We can help prevent suicides. We can prevent suicides by promoting national suicide prevention initiatives and community awareness programs, improving access to mental health resources, and training more mental health professionals.
Survivors of a suicide attempt are an asset in promoting suicide prevention, awareness of the risk factors, and warning signs. Their insights are crucial in our prevention efforts because they can help us recognize signs we may overlook. Survivors of suicide attempts help us to understand suicidal behaviors outside of clinical settings better.
We sometimes struggle with internal conflicts and societal pressures. We work to balance and maintain some semblance of stability in our lives. Some of us become so overwhelmed and do not cope well. Some of us may have suicidal ideation or attempt suicide to solve our struggles in these difficult moments. The World Health Organization (WHO) reports that more people die from suicide annually than HIV, malaria, breast cancer, war, or homicide globally.
WHO identifies suicide as a public health concern globally. The suicide mortality numbers from WHO are from countries that record and report suicide data. However, some countries do not monitor suicide through their public health surveillance systems. Consequently, it isn't easy to get an accurate reading on suicidality.
According to a WHO June 2021 fact sheet, over 700,000 people commit suicide, and in 2019, suicide was the fourth leading cause of death for 15 – 29-year-olds worldwide.
The same publication includes data showing in 2019, worldwide, 77% of reported suicides occurred in low-and middle-income countries.
According to the Commonwealth Fund, among wealthy countries, the United States has the highest rates of suicide per 100,000 individuals in their populations. In addition, in high-income countries, about three times as many men as women commit suicide. For instance, the United States recorded an increase in suicide mortality between 1999 – 2018; men's suicide rates were 3.5 to 4.5 times the rate for females. Over 300,000 people in the United States show up to hospital emergency departments with self-harm injuries.
The methods used to commit suicide in low-and middle-income countries are ingestion of pesticides, hanging (suffocation), and firearms. An estimated 20% of global suicides in low-and middle-income countries are a result of drinking pesticides. The drinking of pesticides is most common in rural agricultural communities.
In 2019, WHO published Suicide in the world: Global Health Estimates. The regions represented in the data are African, the Americas, Eastern Mediterranean, Europe, South-East Asia, and the Western-Pacific. In all the regions, the highest number of suicides by gender were males except for China and Pakistan who recorded higher female suicides than male suicides. India and China recorded the highest number of total suicides, respectively. India recorded 215,872 and China 136,267. Every country in each region recorded at least one suicide.
What are some risk factors for suicide?
Previous suicide attempt(s)
Feelings of Hopelessness
Chronic illness
History of trauma and abuse
Family history of suicide
Mental conditions such as depression
Alcohol and substance abuse-related disorders
A propensity for impulsive behaviors
The inability to cope effectively with stresses
Relationship problems (break-up, intimate partner violence, bullying)
Lack of access to appropriate mental health care
The stigma associated with asking for or seeking help
A cluster of suicide in a community
Some warning signs of suicide
Talking about or feeling like a burden to others (pay close attention to elderly and chronically ill)
Statements of hopelessness and not having a reason to live
Preoccupation with death as a solution to problems
Experiencing extreme mood swings
Giving away valuable possessions, getting one's affairs in order
Researching ways to die
Stockpiling pills or acquiring weapons
Social isolation or withdrawal from social supports
Randomly visiting or calling loved one's to say goodbye
Suicide Prevention
Suicide is preventable with timely and appropriate interventions. There are mental health professionals trained in evidence-based interventions to assist a person who is suicidal. The evidence-based practices include Cognitive Behavior Therapy, Dialectical Behavior Therapy, Acceptance and Commitment Therapy, and Mindfulness-Based Stress Reduction. The evidenced-based practices are effective interventions to reduce symptoms of depression, improve awareness of suicide warning signs, and risk factors for suicide.
Should you recognize someone is suicidal, it is ok to ask,
Are you thinking of hurting yourself? If the answer is "yes," ask follow-up questions such as:
Do you have a plan?
Do you know how you would do it?
Do you know when?
Do you have access to what you would need to hurt yourself?
Should a suicidal person confide in you, they have a suicide plan; keeping the secret is unhelpful. Once you learn of the planned suicide, do not worry about violating the person's trust. Use your knowledge of the planned suicide to get them help or get others to assist with getting the person the needed care/intervention.
If the person is in imminent danger, do not attempt to deal with the situation on your own always get additional support.
If the person says, "I'm suicidal," do not call the person's bluff.
It may seem reasonable to inform a suicidal person, you have a lot to live for, but it may have the opposite effect and result in the person feeling guilty. Instead, inform the person, you will support them in getting help.
It is not a good idea to have the suicidal person seek help on their own. If possible, accompany the person to get help or recruit someone else to help.
The Substance Abuse and Mental Health Services Administration (SAMHSA) operationally defines the following terms:
Suicide "is death caused by an intentional self-directed injurious act, carried out with the intent of causing one's own death."
A suicide attempt "is a non-fatal, self-directed, and potentially injurious behavior with intent to die."
Suicidal Ideations "refers to thinking about or planning suicide. The thoughts lie on a continuum of severity from a wish to die with no method, plan, intent, or behavior, to active suicidal ideation with intent and a specific plan."
Self-harm, "also known as self-directed violence, is behavior that is deliberately self-directed and results in injury or the potential for injury. The term encompasses both suicidal and non-suicidal self-injury and self-harm with unclear intent."
It is crucial to recognize the risk factors and warning signs for suicide. In addition, asking someone about their suicidal thoughts or plan of hurting themselves does not put the idea of self-harm in their minds. They are already thinking about suicide. Notice the operational definitions from SAMHSA include the word "intent," so the person is already actively thinking about suicide. A person who attempts suicide is not weak but someone who needs support.
Stay Naturally Curious
Reference
Hedegaard H, Curtin SC, Warner M. Increase in suicide mortality in the United States, 1999–2018. NCHS Data Brief, no 362. Hyattsville, MD: National Center for Health Statistics. 2020.
Save Suicide Awareness Voices of Education, (2001). Depression awareness and suicide prevention: Information everyone can use.
Substance Abuse and Mental Health Services Administration (SAMHSA): Prevention and Treatment of Anxiety, Depression, and Suicidal Thoughts and Behaviors Among College Students. SAMHSA Publication No. PEP21-06-05-002. Rockville, MD: National Mental Health and Substance Use Policy Laboratory. Substance Abuse and Mental Health Services Administration, 2021.
Suicide in the world: Global Health Estimates: World Health Organization; (2019). License: CC BY-NC-SA 3.0 IGO.