A combination of risk and protective factors can influence whether someone dies by suicide. These include mental health conditions like major depression, relationship disputes, a history of previous suicide attempts, financial problems, physical illness and poverty.
Prevention strategies are needed at the individual, systems and community level. These include gatekeeper training, suicide screening and teaching warning signs.
Risk factors
While there is no single cause for suicide, there are warning signs and risk factors that can increase the likelihood of someone trying to take their own life. These include a mental health condition such as depression, an undiagnosed or untreated substance use disorder, and recent adverse life events.
A standard method for identifying risk factors associated with suicide is psychological autopsy, which involves conducting interviews with proxy informants and reviewing medical and coronial records. Using a uniform analytical approach to identify the full range of risk factors allows direct comparisons of their associations with suicide and provides insight into sources of heterogeneity (see online supplemental table S5).
Several factors can increase the risk of suicide, including the presence of a mental health condition such as depression, a history of self-harm, or a recent adverse life event, and access to lethal means. Increasing the availability of suicide prevention services can help reduce these risks, including mobile crisis teams, walk-in crisis centers, and hospital-based psychiatric emergency services. Other interventions can include distributing gun safety locks, changing medication packaging, and installing barriers on bridges.
Symptoms
Many people who commit suicide exhibit warning signs, such as a change in behavior or the presence of new behaviors. Among these, the most alarming are suicidal thoughts or behavior that may be followed by a suicide attempt.
The risk of suicide increases with the presence of a mood disorder. Depression is the most common of these and it is also associated with a higher risk for suicide attempts. The relationship between suicidal thinking and anxiety disorders, especially panic disorder and Post Traumatic Stress Disorder (PTSD), is less clear. PTSD has been linked to suicide and attempts, but this association is generally found only when comorbid with depression, substance use and personality disorders.
Other factors that increase the risk of suicide include a history of psychiatric disorders, a family history of suicide and a high rate of death from suicide in some ethnic groups or in specific countries. In addition, a high level of access to lethal means may contribute to suicide.
Treatment
Treatment options for suicide prevention include psychotherapy, medication and other health care services. Psychotherapy, also called talk therapy, can help people with suicidal thoughts or behaviors learn to cope with their problems and feel less overwhelmed. It can also help prevent suicide attempts by teaching people to recognize warning signs, such as increased use of alcohol or drugs or feeling hopeless.
Medications to reduce suicidal thoughts and behavior include antidepressants, antianxiety and antipsychotic medications. Sometimes these are used in conjunction with talk therapy to treat underlying mental illness or to reduce side effects of some drugs, such as a paradoxical reaction that can increase feelings of hopelessness and suicidal thinking when antidepressants are suddenly stopped.
Other treatments involve increasing life skills and promoting resilience to reduce risk of suicide. Examples include problem-solving training and other skills building, psychological resilience programs and reducing access to lethal means of self-harm. Another long-term approach is to reduce the stigma of suicide through outreach campaigns and educating people about suicide warning signs, risk factors and ways to get help.
Prevention
The suicide rate can be reduced by reducing access to lethal means and preventing reattempts. This includes educating people about how to store and use firearms safely, making it more difficult for individuals to obtain lethal means through means restriction (such as gun control laws or barriers on bridges), changing the way medications are packaged so they can’t be easily misused and increasing community-based support services.
Talking therapies like psychoeducation and group therapy are also proven to reduce suicidal tendencies. Individualized care, which focuses on both risk and protective factors unique to the person, is critical.
Other preventive measures include improving the reporting of suicides in media, providing gatekeeper training for those with a close relationship to the individual at risk, such as family members, school staff or military commanders, and primary care physicians, and implementing identification methods such as internet-based screening and smartphone passive monitoring. See CDC’s Suicide Prevention Resource for Action to learn more about these preventive strategies.