- Suicide Prevention -

Suicide is a major public health concern. In 2021, suicide was the 11th leading cause of death overall in the United States, claiming the lives of over 48,100 people. Suicide is complicated and tragic, but it is often preventable. Knowing the warning signs for suicide and how to get help can help save lives.

Warning Signs of Suicide

Warning signs that someone may be at immediate risk for attempting suicide include:

Talking about wanting to die or wanting to kill themselves
Talking about feeling empty or hopeless or having no reason to live
Talking about feeling trapped or feeling that there are no solutions
Feeling unbearable emotional or physical pain
Talking about being a burden to others
Withdrawing from family and friends
Giving away important possessions
Saying goodbye to friends and family
Putting affairs in order, such as making a will
Taking great risks that could lead to death, such as driving extremely fast
Talking or thinking about death often

Other serious warning signs that someone may be at risk for attempting suicide include:

Displaying extreme mood swings, suddenly changing from very sad to very calm or happy
Making a plan or looking for ways to kill themselves, such as searching for lethal methods online, stockpiling pills, or buying a gun
Talking about feeling great guilt or shame
Using alcohol or drugs more often
Acting anxious or agitated
Changing eating or sleeping habits
Showing rage or talking about seeking revenge

Suicide is not a normal response to stress. Suicidal thoughts or actions are a sign of extreme distress and should not be ignored. If these warning signs apply to you or someone you know, get help as soon as possible, particularly if the behavior is new or has increased recently.

Learn about actions you can take to help someone having thoughts of suicide.

Risk Factors

People of all genders, ages, and ethnicities can be at risk. Suicidal behavior is complex, and there is no single cause. The main risk factors for suicide are:

Depression, other mental disorders, or substance use disorder
Chronic pain
Personal history of suicide attempts
Family history of a mental disorder or substance use
Family history of suicide
Exposure to family violence, including physical or sexual abuse
Presence of guns or other firearms in the home
Having recently been released from prison or jail

Direct or indirect exposure to others' suicidal behavior—such as that of family members, peers, or celebrities—can increase risk for people with suicidal thoughts.

Most people who have risk factors will not attempt suicide, and it is difficult to tell who will act on suicidal thoughts. Although risk factors for suicide are important to keep in mind, someone who is actively showing warning signs of suicide may be at higher risk for danger and in need immediate attention.

Stressful life events (such as the loss of a loved one, legal troubles, or financial difficulties) and interpersonal stressors (such as shame, harassment, bullying, discrimination, or relationship troubles) may contribute to suicide risk, especially when they occur along with suicide risk factors.

Family and friends are often the first to recognize the warning signs of suicide, and they can take the first step toward helping a loved one find mental health treatment. See NIMH’s page with resources for finding help for mental illnesses if you're not sure where to start.

Identifying people at risk for suicide

Universal screening: Research has shown that a three-question screening tool helps emergency room personnel identify adults at risk for suicide . Researchers found that screening all patients—regardless of the reason for their emergency room visit—doubled the number of patients identified as being at risk for suicide. The researchers estimated that suicide-risk screening tools could identify more than three million additional adults at risk for suicide each year.
Predicting suicide risk using electronic health records: Researchers from NIMH partnered with the VA and others to develop computer programs that could help identify increased suicide risk among veterans receiving VA health care . Other healthcare systems are also beginning to use data from electronic health records to help identify people with suicide risk.

Treatments and Therapies

Effective, evidence-based interventions are available to help people who are at risk for suicide.

Brief interventions

Safety planning: Personalized safety planning has been shown to help reduce suicidal thoughts and actions. Patients work with a health care provider to develop a plan that describes ways to limit access to lethal means such as firearms, pills, or poisons. The plan also lists coping strategies and people and resources that can help in a crisis.
Follow-up phone calls: Research has shown that when at-risk patients receive supportive phone calls that include risk monitoring and they are encouraged to engage in treatment and safe behaviors, their suicide risk goes down.

Psychotherapies

Multiple types of psychosocial interventions have been found to help individuals who have attempted suicide (see below). These types of interventions may prevent someone from making another attempt.

Cognitive behavioral therapy (CBT) can help people learn new ways of dealing with stressful experiences. CBT helps individuals recognize their thought patterns and consider alternative actions when thoughts of suicide arise .
Dialectical behavior therapy (DBT) has been shown to reduce suicidal behavior in adolescents. DBT has also been shown to reduce the risk of suicide attempts in adults with borderline personality disorder , a mental illness characterized by an ongoing pattern of varying moods, self-image, and behavior that often results in impulsive actions and problems in relationships. A therapist trained in DBT can help a person recognize when their feelings or actions become overwhelming and teach the person skills that can help them cope more effectively with upsetting situations.

Medication

Some individuals at risk for suicide might benefit from medication. People can work with their health care providers to find the best medication or medication combination, as well as the right dose. Many people at risk for suicide often have a mental illness or substance use problems and may benefit from medication along with psychosocial intervention.

Clozapine is an antipsychotic medication used primarily to treat individuals with schizophrenia. To date, it is the only medication with a specific U.S. Food and Drug Administration (FDA) indication for reducing the risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorder.

If you are prescribed a medication, be sure you:

Talk with a health care provider to make sure you understand the risks and benefits of the medications you're taking.
Do not stop taking a medication without talking to your health care provider first. Suddenly stopping a medication may lead to worsening of symptoms. Other uncomfortable or potentially dangerous withdrawal effects also are possible.
Report any concerns about side effects to a health care provider right away. They can help determine whether you need a change in the dose or a different medication.
Report serious side effects to the FDA MedWatch Adverse Event Reporting program online or by phone at 1-800-332-1088. You or your health care provider may send a report.

To find the latest information about medications, talk to a health care provider and visit the FDA website.

Collaborative care

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