Whether you are aware or not, it’s very possible that someone you know or love has had suicidal thoughts in the past, or even attempted or died by suicide. Suicide is a leading cause of death in the United States, according to the Centers for Disease Control and Prevention (CDC). It’s an issue that affects people of all ages and demographics (although some people are more at risk than others, including people of color, veterans, LGBTQ+ youth, people with disabilities, tribal populations, and people who live in rural areas), and unfortunately, suicide rates are increasing.
Provisional data released by the CDC in August finds that suicide deaths increased 2.6 percent between 2022 and 2021 (between 2000 and 2021, they increased 36 percent). Rates had declined in both 2019 and 2020, but increased five percent in 2021. To put that into context, the CDC reports that in 2021 3.5 million American adults planned to die by suicide, and 1.7 attempted it. Additionally, around 12.3 had serious thoughts about it.
These numbers are likely underreported because it’s difficult to standardize suicide data; the agencies that track this information have varying levels of reporting capabilities. Though it’s tough to get exact numbers related to suicide, the numbers available are helpful in painting a picture of who is at risk. “The caveat is that there’s a lot we don’t know, but there are a lot of things we do know and are starting to understand more,” says Katherine Delgado, chief program officer at the American Association of Suicidology.
Despite the scope of the problem, talking about suicide remains taboo, which is why one of the major challenges in suicide prevention work is mainstreaming conversations about suicide and its causes. For clinical psychologist Rheeda L. Walker, PhD, author of The Unapologetic Guide to Black Mental Health, talking about suicide is part of her day-to-day. Her work as director of the Culture, Risk, and Resilience Lab at the University of Houston focuses on preventing premature death in communities of color.
One of the main obstacles Dr. Walker says she encounters in her work is even getting people to discuss suicide at all, much less in a fact-based way. Because of how scary and upsetting the topic can be, it’s difficult to even bring it up in the first place. “Suicide is one of those things that folks are like, ‘Oh no, we’re not going to touch that’ when we really need to be mainstreaming these kinds of conversations if we’re going to engage in real prevention,” she says.
“A lot of folks have fears about talking about suicide because they don’t feel prepared.”—Rheeda L. Walker, PhD, clinical psychologist
Talking about suicide is tough even for medical professionals trained to do so. One of Dr. Walker’s duties is to train doctoral students working on their PhDs and she encourages them to be prepared to talk about suicide with their patients. “I get pushback that’s like ‘Well, this person didn’t come in talking about suicide so I don’t really want to bring that up.’ A lot of folks, including professionals in training, have fears about talking about suicide because they don’t feel prepared,” she explains. “A lot of what’s underneath that is concern of not having the tools to help people when they say they’re suicidal.”
Language is part of this. Terms like “committed suicide,” “successful suicide attempt,” and “failed suicide attempt” are considered outdated and stigmatizing; whereas, terms that are more neutral and don’t assign blame or achievement like “died by suicide” or “attempted suicide” are preferred. Suicide is no longer listed as a crime in the United States, although some states still have attempted suicide listed in their criminal statutes and it’s still considered a crime in some countries. Using language that doesn’t shame or stigmatize suicidal thoughts goes a long way toward getting people to share how they’re really feeling instead of hiding it for fear of being judged or getting in trouble.
Suicide prevention is complex work, and a major part of it involves addressing the societal factors that contribute to suicide risk—like experiencing violence, racism and discrimination, poverty, and lack of access to physical and mental health care. But another key piece is looking out for people in our communities and having these conversations. Talking about suicide helps screen for it, and makes those who are suffering more willing to hopefully get help—reaching out can help someone who is struggling with suicidal ideation. “I’ve been doing this work for more than 20 years and I think if we can get to a place where the reframing is, ‘Those folks are in pain and they don’t see any way out,’ that starts to soften thinking about [suicide] and maybe inspires people to be of help to them, one person at a time,” adds Dr. Walker.
According to Dr. Walker and Delgado, the unwillingness to talk openly about suicide has lead a lot of harmful misconceptions to take root that make prevention work tougher. Because it’s so difficult to talk about suicide, it’s important to dispel these myths.
5 dangerous myths about suicide that make it tougher to seek help
Myth 1. Talking about suicide encourages it
This couldn’t be further from the truth, says Dr. Walker—research finds that talking about suicide doesn’t make someone more likely to attempt it1. “If someone is not thinking about suicide, talking about it is not going to put it in their heads,” she says.
In reality, Dr. Walker says that not talking about suicide as the public health crisis it is makes it tougher for those experiencing suicidal ideation and thoughts to share how they feel, which may prevent them from seeking help. “If someone is talking about it, raising this as a concern opens the door for them to feel seen and heard, rather than feeling they have to hide and they’re on their own because people who have the level of pain that would drive them to come up with and go through with a plan need more support, not less,” she says.
There’s not exactly one right way to talk about suicide. Something that helps, though, is to check in with someone who is exhibiting some of the signs that they may be at risk of attempting suicide such as going through a trauma or stressful event; talking about death, dying, guilt, or planning for a future they’re not part of; taking uncharacteristic, dangerous risks; feeling depressed, sad, anxious, empty, or enraged; extreme trouble sleeping or eating; extreme mood swings; withdrawing from friends and loved ones; and/or researching ways to die. It’s important to keep in mind that these are general risk factors to watch for, and that people may not display all or most of these; the presence of a couple, however, is enough to prompt a conversation.
In this case, Dr. Walker says reaching out can look something like saying, “Hey, I know you went through something recently and you don’t quite seem like yourself and I just want to check in with you. Have you ever thought about killing yourself?” Explicitly asking is okay, because the goal is to provide a space for this person to honestly open up. After that, depending on what they say, you can plan for next steps and help connect them to other support methods. “I think where my students [and other people] get stuck is the idea that they have to save a life, but you don’t—you just have to be a good listener to someone who is in pain,” she says.
If you or someone you know has attempted suicide and are injured, immediately call 911; if you’re not able to, have someone else call for help. If you’re not injured but are in immediate danger of hurting yourself, call 911 or a suicide hotline number (several are listed below).
While support from loved ones is an important component of suicide prevention, it’s important to also examine the root causes of suicidal thoughts, as well as treatments for suicidal thoughts and behaviors like specific support for substance abuse, psychotherapy, and medications when applicable.
Dr. Walker says that the idea that talking about suicide encourages it is false, but what it is true is that the way suicides are spoken about—and reported on in the media—matters. For example, media coverage of suicides that glorifies or sensationalizes details can inspire copycat attempts. Studies have shown that among those who are considering suicide, exposure to suicide can influence their decision to attempt suicide themself; this can be especially true for adolescents who know someone who died by suicide2. “If someone gets the details, and maybe they are thinking about suicide and they don’t have anyone else to talk to, they’re more likely to use some of these methods they’ve seen to end their own lives,” says Dr. Walker.
Myth 2. People who attempt or die by suicide are cowardly or weak, or always have a diagnosed mental health condition
Neither of these perceptions is accurate. While people who have mental health issues are at increased risk of suicide, not everyone who is suicidal has a diagnosed mental health issue. “It is true that about 90 percent of people who die by suicide have some either diagnosed or undiagnosed psychological disorder3, there’s a good 10 percent of people who seem to be healthy and high-functioning individuals,” explains Dr. Walker (It’s important to note that most people who have diagnosed mental health conditions don’t die by suicide.) “If we’re going to save any lives, I think it’s misguided to assume that weak-minded people or even mentally-ill people are the individuals who are vulnerable because there are a lot of people in our society who have suicidal thoughts [who don’t fit that profile].”
It is certainly true that some factors put some people more at risk than others—a history of mental health issues, social isolation, access to lethal means, and a lack of support, can increase a person’s risk of suicide—but Dr. Walker says that accepting that anyone could be at risk is a way to be sure that people feel more comfortable talking about their suicidal feelings and thoughts even if they don’t fit the typical profile of someone who seems likely to intentionally end their own life.
In terms of whether people who die by suicide are cowardly or weak? Dr. Walker says that’s not the case because suicide is not a normal response to adversity or stress. In fact, she says the people who carry out a plan to die by suicide work against their natural instincts to preserve their own life and keep themselves from danger4—they are concerned mostly with ending their suffering. “They’re probably more strong-minded than we may imagine, so I think that’s one of the reasons why it’s kind of a misnomer that only a weak person could’ve done this,” she adds.
3. Adolescents and college students are the most at risk of dying by suicide
As mentioned above, suicide is an issue among all age demographics. Furthermore, assessing suicidal risk is complicated, says Dr. Walker. There are a lot of factors that go into examining which groups are most at risk of dying by suicide compared to others, and age is only one factor. Keep in mind that risk factors are not predictive, which is why it’s so important to increase access across the board to mechanisms that can help with the underlying issues that cause someone to be suicidal. “We can’t actually predict who will or who will not die by suicide,” she emphasizes. “I always say to assume that anyone who is in pain could be vulnerable.”
While adolescents are certainly at risk of dying by suicide, they aren’t the group most represented in suicide death data. “In general, older people are more likely to die by suicide than younger people,” says Dr. Walker. Nearly half of all suicides in the United States happen to adults ages 35 to 64, according to the CDC. Within this group, rates are highest among American Indian or Alaska Native men and women, followed by non-Hispanic white men and women. Older adults over age 75 are also at high risk of dying by suicide. By comparison, deaths from suicide of people aged 10 to 24 make up about 15 percent of total suicide deaths recorded by the CDC.
However, this doesn’t mean that younger folks aren’t at great risk. While the suicide rate for this age group is lower than among other age groups, suicide is the second leading cause of death among American adolescents, according to data from the CDC. That same data also finds that suicides increased in this age group by about 52 percent between 2000 and 2021. Within different subgroups, there is also great reason for concern: Among people ages 10 to 24, Black youth saw the largest increase in suicides compared to other racial groups.
Myth 4. People who self-harm or talk about being suicidal just want attention
First, there are key differences between self-harm and suicide attempts; self-harm doesn’t always lead to a suicide attempt, but it puts someone more at risk for it. Delgado adds that plenty of people have suicidal thoughts but don’t actually attempt suicide; even so, the effort it takes to find out how serious these threats are is worth expending to save a life. Bottom line: Mentioning suicide is a cry for help.
That said, there may be some people who do talk about suicide as a means to get attention. Ignoring them is not the answer, according to Dr. Walker. “If this is what they’re doing for attention, I think they’re worth paying attention to,” she says.
Myth 5. If someone wants to die by suicide, they’ll find a way so there’s no point in creating public policy, like restricting access to guns or designing infrastructure, to make it more difficult
Means restrictions refers to making it tougher to access methods of dying by suicide, like guns, substances, and tall structures, and research shows that means restriction works, and that not having it has consequences. Ideally, this is not the only method of prevention, and is is part of a suicide prevention plan that involves addressing the major underlying factors that cause people to attempt suicide.
“Means restriction is one of the most important things that we can do as a society, in part because we won’t do other things like reframe how we think about suicidal people or people who are at risk for suicide,” says Dr. Walker. “But until we can do that, we do need to restrict folks’ access [to lethal means].”
“Means restriction is one of the most important things that we can do as a society.”—Dr. Walker
Some suicide methods have higher lethality rates than others. A meta analysis of studies published in 202210 in the Journal of Affective Disorders that examined lethality of suicide methods found that deaths and attempts that involved firearms resulted in death about 90 percent of the time, followed by hanging or suffocation which is fatal nearly 85 percent of the time, and then drowning which is fatal about 80 percent of the time. This is important because there’s still a chance to help someone who survives an attempted suicide. Research finds that for many people, acute suicidal crises where they’re most at risk of hurting themselves or attempting suicide are brief; because of this, making it harder to access lethal means can give someone time to rethink their decision.
If there is a high structure like a bridge or building that’s known to be a popular jumping point, or a river crossing or body of water where people are known to drown, means restriction can look like erecting tall barriers or blocking access to taller parts where people could fall or jump from. Research has shown that enacting these safety measures saves lives. For example, a 2017 study published9 in the PLoS Online journal looked at different suicide prevention strategies implemented in Switzerland to prevent deaths from falling from high structures, like bridges and buildings. Installing vertical barriers and horizontal safety nets were both effective, and reduced suicides at these spots by 77 and nearly 70 percent, respectively. The study also found that it’s important to limit access to the whole structure (meaning the barriers are everywhere) and that these barriers should be at least 7 feet tall to deter jumps.
Means restriction also extends to broader public health issues, such as implementing stricter gun control measures,6 because reducing gun violence can help prevent suicides. According to the CDC, more than half of suicides involve firearms; a 2022 study published in JAMA Network Open found that guns were the most common method of suicide death among males ages 10 to 19. Suicide attempts with guns are more common in states with looser gun laws8; some of the states with the least restrictive gun laws had the highest suicide rates in 2021, such as Wyoming, Montana, and Alaska. Dr. Walker says personal interventions such as limiting patients’ access to their guns is often part of a safety plan if they’re having suicidal thoughts. “In Texas it’s hard to ask people to give up their guns, but we say can you at least give your ammunition to someone else or make it so it’s not in your home so we can restrict your [risk] of making the gun the way by which you die,” she says. This can also involve locking guns away unloaded, and also securing prescription medications, sharp objects, ropes, or other items someone could use to hurt themselves.
Suicide is a deeply upsetting topic, but one of the first steps toward prevention is bringing it out of the shadows and into the light. Learning what’s fact and what’s fiction is part of that.
If you or someone you know is having suicidal thoughts, know that help is available. Please call the National Suicide Prevention Lifeline at 1-800-273-8255 or chat with a counselor online. Trained counselors are available 24/7. You can also text LIFELINE to 988. There are additional specific resources for people with specific identities available, too. If you need help with mental health and substance abuse, you can call the government’s National Helpline at 1-800-622-HELP (4357).