Suicide prevention


Suicide prevention is a collection of efforts to reduce the risk of suicide. Suicide is often preventable, and the efforts to prevent it may occur at the individual, relationship, community, and society level. Suicide is a serious public health problem that can have long-lasting effects on individuals, families, and communities. Preventing suicide requires strategies at all levels of society. This includes prevention and protective strategies for individuals, families, and communities. Suicide can be prevented by learning the warning signs, promoting prevention and resilience, and committing to social change.
Beyond direct interventions to stop an impending suicide, methods may include:
General efforts include measures within the realms of medicine, mental health, and public health. Because protective factors such as social support and social engagement — as well as environmental risk factors such as access to lethal means — play a role in suicide, suicide is not solely a medical or mental health issue. Suicide is known as the 10th leading cause of death in the United States. However, those who research suicide risks are saying those situations are starting to change. Cheryl King, a psychologist at University of Michigan, her research focuses on improving suicide risk assessments and evaluations in the youth. There is CLSP, which is Coping Long Term with Active Suicide Program. This is delivered over the telephone. Due to this, 30% of the patients had fewer attempts compared to those who did not have the CLSP. Suicide prevention involves using a range of strategies designed to reduce the risk of suicide and support individuals in crisis. According to the National Institute of Mental Health, key approaches include increasing access to mental health care, creating supportive environments, and raising awareness about warning signs such as withdrawal, mood changes, and talking about death or feeling hopeless. Community-based programs, crisis hotlines like the 988 Suicide & Crisis Lifeline, and school-based interventions have been shown to make a difference. Research also suggests that reducing access to lethal means can significantly lower suicide rates.

Detection and assessment of a risk of suicide

Warning signs

Warning signs of suicide can allow individuals to direct people who may be considering suicide to get help.
Behaviors that may be warning signs include:
  1. Talking about wanting to die or wanting to kill themselves
  2. Suicidal ideation: thinking, talking, or writing about suicide, planning for suicide
  3. Substance abuse
  4. Feelings of purposelessness
  5. Anxiety, agitation, being unable to sleep, or sleeping all the time
  6. Feelings of being trapped
  7. Feelings of hopelessness
  8. Social withdrawal
  9. Displaying extreme mood swings, suddenly changing from sad to very calm or happy
  10. Recklessness or impulsiveness, taking risks that could lead to death, such as driving extremely fast
  11. Mood changes, including depression
  12. Feelings of uselessness
  13. Settling outstanding affairs, giving away prized or valuable possessions, or making amends when they are otherwise not expected to die
  14. Strong feelings of pain, either emotional or physical
  15. Considering oneself burdensome
  16. Increased use of drugs, including alcohol

    Direct talk for assessment

An effective way to assess suicidal thoughts is to talk with the person directly, to ask about depression, and assess suicide plans as to how and when it might be attempted. Contrary to popular misconceptions, talking with people about suicide does not plant the idea in their heads. However, such discussions and questions should be asked with care, concern and compassion. The tactic is to reduce sadness and provide assurance that other people care. The WHO advises to not say everything will be all right nor make the problem seem trivial, nor give false assurances about serious issues. The discussions should be gradual and specifically executed when the person is comfortable about discussing their feelings. ICARE is a model of approach used here.

Risk factors

All people can be at risk of suicide. Risk factors that contribute to someone feeling suicidal or making a suicide attempt may include:
  • Depression, other mental disorders, or substance abuse disorder
  • Certain medical conditions
  • Chronic pain
  • A prior suicide attempt
  • Childhood trauma
  • Betrayal and abandonment
  • Financial troubles or poverty
  • Family history of a mental disorder or substance abuse
  • Family history of suicide
  • Family violence, including physical or sexual abuse
  • Psychiatric Abuse
  • Benzodiazepines
  • Having guns or other firearms in the home
  • Having recently been released from prison, jail or mental asylum
  • Self-harm
  • Being exposed to others' suicidal behavior, such as that of family members, peers, or celebrities
  • Food insecurity
  • There may be an association between long-term PM2.5 exposure and depression, and a possible association between short-term PM10 exposure and suicide.

    Strategies for detection and assessment

The traditional approach has been to identify the risk factors that increase suicide or self-harm, though meta-analysis studies suggest that suicide risk assessment might not be useful and recommend immediate hospitalization of the person with suicidal feelings as the healthy choice. In 2001, the U.S. Department of Health and Human Services, published the National Strategy for Suicide Prevention, establishing a framework for suicide prevention in the U.S. The document, and its 2012 revision, calls for a public health approach to suicide prevention, focusing on identifying patterns of suicide and suicidal ideation throughout a group or population. The ability to recognize warning signs of suicide allows individuals who may be concerned about someone they know to direct them to help.
Suicide gesture and suicidal desire are potentially self-injurious behaviors that a person may use to attain some other ends, like to seek help, punish others, or to receive attention. This behavior has the potential to aid an individual's capability for suicide and can be considered as a suicide warning, when the person shows intent through verbal and behavioral signs.

Screening

The U.S. Surgeon General has suggested that screening to detect those at risk of suicide may be one of the most effective means of preventing suicide in children and adolescents. There are various screening tools in the form of self-report questionnaires to help identify those at risk such as the Beck Hopelessness Scale and Is Path Warm?. A number of these self-report questionnaires have been tested and found to be effective for use among adolescents and young adults. There is however a high rate of false-positive identification and those deemed to be at risk should ideally have a follow-up clinical interview. The predictive quality of these screening questionnaires has not been conclusively validated so it is not possible to determine if those identified at risk of suicide will actually die by suicide. Asking about or screening for suicide does not create or increase the risk.
In approximately 75 percent of suicides, the individuals had seen a physician within the year before their death, including 45 to 66 percent within the prior month. Approximately 33 to 41 percent of those who died by suicide had contact with mental health services in the prior year, including 20 percent within the prior month. These studies suggest an increased need for effective screening. Many suicide risk assessment measures are not sufficiently validated, and do not include all three core suicidality attributes. A study published by the University of New South Wales has concluded that asking about suicidal thoughts cannot be used as a reliable predictor of suicide risk.

Underlying condition

The conservative estimate is that 10% of individuals with psychiatric disorders may have an undiagnosed medical condition causing their symptoms, with some estimates stating that upwards of 50% may have an undiagnosed medical condition which, if not causing, is exacerbating their psychiatric symptoms. Illegal drugs and prescribed medications may also produce psychiatric symptoms. Effective diagnosis and, if necessary, medical testing, which may include neuroimaging to diagnose and treat any such medical conditions or medication side effects, may reduce the risk of suicidal ideation as a result of psychiatric symptoms. Most often including depression, which are present in up to 90–95% of cases. The classification of a case as psychiatric frequently implies more rigid treatments.

Methods of intervention

Restriction of lethal means

Restriction of dangerous means ⁠— ⁠reducing the odds that a person attempting suicide will use highly lethal means ⁠— ⁠is an important component of suicide prevention. This practice is also called "means restriction". It has been demonstrated that restricting lethal means can help reduce suicide rates, as delaying action until the desire to die has passed. In general, strong evidence supports the effectiveness of means restriction in preventing suicides. There is also strong evidence that restricted access at so-called suicide hotspots, such as bridges and cliffs, reduces suicides, whereas other interventions such as placing signs or increasing surveillance at these sites appears less effective.
One of the most famous historical examples of means reduction is that of coal gas in the United Kingdom. Until the 1950s, the most common means of suicide in the UK was poisoning by gas inhalation. In 1958, natural gas was introduced, and over the next decade, comprised over 50% of gas used. As carbon monoxide in gas decreased, suicides also decreased. The decrease was driven entirely by dramatic decreases in the number of suicides by carbon monoxide poisoning. A 2020 Cochrane review on means restrictions for jumping found tentative evidence of reductions in frequency.
In the United States, firearm access is associated with increased suicide completion. About 85% of suicide attempts with a gun result in death, while most other widely used suicide attempt methods result in death less than 5% of the time. Matthew Miller, M.D., Sc.D. conducted research comparing the number of suicides in states with the highest rates of gun ownership, to the number of suicides in states with the lowest rates of gun ownership. He found that men were 3.7 times more likely to die by firearm suicide and women were 7.9 times more likely to die by firearm suicide living in states with high rates of gun ownership. There was no difference in non-firearm suicides. Although restrictions on access to firearms have reduced firearm suicide rates in other countries, such restrictions are difficult in the United States because the Second Amendment to the United States Constitution limits restrictions on weapons.
For those who decide to end their lives impulsively, a 24-hour waiting period for firearm access could substantially reduce suicide success rates. Contrary to the popular notion that suicidal people will simply find another way to kill themselves, many people who survive suicide attempts go on to lead long lives. "In 2023, more than 42,967 people died from gun related injuries. Over half of those deaths were suicides" in the United States.