Suicide is when people intentionally act self-destructively with an intent to kill themselves, and they die because of their actions.

In the past 20 years, there has been a 33% increase in the rate of suicide deaths in United States, with the rate increasing more rapidly in rural counties than in large metropolitan areas. In 2019, there were 47,511 recorded suicides in the U.S.

There is no single explanation for the increase. Among contributing factors are the economic crisis, the opioid epidemic, farm bankruptcies, social media, better reporting and tracking of suicides, and decreased access to mental health and medical care. Higher numbers of military and veteran deaths may also play a role.

A suicide attempt is when people intentionally act self-destructively with an intent to kill themselves, but they survive.

For every suicide death in the United States, there are at least 30 suicide attempts. Persons who attempt suicide are at high risk for completion, particularly the elderly. Studies find a lower ratio of attempts to completions in older people than in younger people.

Suicidal ideation is defined as having thoughts about killing oneself. These thoughts may include a plan. These thoughts need to be evaluated, whether or not there is an underlying psychiatric disorder.

Each year, approximately 4% of U.S. adults experience suicidal ideation. Despite the seriousness of such thoughts, fewer than half of these individuals will receive mental health services.

Non-suicidal self-injury (NSSI) is the “intentional destruction of one’s own body tissue without suicidal intent and for purposes not socially sanctioned.” NSSI includes behaviors, such as carving, cutting, or burning oneself, banging or punching objects or oneself, and embedding objects under the skin. Tattooing and piercing are not considered NSSI because they are considered to be culturally sanctioned forms of expression.

Approximately 15% to 20% of adolescents and young adults engage in self-injury at least once. NSSI is far less common in adults, with about 6% of adults reporting self-injury. NSSI needs to be evaluated by a mental health professional, regardless of the person’s age or the degree of destruction.

NSSI presents differently in males and females. Females are more likely to engage in cutting, whereas males are more likely to self-injure by hitting or burning.

Risk factors are characteristics that are associated with an increased risk for suicide.

Segments of the U.S. population at increased risk for suicide:

• US males are 3 to 4 times more likely than females to die by suicide, but suicide attempts occur in a ratio of 3 females to every 1 male.
• Single, widowed, or divorced people are twice as likely to die by suicide as married people.
• The suicide rate is highest among American Indian/Alaskan Native populations.
• While the overall suicide rate of those identifying as black is lower than that for other racial/ethnic groups, suicide attempts among black adolescents have increased significantly over the past few decades. 
• Victims of violence  (e.g., child sexual and physical abuse; intimate partner violence) are associated with heightened suicide risk.
• Suicide attempts are 4 times more common among those who identify lesbian, gay, or bisexual than those who identify as heterosexual.

Common Risk Factors for Suicide:

• Previous suicide attempt(s)
• Family history of suicide
• Psychiatric illness
• Alcohol and substance use disorders
• Serious physical illness or chronic pain
• Feelings of hopelessness or isolation
• Feeling like a burden
• Experiencing severe mental pain
• Impulsive or aggressive tendencies
• History of child abuse
• Access to lethal means
• Life stressors involving loss or extreme distress

Access to Lethal Means
Half of all suicide deaths in the United States are from firearms. Individuals who live in a household with a firearm have at least a 3-fold-increased risk of suicide.

Suicidal thoughts are often transient and suicidal behavior is often impulsive. A large study shows that in those households in which firearms are locked and/or unloaded, there is less likelihood of a completed suicide.

Restricting access to lethal means in those at risk for suicide is one of the most effective means of reducing suicide rates. Multiple studies have found that restricting access to guns reduces the number of suicides, without an increase in suicides by alternative means.

• Social support
• Family connectedness
• Sense of responsibility to family
• Children in the home
• Engagement with religion
• Mental health treatment
• Follow up contact (e.g., phone calls, office visits)
• Problem solving and coping skills
• Reasons for living
• Reduced access to lethal means

Warning signs are either changes in behavior(s) or new, untoward behavior(s) that indicate that a person may be suicidal. Warning signs can be either heard or observed. Common warning signs include:

• Verbal suicide threats
• Expressions of hopelessness and helplessness
• Talking about great guilt or shame
• Talking about being a burden to others
• Increasing use of alcohol or drugs
• Daring or risk-taking behavior
• Experiencing severe mental pain
• Depression
• Severe anxiety, panic attacks
• Inability to sleep
• Showing rage or talking about seeking revenge
• Saying a final goodbye to family and friends
• Putting affairs in order
• Lack of interest in future plans

If you recognize any of these warning signs in yourself or a loved one, please follow the ACTION STEPS and call the 988 Suicide & Crisis Lifeline to speak to a crisis counselor.

• Low perceived need
• Wanting to handle the problem on their own
• Believing the problem is not that severe
• Believing that treatment will not be effective
• Believing the problem will get better without treatment
• Stigma

These barriers to treatment can interfere with getting prompt and appropriate care. If you recognize any of these attitudes about seeking treatment in persons who have thought about suicide or engaged in suicidal behavior, please follow the ACTION STEPS referred to throughout this website to connect the person to intervention.