Despite risk factors, people can protect themselves from suicide by seeking help and gaining access to care. Responsible media reporting on suicide can also reduce stigma and societal pressure to not discuss it.
CBT, DBT and individual psychodynamic therapy prevent suicide attempts. But scalability limits their effectiveness, requiring larger studies to evaluate their impact.
Identifying People at Risk
People at risk for suicide show warning signs that can alert you to a crisis situation. These may include a sudden change in mood, expressions of intense sadness or hopelessness, and/or statements about wanting to die or no longer caring about life. If you see these or other warning signs, please act quickly. You can help by connecting the person with professional support, such as the 988 Suicide & Crisis Lifeline, emergency medical services, or a mental health professional.
There is no single cause of suicide, which occurs across the lifespan and affects people of all ages, sexes and backgrounds. However, there are some common risk factors, such as a history of depression or other mental illness, and/or a previous suicide attempt. These factors, along with environmental and socio-economic factors, contribute to the complexity of suicide. WHO’s mhGAP Intervention Guide includes a specific module on suicide/self-harm to support countries’ efforts in this area. This is one of the four key pillars of WHO’s LIVE LIFE initiative.
Supportive Relationships and Community Connectedness
A person at risk for suicide often feels isolated and disconnected from others. The goal is to provide opportunities for individuals to build meaningful relationships and connect to a community of resources that can help them stay connected during difficult times.
A recent meta-analysis of over 500 studies found that social support was inversely associated with suicidal ideation, plans, attempts and suicide death. Subgroup analyses showed that this protective effect was observed in a variety of populations including general population, students, veterans, immigrants, patients with mental disorders, and HIV + patients.
Using caring language, leaders at all levels can encourage service members to feel connected and prioritize their mental health. Small gestures such as a smile or eye contact when saying good morning, a genuine concern for how a colleague is doing and a simple conversation about an upcoming baseball game or TV show can create a connection and pave the way to a deeper discussion about mental health needs and resources.
Prevention Strategies
In addition to strategies directed at the individual (such as reducing access to lethal means), prevention strategies should include actions at the system and community level. This includes teaching coping and problem-solving skills, expanding options for temporary assistance and connecting people at risk to effective mental health care.
Gatekeepers, such as friends, school staff, military commanders and primary care givers can help identify individuals at risk for suicide. They can also be trained to recognize warning signs and make referrals. Gatekeeper training has been shown to be effective in lowering suicide rates, as demonstrated in a large-scale randomized trial.
Crisis services are available to those at risk for suicide through hotlines, walk-in crisis clinics and hospital-based psychiatric emergency departments. In addition, peer-support programs can be helpful for people at risk. Postvention plans are also critical to address the impact of a suicide death on communities and the people who have been affected by it. These can include immediate responses, and more long-term support for those who have been bereaved by a suicide.
Treatment
Many people at risk for suicide die without being diagnosed or treated for a psychiatric illness. In fact, it’s estimated that 80% of those who died by suicide had contact with general practitioners in the month before their death, but up to 50% were not treated for depression.
For individuals who are already in the care of a health professional, a comprehensive treatment plan should be put into place to address their suicidal thoughts and behaviours. Currently, cognitive behavioural therapy and dialectical behavioural therapy are the most promising interventions for this population. Medications such as antidepressants, anxiolytics and mood stabilisers should also be offered.
Individuals can help reduce their own risk for suicide by avoiding recreational and illicit drugs and getting enough sleep, eating well and staying physically active. They can also build their resilience by developing a strong support network and participating in activities that promote belonging. Resilience is the ability to withstand and bounce back from life’s challenges, such as job loss, relationship breakdown, chronic physical illness or financial difficulties.