Are You Feeling Suicidal?

How to Deal with Suicidal Thoughts and Feelings and Overcome the Pain

You're not alone; many of us have had suicidal thoughts at some point in our lives. Feeling suicidal is not a character defect, and it doesn't mean that you are crazy, or weak, or flawed. It only means that you have more pain than you can cope with right now. This pain seems overwhelming and permanent at the moment. But with time and support, you can overcome your problems and the pain and suicidal feelings will pass.

I'm having suicidal thoughts, what do I need to know?

No matter how much pain you’re experiencing right now, you’re not alone. Some of the finest, most admired, needed, and talented people have been where you are now. Many of us have thought about taking our own lives when we’ve felt overwhelmed by depression and devoid of all hope. But the pain of depression can be treated and hope can be renewed. No matter what your situation, there are people who need you, places where you can make a difference, and experiences that can remind you that life is worth living. It takes real courage to face death and step back from the brink. You can use that courage to face life, to learn coping skills for overcoming depression, and for finding the strength to keep going. Remember:

  • Your emotions are not fixed - they are constantly changing. How you feel today may not be the same as how you felt yesterday or how you'll feel tomorrow or next week.
  • Your absense would create grief and anguish in the lives of friends and loved ones.
  • There are many things you can still accomplish in your life.
  • There are sights, sounds, and experiences in life that have the ability to delight and lift you - and that you would miss.
  • Your ability to experience pleasurable emotions is equal to your ability to experience distressing emotions.

Why do I feel suicidal?

Many kinds of emotional pain can lead to thoughts of suicide. The reasons for this pain are unique to each one of us, and the ability to cope with the pain differs from person to person. We are all different. There are, however, some common causes that may lead us to experience suicidal thoughts and feelings.

Why suicide can seem like the only option

If you are unable to think of solutions other than suicide, it is not that other solutions don’t exist, but rather that you are currently unable to see them. The intense emotional pain that you’re experiencing right now can distort your thinking so it becomes harder to see possible solutions to problems, or to connect with those who can offer support. Therapists, counselors, friends or loved ones can help you to see solutions that otherwise may not be apparent to you. Give them a chance to help.

A suicidal crisis is almost always temporary

Although it might seem as if your pain and unhappiness will never end, it is important to realize that crises are usually temporary. Solutions are often found, feelings change, unexpected positive events occur. Remember: suicide is a permanent solution to a temporary problem. Give yourself the time necessary for things to change and the pain to subside.

Even problems that seem hopeless have solutions

Mental health conditions such as depression, schizophrenia, and bipolar disorder are all treatable with changes in lifestyle, therapy, and medication. Most people who seek help can improve their situation and recover. Even if you have received treatment for a disorder before, or if you’ve already made attempts to solve your problems, know that it’s often necessary to try different approaches before finding the right solution or combination of solutions. When medication is prescribed, for example, finding the right dosage often requires an ongoing process of adjustment. Don’t give up before you’ve found the solution that works for you. Virtually all problems can be treated or resolved.

Take these immediate actions

Step #1: Promise not to do anything right now

Even though you’re in a lot of pain right now, give yourself some distance between thoughts and action. Make a promise to yourself: "I will wait 24 hours and won't do anything drastic during that time." Or, wait a week.

Thoughts and actions are two different things—your suicidal thoughts do not have to become a reality. There’s is no deadline, no one's pushing you to act on these thoughts immediately. Wait. Wait and put some distance between your suicidal thoughts and suicidal action.

Step #2: Avoid drugs and alcohol

Suicidal thoughts can become even stronger if you have taken drugs or alcohol. It is important to not use nonprescription drugs or alcohol when you feel hopeless or are thinking about suicide.

Step #3: Make your home safe

Remove things you could use to hurt yourself, such as pills, knives, razors, or firearms. If you are unable to do so, go to a place where you can feel safe. If you are thinking of taking an overdose, give your medicines to someone who can return them to you one day at a time as you need them.

Step #4: Don’t keep these suicidal feelings to yourself

Many of us have found that the first step to coping with suicidal thoughts and feelings is to share them with someone we trust. It may be a family member, friend, therapist, member of the clergy, teacher, family doctor, coach, or an experienced counselor at the end of a helpline. Find someone you trust and let them know how bad things are. Don’t let fear, shame, or embarrassment prevent you from seeking help. And if the first person you reach out to doesn’t seem to understand, try someone else. Just talking about how you got to this point in your life can release a lot of the pressure that’s building up and help you find a way to cope.

Step #5: Take hope - people DO get through this

Even people who feel as badly as you are feeling now manage to survive these feelings. Take hope in this. There is a very good chance that you are going to live through these feelings, no matter how much self-loathing, hopelessness, or isolation you are currently experiencing. Just give yourself the time needed and don’t try to go it alone.

Reaching out for help

Even if it doesn't feel like it right now, there are many people who want to support you during this difficult time. Reach out to someone. Do it now. If you promised yourself 24 hours or a week in step #1 above, use that time to tell someone what's going on with you. Talk to someone who won't try to argue about how you feel, judge you, or tell you to just "snap out of it." Find someone who will simply listen and be there for you.

It doesn’t matter who it is, as long as it’s someone you trust and who is likely to listen with compassion and acceptance.

How to talk to someone about your suicidal thoughts

Even when you’ve decided who you can trust to talk to, admitting your suicidal thoughts to another person can be difficult.

Tell the person exactly what you are telling yourself. If you have a suicide plan, explain it to them.

Phrases such as, ‘I can't take it anymore’ or ‘I’m done’ are vague and do not illustrate how serious things really are. Tell the person you trust that you are thinking about suicide.

If it is too difficult for you to talk about, try writing it down and handing a note to the person you trust. Or send them an email or text and sit with them while they read it.

What if you don't feel understood?

If the first person you reached out to doesn’t seem to understand, tell someone else or call a suicide crisis helpline. Don’t let a bad experience stop you from finding someone who can help.

If you don’t know who to turn to:

  • In the U.S. - Call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or the National Hopeline Network at 1-800-SUICIDE (1-800-784-2433) or Text SOS to 741741.
  • In the UK and Ireland - Call the Samaritans at 116 123
  • In Australia - Call Lifeline Australia at 13 11 14
  • In other countries - Visit IASP or to find a helpline in your country.

How to cope with suicidal thoughts

Remember that while it may seem as if these suicidal thoughts and feelings will never end, this is never a permanent condition. You WILL feel better again. In the meantime, there are some ways to help cope with your suicidal thoughts and feelings.

If You Have Suicidal Thoughts and Feelings

Things to do:

  • Talk with someone every day, preferably face to face. Though you feel like withdrawing, ask trusted friends and acquaintances to spend time with you. Or continue to call a crisis helpline and talk about your feelings.
  • Make a safety plan. Develop a set of steps that you can follow during a suicidal crisis. It should include contact numbers for your doctor or therapist, as well as friends and family members who will help in an emergency.
  • Make a written schedule for yourself every day and stick to it, no matter what. Keep a regular routine as much as possible, even when your feelings seem out of control.
  • Get out in the sun or into nature for at least 30 minutes a day.
  • Exercise as vigorously as is safe for you. To get the most benefit, aim for 30 minutes of exercise per day. But you can start small. Three 10-minute bursts of activity can have a positive effect on mood.
  • Make time for things that bring you joy. Even if very few things bring you pleasure at the moment, force yourself to do the things you used to enjoy.
  • Remember your personal goals. You may have always wanted to travel to a particular place, read a specific book, own a pet, move to another place, learn a new hobby, volunteer, go back to school, or start a family. Write your personal goals down.

Things to avoid:

Being alone. Solitude can make suicidal thoughts even worse. Visit a friend, or family member, or pick up the phone and call a crisis helpline.

Alcohol and drugs. Drugs and alcohol can increase depression, hamper your problem-solving ability, and can make you act impulsively.

Doing things that make you feel worse. Listening to sad music, looking at certain photographs, reading old letters, or visiting a loved one’s grave can all increase negative feelings.

Thinking about suicide and other negative thoughts. Try not to become preoccupied with suicidal thoughts as this can make them even stronger. Don’t think and rethink negative thoughts. Find a distraction. Giving yourself a break from suicidal thoughts can help, even if it’s for a short time.

Recovering from suicidal thoughts

Even if your suicidal thoughts and feelings have subsided, get help for yourself. Experiencing that sort of emotional pain is itself a traumatizing experience. Finding a support group or therapist can be very helpful in decreasing the chances that you will feel suicidal again in the future. You can get help and referrals from your doctor or from the organizations listed in our Related Links section.

5 steps to recovery

  • Identify triggers or situations that lead to feelings of despair or generate suicidal thoughts, such as an anniversary of a loss, alcohol, or stress from relationships. Find ways to avoid these places, people, or situations.
  • Take care of yourself. Eat right, don’t skip meals, and get plenty of sleep. Exercise is also key: it releases endorphins, relieves stress, and promotes emotional well-being.
  • Build your support network. Surround yourself with positive influences and people who make you feel good about yourself. The more you’re invested in other people and your community, the more you have to lose—which will help you stay positive and on the recovery track.
  • Develop new activities and interests. Find new hobbies, volunteer activities, or work that gives you a sense of meaning and purpose. When you’re doing things you find fulfilling, you’ll feel better about yourself and feelings of despair are less likely to return.
  • Learn to deal with stress in a healthy way. Find healthy ways to keep your stress levels in check, including exercising, meditating, using sensory strategies to relax, practicing simple breathing exercises, and challenging self-defeating thoughts.

More help for suicide prevention

Suicide Prevention: How to Help Someone who is Suicidal and Save a Life

Depression Symptoms and Warning Signs: Recognizing Depression and Getting the Help You Need

Bipolar Disorder Signs and Symptoms: Recognizing and Getting Help for Mania and Bipolar Depression

Resources and references

Suicide crisis lines in the U.S.

National Suicide Prevention Lifeline – Suicide prevention telephone hotline funded by the U.S. government. Provides free, 24-hour assistance. 1-800-273-TALK (8255). (National Suicide Prevention Lifeline)

Crisis Text Line Similar the crisis phone lines. 24/7/366, confidential, national, trained counselors familiar with texting, imodicans, jargon, etc. Text SOS to 741741 Add up to 140 characters in each message.

IMAlive – Toll-free telephone number offering 24-hour suicide crisis support. 1-800-SUICIDE (784-2433). (Kristin Brooks Hope Center)

The Trevor Project – Crisis intervention and suicide prevention services for lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth. Includes a 24/7 hotline: 1-866-488-7386.

SAMHSA's National Helpline – Free, confidential 24/7 helpline information service for substance abuse and mental health treatment referral. 1-800-662-HELP (4357). (SAHMSA)

txt4life – Suicide prevention resource for residents of Minnesota. Text the word "LIFE" to 61222 to be connected to a trained counselor. (

Suicide crisis lines worldwide

Crisis Centers in Canada – Locate suicide crisis centers in Canada by province. (Canadian Association for Suicide Prevention)

Befrienders Worldwide – International suicide prevention organization connects people to crisis hotlines in their country.

IASP – Find crisis centers and helplines around the world. (International Association for Suicide Prevention).

International Suicide Hotlines – Find a helpline in different countries around the world. (

Samaritans UK – 24-hour suicide support for people in the UK and Republic of Ireland (call 116 123). (Samaritans)

Lifeline Australia – 24-hour suicide crisis support service at 13 11 14. (Lifeline Australia)

If you are having suicidal thoughts: Tips for getting you through when you’re feeling suicidal, as well as information about maintaining recovery and healing. (

About Suicide – UK National Health Service site offering information for those considering suicide or have attempted suicide in the past. (Moodjuice)

Coping with suicidal thoughts – PDF download with information on how to understand your suicidal feelings and how to develop a safety plan. (Consortium for Organizational Mental Health)

Are You Feeling Suicidal? - Blog Post

We are strictly a library and resource center. We do not do crisis intervention or counseling. The information that follows is not a substitute for professional counseling. It is strongly recommended that you seek guidance from a professional caregiver. If you are feeling suicidal, please contact your local crisis line or counseling center or click here NOW.

If you are feeling suicidal now, please stop long enough to read this. It will only take about five minutes. I do not want to talk you out of your bad feelings. I am not a therapist or other mental health professional - only someone who knows what it is like to be in pain.

I don’t know who you are, or why you are reading this page. I only know that for the moment, you’re reading it, and that is good. I can assume that you are here because you are troubled and considering ending your life. If it were possible, I would prefer to be there with you at this moment, to sit with you and talk, face to face and heart to heart. But since that is not possible, we will have to make do with this.

I have known a lot of people who have wanted to kill themselves, including myself, so I have some small idea of what you might be feeling. I know that you might not be up to reading a long book, so I am going to keep this short. While we are together here for the next five minutes, I have five simple, practical things I would like to share with you. I won’t argue with you about whether you should kill yourself. But I assume that if you are thinking about it, you feel pretty bad.

Well, you’re still reading, and that’s very good. I’d like to ask you to stay with me for the rest of this page. I hope it means that you’re at least a tiny bit unsure, somewhere deep inside, about whether or not you really will end your life. Often people feel that, even in the deepest darkness of despair. Being unsure about dying is okay and normal. The fact that you are still alive at this minute means you are still a little bit unsure. It means that even while you want to die, at the same time some part of you still wants to live. So let’s hang on to that, and keep going for a few more minutes.

Start by considering this statement: “Suicide is not chosen; it happens when pain exceeds resources for coping with pain.”

That’s all it’s about. You are not a bad person, or crazy, or weak, or flawed, because you feel suicidal. It doesn’t even mean that you really want to die - it only means that you have more pain than you can cope with right now. If I start piling weights on your shoulders, you will eventually collapse if I add enough weights... no matter how much you want to remain standing. (That’s why it’s useless for someone to say to you, “cheer up!” - of course you would, if you could.)

Don’t accept it if someone tells you, “that’s not enough to be suicidal about”. There are many kinds of pain that may lead to suicide. Whether or not the pain is bearable may differ from person to person. What might be bearable to someone else, may not be bearable to you. The point at which the pain becomes unbearable depends on what kinds of coping resources you have. Individuals vary greatly in their capacity to withstand pain.

When pain exceeds pain-coping resources, suicidal feelings are the result. Suicide is neither wrong nor right; it is not a defect of character; it is morally neutral. It is simply an imbalance of pain versus coping resources.

You can survive suicidal feelings if you do either of two things: (1) find a way to reduce your pain, or (2) find a way to increase your coping resources. Both are possible.

Now I want to tell you five things to think about.

1 The first thing you need to hear is that people do get through this -- even people who feel as badly as you are feeling now. Statistically, there is a very good chance that you are going to live. I hope that this information gives you some sense of hope.

2 The next thing I want to suggest to you is to give yourself some distance. Say to yourself, “I will wait 24 hours before I do anything.” Or a week. Remember that feelings and actions are two different things - just because you feel like killing yourself, doesn’t mean that you have to actually do it right this minute. Put some distance between your suicidal feelings and suicidal action. Even if it’s just 24 hours. You have already done it for 5 minutes, just by reading this page. You can do it for another 5 minutes by continuing to read this page. Keep going, and realize that while you still feel suicidal, you are not, at this moment, acting on it. That is very encouraging to me, and I hope it is to you.

3 The third thing is this: people often turn to suicide because they are seeking relief from pain. Remember that relief is a feeling. And you have to be alive to feel it. You will not feel the relief you so desperately seek, if you are dead.

4 The fourth thing is this: some people will react badly to your suicidal feelings, either because they are frightened, or angry; they may actually increase your pain instead of helping you, despite their intentions, by saying or doing thoughtless things. You have to understand that their bad reactions are about their fears, not about you.

But there are people out there who can be with you in this horrible time, and will not judge you, or argue with you, or send you to a hospital, or try to talk you out of how badly you feel. They will simply care for you. Find one of them. Now. Use your 24 hours, or your week, and tell someone what’s going on with you. It is okay to ask for help. Try The Samaritans by phone or e-mail worldwide, or look in the front of your phone book for a crisis line), call your family doctor or a psychotherapist, carefully choose a friend or a minister or rabbi, someone who is likely to listen. But don’t give yourself the additional burden of trying to deal with this alone. Just talking about how you got to where you are, releases an awful lot of the pressure, and it might be just the additional coping resource you need to regain your balance.

5 The last thing I want you to know right now is this: Suicidal feelings are, in and of themselves, traumatic. After they subside, you need to continue caring for yourself. Therapy is a really good idea. So are the various self-help groups available both in your community and on the Internet and various online services.

Well, it’s been a few minutes and you’re still with me. I’m really glad.

Since you have made it this far, you deserve a reward. I think you should reward yourself by giving yourself a gift. The gift you will give yourself is a coping resource. Remember, back up near the top of the page, I said that the idea is to make sure you have more coping resources than you have pain. So let’s give you another coping resource, or two, or ten...! until they outnumber your sources of pain.

Now, while this page may have given you some small relief, the best coping resource we can give you is another human being to talk with. If you find someone who wants to listen, and tell them how you are feeling and how you got to this point, you will have increased your coping resources by one. Hopefully the first person you choose won’t be the last. There are a lot of people out there who really want to hear from you. It’s time to start looking around for one of them.

Now: I’d like you to call someone.

And while you’re at it, you can still stay with me for a bit. Check out these sources of online help.

Additional things to read at this site:

How serious is our condition? ..."he only took 15 pills, he wasn’t really serious...” if others are making you feel like you’re just trying to get attention... read this.

Why is it so hard for us to recover from being suicidal? ...while most suicidal people recover and go on, others struggle with suicidal thoughts and feelings for months or even years. Suicide and post-traumatic stress disorder (PTSD).

Recovery from grief and loss ...has anyone significant in your life recently died? You would be in good company... many suicidal people have recently suffered a loss.

The stigma of suicide that prevents suicidal people from recovering: we are not only fighting our own pain, but the pain that others inflict on us... and that we ourselves add to. Stigma is a huge complicating factor in suicidal feelings.

Resources about depression ...if you are suicidal, you are most likely experiencing some form of depression. This is good news, because depression can be treated, helping you feel better.

When Someone Feels Suicidal Do you know someone who is suicidal... or would you like to be able to help, if the situation arises? Learn what to do, so that you can make the situation better, not worse.

How to Help What can I do to help someone who may be suicidal? ...a helpful guide, includes Suicide Warning Signs.

Short Form

The suicide rate for men continues to rise as men get older, and the primary reason men kill themselves is that they are suffering from depression. What's more, we now know that men often show different symptoms for depression than do women. Depressed men are more likely to "act out" their depression through things like irritability, anger, anxiety, and frustration.

  • The suicide rate for men in their 40s is 3.5 times higher than it is for women.
  • The suicide rate for men in their 50s is 4 times higher than it is for women.
  • The suicide rate for men in their 60s is 5 times higher than it is for women.

Something to think about!

90% of men who die by suicide have a diagnosable mental health issue at the time of death.

46.3% had an intimate partner problem
31.6% had a problem with alcohol
29.6% had a job problem
27.5% had a financial problem
24.3% had a physical health problem
62.9% had a current depressed mood

Youth 15-19 suicides are on the increase in the US. Suicide is the second leading cause of death (after unintentional injury). Two-thirds of all suicides under 25 were committed with firearms. Suicide is increasing, particularly for those under 14.


Teen students are more likely to take their life when:

Alcohol or drugs are involved
If their parents are divorced
If they have access to a gun
Are failing education
Are involved in teen pregnancy
Hear of other teen suicides
Have low self-esteem
Are highly sexually active.

However, you never know

Young people don’t always know how to get through stressful times. Adults tend to end their lives because of major life stressors, but for an adolescent, the breaking point is often less significant.

Risk factors line up like lights on the street. For a student to go from thinking about suicide to attempting suicide, all these lights have to turn green. One light might be a fight with a parent. Another might be a flunked test, a breakup, a peer’s suicide. They might contemplate suicide for months, and then the final act is often on impulse, if everything falls into place. Teachers have even said about a particular suicide. "If you would have given me 200 names, hers would have been at the bottom of the list of someone who would do this.”

Starting the Conversation

Did you know that 75% of all mental health conditions begin by age 24? That’s why the college years are so critical for understanding and talking about mental health. NAMI created this video based on the guide Starting the Conversation: College and Your Mental Health developed in partnership with The Jed Foundation.

Check out these shorter clips that break down the guide into key sections:

  • Navigating College
  • Mental Health Conditions Are Common
  • Who to Talk To
  • Make a Plan

Keep these in mind when you start your conversation:

  • Mental health conditions are common. In fact, one in five young adults will experience a mental health condition during college. If you develop a mental illness, remember that you are not alone.
  • Exercise, sleep and diet are important. Your physical health and mental health are connected and impact one another. Remember to take care of your body in order to take care of your mind.
  • Know where and when to seek help, and who to talk to. Make yourself aware of resources and care options on and off campus. If you start to feel overwhelmed, don’t hesitate to reach out to the counseling center or a trusted advisor.
  • Understand your health privacy laws. Devise a plan on whether and how you will allow your school to share sensitive information about your mental health with your family or a trusted adult. Find out if your school has an authorization form, or use the one included in our guide.
  • There are warning signs. Verse yourself on the warning signs of mental health conditions and how to respond. These are available in the guide and the infographic below. Being informed can save lives.

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The college guide was prepared with support from the National Technical Assistance Network for Children’s Behavioral Health under contract with the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Contract #HHSS280201500007C. However, the guide contents do not necessarily represent the policy of the U.S. Department of Health and Human Services, and you should not assume endorsement by the Federal Government.

Suicide Ideation

The Centers for Disease Control and Prevention (CDC) defines suicidal ideation as thinking about, considering, or planning suicide. Suicide ideation itself does not necessarily mean that a person is at imminent risk of harming themselves, but can be a symptom of major depression. The CDC defines a suicide attempt as a nonfatal self-directed potentially injurious behavior with any intent to die as a results of the behavior. A suicide attempt may or may not result in injury.

16 Suicide Warning Signs & Behaviors To Recognize

If you or someone you know is depressed, there is a chance that suicidal thoughts may accompany their depression. If left untreated, depression is known to be one of the top causes of suicide. In up to 90% of suicides, an underlying mental illness – usually depression was the most influential factor. Although untreated mental health issues can be the biggest influence on whether someone makes a decision to take their life, there are other suicide risk factors such as: being unemployed, financial troubles, death of a loved one, relationship problems, etc.

These other factors and life circumstances can have a huge impact on whether someone decides to follow through with the act. In most cases, there is some sort of treatment available that will help improve a person’s situation. Individuals that are suicidal do not usually really want to die, rather they see dying as the only solution to the pain that they are currently facing. Typically when a person’s ability to cope with their pain and/or their pain is reduced, they no longer feel suicidal.

For individuals that are concerned with the wellbeing of another person who is suicidal, it is important to understand suicide warning signs – or behaviors that could signal that the person is prepared to follow through with the act. If you recognize any of these warning signs, be sure to take the person seriously and get help. Get the person in for therapy and/or if they pose an immediate threat to their own life, call the police.

Suicide Warning Signs: List Of Possibilities

Below are a list of common warning signs to look for when a person is suicidal. Keep in mind that not every suicidal person will exhibit all of these signs. Additionally some people may be suicidal and not exhibit any of these signs. However, usually those who are close to the suicidal person should be able to pick up on a few signs.

1. Talking about suicide: Perhaps the biggest and most obvious warning sign is when a person talks about suicide. They may casually bring up the topic, but usually the individual may talk about wanting to take their own life. The problem with this is that many people do not take this talk very seriously or think it’s just a phase that will eventually pass. If someone brings up suicide and/or suggests that they may take their own life, it must be taken very seriously.

2. Untreated depression: If a person is clinically depressed, they may be prone to crying spells, have difficulty getting out of bed, problems sleeping and eating, and feel hopeless about their situation. When a person’s depression is untreated, they are in a state of pain and basically shut down. Their thinking becomes clouded by the depression that they are experiencing and they may feel as though life is pointless due to the way that they feel.

3. Giving away possessions: One of the most obvious warning signs is when a depressed individual gives away all of their possessions. Uneducated people may be confused as to why a person would give away their property without reason. Usually family and/or close friends will take note of a person giving all of their valuable property away. When they confront the person, they may say that they won’t need it anymore, etc. Giving things away can be one of the key signs that a person is planning on following through with taking their life.

4. Saying “goodbye”: In many cases, a person will visit family and/or other close friends prior to following through with the act to say “goodbye.” They want to tie up loose ends and let the people that are close to them know that they care about them a lot. Sometimes it may not seem like a “goodbye,” rather it may seem as though the person is spending some time with everyone that is important to them. Watch out for this type of behavior – the person will generally pursue most immediate family and friends for some closure. Keep in mind that saying “goodbye” could also be over the phone or via text message.

5. Suicide notes: An extremely obvious warning sign is that of a suicide note. In this note a person may write about a variety of topics including: how much they will miss their family, that they love their friends, the pain that they are dealing with, and in some cases, why they must end their life. If you find a suicide note, be sure to take it very seriously because the person may follow through with the act. Get the person some sort of help and if they are unwilling, you may need to call 911 with the note in hand.

6. Alcohol & drugs: In many cases when a person is suicidal, they may turn to abusing alcohol or other drugs as a way to escape these feelings. Although they may find temporary relief from their pain as a result of their substance use, in many cases alcohol and drugs make the situation worse. Many times the person ends up increasingly depressed following the usage of substances. It should also be noted that when a person is serious about following through with the act of suicide, they may drink, pop pills, etc. so that they can build up the courage follow through with it. Be on the lookout for the person using alcohol, drugs, and/or both more frequently to the point of abuse – this is a warning sign.

7. Change to “calm” demeanor: Often leading up to a suicide, a person will exhibit a change in mood from being very sad to a general calmness and/or in some cases, appearing happy. If you notice that a person is all of a sudden very calm and was previously extremely depressed, this may be a red flag. The calmness and/or happier appearance is generally due the person being convinced that they are going to follow through with the act.

8. Reckless behavior: When a person has decided to take their own life, they may engage in more reckless behavior and decision making. For example, they may speed while driving, drive through red lights, try illicit drugs, have unprotected sex, shoplifting, etc. This reckless behavior is usually due to the person not caring about their life anymore. In some cases, this behavior is easily noticed by others close to the individual who is suicidal. If you notice someone acting reckless, especially someone who was previously more reserved, it may be warning sign.

9. Researching suicide methods: You may notice on the person’s internet browser history that they have been researching painless suicide methods and/or how to kill themselves. If you see this in the person’s search history, take it very seriously and assume that they are going to follow through with the act. In this case, the person needs some sort of immediate help and intervention to help them get out of the pain that they are in. Help guide the person by getting them in for help and if they refuse, call the police.

10. Buying suicide materials: If you catch someone who is severely depressed and/or suicidal purchasing materials to help them follow through with the act, this needs to be addressed. For example, the person may be visiting pawn shops or auctions looking to buy a gun. They may also be buying things like rope, pills, knives, razors, etc. online or at general stores. Purchasing materials shows that the person is ready to go through with the act, and now has the means to carry the act out.

11. Creating a Will: A person who has plans of suicide may take the steps to create a will so that their loved ones get their possessions when they pass. Additionally if a person already has a will, they may make some last-minute revisions to it before following through with the act. If you notice any preoccupation with the creation of a will accompanied by the person giving away prized possessions, this could be a warning sign.

12. Social withdrawal or isolation: Another very common warning sign leading up to suicide is that of social withdrawal. Many people isolate themselves from friends, colleagues, and other family members. This increased social withdrawal can actually make the person more depressed and suicidal than they already are. Prior to committing suicide, a person may gradually withdraw from friendships, social commitments, and extracurricular or work related functions. If you notice someone – (especially someone who was previously very involved) – withdrawing from these functions, this could be another indication that the person is suicidal.

13. Talking about being a burden: If you notice someone talking about being a “burden” to others including friends, family, etc. – this could indicate that they feel as if they aren’t wanted. Feelings of being a burden may make the person feel like an outcast and may contribute to depression and/or suicidal ideation. When someone frequently says that they are a burden and/or all that they do is cause problems for others, this can be a warning sign.

14. Feeling hopeless: When someone says that they are in a hopeless situation or that they have no hope for their future, this could suggest suicide as well. Besides feeling hopeless to change their situation, the person may describe themselves as being “helpless” and/or “worthless.” Anytime someone lacks hope to improve their current situation or future and thinks that they are worthless, this signifies that they need some sort of help. If a person feels this way, especially for a long period of time, they may end up turning to suicide.

15. Preoccupation with death: Individuals who are preoccupied with death and/or think about it often may be considering suicide. You may notice a person openly talking about death, researching it, and considering the afterlife. Although death can be a topic of normal conversation, the preoccupation with it is what could suggest that a person may be suicidal.

16. Previous suicide attempt: It is estimated that between 20% and 50% of people who take their own life had previously attempted suicide. If someone you know has previously attempted suicide and is acting suicidal, take it very seriously. Statistics show that if a person has tried it once, they are more likely to try it again in the future. If you suspect that something may be in the works, talk to the person and listen to what’s on their mind.

Other warning signs of suicide include:

Commentary such as “I want to die” – If you hear anyone say things like “I wish I was never born,” “I wish I was dead,” or “I don’t want to be here anymore,” they are probably thinking of suicide. Keep this in mind and either help the person yourself or get them some sort of help.

Rage / revenge seeking – In some cases a person may be motivated by rage or threaten to take their life as some sort of revenge. Although most cases of suicide involve depression, there are cases involving anger and rage.

Losing interest in life – People who lose interest in life and/or previously important things are likely already going through depression. If the person is not able to regain some sort of interest, they may be thinking of suicide.

What should you do if you think someone is suicidal?

Get help. The best thing you can do for someone who is suicidal is to get them some sort of help. You could get them to agree to go in for therapy and/or some sort of psychiatric intervention. If the person refuses to change and you suspect that they may take their own life, do not hesitate to call the police. Many people are afraid to call the police when a person is suicidal, yet it can be the exact intervention needed to turn a person’s situation around.

Prior to calling the police though, talk to the person by speaking up. Don’t argue with the person, just be empathetic to their situation and promise that you’re going to get some sort of help. Once you ask a few questions about their situation, determine the degree to which you think the person will carry out the act. Ask them whether they have a plan, whether they have materials, if they know when they would do it, or if they still have the intention.

If the person says that they have a plan and materials, you may want to recruit extra help. If you are able to remove potentially lethal objects from the person’s possession, take this step. Continue to offer the person help and support and encourage them to seek treatment. Also come up with a safety plan or contract to further minimize their risk of self-harm. It takes a lot of courage to intervene when someone is suicidal, but at the end of the day, you may save someone’s life.

Suicide Rate Has Increased 24 Percent Since 1999 in the U.S., Says CDC

For some time, public health experts have expressed concern over the growing rate of suicide, and a new report from the U.S. Centers for Disease Control and Prevention says the public health concern may be even worse than most think. On Friday, the CDC announced rates of suicide have increased 24 percent within the past decade and a half. In 1999, there were 10.5 suicides per 100,000 people, compared with 2014, when the number rose to 13 per 100,000. (Editor's note: 47,173 people killed themselves in 2017 up from 42,826 in 2014.)

The most dramatic increase was seen among girls aged 10 to 14; in a decade and half, the rate of suicide in this age group went up 200 percent. Teen boys had the lowest rate of all age groups but the second-largest increase, 37 percent.

Rates of suicide increased 43 percent between 1999 and 2014 among middle-aged adults. As seen in many previous reports, men were much more likely to take their life than women; in 2014, the age-adjusted rate for men was three times higher than for women.

The report also highlights trends in suicide methods. Men were most likely to use guns (55.4 percent), while poisoning was the most commonly chosen method for women (34.1 percent). The number of suicide deaths that resulted from suffocation also rose in the past 15 years, for both sexes.

“If we saw numbers like this for any other medical condition, there would be an immediate declaration of a medical emergency. This study should be a call to action to improve access to care, reduce stigma and improve treatment by funding research,” Dr. Jeffrey Borenstein, president and CEO of the Brain & Behavior Research Foundation, who was not involved in the report, said in an email statement.

In the U.S., suicide is the 10th leading cause of death. (Heart disease, cancer and lower respiratory disease are the top three.) Medical research and improvements in preventive care have reduced the number of people who die from physical conditions such as heart attack, stroke and many types of cancer. However, research on mental illness continually lags. In 2013, for example, the National Institutes of Health spent $5.3 billion on cancer research and just $415 million on depression research.

A number of factors may be driving the rise in suicide. Some experts point to flawed gun ownership laws. A study published in The New England Journal of Medicine found that men were over three times more likely to die by gun suicide in the 15 states with highest gun ownership. Experts also suggest the policies surrounding prescriptions painkillers may be driving the rise in suicide. And, finally, inadequate social service and a failing mental health system are said to be driving the trend.
Source for actual report at

Suicide note themes and suicide prevention


The aim was to determine if suicide note themes might inform suicide prevention strategies.


The themes of 42 suicide notes from the Northern Ireland Suicide Study (major psychological autopsy study) were examined.


The commonest themes were "apology/shame" (74%), "love for those left behind" (60%), "life too much to bear" (48%), "instructions regarding practical affairs post-mortem" (36%), "hopelessness/nothing to live for" (21%) and "advice for those left behind" (21%). Notes of suicides with major unipolar depression were more likely than notes of suicides without major unipolar depression to contain the themes "instructions regarding practical affairs post-mortem" (67% versus 19%, p = 0.005) and "hopelessness/nothing to live for" (40% versus 11%, p = 0.049). Notes of suicides with a previous history of deliberate self-harm were less likely than notes of suicides without a history of deliberate self-harm to contain the theme "apology/shame" (58% versus 87%, p = 0.04). Notes of elderly suicides were more likely than non-elderly notes to contain the theme "burden to others" (40% versus 3%, p = 0.03).


The fact that three quarters of suicide notes contained the theme "apology/shame" suggests that the deceased may have welcomed alternative solutions for their predicaments. Scrutiny of suicide note themes in the light of previous research findings suggests that cognitive therapy techniques, especially problem solving, may have an important role to play in suicide prevention and that potential major unipolar depressive (possibly less impulsive) suicides, in particular, may provide fertile ground for therapeutic intervention (physical and psychological). Ideally all primary care doctors and mental health professionals working with (potentially) suicidal people should be familiar with basic cognitive therapy techniques, especially problem solving skills training.

Former NFL QB shoots himself in apparent suicide attempt

Former Bears QB Erik Kramer was found with a self-inflicted gunshot wound by the Los Angeles County Police Tuesday evening (8/18/15) as a result of a suicide attempt according to the Washington Post. Kramer’s former-wife has said that he has been suffering from depression caused by brain injuries.

Authorities were called to a motel in Calabasas, Calf, where Kramer had been staying. At first, it was described as a non life-threatening injury. However, Kramer’s sister told his former-wife that it was more serious.

Kramer is from California who played college ball at N.C. State. He is best known for his stint with the Lions where he led the 1991 team to a 12-4 record and a playoff win that season. He then went on to play for the Bears from 1994-1998 where he threw for over 3,000 yards and 29 touchdowns in 1995. He ended his NFL career with the San Diego Chargers in 1999. Kramer finished his career with over 15,000 passing yards and 92 touchdowns.

In 2011, Kramer’s 18-year old son, Griffen, died of a drug overdose. He and his former-wife have another son, Dillon, who is 17.

When Someone Feels Suicidal

We are born with the ability to take our own lives. Each year a million people make that choice. Even in societies where suicide is illegal or taboo, people still kill themselves.

For many people who feel suicidal, there seems to be no other way out. Death describes their world at that moment and the strength of their suicidal feelings should not be underestimated – they are real and powerful and immediate. There are no magic cures. But it is also true that: Suicide is often a permanent solution to a temporary problem.

When we are depressed, we tend to see things through the very narrow perspective of the present moment. A week or a month later, things may look completely different.

Most people who once thought about killing themselves are now glad to be alive. They say they didn’t want to end their lives – they just wanted to stop the pain.

The most important step is to talk to someone. People who feel suicidal should not try to cope alone. They should seek help NOW. Talk to family or friends. Just talking to a family member or a friend or a colleague can bring huge relief.

Talk to a befriender. Some people cannot talk to family or friends. Some find it easier to talk to a stranger. There are befriending centers all over the world, with volunteers who have been trained to listen. If calling is too difficult, the person can send an email. Or text "SOS" to 741741. They should seek help NOW

Talk to a doctor. If someone is going through a longer period of feeling low or suicidal, he or she may be suffering from clinical depression. This is a medical condition caused by a chemical imbalance, and can usually be treated by a doctor through the prescription of drugs and/or a referral to therapy.

Time is an important factor in ‘moving on’, but what happens in that time also matters. When someone is feeling suicidal, they should talk about their feelings immediately.

Warning Signs

Suicide is rarely a spur of the moment decision. In the days and hours before people kill themselves, there are usually clues and warning signs.

The strongest and most disturbing signs are verbal – ‘I can’t go on,’ ‘Nothing matters any more’ or even ‘I’m thinking of ending it all.’ Such remarks should always be taken seriously. Of course, in most cases these situations do not lead to suicide. But, generally, the more signs a person displays, the higher the risk of suicide.


  • Suffering a major loss or life change
  • Family history of suicide or violence
  • Sexual or physical abuse
  • Death of a close friend or family member
  • Divorce or separation, ending a relationship
  • Failing academic performance, impending exams, exam results
  • Job loss, problems at work
  • Impending legal action
  • Recent imprisonment or upcoming release


  • Showing a marked change in behavior, attitudes or appearance
  • Crying
  • Fighting
  • Behaving recklessly
  • Breaking the law
  • Impulsiveness
  • Abusing drugs or alcohol
  • Self-mutilation
  • Writing about death and suicide
  • Previous suicidal behavior
  • Extremes of behavior
  • Changes in behavior
  • Getting affairs in order and giving away valued possessions

Physical Changes

  • Lack of energy
  • Disturbed sleep patterns – sleeping too much or too little
  • Loss of appetite
  • Becoming depressed or withdrawn
  • Sudden weight gain or loss
  • Increase in minor illnesses
  • Change of sexual interest
  • Sudden change in appearance
  • Lack of interest in appearance

Thoughts and Emotions

  • Thoughts of suicide
  • Loneliness – lack of support from family and friends
  • Rejection, feeling marginalized
  • Deep sadness or guilt
  • Unable to see beyond a narrow focus
  • Daydreaming
  • Anxiety and stress
  • Helplessness
  • Loss of self-worth

If you are worried about someone you know, make sure you read the following How To Help Someone Else.
Warning Signs
Warning Signs for Youth

How to Help Someone Else

If someone is feeling depressed or suicidal, our first response is to try to help. We offer advice, share our own experiences, try to find solutions. We’d do better to be quiet and listen. People who feel suicidal don’t want answers or solutions. They want a safe place to express their fears and anxieties, to be themselves.

Listening – really listening – is not easy. We must control the urge to say something – to make a comment, add to a story or offer advice. We need to listen not just to the facts that the person is telling us but to the feelings that lie behind them. We need to understand things from their perspective, not ours.

Here are some points to remember if you are helping a person who feels suicidal.

  • They want someone to listen. Someone who will take time to really listen to them. Someone who won’t judge, or give advice or opinions, but will give their undivided attention.
  • They want someone to trust. Someone who will respect them and won’t try to take charge. Someone who will treat everything in complete confidence.
  • They want someone to care. Someone who will make themselves available, put the person at ease and speak calmly. Someone who will reassure, accept and believe. Someone who will say, ‘I care.’

What do people who feel suicidal not want?

  • They don't want to be alone. Rejection can make the problem seem ten times worse. Having someone to turn to makes all the difference. Listen.
  • They don't want to be advised. Lectures don’t help. Nor does a suggestion to ‘cheer up’, or an easy assurance that ‘everything will be okay.’ Don’t analyze, compare, categorize or criticize. Listen.
  • They don't want to be interrogated. Don’t change the subject, don’t pity or patronize. Talking about feelings is difficult. People who feel suicidal don’t want to be rushed or put on the defensive. Listen.

So, if you are concerned that someone you know may be thinking of suicide, you can help. Remember, as a helper, do not promise to do anything you do not want to do or that you cannot do.

First of all...

If the person is actively suicidal, get help immediately. Call your local crisis service or the police, or take the person to the emergency room of your local hospital. Do not leave the person alone.

If the person has attempted suicide and needs medical attention, call 9-1-1 or your local emergency services number.

The following are suggestions for helping someone who is suicidal:

Ask the person - "Are you thinking of suicide?" Ask them if they have a plan and if they have the means. Asking someone if they are suicidal will not make them suicidal. Most likely they will be relieved that you have asked. Experts believe that most people are ambivalent about their wish to die.

Listen actively to what the person is saying to you. Remain calm and do not judge what you are being told. Do not advise the person not to feel the way they are.

Reassure the person that there is help for their problems and reassure them that they are not "bad" or "stupid" because they are thinking about suicide.

Help the person break down their problem(s) into more manageable pieces. It is easier to deal with one problem at a time.

Emphasize that there are ways other than suicide to solve problems. Help the person to explore these options, for example, ask them what else they could do to change their situation.

Offer to investigate counselling services.

Do not agree to keep the person's suicidal thoughts or plans a secret. Helping someone who is suicidal can be very stressful. Get help - ask family members and friends for their assistance and to share the responsibility.

Suggest that the person see a doctor for a complete physical. Although there are many things that family and friends can do to help, there may be underlying medical problems that require professional intervention. Your doctor can also refer patients to a psychiatrist, if necessary.

Try to get the person to see a trained counselor. Do not be surprised if the person refuses to go to a counselor - but be persistent. There are many types of caregivers for the suicidal. If the person will not go to a psychologist, or a psychiatrist, suggest, for example, they talk to a clergyperson, a guidance counselor or a teacher.

One Important Suicide Fact That Nobody Is Talking About

Most suicide attempts are unsuccessful—except when it comes to guns.

We hear about gun violence in blips: The latest mass shooting or grisly homicide brings national attention and calls to action, and then the issue falls under the radar. It's easy to forget that two-thirds of gun deaths aren't high-profile homicides, but suicides—happening quietly, at a rate of one every 25 minutes.

A new report by the Brady Center to Prevent Gun Violence, a gun safety advocacy group, delivers sobering stats based on data from the Centers for Disease Control and Prevention and academic journal articles—perhaps the most eye-opening being that keeping a firearm at home increases the risk of suicide by three times. A whopping 82 percent of teens who commit suicide with a gun are using a family member's firearm.

Guns are a particularly effective means of suicide precisely because they are so lethal: Of those who attempt suicide by firearm, nine in 10 succeed. By contrast, only one in 50 overdose attempts result in death. The lethality is compounded by impulsivity: The majority of suicide attempts occur less than an hour after the decision is made to commit suicide.

One common argument of the gun lobby is that suicidal individuals will find a way to take their lives—if they don't die by gun, they'll do it by some other means. But the reality is that 90 percent of those who fail in a suicide attempt do not end up dying by suicide. With guns, though, not many get a second chance.

Myths & Facts About Suicide

Myth: People who talk about suicide don't kill themselves.

Fact: Eight out of ten suicides have spoken about their intent before killing themselves.

Myth: People who kill themselves really want to die.

Fact: Most people who commit suicide are confused about whether or not they want to live or die. Suicide is often a cry for help that ends in tragedy.

Myth: Once the depression seems to be lifting, would-be suicides are out of danger.

Fact: At such a time, they are most vulnerable to a reversal: something can go wrong to make the person even worse than before. The person's apparent calm may be due to having already decided on suicide.

Myth: When people talk about suicide, you should get their minds off it, and change the subject.

Fact: Take them seriously; listen with care; give them the chance to express themselves; offer whatever help you can.

Mental health problems rising among college students

Amy Ebeling struggled with anxiety and depression throughout college, as her moods swung from high to low, but she resisted help until all came crashing down senior year.

"At my high points I was working several jobs and internships — I could take on the world," said Ebeling, 24, who graduated from Ramapo College of New Jersey last December.

"But then I would have extreme downs and want to do nothing," she told NBC News. "All I wanted to do was sleep. I screwed up in school and at work, I was crying and feeling suicidal."

More than 75 percent of all mental health conditions begin before the age of 24, according to the National Alliance on Mental Illness, which is why college is such a critical time.

Ebeling resisted getting therapy, but eventually got a diagnosis of bipolar II disorder from a psychiatrist associated with Ramapo's counseling office.

"Then everything fell into place," said Ebeling, who is doing well on medication today.

RELATED:Young Adults and Mental Health: A Guide for Parents

College counselors are seeing a record number of students like Ebeling, who are dealing with a variety of mental health problems, from depression and anxiety, to more serious psychiatric disorders.

"What has increased over the past five years is threat-to-self characteristics, including serious suicidal thoughts and self-injurious behaviors," said Ashley Stauffer, project manager for the Center for Collegiate Mental Health at Penn State University.

According to its data, collected from 139 institutions, 26 percent of students who sought help said they had intentionally hurt themselves; 33.2 percent had considered suicide, numbers higher than the previous year.

And according to the 2016 UCLA Higher Education Research Institute survey of freshmen, nearly 12 percent say they are "frequently" depressed.

At Ramapo College, counselors are seeing everything from transition adjustment to more serious psychiatric disorders, according to Judith Green, director of the campus' Center for Health & Counseling Services.

Being away from home for the first time, access to alcohol and drugs and the rigorous demands of academic life can all lead to anxiety and depression.

Millennials, in particular, have been more vulnerable to the stressors of college life, Green told NBC News.

"This generation has grown up with instant access via the internet to everything," she said. "This has led to challenges with frustration tolerance and delaying gratification."

Millennials tend to hold on to negative emotions, which can lead to self-injury, she said. It's also the first generation that will not likely do as well financially as their parents.

"Students are working so much more to contribute and pay for college," said Green. "Seniors don't have jobs lined up yet."

'I dragged myself to the counseling center'

Like Ebeling, many students often experience mental illness breaks in college.

She had been in grief counseling after the death of her father at age 8, and even had therapy — but refused medication — during her teen years.

"I thought that it was weakness — 'why can't I just snap out of it?'" she said. "It became apparent it just wasn't that easy."

She hit a deep low her senior year.

"I was a crazy over-achiever," she said. "I got involved in all the clubs and extracurricular activities." But when her mood dropped, she said, "I couldn't do anything, but had all those responsibilities."

"In one class I panicked so much, I freaked out," said Ebeling. "I dragged myself to the counseling center."

The resources are available, according to Green, who first counseled Ebeling.

Ramapo reaches out to freshman and their parents at orientation and reinforces the availability of mental health resources throughout the year. The college also maintains an online anonymous psychological screening tool so students can see if therapy might be helpful.

RELATED:Meditation May Help Students Combat High Levels of Stress, Depression

"Students are electronically savvy, so we meet them where they are," said Green.

They also sponsor wellness fairs so students learn about nutrition, exercise and even financial well-being — "the whole gamut to keep themselves well," she said.

As for Ebeling, she took her experience and devoted her senior capstone project to learn more about mental illness. "It was therapeutic."

"Kids going to college need to realize it's not a weakness," she said. "They shouldn't be afraid to get help."

"I try to be open and talk about it with friends and family," said Ebeling. "Don't shy away from it. It needs to be addressed. Let go of the stigma."

Ebeling had good communication with her mother regarding her mental health diagnosis, but said other students should consider sharing their medical information if they "feel they have a good support system.

"I have friends who tried to discuss mental health issues with family members and completely got brushed off, which can be crushing and damaging," she said.

"I think both students and parents need to keep an open mind, but at the end the of the day, those who are seeking help need to realize that they are doing this for themselves and no one else, and they need to put themselves first and foremost no matter what."

Tips for Parents from the National Association of Mental Illness:

  • Let your child know that mental health conditions are common — one in five college students — so they don't feel alone.
  • Emphasize the importance of exercise, sleep and diet.
  • Know the warning signs of mental stress and when and how to seek help. Check out the college's resources.
  • And because of privacy laws, come up with a plan in advance for which information about mental health can be shared with the parent.


Young Adults and Mental Health: A Guide for Parents

Talking with your kids about mental health can take many shapes and forms, but with a few questions in mind, and an open dialogue, you can help major transitions run a bit smoother.

Transitions are often a challenging time for many families. Whether it’s going to middle school, going into high school, going to college, or entering the workforce full-time, any major life change comes with mixed emotions. You may be excited one minute and scared or stressed the next. That’s completely normal, and normal for your kids, too. When young adults leave high school or college, the future can seem overwhelming.

As a parent, your role in your kids’ lives change as they grow up, but maintaining an open line of communication can be beneficial for everyone. One of those benefits is on mental health. Talking with your kids about mental health can take many shapes and forms, but with a few questions in mind, and an open dialogue, you can help major transitions run a bit smoother.

What Is “Normal?”

Clinical psychologist Dr. Bobbi Wegner has parents who often come to her with concerns about their student’s transition into or out of college. She says that many kids go through adjustment issues, and it’s completely normal. But often young adults and their parents aren’t expecting these feelings to come up, so when they do, there is a heightened sense of worry.

“Anxiety and depression is the common cold of mental health, but people don’t talk a lot about it,” Wegner says. “As a parent, a part of helping is normalizing anxiety, and feeling low or depression can be a ‘normal’ part of the experience.”

“Normal” difficulties during transition times include increased anxiety, depression, and relationship issues. Young adults can have a hard time making new friends in the work place or at school and start to feel lonely or isolated. Increased workload and responsibilities can contribute to stress. Raising their awareness that those feelings are valid can go a long way.

Be Prepared

UCLA’s Executive Director of Counseling and Psychological Services Dr. Nicole Presley Green’s biggest advice to parents is to be proactive before there is a problem. Knowing what resources are available on campus, like student counseling centers, is a great step to being prepared. Similarly, making sure your young adult knows about their insurance information can help prepare them should they need to seek care at any point.

Related: Guide to Young Adult Physical Health Care

Being prepared also means maintaining an open line of communication between you and your young adult. That doesn’t mean you have to call them every few hours, but simply letting them know they can call you or reach out whenever they need to. Keep in mind that you’ve been with your kid for most of their life; you know what is normal for them.

“It’s a really challenging time for parents. They don’t know how much to let them flourish and flounder, and how much to get involved,” Dr. Green says. “But they do know when their kid is really reaching a point where they need help.”

Know the Red Flags

As a parent, hearing that it’s “normal” might not help when you’re worried whether or not your kid is able to handle their new world. Fortunately, there are ways for you to help identify whether or not something more serious is going on.

Dr. Wegner recommends keeping an eye out for any major changes in behavior in three categories she calls the “holy trilogy of health”:sleeping, eating, and energy. Any major shift in any of those areas (eating much more, eating much less, sleeping much more, sleeping much less, etc.) can be a red flag and a time for you to get curious and ask more about what is going on with your kid.

Psychologist Dr. Michele Borba recommends keeping a few questions in mind when you’re talking and listening with your young adult. Ask yourself:

  • Does he seem to be adjusting?
  • Does she have new friends?
  • Does he seem happy?
  • Are they joining in activities, like going to the gym or joining a club?
  • Do they seem to have pride in their work or school? (For example, “Our team just got on a new project,” or “My school was listed as one of the top in the state.”)

If you answer “yes” to these questions, it’s likely your teen is adjusting well, even if they say they’re stressed or sad. If they are showing no connections, or no interest in making new friends or getting involved, Dr. Borba says that is a “red flag” that there could be trouble ahead.

Acknowledge, Empathize, and Be Intentional

Ways to support your young adult are to acknowledge their feelings, empathize with them, and be intentional about the questions you ask. Often, when young adults reach out to parents in times of struggle, they’re looking for support or a shoulder to cry on. Dismissing their feelings or trying to fix their problems for them is a surefire way to end the conversation completely.

For example, if your teen is feeling anxious or depressed, don’t dismiss those feelings by saying “That’s not something to be stressed about,” or “Everyone feels like that.” Similarly, trying to fix the problem also isn’t the answer. If your kid says they “don’t have any friends” don’t point out all the friends they had in high school, or their new coworker. It may be that they mean they don’t have the same strong friendships they used to have, which is something that can make them feel isolated or lonely.

Instead, be intentional in your responses and turn the question or concern back to them. Dr. Wegner says this is a common tactic used by therapists to validate a patient’s concern, and empower them to find the answers themselves. You could try asking:

  • “I’m sorry to hear you’re feeling that way. Why do you think that is?
  • “It sounds like you don’t want to go to class, why is that?”
  • “What do you think is going on?”
  • “What have you tried to make you feel better?”
  • “How can I help you?”
  • “I’ve noticed X, how are you feeling about that?”

Simply by listening, and allowing your young adult to come to conclusions on their own, you’re empowering them to understand more about their feelings and address them.

Let Your Kids Know It’s O.K. to Ask for Help

Asking for help, especially for mental health, is often stigmatized in America. But it doesn’t have to be. For college students, most counseling centers are a free resource that anyone can use. For young adults not enrolled in college, most health insurance plans also offer mental health coverage. So visits to a therapist or psychiatrist are often covered in some form. And as far as that stigma, Dr. Wegner says there shouldn’t be shame in asking for help if you need it, even if the situation isn’t dire.

“People think it’s something you should only do if you’re clinically depressed and that’s not true,” Wegner says. “You don’t have to make a commitment, and you don’t have to go forever. Sometimes just a few sessions and then moving on can be helpful.”

Dr. Green does a lot of outreach on campus to try and decrease stigma associated with getting help. In some cases, that can be recommending parents encourage students to seek help in any way that seems accessible to them. For example, if therapy seems to scary, parents can suggest their students to talk with their RA as a first step.

When to Get Professional Help

First and foremost, trust your gut instinct. Dr. Green reminds parents that “they know their kid the best.” Any drastic difference in behavior or temperament from what is normal for your young adult can be a sign that something more serious is happening.

If your young adult talks about self-harm, suicide, or suicidal thoughts, do not avoid it. Try to find out if they mean they want to hurt themselves right now and, if so, seek immediate help by calling 9-1-1.

If your young adult is drinking in excess or using other drugs to the point it is interfering with their ability to function normally, that’s also a time to seek professional help.

For a small subset of the population that has psychotic disorders, young adulthood is often when symptoms start showing up. If your young adult is behaving erratically, having hallucinations, staying awake for extended periods of time, or sleeping for extend periods of time, seek professional help.

For more help, try any of these resources:

National Suicide Prevention Life Line—call 1-800-273-8255 or visit

Crisis Text Line – Text “Connect” to 741741 or visit

Substance Abuse and Mental Health Services Administration Treatment Locator – call 1-800-662-HELP (4357) or visit:

Taxi Watch: Suicide Prevention Drive that Saved 200 Lives

A group of taxi drivers in Kilkenny, Ireland are helping to prevent suicide in their community. Founded by taxi driver and suicide attempt survivor Derek Devoy, the Taxi Watch initiative trains taxi drivers how to identify and assist people in distress. Since its founding in 2014, Taxi Watch volunteers have intervened in nearly 200 suicide attempts and helped connect hundreds of people with counseling. A similar program in Londonderry also trains taxi drivers in life-saving techniques, such as how to use a throwline to rescue someone from drowning. Currently, there are about 200 trained Taxi Watch volunteers in Ireland, with possible plans to replicate the program in Northern Ireland. Kilkenny Taxi Watch founder Derek Devoy draws from his own history of depression to connect with those who are struggling, and said that his personal experience has made him a more effective counselor. "People want to know that you've gone through it," he said. "They don't want to talk to professors. You need people who have been there--and come out the other side--to speak out."

"So You Wanna Kill Yourself?  Gays and Suicide."

Gay men are six times more likely to attempt suicide than their straight counterparts and the numbers increase exponentially during the holidays. This story appears in the Dec/Jan 99 issue of Genre and examines the issues behind why they are taking their own lives, and offers some solutions to the holiday blues. (Also see our own # 7 Happy Holidaze A report from P-FLAG (Parents and Friends of Lesbians and Gays) states that in a study of 5,000 gay men and women, 35 percent of gay men and 38 percent of lesbians have considered or attempted suicide. The statistics are even higher among gay teens: The Department of Health study indicates that gay youth are up to six times more likely to attempt suicide than straight teens, and gay teenagers account for up to 30 percent of all teenage suicides in the nation.

"Far more women suffer from depression that men do, so it seems odd that women would commit suicide at only one-fourth the rate of men. The key difference between the two sexes may be that women talk out their problems. George E. Murphy, an emeritus professor of psychiatry at Washington University School of Medicine in St. Louis, says that women may be protected because they are more likely to consider the consequences of suicide on family members or others. Women also approach personal problems differently than men and more often seek help long before they reach the point of considering suicide. 'As a result, women get better treatment for their depressions,' Murphy says. To reduce the rate of suicide in men, Murphy suggests that physicians should be alert for risk factors in men and refer them into treatment. Writing in the Journal of Comprehensive Psychiatry, he says that identifying men at risk require mental health professionals to recognize that depressed men may understate emotional distress or difficulty with their problems."  Black Men, 3/99. Source:  HealthScout,

It's important for people with suicidal feelings to let themselves be assisted in overcoming deep depression. It's also a good idea to talk about your feelings with friends. No man is an island and there's nothing wrong with leaning on people who love you in times of need.

See Suicide Prevention Services available locally. Dial 411 for your city's Suicide Prevention Hotline, or try your local Gay & Lesbian Center, which offers referrals for counseling, domestic violence and suicide prevention.

Divorce Doubles Suicide Risk in Men

New York, Mar 15 (Reuters Health) -- Divorced or separated men are more than twice as likely to commit suicide as men who remain married, a US researcher reports. But divorce and separation do not appear to affect suicide risk in women, according to Dr. Augustine J. Kposowa, of the University of California at Riverside. Kposowa examined the link between suicide and marital status using data on nearly 472,000 men and women included in the National Longitudinal Mortality study. Between 1979 and 1989, 545 of these individuals committed suicide.

'Men were nearly 4.8 times as likely to commit suicide as women,' the researcher writes in the March 15th issue of the Journal of Epidemiology and Community Health. Whites were at greater risk of suicide than African Americans, and individuals with household incomes between $5,000 and $9,999 were more likely to commit suicide than others. Suicide rates were also higher in older age groups, especially those aged 65 and older, and in residents of Western states.

In addition, divorce or marital separation more than doubled the risk of suicide in men, whereas in women, marital status was unrelated to suicide. Kposowa suspects that this difference is related to the social networks men and women form outside their marriages, which may be stronger or more meaningful in women than in men. 'Women have better ways of communicating,' Kposowa told Reuters Health in an interview. 'They may have more social support networks, friends and relatives that they talk to, whereas men don't have social support networks.'

Primary care physicians should educate men about the risk of suicide following a divorce, and encourage them to seek counseling or group therapy, Kposowa added. Parents can also play an important role in addressing the divorce-suicide link in men, he believes. Raising boys to 'be themselves, talk about their problems' and express their emotions can help reduce the cultural constraints on men to hold back their feelings, he suggested.
Source: Journal of Epidemiology and Community Health 2000;54:254-261.

Can Ketamine Rapidly Reduce Suicidal Ideation?

Suicide is preventable, yet still remains a worldwide cause of death in part due to a lack of available medical interventions that can work during a suicidal crisis. Most potentially helpful medications take days or weeks to work: time that is not feasible in an emergency. Novel biological targets and interventions are urgently needed for those in such pain that they are at risk of taking their life.

Ketamine, a commonly used anesthetic, has shown rapid therapeutic effects as an antidepressant for those with depression, especially when the depression is resistant to treatment. The antidepressant effect is rapid, and many have wondered if Ketamine could have the same effect specifically for suicidal behavior. This has yet to be examined in larger studies over an extended period of time.

Additional information is needed regarding whether it is feasible to use Ketamine for immediate or even longer standing suicide risk. It will also be important to determine the best dosage and means of administration for it to be considered an effective form of medical intervention for highly suicidal individuals.

The Question

Can Ketamine rapidly reduce suicidal ideation?

The Study

Dr. James Murrough, an Assistant Professor of Psychiatry and Neuroscience at Mount Sinai Medical Center in New York, conducted a randomized clinical trial in which the treating clinician and participant did not know if they were receiving Ketamine or Midazolam, a calming sedative medication typically used before medical procedures. The treatment group received a single IV infusion of Ketamine. This study is unique in that the control group was receiving an active intervention, rather than a non-effective, non-active placebo.

Participants included 24 people who were being treated as inpatients and outpatients at Mount Sinai Hospital with a range of primary mood disorders and high levels of suicidal ideation (SI). Those excluded from the study because of potential negative consequences of ketamine were people with a lifetime history of schizophrenia, primary psychotic disorders or symptoms, unstable medical illnesses or clinically significant abnormal laboratory findings; those screening positive for drug use upon admission or drug use or abuse within one month preceding their admission; pregnant or breastfeeding women; and women who planned to become pregnant.

Depression, suicidal ideation and side effects were measured prior to treatment and at 24hr, 48hr, 72hr, and one week after treatment. Suicidal ideation was measured using two measurement tools, the Beck Scale for Suicidal Ideation (BSI) and the Montgomery-Asberg Depression Rating Scale (MADRS).

The Results

Both groups experienced reduced suicidal ideation after treatment. At the 24hr post measurement, the Beck Scale for Suicidal Ideation (BSI) showed no significant difference between the Ketamine and Midazolam group. However, reduced effects for suicidal ideation were significant at 48 hours following treatment intervention. Those receiving Ketamine treatment showed significantly lower suicidal ideation than those who received the control treatment.

On the other hand, MADRS-SI, a measurement tool for depression and suicidal ideation, showed a marked difference between the two treatment groups at 24hr and 48hr, with the Ketamine group showing lower rates of depression and suicidal ideation than the Midazolam group. By 72 hours there was no longer a difference between groups.

This study is one of the first demonstrations showing the rapid therapeutic effects of Ketamine as an intervention for those with increased suicidal ideation and suicidal behavior. Results are promising regarding the rapid effects of Ketamine for reducing depression and suicidal ideation.

The Takeaway

Although the effects of Ketamine are not known over extended periods of time, this novel medical intervention may have a major impact saving lives by disrupting the suicidal crisis.

Grant Related Publications

Murrough, James W., and Dennis S. Charney. “Is there anything really novel on the antidepressant horizon?.” Current psychiatry reports 14.6 (2012): 643-649.

Murrough, J. W., et al. “Ketamine for rapid reduction of suicidal ideation: a randomized controlled trial.” Psychological medicine 45.16 (2015): 3571-3580.

Lapidus, K. A., Soleimani, L., & Murrough, J. W. (2013). Novel glutamatergic drugs for the treatment of mood disorders. Neuropsychiatr Dis Treat, 9, 1101-1112.

Murrough, J. W., & Charney, D. S. (2012). Is there anything really novel on the antidepressant horizon?. Current psychiatry reports, 14(6), 643-649.

Soleimani, L., Welch, A., & Murrough, J. W. (2015). Does ketamine have rapid anti-suicidal ideation effects?. Current treatment options in psychiatry, 2(4), 383-393.

Costi, S., Van Dam, N. T., & Murrough, J. W. (2015). Current Status of Ketamine and Related Therapies for Mood and Anxiety Disorders. Current behavioral neuroscience reports, 2(4), 216-225.

Deaths by Suicide and Self-inflicted Injury per 100,000 age 15-24, 1991-1993

Note that religious and social strictures against suicide may result in some underreporting in some nations. i.e., China is believed to represent over 46% of the suicides in the world. And, no information is currently available on Denmark and France.

Ranked by


Ratio M/F
Highest Ratio M/F











Czech Rep


























New Zealand








Russian Fed















Source: WHO, World Health Statistics Annual 1993 and 1994, 1994 and 1995, Center for Disease Control, National Center for Injury Prevention and Control; National Institute for Mental Health.


Update: Deaths by Suicide per 100K by Age

Will Courtenay, Ph.D. in his forthcoming book, Dying to be Men: Psychosocial, Environmental, and Biobehavioral Directions in Promoting the Health of Men and Boys (April, 2011, Routledge) reports the following suicide and death rates (per 100,000 U.S. population) from the National Center for Disease Control, for males and females in various age groups:

Age Group
Male Rate
Female Rate
Male/Female Ratio
Source: Article

Suicide -- Washington State, 1980-1995

The ongoing assessment of health data and health data sources is essential to the development of effective prevention strategies for priority health issues. In Washington, assessment efforts include the analysis of suicide data. In 1995, suicide was the eighth leading cause of death in Washington (1), and most (58%) were firearm related. To determine trends in suicide during 1980-1995, the Injury Prevention Program of the Washington Department of Health (WDOH) analyzed death-certificate data. This report presents the findings of the analysis, which indicate that, while overall suicide rates in Washington remained relatively stable during 1980-1995, suicides became more common among persons aged 15-24 years and greater than or equal to 75 years and less common among persons aged 25-74 years.

Computerized death-certificate data and external cause-of-injury codes (E-codes) were used to identify all suicides (E950-E959) among Washington residents. Population data were derived from the 1980 and 1990 U.S. census and from intercensal and postcensal estimates from the Office of Management of Washington state. Contiguous age categories with similar death rates were grouped, and patterns within age groups were examined.

The average 1-year change in mortality was estimated using negative binomial regression in models that accounted for changes in the age, sex distribution, and size of the population. This regression method is useful for analyzing count data that do not meet the restrictive assumptions of Poisson models (2). Results are expressed as the overall percentage change in mortality from 1980 to 1995. Trends are presented graphically using robust locally weighted regression (3). Because suicide methods might change over time, trends in firearm-related suicides were compared with those in non firearm-related suicides.

During 1980-1995, a total of 10,650 suicides occurred in Washington, representing an overall average rate of 14.2 per 100,000 population. The most common method of suicide was use of firearms (E950.0-E955.4) (56%), followed by poisoning (E950-E954) (23%), suffocation (E953) (13%), and other or unspecified means (8%). Most (78%) suicides occurred among males. Although the overall average rate of suicide in the total population remained relatively constant during the 16-year period, the rate of firearm-related suicide increased 8% (p=0.2), and the rate of suicide by other means decreased 15% (p less than 0.01) (Table 1). Changes in the overall suicide rate varied by age, increasing by 127% for children aged 5-14 years (all except one suicide in this age group during 1980-1995 occurred among children aged 10-14 years); by 16% for persons aged 15-24 years; and by 42% for persons aged greater than or equal to 75 years (Figure 1). For persons aged 25-74 years, the rate declined substantially. The increase for children aged 5-14 years primarily reflected an increase in non firearm-related suicide, the increase for persons aged 15-24 years and greater than or equal to 75 years reflected an increase in firearm-related suicide, and the decrease for persons aged 25-74 years reflected a decrease in both firearm-related and non firearm-related suicide (Figure 2). Reported by: M LeMier, MPH, D Keck, Injury Prevention Program, Washington Dept of Health; P Cummings, MD, Harborview Injury Prevention and Research Center, Seattle. Div of Violence Prevention, National Center for Injury Prevention and Control, CDC.

Editorial Note: The analysis by WDOH illustrates the usefulness of death-certificate data in assessing trends in suicide. Although overall suicide rates remained stable among residents of Washington during 1980-1995, age-specific analyses indicate that the rate of non firearm-related suicide increased significantly for children aged 5-14 years, and the rate of firearm-related suicide increased for persons aged 15-24 years and the elderly (aged greater than or equal to 75 years). Suicide rates for persons aged 25-74 years declined, reflecting a decrease in both firearm-related and non firearm-related suicide. These findings can assist in identifying risk factors for suicide and high-risk groups; such analyses should be considered by other state and local health departments to better understand local suicide trends and guide prevention efforts.

The high proportion of firearm-related suicides in Washington is consistent with national patterns during the 1980s and 1990s (4). The increases in Washington in the overall rates of suicide for youths and for the elderly and in the rate of firearm-related suicide for persons aged greater than or equal to 75 years also were consistent with national trends. Although reasons for these increasing trends in suicide are unknown, potential explanations include changes in the prevalence of depression, the use of more lethal methods, and changes in societal attitudes toward suicide among the elderly.

The findings in this analysis may have underestimated the true rate of suicide. The intent of some persons who commit suicide may be unknown or unrecognized; therefore, their deaths may not be reported as suicides. The magnitude of underreporting associated with these misclassification errors is unknown. In contrast, a previous report indicated that coding a non suicide death as a suicide probably is uncommon; in that study, 90% of deaths coded as suicides were coded correctly (5).

Routine collection of the circumstances of injury events may assist in more accurate coding of suicides on death certificates and in developing effective prevention strategies. In Washington, efforts to improve basic injury data collection include the reporting of firearm injury data to WDOH by all hospitals (admissions and emergency department visits), coroners, and medical examiners. In addition, WDOH is collecting information about the intent and circumstances of shootings and the types of firearms involved.

An important prevention measure for persons who are suicidal is to restrict access to highly lethal methods of suicide (6). For example, measures associated with reductions in suicide rates without compensatory increases in the use of other methods include removal of carbon monoxide from domestic gas (7), limiting the size of prescriptions to barbiturates and other drugs commonly used in self-poisonings (8), and restricting access to handguns (9). In addition to means restrictions, other interventions for reducing the risk for suicide include 1) training of clergy, tribal leaders, school personnel, healthcare professionals, and others who have contact with persons who may be contemplating suicide to recognize persons at risk for suicide and refer them for appropriate counseling; 2) educating the general public about warning signs for suicide and opportunities to seek help; 3) implementing screening programs for identifying and referring persons at highest risk for suicide; 4) improving access to or promoting crisis centers, hotlines, and peer support groups (including family and friends) for high-risk persons; and 5) implementing post-suicide actions to reduce the probability of cluster suicides (5). The effectiveness of each of these suicide-prevention strategies requires further assessment.

WDOH, in collaboration with the University of Washington School of Nursing, has developed a Youth Suicide Prevention Plan (10) that includes a public education campaign to heighten awareness among adults about the increasing problem of youth suicide and to teach adults how to recognize common suicide warning signs and how to respond to youth who exhibit these signs. In addition, the program provides adults working with high-risk youth with information about effective screening and crisis-intervention strategies. The goals of this plan are to 1) prevent both fatal and nonfatal suicide behaviors among youth; 2) reduce the impact of suicide and suicidal behaviors on individuals, families, and communities; and 3) improve access to and availability of appropriate prevention services for at-risk persons and groups. Although this program is designed to prevent suicide among youths, some elements of the program may be useful to prevent suicide among the elderly.

1. Estee S, Starzyk P, Harmon L, Parker C. Washington state vital statistics, 1994 and 1995. Olympia, Washington: Washington Department of Health, 1996.
2. McCullagh P, Neider HA. Generalized linear models. New York, New York: Chapman and Hall, 1989.
3. Cleveland WS. The elements of graphing data. Murray Hill, New Jersey: Bell Telephone Laboratories, 1985.
4,. Kachur SP, Potter LB, James SP, Powell KE. Suicide in the United States, 1980-1992. Atlanta, Georgia: US Department of Health and Human Services, Public Health Service, CDC, National Center for Injury Prevention and Control, 1995. (Violence surveillance summary series, no. 1).
5. Moyer LA, Boyle CA, Pollock DA. Validity of death certificates for injury-related causes of death. Am J Epidemiol 1989;130:1024-32.
6. CDC. Youth suicide prevention programs: a resource guide. Atlanta, Georgia: US Department of Health and Human Services, Public Health Service, 1992.
7. Kreitman N, Platt S. Suicide, unemployment, and domestic gas detoxification in Britain. J Epidemiol Community Health 1984;38:1-6.
8. Harrison J, Moller J, Dolinis J. Suicide in Australia: past trends and current patterns. Australian Injury Prevention Bulletin 1994; issue no. 5.
9. Loftin C, McDowall D, Wiersema B, Cottey TJ. Effects of restrictive licensing of handguns on homicide and suicide in the District of Columbia. N Engl J Med 1991;325:1615-20.
10. Eggert LL, Thompson EA, Randall BP, McCauley E. Youth Suicide Prevention Plan for Washington State. Olympia, Washington: Washington Department of Health, 1995.

Differences in Suicide Among Men and Women

Differences Between Men and Women in Suicide and Suicidal Behaviors

Gender Differences in Suicide

Are their gender differences in suicide and the methods men and women use?. Ismail Akin Bostanci/Getty Images

There are several gender differences with regard to suicide, involving differences in both successful suicides and suicidal behaviors for men and women.

While it is difficult to discuss this topic, it has to be stressed that this knowledge is important if we are to reduce the number of successful suicides occurring in the United States and around the world each year.

Gender Differences Suicide Attempt and the Risk of Death from Suicide

In reviewing suicide statistics it's been found that women are roughly three times more likely to attempt suicide, though men are around three times more likely to die from suicide.

From this information it is clear that there are other important differences between the sexes with regard to suicide that we will address.

There are also differences in the risk of suicide between men and women based on previous attempt. Around 62 percent of women who are successful in suicide have made a previous attempt, but when it comes to men, 62 percent of those who die from suicide have not had a previous attempt.

It's important to discuss one fallacy when it comes it suicide in men and women up front. The differences in attempts and successful suicides in women has erroneously led many people to believe that suicide attempts in women are often a method of getting attention. This is far from true. It is important to note that among women an attempted (but failed) suicide attempt is the greatest risk factor for suicide in the future, and all suicide attempts, whether in men or in women, need to be taken very seriously.

Differences in Suicide Methods Between Men and Women

One of the most important reasons for the difference between suicide attempts and successful suicides between men and women is the method of suicide used. Men tend to choose violent (more lethal) suicide methods, such as firearms, hanging, and asphyxiation, whereas women are more likely to overdose on medications or drugs.

Common suicide methods in men include:

  • Firearms
  • Hanging
  • Asphyxiation, or suffocation
  • Jumping
  • Moving objects
  • Sharp objects
  • Vehicle Exhaust Gas

In general, women tend to use a greater variety of suicide methods than men. Common suicide methods in women include:

  • Self-poisoning (women four times as likely as men to die from drug poisoning)
  • Exsanguination (bleeding out from a cut such as a "slit" wrist)
  • Drowning
  • Hanging (one study found that men and women are both just as likely to die by hanging)
  • Firearms (women were 73 percent less likely to use firearms as men)

Other Differences in Suicide Methods

There are differences in suicide methods beyond those between the sexes. Men who were married were more likely to use firearms, whereas men who were unmarried were more likely to die by hanging. There are differences which depend on whether a suicide is conducted at home or away from home as well. Youth, likely due to access of methods, have a high proportion of dying by hanging. In addition, methods can vary depending on situations. Methods such as an overdose are more common in those who have been depressed for some time. Firearms, in contrast, appear to be more common when people are reacting to acute situations.

This would support current recommendations to remove guns from a home in the setting of an acute mental health crisis.

Differences in Severity of Suicide Attempts in Men and Women

Even when the same method of suicide is used by men and women, attempts by men tend to be more serious and severe (60 percent more severe, at least statistically speaking). Men who attempt suicide and survive are more likely than women who attempt and survive suicide to require intensive care hospitalization. With regard to suicide by firearms, men are more likely to shoot themselves in the head (which is more likely to be fatal) than women.

The reason for this has been debated, but could be related to less intent to die in women. It could be, however, that cosmetic fears in women, should the attempt fail, play a role in the location of a gunshot.

Prior Suicide Attempts Before Suicide in Men and Women

As noted above, both men and women who have a history of a prior suicide attempt are at risk for suicide. Over half of women who are successful in suicide have a previous attempt, whereas less than half of men who commit suicide have a prior attempt.

Differences in Self-Harming Behavior Between Men and Women

While men are more likely to die as a result of a suicide attempt, women are more likely to engage in what is known as deliberate self-harm (DSH) or self-mutilation. DSH involves any sort of self-harming behavior, whether or not the intent is to commit suicide.

Research suggests that people who use self mutilation are not usually trying to kill themselves, though sometimes they do. While many people associate self harm with a desire for attention, it is not, and is often done in private. Examples of DSH include non-lethal drug overdoses and self-injury such as cutting. While suicide may not be the motivation, many people who engage in self-harm may be having suicidal thoughts, and may also go too far in their self-harming behavior resulting in unintentional suicide.

Risk factors for suicide in those who engage in self-harming behavior include:

  • Previous episodes of self harm
  • Suicidal intent
  • Physical health problems
  • Male gender

Gender Differences in Depression and Suicide

It's thought that major depression occurs in roughly half of people who commit suicide, both male and female, and there are differences in this regard as well. Women are twice as likely as men to carry a diagnosis of major depression, though, as noted, successful suicide occurs much more often in men than women. It's also known that women are more likely to seek treatment for depression than men.

Why Are There Gender Differences With Suicide?

Differences in gender roles and expectations may account for some of the differences in suicide behavior. The gender stereotype of men being "tough" and "strong" does not allow for failure, perhaps causing men to select a more violent and lethal method of suicide; while women, who are allowed (in social acceptance terms) the option to express weakness and ask for help, may use suicide attempts as a means of expressing their desire for assistance.

Some researchers have postulated that women are more likely to take others into consideration, and looking at suicide in the context of a relationships may give women less incentive to want to die. Others have wondered if perhaps women feel freer to change their minds following a decision to attempt suicide.

Experts suggest that gender might also influence what methods a person is familiar with or has ready access to use. For example, men are generally more likely than women to be familiar with firearms and use them in their daily lives, and thus they might choose this method more often.

While certain generalizations can be made about male and female suicide behavior, it should be noted that general tendencies cannot be taken as absolute guidelines for suicide prevention efforts. Suicide attempts should always be taken seriously and not dismissed as attention seeking behavior, nor should it be assumed that only persons of a particular gender will use any given method.

Suicide Warning Signs

Regardless of gender differences in suicide, everyone should be aware of the risk factors and warning signs for suicide. If you or a loved one have a history of depression, you may wish to create a suicide safety plan as well.

If You are a Parent

If you are a parent, you may have lost sleep hearing about the risk of suicide in our young people. Thankfully this is being addressed, complete with posters telling adolescents to break the silence if they learn another student may be suicidal. Articles now abound which speak of teen cutting and self harm behaviors. Yet determining if a teenage child is suicidal may be very difficult among the normal angst of adolescence. In addition to learning about the warning signs of suicide in adults, take a moment to learn about the common warning signs for suicide in teenagers, and become familiar with these myths about teen suicide.


Callanan, V., and M. Davis. Gender Differences in Suicide Methods. Social Psychiatry and Psychiatric Epidemiology. 2012. 47(6):857-69.

Chan, M., Bhatti, H., Meader, N. et al. Predicting Suicide Following Self-Harm: Systematic Review of Risk Factors and Risk Scales. British Journal of Psychiatry. 2016. 209(4):277-283.

Hamilton, E., and B. Klimes-Dougan. Gender Differences in Suicide Prevention Responses: Implications for Adolescents Based on an Illustrative Review of the Literature. International Journal of Research and Public Health. 2015. 12(3):2359-72.

Maddock, G., Carter, G., Murrell, E., Lewin, T., and A. Conrad. Distinguishing Suicidal from Non-Suicidal Deliberate Self-Harm Events in Women with Borderline Personality Disorder. Australia and New Zealand Journal of Psychiatry. 2010. 44(6):574-82.

Mergi, R., Koburger, N., Heinrichs, K. et al. What Are Reasons for the Large Gender Differences in the Lethality of Suicidal Acts? An Epidemiological Analysis in Four European Countries. PLoS One. 2015. 10(7):e0129062.

Tsirigotis, K., Guszczynski, W., and M. Tsirigotis. Gender Differentiation in Methods of Suicide Attempts. Medical Science Monitor. 2011. 17(8):PH65-PH70.

Macroeconomics and Suicide

There are rumors that Wall Street tycoons, and other newly-poor people, committed suicide in droves following the stock market crash of 1929. Many newspapers at the time investigated countless reports of suicide-on-the-street, but most rumors were proved false. But, the rumor was and is easily believable (and people suddenly on the brink of the Great Depression wanted to believe it was true), and throughout history, changes in macroeconomics have been attributed to population mental health, specifically fluctuating rates of suicide.

A new study, published in the American Journal of Epidemiology, evaluates the economic conditions and suicide rates in New York City over the last 3 decades. The authors evaluated levels of economic activity and the volatility of the New York Stock Exchange, as well as all suicides among New York City residents, between 1990 and 2006. Overall, during the study period, there were nearly 8100 suicides. The rate of suicide declined from 8.1 per 100,000 residents in 1990 to 4.8 per 100,000 in 1999; it remained relatively stable through 2006.

There was a negative association between economic activity and rates of suicide, and suicides were highest when economic activity was at its lowest. Suicide rates varied according to gender, age, race, and sociodemographic status, and most of the association with economic activity was attributed to suicides of older, white males. This group accounted for more suicides during economic downturns than other demographic groups. Stock market volatility was not associated with changes in suicide rates, but, the authors report that this may be due to the small sample size of people invested in the stock market.

Every year, around the world, approximately 1 million people take their own lives. Nearly all of these people have pre-existing psychiatric morbidity, but other factors influence the decision to commit suicide: genetics, stressful life events, access to means of committing suicide, and poor health. Suicide rates are highly variable, however, at population and individual levels. From a broader, population-based perspective, changes in suicide rates have been attributed to stressors that occur within populations, including economic instability. The term “econocide” has recently been coined by psychologists to explain this phenomenon.

Economic recessions and financial troubles are associated with decreased physical and psychological health and increased mortality, and, throughout history, suicides have increased during recessions and economic downturns. (Suicide rates during the Great Depression peaked when the gross domestic product in the United States was at its lowest point.) And, suicide rates are historically highest among impoverished and unemployed people. However, there is a lack of data showing low rates of suicide at times of economic prosperity.

The new study concludes that macroeconomic forces influence mental health, but a causative factor is not identified. Perhaps, economic struggles limit the resources available for mental health services or individuals with underlying conditions might be more likely to experience job loss or unemployment during these periods. Ultimately, the decision to commit suicide is multifaceted and one measure of economic activity in one city cannot explain the choice entirely.

The current study does not include data from the most recent economic recession, and it does not include individual economic status as a confounder of the suicide rate. (Were the older, white males failed Wall Street tycoons or elderly men living on a fixed income?) A bad economy likely brings out the worst in people – physically, mentally, and emotionally – and no one is immune to its strain. Disgraced financial executives might not be killing themselves in the streets today – they have congressional hearings and country club prisons to go to – but suicide prevention services should be directed toward those at highest risk, even at the worst of economic times.


Hawton K, Harriss L, Hodder K, Simkin S, & Gunnell D (2001). The influence of the economic and social environment on deliberate self-harm and suicide: an ecological and person-based study. Psychological medicine, 31 (5), 827-36 PMID: 11459380

Nandi A, Prescott MR, Cerdá M, Vlahov D, Tardiff KJ, & Galea S (2012). Economic conditions and suicide rates in New York City. American journal of epidemiology, 175 (6), 527-35 PMID: 22362583

Rehkopf DH, & Buka SL (2006). The association between suicide and the socio-economic characteristics of geographical areas: a systematic review. Psychological medicine, 36 (2), 145-57 PMID: 16420711

Social Isolation and Mental Illness

Think about what it would be like to spend most of your time alone because being around other people is just too difficult. You feel that others are judging you for your mental illness, and so you are scared to face the world. You withdraw to avoid this stigmatization. This social withdrawal is emotionally very costly. But this is a two-way street — the mentally ill withdraw from society–society withdraws from them.

An Australian survey reported that two-thirds of people affected by a mental illness feel lonely “often” or “all of the time”. The research says in contrast, just 10 per cent of the general population reported feelings of loneliness. (1)

Social relationships are important for anyone in maintaining health, but for the mentally ill it is especially important. People with mental illness value contact with family. But families may be unwilling to interact with their mentally ill family member. Social isolation is also sometimes due to the unwillingness of others to befriend the mentally ill. The public may avoid them altogether. The stigma associated with mental illness creates huge barriers to socialization.

People with severe mental illness are probably the most isolated social group of all. They are judged, disrespected and made into pariahs. They fear rejection from others, who may be afraid of the mentally ill, so the mentally ill person may feel overwhelmed by the thought of attempting to form new friendships. Just avoiding any contact is often the choice. Or, they may make a great effort to conceal their condition from others, which results in additional stress from worrying about their true condition being discovered.

It is sometimes the case that the severely mentally ill person becomes homeless. This in itself is isolating, and they then must suffer the double stigmatization of being homeless as well as mentally ill.

Another reason the person with mental illness may experience social isolation is the nature of their mental illness. Social phobias like agoraphobia, or severe anxiety or depression often cause the suffering person to be afraid to venture out into society.

When anyone, mentally ill or not, does not have enough social contact, it affects them mentally and even physically. Loneliness creates stress, taking a toll on health. Other things affected can be the ability to learn and memory function. High blood pressure is also seen. It can be the trigger of depression and alcoholism. (2) Imagine the consequences, then, if you are already depressed or have other mental illnesses? Loneliness can make you worse. Loneliness and loss of self-worth lead many mentally ill to believe that they are useless, and so they live with a sense of hopelessness and low self-esteem.

Social isolation is both a cause and an effect of mental distress. When the person isolates more, they face more mental distress. With more mental distress, they want to isolate. This vicious cycle relegates many people with severe mental illness to a life of social segregation and isolation.

Many people with severe psychiatric disabilities say that the stigma associated with their illness is as distressing as the symptoms themselves. This stigmatization not only prevents them from interacting with others, but may prevent them from seeking treatment, which in turn exposes them to a greater risk of suicide.

Too often the public does not understand the challenges of the mentally ill and doesn’t want to try. It is therefore necessary to confront biased social attitudes in order to reduce the discrimination and stigma of people who are living with mental illness.


1. Mentally Ill ‘neglected by communities’. (05/08/2002). Yahoo. AU.

Image via KYTan / Shutterstock.

2. Psychology Today. The Dangers of Loneliness. Morano, Hara Estroff. (Aug. 21, 2033).

Mother hopes to save lives by sharing story of son who took his own life

Each year, more than a thousand college students in America die by suicide. Only traffic accidents take more of their lives. A metro mom wants the tragic loss of her son to prompt others to think and talk about depression and suicide in hopes of preventing it.

Jason Arkin's mom, Dr. Karen Arkin, says he was a good kid. He was a best friend to his sister, Jennifer. He was always a perfectionist. Jason would go on to become an Eagle Scout and a National Merit Scholar at Blue Valley Northwest High School.

"People would describe him as a perfect kid. I hate that word perfect. I think it's a terrible word," said Dr. Arkin.

She says her son's perfectionism and his chronic depression were a lethal combination. At age 12, Jason heard a presentation about a young man's depression and suicide.

"And Jason said, 'Mom, I've always been like that guy, and my heart just shattered,'" recalled Dr. Arkin.

She and her husband, Dr. Steven Arkin, are neurologists with Saint Luke's Health System. They got their son treatment, but she says after he turned 18 and went to Northwestern University, they couldn't force him to get treatment.

"For someone who's depressed, especially a male, they just don't ask for help. They really don't," she said.

Dr. Arkin says her son was in a highly competitive electrical engineering program.

"He would say things like he was the dumbest student at Northwestern," she recalled.

In May, just a few weeks before finals, and just five days before his twenty-first birthday, Jason took his own life.

"And I can't understand it. I can't pretend that I'll ever understand it," she said.

Dr. Arkin encourages other parents to talk with their children about their pain, hopelessness and despair. Talk about depression.

"Don't be ashamed or embarrassed to talk about it. You know, never be ashamed to love your child enough to have the difficult conversations with them," she said.

And get them help while you can.

The group Suicide Awareness Survivor Support Missouri-Kansas will hold its annual Remembrance Walk this Sunday, September 6, at Loose Park in Kansas City, Missouri. Registration is at 8 a.m. with the walk beginning at 9 a.m. The group says the event will remember those who've lost their lives to suicide, homicide, fire, accident and other traumatic deaths. For more information, e-mail

The first Jason Arkin Memorial Walk will be held Sunday, September 20, Congregation Beth Torah, 6100 W. 127th Street, Overland Park, Kansas. People are invited to gather at 7:30 a.m. with the walk starting at 8:15 a.m. Donations may be made to the Greater Kansas City Mental Health Coalition. For more, click here.

If you are having suicidal thoughts, we urge you to get help immediately.

Go to a hospital, call 911 or call the National Suicide Hotline at 1-800-SUICIDE (1-800-784-2433).


  • Every 12 minutes another life is lost to suicide. Every day 120 Americans take their own life and over 3,000 attempt suicide. (cir. 2015)
  • Suicide was the eighth leading cause of death of all Americans, the second leading cause of death for young people 10-24 and 25-34. (cir., 2015)
  • For every two victims of homicide in the U.S. there are three deaths from suicide.
  • There are now twice as many deaths due to suicide than due to HIV/AIDS.
  • Between 1952 and 1995, the incidence of suicide among adolescents and young adults nearly tripled.
  • In the month prior to their suicide, 75% of elderly persons had visited a physician.
  • Over half of all suicides occur in adult men, aged 25-65.
  • White men accounted for 72% of all suicides.
  • Women are more likely to attempt suicide. However, men are four times more likely to die from suicide than are women.
  • Many who make suicide attempts never seek professional care immediately after the attempt.
  • More teenagers and young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia and influenza, and chronic lung disease, combined.
  • Suicide took the lives of 30,535 Americans in 1997 (11.4 per 100,000 population). In 2015 that number was 44,193,
  • Nearly 3 of every 5 suicides were committed with a firearm.
  • Divorced or separated men are more than twice as likely to commit suicide as men who remain married. Divorce and separation do not appear to affect suicide risk in women.

Suicide Among the Elderly

  • Suicide rates are highest among Americans aged 65+.
  • Men accounted for 83% of suicides in this category.
  • Firearms were the most common method of suicide by both men and women accounting for 77% of men and 33% of women suicides in that age group.
  • Risk factors for suicide among older persons differ from those among the young. Older persons have a higher prevalence of depression, a greater use of highly lethal methods and social isolation. They also make fewer attempts per completed suicide, have a higher-male-to-female ratio than other groups, have often visited a healthcare provider before their suicide, and have more physical illness.

Suicide Among the Young

  • Persons under 25 account for 15% of all suicides.
  • The incidence of suicide has nearly tripled in this age group since 1952.
  • Suicide is the second leading cause of death for 10-24 and 25-34 year olds, behind unintentional injury and homicide. (cir. 2015)
  • Among persons 15-19, firearm-related suicides accounted for 62% of the increase in the overall rate of suicide.
  • The risk for suicide among young people is greatest among young white males although the suicide rates increased most rapidly among young black males.
  • Although suicide among young children is a rare event, the dramatic increase in the rate among persons aged 10-14 underscores the urgent need for intensifying efforts to prevent suicide among persons in this age group.

Suicide in Men over 50: An Epidemic

Suicide is the eighth leading cause of death in the United States, resulting in over 30,000 deaths per year. This is clearly an underestimate of the true figure since many suicides are not recorded as such because of social stigma, financial considerations, and other factors. For as long as statistics about suicide have been collected in the United States there has been a very consistent strong association between suicide and 3 factors: age, gender, and race. Though women have many more suicide attempts than men, per attempt, a man is 4 times more likely to die than a woman; in fact, white males accounted for 73% of all suicides in the US in 1996.

From 1970 to 1998, US annual suicide rates per 100,000 rose from 16.2 to 18.7 in men, but decreased from 6.8 to 4.5 in women. In 1998, the rate of suicide in white men was 20.3/100,000 and in nonwhite men was 10.5/100,000; in male youths aged 15-24 years, these rates were 19.3 for whites and 15.6 for nonwhites (Table 1). Among the US elderly (aged 65+), 1998 suicide rates among elderly women were similar to those among women of all ages (4.7/100,000), but rates increased significantly for elderly men (from 18.7 to 34.1/100,000). When categorized by race, these rates of suicide among elderly white men substantially increase (from 20.3 to 36.6/100,000) and increase moderately in nonwhite elderly men (from10.5 to 13.7/100,000). According to 1997 data from the National Institute of Mental Health, the highest rate of suicide is among white men older than age 85 (65/100,000).

Table 1. Suicide Rates in the US, 1998 Data Rate/M


# Suicides
All Ages


















Source: Adapted from American Association of Suicidology. U.S.A. Suicide: 1998
Official Final Data. Available at:[42]   

Thus in the United States the suicide cohort is overwhelmingly white, male, and older than age of 60. Strikingly, the relationship between age, gender and suicide is consistent throughout the world and across cultures. Although base rates of individual countries may vary, data from Western Europe, Asia, and South America quite consistently show that in all countries suicide is significantly more prevalent among men and that after age 60 the suicide rate for men dramatically increases.

There is a well-established strong association between depression and suicide. About 90% of suicides result from treatable mental disorders, most commonly depression or substance abuse disorder ." Despite very effective treatments for depression, there has not been a significant reduction in the suicide rate in the United States, specifically no dramatic reduction in the rate of suicide in men over age 60. The argument that doctors do not have the opportunity to treat patients who commit suicide is not supported by the data. Among people who commit suicide, 20% have seen a physician on the day of the suicide, 40% have seen a physician within1week and 70% have seen a physician within 1 month. Physicians may not be routinely evaluating suicide potential at each office visit for the high-risk population of older men.

Why white, older men are more likely to die of suicide

In the United States, older men of European descent (so-called white men) have significantly higher suicide rates than any other demographic group. For example, their suicide rates are significantly higher than those of older men of African, Latino or Indigenous descent, as well as relative to older women across ethnicities.

Behind these facts there is a cultural story, not just individual journeys of psychological pain and despair. Colorado State University's Silvia Sara Canetto has spent a large portion of her research career seeking to uncover cultural stories of suicide.

A professor in the College of Natural Sciences' Department of Psychology, Canetto adds a new chapter to that story in an article recently published in the journal Men and Masculinities. Among her findings are that older white men have higher suicide rates, yet fewer burdens associated with aging. For example, they are less likely to experience widowhood and have better physical health and fewer disabilities than older women. They have more economic resources than ethnic minority older men, and than older women across ethnicities.

White older men, however, may be less psychologically equipped to deal with the normal challenges of aging, likely because of their privilege up until late adulthood, Canetto asserts.

Scripts of masculinity

An important factor in white men's psychological brittleness and vulnerability to suicide once they reach late life, Canetto says, may be dominant scripts of masculinity, aging and suicide. Particularly pernicious for this group may be the belief that suicide is a masculine response to "the indignities of aging." This is a script that implicitly justifies, and even glorifies, suicide among men.

As illustrations, in her article Canetto examines two famous cases. Eastman Kodak founder George Eastman died of suicide in 1932, at age 77. His biographer said Eastman was "unprepared and unwilling to face the indignities of old age." Writer Hunter S. Thompson, who killed himself in 2005 at age 67, was described by friends as having triumphed over "the indignities of aging." Both suicides were explained in the press through scripts of conventional "white" masculinity, Canetto asserts. "The dominant story was that their suicide was a rational, courageous, powerful choice."

New ways of understanding, preventing suicide

Canetto's research challenges the notion that high suicide rates are inevitable among white older men. As additional evidence that suicide in this population is culturally determined, and thus preventable, Canetto points out that older men are not the most suicide-prone group everywhere in the world. For example, in China, women of reproductive age are the demographic group with the highest suicide mortality.

Among the implications of Canetto's research is that attention to cultural scripts of suicide offers new ways of understanding and preventing suicide. As cultural stories, the "indignities of aging" suicide script as well as the belief that suicide is a white man's powerful response to aging can and should be challenged, and changed, she says.

A Rational Suicide?

Editor’s Note: We invite you to read the article, take the ethics quiz, and leave comments; you can also see how your colleagues answered as well as their comments. And, stay tuned, Dr Geppert will provide an ethical analysis of the Case in response to the quiz results and your comments in an upcoming issue of Psychiatric Times.

Mrs N is a 65-year-old retired intensive care nurse who underwent an esophagectomy for esophageal cancer 3 years ago. Since then she has remained cancer-free. Despite her good prognosis, Mrs N has had a poor quality of life ever since the surgery, largely due to intractable nausea and vomiting. She has seen a variety of specialists and tried multiple medications, without significant relief. Mrs N had retired about a year before her diagnosis and surgery and was looking forward to playing golf and visiting her friends around the country . . . things she never had time to do as a critical care nurse. The refractory GI symptoms have prevented her from traveling or even playing a round of golf because she never knows when the waves of nausea will come.

Were it not for these distressing symptoms, Mrs N would say she has a very good life. Although divorced for many years, she continues to have a close relationship with her ex-husband, who is her power of attorney (POA) for health care decisions. She is financially comfortable and has stayed in touch with many friends from her nursing career, but she is unable to be socially active because of her disabling and embarrassing fits of nausea and vomiting.

Over several months, Mrs N and her ex-husband discuss her desire to end her life that she had come to find unbearable. Neither is religious and both have always believed that a person has a right to determine the timing and manner of his or her own death. Mrs N has been stockpiling fentanyl from various sources and has calculated the amount she will need to kill herself. She arranges with her ex-husband that she will text him when she is ready to die and then after a specified amount of time, he will come over and find her dead and take care of her remains and affairs.

The attempt, however, does not go as planned; when her ex-husband comes to the house, she is still alive. Panicked, he calls 911, and an ambulance takes Mrs N to the emergency department (ED) of a large hospital. The ex-husband admits he knew of the suicide attempt and expresses his view that his ex-wife should be allowed to die; at one point he even asks the paramedics “why they cannot just finish this.” The patient is revived with several doses of narcan en route and is given fluids and oxygen before transfer to a medical unit.

When the paramedics provide the history to the ED charge nurse, she calls for an ethics consultation regarding whether the ex-husband should be reported to some authority. When the hospitalist admitting the patient asks about code status, the patient requests to be DNR. The hospitalist feels uncomfortable letting a patient who just attempted suicide and who endorses an intention to try again to be DNR. The hospitalist requests an ethics consultation.

The psychiatric consultant on duty is called into the ED and interviews the patient. The patient reports no psychiatric history or previous suicide attempts. She denies feeling depressed and says there are many things in life she enjoys. The consultant can identify no signs and symptoms consistent with a diagnosis of any primary psychiatric disorder, including major depression. Mrs N calmly and respectfully explains her views regarding suicide and her disagreement with the social prohibition against the practice. While the psychiatrist has never believed in the concept of a “rational suicide,” she is now finding that belief seriously challenged.

Concerned that she may be missing something in the presentation, the psychiatrist asks that a geropsychiatrist colleague also assess Mrs N in the hospital. The geropsychiatrist sees Mrs N the next day and finds her to be completely cognitively intact and of high intelligence, with good ego strength, coping skills, and self-esteem.

Both clinicians are impressed with Mrs N’s reasoning that she enjoys her life and would want to live if only her symptoms could be managed. She is willing to have a new group of specialists work up her case and is even willing to try new medications so long as they do not impair her psychomotor ability, on which her highly valued independence rests. However, she makes very clear to the psychiatrist that she will return home and this time succeed in killing herself if these medical interventions do not improve her symptoms to a degree she finds acceptable.


Have you seen anyone with a semicolon tattoo? (See a 1000 samples here.)


Here's what it's about. One small character, one big purpose.

Have you seen anyone with a tattoo of a semi-colon? If not, you may not be looking close enough. They're popping up...everywhere.

That's right: the semicolon. It's a tattoo that has gained popularity in recent years, but unlike other random or mystifying trends, this one has a serious meaning behind it.

This mark represents mental health struggles and the importance of suicide prevention.

Project Semicolon was born from a social media movement in 2013.

They describe themselves as a "movement dedicated to presenting hope and love to those who are struggling with depression, suicide, addiction, and self-injury. Project Semicolon exists to encourage, love, and inspire."

But why a semicolon?

"A semicolon is used when an author could've chosen to end their sentence, but chose not to. The author is you and the sentence is your life."

Originally created as a day where people were encouraged to draw a semicolon on their bodies and photograph it, it quickly grew into something greater and more permanent. Today, people all over the world are tattooing the mark as a reminder of their struggle, victory, and survival.

I spoke with Jenn Brown and Jeremy Jaramillo of The Semicolon Tattoo Project, an organization inspired by the semicolon movement. Along with some friends, Jenn and Jeremy saw an opportunity to both help the community and reduce the stigma around mental illness.

In 2012, over 43 million Americans dealt with a mental illness . Mental illness is not uncommon, yet there is a stigma around it that prevents a lot of people from talking about it — and that's a barrier to getting help.

More conversations that lead to less stigma? Yes please.

"[The tattoo] is a conversation starter," explains Jenn. "People ask what it is and we get to tell them the purpose."

"I think if you see someone's tattoo that you're interested in, that's fair game to start a conversation with someone you don't know," adds Jeremy. "It provides a great opportunity to talk. Tattoos are interesting — marks we put on our bodies that are important to us."

Last year, The Semicolon Tattoo Project held an event at several tattoo shops where people could get a semicolon tattoo for a flat rate. "That money was a fundraiser for our crisis center," said Jenn. In total, over 400 people received semicolon tattoos in one day. Even better, what began as a local event has spread far and wide, and people all over the world are getting semicolon tattoos.

And it's not just about the conversation — it's about providing tangible support and help too.

Jenn and Jeremy work with the Agora Crisis Center. Founded in 1970, it's one of the oldest crisis centers in the country. Through The Semicolon Tattoo Project, they've been able to connect even more people with the help they need during times of crisis. (If you need someone to talk to, scroll to the end of the article for the center's contact information.)

So next time you see this small punctuation tattoo, remember the words of Upworthy writer Parker Molloy:

"I recently decided to get a semicolon tattoo. Not because it's trendy (though, it certainly seems to be at the moment), but because it's a reminder of the things I've overcome in my life. I've dealt with anxiety, depression, and gender dysphoria for the better part of my life, and at times, that led me down a path that included self-harm and suicide attempts.

But here I am, years later, finally fitting the pieces of my life together in a way I never thought they could before. The semicolon (and the message that goes along with it) is a reminder that I've faced dark times, but I'm still here."

No matter how we get there, the end result is so important: help and support for more people to also be able to say "I'm still here."

Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline or text the Crisis Text Line "SOS" 741741

Scroll down to 6:20 video

I've seen it all over Facebook and now I’m asking myself, “Why is everyone getting a tattoo of a semicolon on their wrist?” I decided to find out….First of all, the semicolon represents where the sentence could’ve ended but didn’t. Just as how suicide could be prevented but wasn’t. Many teachers are getting this tattoo in support of the fight against suicide in students. Three teens self harm every hour, teachers see this in students everyday and are spreading awareness to put it to a stop.

Their mission statement on Facebook reads…”We are trying to raise awareness about self harming. We are a group of people who will listen to your stories and help you get through any tough time, answer and questions, and give as much advice as possible.Together we can get through anything.”

If you know of someone who can benefit from this Facebook page, maybe even yourself, here is the link:

Let’s stop the self harming, the suicides and the bullying.

Related stories: USA Today , Huffington Post, The Semicolon Tattoo Project Facebook

Need to talk?

Find a therapist that's a good fit for you with this health tool.

Data Debunk Myth of "Holiday Suicides"

Just over half of last year's newspaper stories that mentioned suicides and the holidays reported the persistent myth that suicides rise around Christmas. The Annenberg team checked Nexus for every U.S. newspaper story mentioning suicide and the holidays between Thanksgiving and the first week of the new year. Newspapers were doing better at debunking this myth from 2000 to 2006; fewer than 10% of stories confirmed this phony connection by the 2006 holiday season, according to the study. But in 2007, 51% of stories mentioning suicide and the holidays said there were higher deaths around Christmas.
Source: USA Today, 12/11/08

17 Vet Suicides a Day

Penny Coleman writes on AlterNet: "Earlier this year, using the clout that only major broadcast networks seem capable of mustering, CBS News contacted the governments of all 50 states requesting their official records of death by suicide going back 12 years. They heard back from 45 of the 50. From the mountains of gathered information, they sifted out the suicides of those Americans who had served in the armed forces. What they discovered is that in 2005 alone - and remember, this is just in 45 states - there were at least 6,256 veteran suicides, 120 every week for a year and an average of 17 every day." (Editor's note: The current number is 22 a day. (August, 2015)

Inpatient Care Best For Suicidal Addicts

Intensive therapy can fight substance abuse, depression, study found

Suicide Risk Persists Many Years After Attempted Suicide

The risk of suicide for people with a history of attempted suicide or deliberate self harm (parasuicide) persists without decline for two decades, finds a study in this week's BMJ. Providing a high standard of care to these patients could help to reduce this rate.
Source: British Medical Journal,

China Moves To Stop Suicides

One day next week, three nurses will sit down at telephones in Beijing and do something that would have been unheard of in China just a decade ago: They'll try to stop anyone who calls from committing suicide.

CDC Releases Study On Non-Traditional Risk Factors For Nearly Lethal Suicide Attempts

Employing an innovative approach to studying suicide attempters who either used a highly lethal method or would have died without medical help, researchers at the Centers for Disease Control and Prevention (CDC) have identified several non-traditional health risk factors that have rarely been included in suicide research. These non-traditional health associated risk factors include: acute alcohol use, changing residences, existing medical conditions, and characteristics of impulsive suicide behavior. The findings are published in a special supplement to the spring edition of Suicide and Life-Threatening Behavior (SLTB). SLTB is the official Journal of the American Association of Suicidology.

Teen who texted her boyfriend encouraging his suicide will go on trial

Michelle Carter, the then-17-year-old girl who sent her boyfriend Carter Roy dozens of text messages encouraging him to commit suicide, will face trial, the Associated Press reports. Carter was indicted by a grand jury for her role in Roy's death, but a lack of legal precedent left it unclear whether a trial would go forward. In a stern ruling, a Massachusetts Supreme Judicial Court ruled on Friday that Carter's texts amounted to a "systematic campaign of coercion" and constituted a "direct, causal link" to Roy's suicide.

Carter's lawyer had argued that her texts, which included messages like, "When are you gonna do it? Stop ignoring the question. ????" and "If you want it as bad as you say you do it's time to do it today," were protected under the First Amendment, and that Carter's own mental-health issues played a role. Furthermore, Massachusetts does not have a specific law prohibiting encouraging or verbally assisting in suicide.

But the judge ruled that "the coercive quality of the defendant's verbal conduct overwhelmed whatever willpower the 18-year-old victim had to cope with his depression, and that but for the defendant's admonishments, pressure, and instructions, the victim would not have gotten back into the truck and poisoned himself to death."

Involuntary manslaughter charges usually result from reckless, criminal negligence or misdemeanor charges such as hit-and-runs or driving under the influence. Prosecutors said they "appreciate" the court's decision and will focus on preparing for the trial, which has not yet been assigned a date.

Therapy Prevents Repeat Suicide Attempts

Short-term psychotherapy may be an effective way to prevent repeated suicide attempts.

Using detailed Danish government health records, researchers studied 5,678 people who had attempted suicide and then received a program of short-term psychotherapy based on needs, including crisis intervention, cognitive therapy, behavioral therapy, and psychodynamic and psychoanalytic treatment. They compared them with 17,034 people who had attempted suicide but received standard care, including admission to a hospital, referral for treatment or discharge with no referral. They were able to match the groups in more than 30 genetic, health, behavioral and socioeconomic characteristics. The study is online in Lancet Psychiatry.

Treatment focused on suicide prevention and comprised eight to 10 weeks of individual sessions.

Over a 20-year follow-up, 16.5 percent of the treated group attempted suicide again, compared with 19.1 percent of the untreated group. In the treated group, 1.6 percent died by suicide, compared with 2.2 percent of the untreated.

“Suicide is a rare event,” said the lead author, Annette Erlangsen, an associate professor at the Johns Hopkins Bloomberg School of Public Health, “and you need a huge sample to study it. We had that, and we were able to find a significant effect.”

The authors estimate that therapy prevented 145 suicide attempts and 30 deaths by suicide in the group studied.

What you can do to support Suicide Prevention Day - 9/10/17

World Suicide Prevention Day, September 10th, is an opportunity for all sectors of the community - the public, charitable organizations, communities, researchers, clinicians, practitioners, politicians and policy makers, volunteers, those bereaved by suicide, other interested groups and individuals - to join with the International Association for Suicide Prevention (IASP) to focus public attention on the unacceptable burden and costs of suicidal behaviours with diverse activities to promote understanding about suicide and highlight effective prevention activities. ention (IASP) to focus public attention on the unacceptable burden and costs of suicidal behaviours with diverse activities to promote understanding about suicide and highlight effective prevention activities.

Those activities may call attention to the global burden of suicidal behaviour, and discuss local, regional and national strategies for suicide prevention, highlighting cultural initiatives and emphasizing how specific prevention initiatives are shaped to address local cultural conditions.

Initiatives which actively educate and involve people are likely to be most effective in helping people learn new information about suicide and suicide prevention. Examples of activities which can support World Suicide Prevention Day include:

  • Launching new initiatives, policies and strategies on World Suicide Prevention Day, September 10th.
  • Learning about connecting, communicating, caring and suicide prevention and mental health from materials found in IASP’s Web resource directory
  • Using the WSPD Press Preparation Package that offers media guides in the planning of an event or activity.
  • Downloading the World Suicide Prevention Day Toolkit that contains links to World Suicide Prevention Day resources and related Web pages
  • Holding conferences, open days, educational seminars or public lectures and panels
  • Writing articles for national, regional and community newspapers, blogs and magazines
  • Holding press conferences
  • Placing information on your website and using the IASP World Suicide Prevention Day Web banner, promoting suicide prevention in one’s native tongue.
  • Securing interviews and speaking spots on radio and television
  • Organizing memorial services, events, candlelight ceremonies or walks to remember those who have died by suicide
  • Asking national politicians with responsibility for health, public health, mental health or suicide prevention to make relevant announcements, release policies or make supportive statements or press releases on WSPD
  • Holding depression awareness events in public places and offering screening for depression
  • Organizing cultural or spiritual events, fairs or exhibitions
  •  Organizing walks to political or public places to highlight suicide prevention
  • Holding book launches, or launches for new booklets, guides or pamphlets
  • Distributing leaflets, posters and other written information
  • Organizing concerts, BBQs, breakfasts, luncheons, contests, fairs in public places
  • Writing editorials for scientific, medical, education, nursing, law and other relevant journals
  • Disseminating research findings
  • Producing press releases for new research papers
  • Holding training courses in suicide and depression awareness
  • Joining us on the official World Suicide Prevention Day Facebook Event Page
  • Supporting suicide prevention 365 days a year by becoming a Facebook Fan of the IASP
  • Following the IASP on Twitter (, tweeting #WSPD or #suicide or #suicideprevention
  • Creating a video about suicide prevention. See the IASP WSPD Playlist at:
  • Lighting a candle a candle, near a window at 8 PM in support of: World Suicide Prevention Day, suicide prevention and awareness, survivors of suicide and for the memory of loved lost ones. Find “Light a Candle Near a Window at 8 PM” postcards in various languages at:
  • Participating in the World Suicide Prevention Day - Cycle Around the Globe


 Social Media, Suicidal Thoughts and an Identity Crisis Among Young Adults - 9/29/23

Social media is a double-edged sword that can spark both self-expression and potentially harmful self-doubt during a critical time of transition.

“As I get older, I sometimes find it hard to know what my purpose in life is.”

The above statement rings true for 63% of 18- to 34-year-old respondents to a CVS Health and Harris Poll survey released during Suicide Prevention Month this September. It’s a heartbreaking window into the mental health of today’s young adults, considering more than a third of this age group also said they had moments in the past year when they contemplated suicide.

As parents ourselves, we are extremely concerned about this crisis and its potential causes, such as social media and the identity crisis it can foster within young adults. As this generation moves from their teenage years to adulthood, it can become harder to find a sense of purpose or identity when values, life milestones and even appearances are compared to those of others their age within the digital world.

Parents have experienced this transitional period themselves, but understanding social media's new role in mental health is crucial as we seek to protect our kids and others we love.

Struggling With Life Online

The journey into and through young adulthood is a pivotal and complex period of identity formation. Although this can be a positive time of self-discovery, it often can be marked by uncertainty or self-doubt as well, compounding with academic, financial and relationship stressors to create feelings of desperation and hopelessness. And when this generation watches their peers have an “easier” time online, with celebratory photos of life events and nights out, it can feel as if they are not transitioning into adulthood the “right way.”

This exemplifies how using social media is a double-edged sword, as it provides a platform for self-expression while simultaneously fueling unrealistic standards and a constant desire for validation. Incessant comparisons to peers, celebrities and influencers can intensify a young person’s internal struggle to align their personal identity with societal standards and ideals.

The real world, however, exists outside of any social media platform, which is an important sentiment to remember. Talking to friends in person about their lives will always provide a more satisfying view into their world than their latest Instagram post or TikTok video, because what they’re depicting may not be an honest representation of their reality.

Setting boundaries on social media for teens – and for yourself – can help foster more of this valuable in-person contact and form deeper, more meaningful relationships that can set a foundation for a healthier identity. But while completely unplugging is likely the best course of action to counter the negative effects of social media, it might feel like things can never truly be turned off in today’s digital world. If that’s the case, try to limit the time your family spends on social media. Use phone settings to help create and manage those boundaries, and reach out to family or friends to suggest a group activity that can take the place of swiping, clicking or doomscrolling.

Cyberbullying is another common issue tied to social media, and we’ve seen its effects as parents of young adults. To help stop the cycle, be the change you wish to see, and consider whether the comment or post you’re contemplating would be reflective of your in-person behavior. Encourage your teens to do the same.

If you are worried that social media is affecting your child’s mental health, be on the lookout for signs that can include withdrawal from family and friends, a lack of interest in the future, decreased interest in hobbies, and major changes in behavior, sleep or appetite.

Knowing the signs of suicidal ideation also can be critical. Noticeable indicators that someone might be considering suicide include talking about death or feelings of emptiness, increased alcohol or drug use, and saying goodbye to loved ones. While it might feel intrusive or uncomfortable, acting on your concerns is an act of courage, and can be lifesaving. If your child or someone you know is at risk, follow these five steps as outlined by the 988 Suicide & Crisis Lifeline until you locate additional support systems:

Ask: Do not be afraid to be blunt and ask your loved one if they are considering suicide, as this can open an honest dialogue. Make sure when you ask that you are able to actively listen, and do not promise to keep suicidal thoughts a secret.

Be There: Be present, whether that means being with a person physically, talking with them on the phone or any other way you can show you are available. By doing this, you reestablish a sense of connectedness for someone struggling.

Help Keep Them Safe: Establish if there are any methods or actions that the individual has considered or already taken. Knowing the plans for a suicide attempt is the most effective way to stop one, and if you are not physically present, connect with someone who can remove access to any potential lethal means. Be sure to remove any firearms from the home or, at minimum, ensure they are properly locked away.

Help Them Connect: Establish a safety net by providing resources and support systems to someone you’ve identified as being in crisis. This can involve community resources like a mental health counselor or help available through the 988 lifeline.

Follow Up: Set up another time to talk in person or via phone call to see how your loved one is doing and if they’ve received support. This is a good opportunity to discuss ways to seek help in case of another crisis, confirm that you are a trusted source for this person and further their sense of connectedness.

It’s not only our children who may be affected by social media and have thoughts of suicide, and it’s important to be familiar with ways to help before we need them for our loved ones or ourselves. Additional resources include depression screenings that can be accessed at more than 1,000 MinuteClinic locations across the U.S. – with some offering virtual services – as well as tools and supports available through The JED Foundation and the American Foundation for Suicide Prevention.

Suicide Can Be Preventable

Society as a whole is growing increasingly aware of mental health struggles and working to mitigate them. In 2022, 94% of people surveyed believed that at least some instances of suicide can be prevented. But just like physical health, mental health requires preventive care that people should seek before they ever get close to a moment of crisis.

You don’t have to be a medical professional to listen and offer support. Check in on your loved ones regularly to see how they are feeling and show them that they are not alone. Reach out to family members, friends, community leaders or doctors if you feel hopeless or know someone exhibiting signs of suicide. Use social media responsibly, and encourage others to do the same.

Together, we can shift the stigma that social media can bring and change conversations on suicide from taboo to honest discussions. By getting real, we can help others heal – and even save lives.

The role of shame in suicide - APA PsycInfo


Discusses the role of shame as a motive for suicidal behavior and uses examples from various areas including Greek tragedy, Asian cultures, and jails, and among contemporary suicides as illustrations. The relationship between suicide and psychiatric disturbance is discussed. The differences between shame and guilt are explored, with a focus on experiential and developmental factors and on behavioral reactions to these emotions.

The Shame of Suicide 9/23/19

One thing I have learned from years as a social worker is that suicide is shameful. People surrounded by those who have died by suicide, almost died by suicide, or contemplated suicide feel a sense of shame. This shame stems from misnomers and stigma. Society also perpetuates the belief that suicide is a choice, rather than a symptom of a mental health disorder.

In fact, suicide is an impulse. Making an individual’s ability to delay, distract, and deescalate critical to saving a life. Why? Impulses go away, fade, and change. When the person experiences this impulse, it is the only thing they are thinking about. They are not thinking about their loved ones, consequences, other choices, or the pain.

Fighting the shame of suicide also starts with understanding what happens to an individual before their death. Knowing someone’s history doesn’t just provide critical risk factors, it allows us to grow, show empathy, and encourage those still alive with similar histories to seek help. Below is a list of life events that can increase a person’s risk of suicide. Some are everyday events, which can lead to thoughts of death, while others are traumatic events that impact a person’s mental health long-term. With both these types of events, it’s important to remember, the person who dies by suicide may not have experienced this event but could have witnessed this event and still suffered the same impact.

Everyday events
Less common events


Loss of a job

Being arrested

Using alcohol or drugs

Changing schools

Feeling unsupported


Seeing violence

Seeing someone die by suicide

Being abused

Not being cared for as a chid

Having health issues that don’t get better

Mass shootings

Community Violence

Intimate Partner Violence

Kahn, 2019; Stone, Bou-Saada, & Ceurvo, 2018

Let us step into their shoes for a quick minute — imagine yourself as you are today. You are blank years-old, reading this blog post, then you get a text message. Déjà vu happens. Suddenly, you become a five year-old little being abused by his or her uncle or a five year-old, terrified child watching their mother get hit, or a five year-old feeling alone after your friend dies. Your younger self then thinks, life is hopeless, hurtful, and will never get better. It is not the you of today that acts on the impulse to harm yourself, but the younger you that was hurt.

A more common scenario might be — you are in a car accident and hit a deer. You are terrified and keep thinking, “I could have almost died.” Every time you get in the car, you think about that deer. You feel scared again. It gets better, time goes by and you think about it less. Then, a year later, you drive by that spot for the first time. A wave of panic hits you and you cannot breathe. You are sweating, shaking, and you cannot stop thinking about that deer. This is how our bodies react to trauma.

Some of us experience this and start to think about suicide. Maybe our brains tell us “you should have died that day,” “why did I survive,” “it is all my fault and I should be dead.” Take a second to focus on how you feel just reading these words. This feeling is a thousand times stronger when they are being said in your own head. This is what the impulse of suicide feels like.

Therefore, it is important to remember our histories are not like the histories in textbooks. We do not always experience them and move on, but rather we move on, always carrying those histories with us.

If you filled a book bag with books, each book representing an experience listed above that has happened to you (a breakup, being arrested, seeing violence), how heavy would your book bag be? Would you struggle to stand up? Would you fall backwards? Would your shoulders hurt? Or would it be light and easy to carry? Every person has their own book bag to carry and only you know how heavy it is.

We must support each other as we carry our own book bags. We must show each other healthy positivity to get through the tough moments. You do not need to sacrifice yourself or be everybody’s best friend — but random acts of kindness, politeness, friendship, and empathy can save someone’s life.

What is one small act of healthy positivity you can do today?

  • Text your friend that you love them and are glad they are in your life.
  • Hug your parents or your siblings.
  • Reach out for help.
  • Thank the restaurant employee who serves you.
  • Surprise the office with donuts.
  • Leave a random note of kindness for a stranger.
  • Donate your time or money to a non-profit.


Kahn, A. (2019, May 1). What You Should Know About Suicide. Retrieved from

Stone, D. M., Bou-Saada, I., & Cuervo, E. (2018, March 15). Suicide & Adverse Childhood Experiences (ACEs): Preventing Suicide through Collaborative Upstream Interventions. Retrieved from

Self-Compassion and Suicide Risk in Veterans: Serial Effects of Shame, Guilt, and PTSD


Suicide is a significant public health concern and ranks as the 10th leading cause of death in the U.S. Veterans are at a disproportionately higher risk for suicide, due to risk factors such as exposure to trauma and its negative cognitive-emotional sequalae, such as PTSD, shame, and guilt. However, not all veterans exposed to traumatic events, or who experience shame and guilt, die by suicide, perhaps as a result of the presence of individual-level protective factors such as self-compassion. Conceptualized as self-kindness, mindfulness and common humanity, self-compassion is beneficially associated with mental and physical health, including reduced suicide risk. We examined the potential serial mediating effects of shame/guilt, separated into two models, and PTSD in the relation between self-compassion and suicide risk in a sample of U.S. veterans (N = 317). Participants in our IRB-approved study provided informed consent and completed the Self-Compassion Scale - Short Form, Differential Emotions Scale-IV, PTSD Checklist-Military Version (PCL-M) for DSM-IV, and Suicidal Behaviors Questionnaire - Revised (SBQ-R). Supporting hypotheses, shame/guilt and PTSD, and PTSD alone, mediated the relation between self-compassion and suicide risk, but shame/guilt alone did not. Our results remained significant when covarying depressive symptoms. Therapeutic interventions such as Mindful Self-Compassion and Compassion-Focused Therapy may increase self-compassion and ameliorate negative cognitive-emotional sequelae, including suicide risk, in veterans.

Shame, guilt, and suicidal thoughts: The interaction matters


Objectives: This study examined associations between generalized shame and guilt, and suicidal ideation.

Methods: Individuals attending outpatient mental health services (N = 100) completed study measures at a single time point. Correlation and regression analyses examined associations between recent suicidal ideation and generalized shame and guilt, both concurrently and interacting, controlling for depressive symptoms and history of previous suicide attempt.

Results: When examined concurrently, guilt - but not shame - remained significantly associated with suicidal ideation, after accounting for effects of depressive symptoms and past suicide attempt. A significant shame × guilt interaction revealed the association between guilt and suicidal ideation intensified with higher shame.

Conclusions: Findings emphasize consideration of generalized shame and guilt - and their interaction - when working with patients exhibiting suicidal thoughts.

Practitioner points: Shame and guilt are self-conscious emotions that, when generalized and excessive, may confer risk for suicidal ideation Generalized guilt may be uniquely linked with suicidal ideation, yet this association may also amplified by shame Both shame and guilt - and their interaction - are important to consider when working with patients exhibiting suicidal thoughts.

Why do people die by suicide? Mental illness isn’t the only cause – social factors like loneliness, financial ruin and shame can be triggers - 5/28/20

The U.S. suicide rate has been increasing for decades. In 1999, the rate was about 10 suicides per 100,000 people. In 2017, the most recent year for which complete statistics are available, it was just over 14 per 100,000 – a rise of 40% in only 18 years.

And the problem is not evenly distributed across the country. The increase has been especially severe in rural areas, some of which have seen their suicide rates jump by over 30% in just the past decade.

That rates can change from one decade to another, and vary so much across regions, suggests that suicide is shaped by social conditions.

Perhaps the most obvious of these is access to mental health services – psychiatrists, therapists and prescription antidepressants. Indeed, the most conventional way of talking about suicide in the modern world is in terms of mental health.

This view is not incorrect: Clinical depression increases the risk of suicide, and so therapies that treat depression can help prevent it. But as a sociologist who studies suicide, I think the medical model of suicide is incomplete. My research shows there are additional causes.

Suicide in response to an event

Not all who kill themselves do so after a long struggle with depression – from Cato to Hitler, many famous figures of history have taken their own lives after sudden reversals, such as military defeats.

Those who already suffer depression can be pushed over the edge by “the slings and arrows of outrageous fortune.” It is likely no coincidence that poet Sylvia Plath, with her long history of depression, killed herself shortly after being abandoned by her husband. The human mind does not exist in a vacuum.

Thanks to the current pandemic, the National Suicide Prevention Hotline is reporting a nine-fold increase in calls compared to this time last year.

Financial causes

Loss of material wealth – reduced income, mounting debts and other financial disasters – can certainly provoke suicide. Numerous studies document that the unemployed have higher suicide rates than the employed. Others show that rates rise during economic downturns.

Suicide rates spiked during the Great Depression of the 1930s and were more prevalent in areas where banks folded, taking their customers’ savings with them.

Suicide rates – in the U.S. and many other countries – also rose during the Great Recession of 2008. Some argue, in many parts of the U.S., the recession never ended, which may help explain the rise in rural suicide.

South Dakota farmer Chris Dykshorn texted, “I seriously don’t know how we r gonna make it. I am failing and feel like I’m gonna lose everything I’ve worked for,” before killing himself in 2019. His case is hardly unique.

Along with high rates of suicide go high rates of drug overdose. It’s sometimes hard to distinguish an intentional overdose from an accidental one, and some researchers lump them together as “deaths of despair.”


Reputation and good name are extremely important to most people, so all manner of shame and humiliation can cause suicide. For instance, in South Korea, a former president killed himself after a corruption investigation in 2009. In 2017, a Kentucky state legislator killed himself after allegations of sexual misconduct.

Gossip and scandal are powerful sanctions in small towns and villages. The growth of social media has made people vulnerable to public shaming on a mass scale. Not surprisingly, social media shaming also provokes suicide.

Broken relationships

In addition to the loss of stature, people also might kill themselves over the loss of social ties. Sociologists have known for over a century that people with more and stronger social connections have lower rates of suicide. Marriage, parenthood and other sources of social integration provide a protective effect.

Suicide victims are more likely than others to live alone, tend to have fewer friends and are less involved in organizations. America’s long-term decline in civic and religious organizations – or even voluntary groups such as bowling leagues – likely exacerbates other issues that might encourage suicide.

If lacking social ties is bad, the sudden shock of losing them is worse. Breakups and divorces are a common reason for suicide: One study of over 400,000 Americans found that being divorced more than doubled the risk of suicide. The same is true in other countries, and the risk is greatest immediately after the loss.


People also kill themselves in reaction to social conflict. Depending on the nature of the conflict, suicide might be a kind of protest, punishment or escape.

Hundreds of Tibetans, for instance, have burned themselves in protest of Chinese rule.

In places such as rural Iran and Afghanistan, large numbers of women burn themselves to protest and escape from domestic abuse.

In modern America, people sometimes kill themselves to inflict guilt on someone who has hurt them. In other cases, suicide can be a response to bullying and abuse by one or more people.

Rethinking suicide prevention

These realities suggest that suicide prevention involves much more than increasing the availability of therapists and prescriptions. It requires providing economic development and financial assistance to those in distress. People can help by strengthening communities and building social ties. Additionally, they can provide moral support, alternative means of conflict resolution and escape routes from abusive relationships.

To combat suicide, it’s important to account for all its causes.

No Shame - Sharing Hearts and Minds to Prevent Suicide - 5/26/23

The Alabama Department of Mental Health introduces the “No Shame” Suicide Prevention campaign, addressing the stigma surrounding suicide and mental illness. The campaign speaks not about judgment but rather of hope. The campaign also features the National Suicide and Crisis Lifeline number, 988. If you or someone else is in crisis, you can immediately call, chat or text a mental health professional by contacting 988. Since July 16, 2022, more than 37,700 Alabamians have contacted 988.

In 2021, 821 individuals died by suicide in Alabama, according to the Alabama Department of Public Health. More than 15 percent were children or adolescents between the ages 10-19. An individual may experience suicidal thoughts or feelings due to many factors. These may cause someone to feel hopeless and/or believe that it is impossible to change the situation. Sharing our feelings can be hard. Friends, family, and mental health professionals are here to help, and you can share, without fear. Speaking freely with others, including peers and counselors can help. They can offer important resources. There is a strong support system of people ready to listen and help.

Click here to watch a video from the No Shame Campaign. Learn the warning signs of someone in a mental health crisis, and how to reach out for help, for yourself or a loved one.

There is no shame in sharing. If you are in crisis, call or text 988. Or the Crisis Text Line at 741741