Smart Health

Suicide Prevention

Some warning signs and strategies for getting help.

Each December, messages about the increased risk for suicide during the holidays begin circulating. While many people may experience loneliness and isolation around this time of year, it is a myth that the holiday season is associated with increased rates of suicide.

Interestingly, the National Center for Health Statistics reports that suicide rates are lowest in December. Studies suggest that suicide rates peak in the spring and the fall. But while people are not necessarily at an elevated risk for suicide in the month of December, this holiday season is still a good time for us to have discussions about suicide prevention.

Suicide is one of the most well-researched aspects of mental health. This is because understanding the risk factors of suicide can directly save lives. Much of the work around suicide prevention is intended to help individuals, families, and communities identify and reduce the risk factors of suicide.

The Statistics

Suicide is a leading cause of death in the US. In 2020, there were roughly 46,000 deaths by suicide—roughly one death every 11 minutes. Among persons age 10 to 64, suicide was the ninth leading cause of death, and among young people age 10 to 14 and 25 to 34, suicide was the second leading cause of death.

Rates of suicide are actually highest among persons age 85 or older, highlighting the vulnerability of our elderly relatives and neighbors. This is likely because older folks tend to experience higher rates of chronic illness and shrinking social networks.

The number of people who simply have thoughts about suicide (also known as suicidal ideation) is even higher. It is estimated that 12.2 million adults have thought seriously about suicide, 3.2 million adults have made plans to attempt suicide, and 1.2 million adults have attempted suicide. It is impossible to measure exact numbers because some people may die by suicide and it goes unrecognized. For example, people who die from an “accidental” overdose may have had some intent to die that was not known to others. This means that the number of suicides may be even higher than estimates suggest.

Tragically, studies show that more than 1 in 3 people who make a non-fatal suicide attempt do not subsequently receive mental-health treatment. Better suicide awareness allows us to improve our conversations about suicide. Having suicidal ideation is not something to be ashamed of, and it doesn’t mean that one is weak. It is a legitimate reason to seek out mental-health evaluation and support.

Risk Factors for Suicide

While there is no single cause of suicide, numerous factors have been identified. Previous suicidal behaviors (such as someone telling friends that they “just want to die”) appear to have the strongest link to a person’s future risk for suicide.

Psychiatric illness, and particularly depression, is one of the most potent risk factors for suicide. However, it is important to note that not everyone with depression will go on to think about or attempt suicide. Sleep problems, substance-use disorders, physical illness, and impairment caused by mental-health conditions also represent a risk for suicide.

The good news is that these conditions are amenable to treatment, so seeking out appropriate care is an important step in preventing suicide.

Suicide at the Margins

Certain racial and ethnic groups possess a higher risk for thinking about or attempting suicide. According to the most recent Centers for Disease Control (CDC) reports, non-Hispanic Native Americans and Alaska natives (as well as white residents of Alaska) are particularly vulnerable. People experiencing socioeconomic disadvantage are also at increased risk for suicide.

LGBTQ people are thought to have an increased suicide risk because of their relative lack of familial and societal acceptance combined with homophobia, transphobia, and discrimination. LGBTQ youth are particularly at risk, being four times more likely to attempt suicide than their peers. In fact, The Trevor Project estimates that more than 1.8 million LGBTQ youth ages 13 to 24 seriously consider suicide each year.

Why might suicide rates be higher among vulnerable and marginalized communities? One psychological model, the Interpersonal Theory of Suicide, may offer some insight. The interpersonal theory asserts that the simultaneous presence of “thwarted belongingness” and “perceived burdensomeness” produces the desire for suicide. Thwarted belongingness refers to the feeling or sense that one is not accepted by or connected to others. Perceived burdensomeness is the belief that one is a burden to others or to society. Adjacent to this belief is the idea that one’s death would actually be a relief for others.

Importantly, simply having the desire for suicide is not in and of itself sufficient. There must also be acquired capability, or the ability to overcome one’s natural instincts and fear of death. That natural fear can be weakened by factors such as trauma, chronic pain, or compulsive engagement in self-harm behaviors.

Using the interpersonal theory of suicide to prevent needless death is still an active area of research, and is only one of many theories. Its relevance among LGBTQ people is particularly important, however, given the homophobia and transphobia that can negatively impact one’s sense of belonging. Being told that there is no place for you because of your gender identity can disrupt any sense of safety and connection.

It is important to remember that LGBTQ people specialize in the creation of chosen families to compensate for the lack of acceptance within their families of origin. Developing a sense of belonging with other LGBTQ community members is one of the most powerful ways to find connection and understanding. Coming out, being invited in, and finding support can directly combat the sense of “thwarted belongingness” that may lead to suicide.

What If I’m Having Suicidal Thoughts?

First, it’s important to know that immediate help is available. You can always reach out to the national Suicide and Crisis Lifeline by texting or calling 988. It’s OK to speak with someone about suicidal thoughts. You can also go to the nearest urgent-care clinic or emergency room if you would rather speak with someone in person.

In addition to seeking help, remember that depression and hopelessness can cloud your ability to see things clearly. Suicidal thoughts and feelings are often caused by problems that have a solution—perhaps even an easy solution that just hasn’t been found yet. This is why seeking help is so critical in the moment. Talking with someone can often lessen the intensity of harmful emotions.

It is also important to remove weapons, medications, and sharp objects from your surroundings if you are in a period of intense depression, or if suicidal thoughts are present. If guns cannot be removed, locking them up is important. If you have access to harmful medications, ask a friend or family member to safely store and dispense them for you.

Seek out ongoing mental-health support and treatment. Speak with a counselor, therapist, primary-care physician, or psychiatrist who can identify potential underlying causes for your suicidal thinking. Professional therapy can provide an opportunity to work on coping strategies and deal with your thoughts of suicide or despair.

A Year-Round Strategy

Let’s not simply focus on suicide prevention during this holiday season. Engaging in wellness techniques, connecting with others, and being supportive of friends and family in distress should be our year-round mental-health strategy.

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Daryl Shorter, MD

Daryl Shorter, MD, is a Diplomate of the American Board of Psychiatry and Neurology and is board certified in both general and addiction psychiatry. His clinical practice focuses on the use of psychotherapy and medications to treat mental health and substance use disorders. Dr. Shorter serves as the psychiatrist of record at The Montrose Center and lectures widely on LGBTQ mental health and wellness. Dr. Shorter can be reached at dr.darylshorter@gmail.com.
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