Suicide is a serious public health problem, one that affects a broad segment of the population, according to the Centers for Disease Control and Prevention. But it can be hard to talk about.
In fact, there is one suicide death every 11 minutes, and that does not reflect the number of attempts. The suicide rate had been rising dramatically prior to the pandemic, which is one reason why the federal government in July launched the 988 National Suicide & Crisis Lifeline, an upgraded hotline for those in crisis.
At the same time, it’s important to remember there are ways to mitigate the risk of suicide and specific things you can do if you are concerned about a friend of family member. In this Q&A, Marianne Goodman, MD, Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai, offers some guidance on this sensitive topic.
“If we can help people identify suicide risks, limit access to ways that they could die by suicide, and use the crisis services that are now much more available, including the national 988 hotline, we can make a big difference,” says Dr. Goodman, acting director of the Mental Illness Research, Education and Clinical Centers at the James J. Peters VA Medical Center in the Bronx, who also co-leads a new initiative to help concerned family members speak to veterans about safely storing firearms and reducing the risk of self-harm.
How serious is the problem of suicide in the United States?
Suicide is the 12th leading cause of death. There are about 130 suicide deaths every day, and that’s one about every 11 minutes. In 2020, almost 46,000 Americans died by suicide, and this is twice as many as those who die in homicides. There were also 1.2 million suicide attempts. White males account for about 70 percent of the suicide deaths, and firearms are involved in more than half of these deaths. Unfortunately, in the past 20 years, the age adjusted suicide rate has increased 30 percent. This is a national crisis prompting a tremendous amount of research and clinical programming developed to target this elevating rate of suicide.
Who is most at risk, and why?
Certain populations have a particularly heightened risk. These include those encountering chronic stressors such as the elderly, veterans, lesbian, gay, bisexual, transgender, and queer populations, those with debilitating physical and mental illness, and especially those with a previous suicide attempt. Other risk groups include people with acute stressors such as a recent job loss, having been stigmatized, victimized, or traumatized, or who have experienced financial or relationship problems. But there’s not an equal risk at all times. It turns out that the rate of suicide is higher on Mondays and lower on the weekends; rates are higher during the spring and summer and after midnight.
What are some of the most common causes of suicide and suicidal thinking?
Suicide and suicidal thinking is prompted by many factors. In addition to the known risk factors, suicidal symptoms can be triggered by intense feelings of failure, shame, and being a burden to others. A deep sense of isolation, helplessness, and hopelessness leads to the belief that taking one’s life is the only answer to the misery they are feeling. However, there are also protective factors that actually lower the risk of suicide. These include bolstering coping abilities, having a purpose and reason for living; possessing a strong cultural identity; and a connection to others. If we can increase our protective factors, it actually mitigates some of the risks.
There are growing concerns about suicide among younger people. Why is that?
There is a tremendous and growing concern about suicide in younger people. Suicide is now the second leading cause of death among people aged 15 to 24. The highest rate of suicide death in youth are American Indians and Alaska Natives, with about 23 deaths per 100,000 people. White youth are second with about six suicide deaths per 100,000 people. While these numbers are certainly concerning, there’s a lot of recent evidence that suggests that youth suicide is a growing problem. A recent study that looked at just the past year found that 20 percent of high school students reported serious thoughts of suicide, and 9 percent made an attempt. Those are astronomical numbers. It’s not just high school students at risk; other concerning emergency room data of pre-adolescent children 10 to 12 years old document an increase in suicidal ingestion of substances, up four and a half fold in the past two decades. Also, reports of firearm use in youth is the highest in the past 20 years. During the pandemic, there was an increase in firearm suicide deaths of about 2 percent in adults, but 15 percent in young people. So clearly life stressors are affecting youth, and it’s being expressed through suicidal expression.
What has been the impact of the pandemic?
Suicide rates peaked in 2018. During the pandemic, suicide rates actually declined 3 percent in 2020. Pandemic related decreases could be explained by the notion that people pull together during a crisis. Some stressors were lessened during the pandemic, such as no longer needing to endure long commutes to work. The pandemic did draw attention to the importance of mental health. So while the pandemic was stressful, some of those forces were mitigated with the suicide rate coming down since 2020.
Has the new 988 National Suicide Prevention Hotline helped?
The 988 hotline is the 911 for mental health crises. The national hotline, accessed through calling 988, now connects people to the National Suicide Prevention Lifeline. This lifeline then connects individuals to various resources, including the Veteran’s Crisis Line, and a network of more than 200 state and local call centers services through the U.S. Department of Health and Human Services. The Biden administration invested a tremendous amount of money into this infrastructure. In fact, funding increased from $24 million to $432 million to address our mental health and suicide crises. In the year before the hotline, there were about three million calls, chats, and text to these centers. That’s expected to double within the first year of the national hotline.
What are some signs that someone may be in need of help?
Suicide prevention is everybody’s responsibility. There are warning signs that signal that someone is struggling. These include a preoccupation with death, comments about feeling trapped or a burden to others, or suggesting that people would be better off without them. Look for reckless behavior and impulsivity, such as driving at high speeds or enhanced use of alcohol and mind-altering substances. Mood swings, irritability, and worsening anger are concerning signs, as are changes in behavior including pushing people away, turning off phones, excessive sleep, or inability to sleep.
What should you do if you are concerned about a loved one or friend?
If you are concerned about a loved one or a friend, it’s important to reach out to that person. Talk to them and listen carefully. Encourage them to tell you what’s going on. Ask some difficult questions, such as: Are they feeling so bad that they want to think about ending their life? Do they have a plan to end their life? Don’t pass judgment about what they’re saying. Just be there to hear what they have to say. It’s important to empathize with the pain that they are going through. Help them to connect to either friends or support. If they are in crisis, use the 988 hotline, or seek professional help in a local emergency room. It’s very important to reassure the person that that they will not feel this bad forever and that negative feelings do get better over time.
What resources are available?
There are tremendous resources available. You can call the 988 hotline line 24/7. There are many organizations that offer assistance, including the American Foundation for Suicide Prevention, which has a website with lots of information. Another website, Means Matter, offers information about the importance of restricting access to a means to die by suicide, such as firearms. The Suicide Prevention Resource Center is another valuable resource.
Why is the issue of firearms so important?
When firearms are used, more than 85 percent of suicide attempts end in death. All other methods average about a 2 percent likelihood of death. More than 50 percent of people who die by suicide use firearms. If we can limit access to firearms, especially for those who are vulnerable, during high-risk times, we can meaningfully bring down suicide death rates. Promoting safe storage of firearms, and involving family in these decisions, is key. Pulling a trigger can happen so quickly with firearms—that urge, that impulse, once it is acted upon, you can’t take it back.