Description

Suicide and attempted suicide are significant causes of morbidity and mortality.

Epidemiology

• Women attempt suicide 1.5 times more often than men. Men complete suicide 4 times more often than women.
• In the United States: predominant age: 10 to 14 years; 25 to 34 years (2nd leading cause of death), 11th leading cause of death overall, per final review of 2023 Centers for Disease Control and Prevention (CDC) data.
• In the United States, >49,300 died of suicide in 2024. Young adults who are gender nonconforming were 4 times more likely to attempt suicide than their gender conforming peers.
• The highest risk professions are: construction 65 per 100,000 for men, 25 per 100,000 for women; next highest risk: farming/fishing/forestry 49 per 100,000 for men; 26 per 100,000 for women in maintenance and repair.
• Suicide risk for women physicians in the United States was 53% higher than nonphysician women, in general (method most often used was poisoning or cutting); while the suicide risk for male physicians was 16 percent lower than male nonphysicians.
• Veterans have a 57.3% higher rate than nonveterans (with increased risk at time of discharge from service).
• Incarcerated persons are at increased risk (49 per 100,000 in jails—which house unsentenced persons and those with shorter sentences); state jails (27 per 100,000); federal prisons (14.47 per 100,000) (with highest risk the first day of incarceration and at release).
• Worldwide, suicide is the 14th cause of death leading cause of death, overall, and the 3rd cause of death among youths (ages 15 to 29 years), per World Health Organization reports from 2021.

Risk Factors

• 80% who complete suicide had a previous attempt.
• 90% who complete suicide meet Diagnostic and Statistical Manual, Fifth Edition Text Revision criteria for major depression, bipolar disorder, anorexia, panic, and personality disorders; schizophrenia or acute onset of psychosis are also risk factors due to command hallucinations and hopelessness that can accompany these states; delusional disorders—specifically persecutory and somatic delusions—associated with increased depression accompanying those symptoms (1)
• In addition to mental illness, other factors that could increase risk for suicide attempts include genetics, life history, and environmental factors. Retrospective studies have identified additional factors, which correlate to increased risk for suicide:
• Childhood trauma (adverse childhood experiences [ACEs])
• Substance use and withdrawal
• Family history of suicide
• Physical illness, including head injury (associated with 20% increased risk of death by suicide)
• For teenagers: not feeling “connected” to their peers or family; being bullied; perceiving lack of understanding about possible gender identity issues; poor grades
• Among veterans: childhood abuse; major depression; multiple psychiatric hospitalizations are the best predictors of suicide risk (2).
• For the general public: access to lethal means: firearms, poisons; including prescription and nonprescription drugs; pesticides

General Prevention

• Screen for risk: Screening instruments include the Patient Health Questionnaire-2 (PHQ-2), the PHQ-9, the Columbia Suicide Severity Rating Scale, Beck Scale for Suicide Ideation, Linehan Reasons for Living Inventory, and Risk Estimator for Suicide.
• Treat underlying mental and medical illnesses and substance abuse. Continuity of care has been identified as a key protective factor.
• Screen for possession of means of harm, including prescribed/unprescribed drugs, poisons, and firearms.
• Create a safety plan for patients at risk patients and their families, including how to access 24/7 emergency care.
• For additional resources, for needs ranging from quick support to educational:
  • Military: https://www.realwarriors.net/; suggested treatments include cognitive restructuring techniques (that their experience with adversity can be a source of strength) and help with problem-solving (so the service member does not feel like a “burden”), therapeutic martial arts training, and focus on vets’ helping others: “Power of 1” initiative (any “one” helpful contact could save a life).
  • Within the United States for anyone in need: https://988lifeline.org/; text: Enter 988 to get a prompt allowing for communication via phone/text message/chat.
  • For teens, their families, and their educators: https://www.cdc.gov/healthy-youth/index.html/; https://www.stopbullying.gov/; https://988lifeline.org/help-yourself/youth/; Text: https://988/lifeline.org/chat/.
  • Members of “minority” populations (ethnic or gender) who are concerned that their cultures/life experiences might not be understood by the medical establishment: resources with counselors with specific knowledge/training include: https://988lifeline.org/help-yourself/black-mental-health/; https://988lifeline.org/help-yourself/native/.
  • For healthcare providers: multiple links available via the links above; additional resources at the national Suicide Prevention Resource Center (https://SPRC.org).