Suicide

Overview

Suicide is a major public health concern. Suicide is among the leading causes of death in the United States. 

When a person dies by suicide, the effects are felt by their family, friends, and communities. Suicide is complicated and tragic, but there are treatments and preventative interventions available. Knowing the warning signs for suicide and how to get help can save lives.

You can learn more about national, regional, state, and other subgroup level suicide rates on the CDC website.

Definitions

• Suicide is defined as death caused by self-directed injurious behavior with intent to die as a result of the behavior.
• A suicide attempt is a self-directed, potentially injurious behavior with intent to die as a result of the behavior. A suicide attempt might not result in death or injury.
• Suicidal ideation refers to thinking about, considering, or planning suicide.

A note on language: Avoid using terms such as “committing suicide,” “successful suicide,” or “failed suicide” when referring to suicide and suicide attempts, as these terms often carry negative meanings.

Signs and Symptoms

Suicidal thoughts or actions are a sign of extreme distress and an indicator that someone needs help. Talking about wanting to die by suicide is not a typical response to stress, and all talk of suicide should be taken seriously and requires immediate attention.

Behaviors That May Be Signs That Someone Is Thinking About Suicide

They are talking about:

• Wanting to die
• Great guilt or shame
• Being a burden to others
• Feeling that there are no solutions

They are feeling:

• Empty, hopeless, trapped, or having no reason to live
• Extremely sad, more anxious, agitated, or full of rage
• Unbearable emotional or physical pain

They are changing their behavior, such as:

• Making a plan or researching ways to die, such as searching for lethal methods online, stockpiling pills, or buying a gun
• Withdrawing from friends, saying goodbye, giving away important items, or making a will
• Taking dangerous risks such as driving extremely fast
• Displaying extreme mood swings, suddenly changing from very sad to very calm or happy
• Eating or sleeping more or less
• Using drugs or alcohol more often
• Showing rage or talking about seeking revenge

If these warning signs apply to you or someone you know, get help as soon as possible—particularly if the behavior is new or has increased recently.

Risk Factors

All people can be at risk for suicide. Most people who have risk factors for suicide will not attempt suicide. It is difficult to tell who will act on suicidal thoughts. 

Data show that the rates of suicide attempts and suicide deaths vary according to characteristics such as age, sex, race, ethnicity, and geographic location. For example, males have higher suicide rates than females, and American Indian/Alaska Native (non-Hispanic) and White (non-Hispanic) populations have higher suicide rates than other racial and ethnic groups. Other risk factors for suicide also include:

• A history of suicide attempts
• Depression, other mental disorders, or substance use disorder
• Chronic pain
• Family history of a mental disorder or substance use
• Family history of suicide
• Exposure to violence, including physical or sexual abuse
• Presence of guns or other firearms in the home
• Having recently been released from prison or jail
• Exposure, either directly or indirectly, to others’ suicidal behavior, such as that of family members, peers, or celebrities
• Nearly all physical health conditions can be associated with suicide risk. Having multiple physical health conditions further increases suicide risk. This is particularly true for older adults.

Stressful life events may contribute to suicide risk, especially when they occur along with other suicide risk factors. These life events include 

• The loss of a loved one
• Legal troubles
• Financial difficulties
• Interpersonal stressors, such as shame, harassment, bullying, discrimination, or relationship troubles.

Prevention Guidance

Family and friends are often the first to recognize the warning signs of suicide. They can take the first step toward helping a loved one find mental health treatment.

If someone tells you that they are going to kill themselves, do not leave them alone. Do not promise that you will keep their suicidal thoughts a secret. Tell a trusted friend, family member, or other trusted adult. Also, connect them to crisis services, such as the 988 Suicide & Crisis Lifeline.

Knowing how to get help when someone posts suicidal messages can help save a life. Many social media sites have a process to get help for the person posting the message. To learn more, visit the 988 Suicide & Crisis Lifeline’s webpage about safety and support on social media. If you see messages or live streaming content that suggests someone is actively engaging in suicidal behavior, you can contact safety teams at the social media company, who will reach out to connect the person with the help they need.

If you have concerns about your mental health, tell your healthcare provider and work together to figure out next steps. Learn about how to talk with a doctor or healthcare practitioner about mental health.

5 Steps You Can Take to Help Someone Who is Having Thoughts of Suicide

1. Ask: “Are you thinking about suicide?” It’s not an easy question to ask, but it can help start a conversation. Studies show that asking people if they are suicidal does not increase suicidal behavior or thoughts.
2. Be there: Listening without judgment is key to learning what the person is thinking and feeling. Research suggests acknowledging and talking about suicide may reduce suicidal thoughts.
3. Help keep them safe: Reducing access to highly lethal items or places can help prevent suicide. Asking the person if they have a plan and making lethal means less available or less deadly can help the person stay safe when suicidal thoughts arise.
4. Help them connect: Connecting the person with the 988 Suicide & Crisis Lifeline (call or text 988) and other community resources can give them a safety net when they need it. You can also help them reach out to a trusted family member, friend, spiritual advisor, or mental health professional.
5. Follow up: Staying in touch with the person after they have experienced a crisis or been discharged from care can make a difference. Studies show that supportive, ongoing contact can play an important role in suicide prevention.

Managing a Chronic Health Condition

Talk with your doctor or healthcare provider if you have thoughts of suicide. They can help you address the health conditions and medicine side effects that may contribute to suicide risk. They can also refer you to a behavioral healthcare provider, who can see what else may be contributing to your suicide risk. They can also help you stay safe, develop new coping skills, and manage stressors.

Treatment and Management

Effective, evidence-based interventions are available to help people who are at risk for suicide. A treatment plan can be guided by a thorough assessment of an individual’s risk history and current needs. 

Early Detection and Screening

Early detection is a key prevention strategy. The majority of people who die by suicide visit a healthcare provider within months before their death. This represents a tremendous opportunity to identify those at risk and connect them with mental health resources. 

The Ask Suicide-Screening Questions (ASQ) tool is a brief validated tool for use among both youth and adults. Additional materials to help with suicide risk screening implementation are available in The Ask Suicide-Screening Questions (ASQ) Toolkit, a free resource for use in medical settings (emergency department, inpatient medical/surgical units, outpatient clinics/primary care) that can help providers successfully identify individuals at risk for suicide. The ASQ toolkit consists of youth and adult versions as some of the materials consider developmental considerations.

Treatment Strategies

Cognitive Behavioral Therapy (CBT)

CBT is a type of psychotherapy that can help people learn new ways of dealing with stressful experiences. CBT helps people learn to recognize their thought patterns and consider alternative actions when thoughts of suicide arise.

Dialectical Behavior Therapy (DBT)

DBT is a type of psychotherapy that can reduce suicidal behavior in adolescents. DBT reduces the rate of suicide attempts in adults with borderline personality disorder. A therapist trained in DBT can help a person recognize when their feelings or actions are disruptive or unhealthy and teach the person skills to cope more effectively with upsetting situations.

Brief Intervention Strategies

Creating a safety plan or crisis response plan—with specific instructions for what to do and how to get help when having thoughts about suicide—can help reduce a person’s risk of acting on suicidal thoughts. Increasing safe storage of lethal means can help reduce suicide attempts and deaths by suicide. In addition, Collaborative Assessment and Management of Suicidality (CAMS) can help reduce suicidal thoughts.

Collaborative Care

Collaborative care is a team-based approach to mental healthcare. A behavioral healthcare manager will work with the person, their primary healthcare provider, and mental health specialists to develop a treatment plan. Collaborative care can be an effective way to treat depression and reduce suicidal thoughts.

Medicines and Modulation

Medicines and neuromodulation can help treat and manage suicide risk, depending on a person’s symptoms and severity of risk. However, medicines have the strongest impact when done in combination with behavioral treatments.

Find Clinical Trials

Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Find clinical trials on suicide.

Find Treatment

If you have concerns about your or your loved one’s mental health, talk to a primary care provider. They can refer you to a qualified mental health professional, such as a psychologist, psychiatrist, or clinical social worker, who can help you figure out the next steps.

Learn how to find support and locate mental health services in your area on the Substance Abuse and Mental Health Services Administration website.

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.

NIH supports promising research that is likely to have an impact on reducing suicide. Research is helping improve our ability to:

• Identify people at risk for suicide
• Develop and improve effective treatments
• Implement suicide prevention and intervention programs in different settings, including healthcare, community, school, and the justice system

One example of NIH investments in suicide prevention research include the development of the Ask Suicide-Screening Questions (ASQ) tool, a brief validated tool for use among both youth and adults. Additional materials to help with suicide risk screening implementation are available in The Ask Suicide-Screening Questions (ASQ) Toolkit, a free resource for use in medical settings (emergency department, inpatient medical/surgical units, outpatient clinics/primary care) that can help providers successfully identify individuals at risk for suicide. The ASQ toolkit consists of youth and adult versions as some of the materials consider developmental considerations.

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.