care, we can work together to prevent suicide and offer hope and help.