A Guide to Suicide Prevention and Support

Signs and Symptoms of Suicidal Ideation

Research shows that most people who attempt or die by suicide give warning signs and often make efforts to seek help. Recognizing signs and reaching out to help a friend or family member access professional support can make a lifesaving difference.

Although suicide cannot be predicted with certainty, recognizing these warning signs is our best tool. The following behaviors indicate an urgent need for help, either for yourself or a loved one:

• Talking or writing about wanting to die or to harm oneself
• Looking for a way to harm oneself, such as searching online or obtaining a gun
• Talking about feeling hopeless or having no reason to live

If you or someone you know is in immediate danger, contact a crisis line or go to your nearest emergency room.

Other important warning signs can include:

• A strong preoccupation with death
• Saying goodbye as if they’ll never see family/friends again
• Withdrawing completely from friends and family
• Engaging in reckless behaviors, like unsafe driving or self-destructive activities
• Expressing self-hatred or self-loathing
• Getting affairs in order, like making a will or giving away possessions
• Experiencing sudden calmness after a period of distress

If you notice any of these signs, help the person connect with a mental health professional or crisis support immediately.

Identifying Those at Risk for Suicide

Suicide is a serious public health issue, claiming tens of thousands of American lives each year. Anyone can experience suicidal thoughts, but certain factors increase a person’s vulnerability. Recognizing risk factors, warning signs, and protective factors can help guide timely support.

“Suicidal thinking is common and widespread, especially among people with mental health disorders,” says Dost Öngür, MD, PhD, chief of the Division of Psychotic Disorders at McLean Hospital.

“Yet we don’t have good ways of deciding who is at genuine risk, and who is struggling but won’t go through with hurting themselves.”

About 90% of people who die by suicide have an existing mental health or substance use disorder. These conditions can affect anyone—regardless of gender, age, race, or background.

Risk Factors

Key factors linked to increased risk include:

• Mental health issues: Depression, anxiety, and other disorders can increase suicidal thoughts and behaviors.
• Substance use disorders: Addiction often occurs alongside mental health conditions, raising risk.
• History of abuse or trauma: Past or ongoing emotional, physical, or sexual abuse can increase vulnerability.
• Family history: Relatives who attempted or died by suicide increase a person’s risk.
• Life stressors: Bereavement, legal issues, financial hardship, or major life changes can contribute.
• Marginalized communities: Groups facing stigma or discrimination, including LGBTQ+ and Native American communities, may be at higher risk.
• Armed forces experience: Veterans or active-duty members may face PTSD, difficulty adjusting to civilian life, or strained relationships.
• Chronic medical conditions: Long-term health issues can heighten vulnerability.
• Prior suicide attempts: A history of attempts is one of the strongest predictors of future risk.

Warning Signs

Behaviors that may indicate immediate risk, especially if new or intensified, include:

• Talking about feeling trapped, being a burden, or wanting to die
• Using alcohol or drugs more than usual
• Acting recklessly, withdrawing, or showing agitation
• Changes in sleep, extreme mood swings, or intense anger
• Talking about losing fear of death

“It’s important to understand that these behaviors are signs of serious distress,” notes Öngür. “They do not mean a person will definitely attempt suicide, but they highlight vulnerability and the need for support.”

Protective Factors

Factors that can help reduce risk include:

• Access to effective mental health care
• Strong connections with family, friends, and community
• Problem-solving and coping skills

Understanding risk factors, observing warning signs, and supporting protective factors can reduce stigma, encourage timely help, and provide individuals with the care they need.

So How Do We Prevent Suicide?

If someone is showing signs that they may be considering suicide, what is the next step? Often people are unsure if they should tell someone they are worried about them.

Many people are afraid to bring up suicide because they think it is awkward. They also do not want to put the idea in someone’s head.

While it may feel uncomfortable, it is very important to discuss suicide openly and without judgment.

The best way to find out if someone is thinking about attempting suicide is simple: ask. Remember that showing someone you care may help them openly express their feelings of loneliness or hopelessness.

Certain phrases can help start a conversation about suicide. Some examples include:

• I’ve been concerned about you lately. Is it okay if we talk about this?
• I wanted to check in with you. It seems you haven’t been yourself lately. You don’t seem to enjoy activities you previously enjoyed. Is it okay to talk about that?
• I have noticed a bit of a personality shift in you recently. Is it okay if I ask you about it?
• I understand you have been feeling alone recently. Know that whatever you are experiencing, you do not have to go through it alone. I am here for you. Is there something I can do to help?
• I know it is hard to believe this now, but it will get better. Things will change. What is something you are looking forward to?
• Even if you feel like giving up, you do not have to. Remember that you can reach out to me for a helping hand. Is there something I can help you with?

Fact: There is no singular “best” way to help. The most important thing you can do is just to ask how someone is feeling or if they are thinking about hurting themselves.

If people are more comfortable talking about suicide, it is possible for them to get the help they need.

The Impact of Suicide

The truth is that everyone deserves to know that their life matters and that help is available.

By definition, suicide is caused by self-harming behavior with an intent to die. Attempted suicide is a self-directed, intentional behavior with an attempt to die that does not result in death.

When people talk about “suicidal ideation,” this refers to thoughts of suicide. Some people may have thought about or devised a plan to end their own lives yet have not acted on it.

To put suicide’s impact into perspective, it leads to nearly twice as many deaths every year as homicide.

Suicide doesn’t discriminate—it affects people of all ages, including children. Close to 10% of high school students report having attempted suicide at least once during the preceding year.

Dispelling Myths About Suicide

Though there has been progress around encouraging people to openly discuss suicide, there is still a lot of work to be done. Some of the most common misconceptions that surround suicide include:

Myth: People Who Talk About Suicide Likely Won’t Act on It

If someone is talking about suicide, it is a sign that they potentially need help. You should use this as an opportunity to ask them how they are feeling and ensure that they are safe.

Myth: People Who Die by Suicide Must Be Crazy

First, there are some people who accidentally take their own lives. Second, not everyone who dies by suicide has a diagnosed mental health condition.

People take their lives for many reasons, including because they are overcome with grief, are in a state of despair, are experiencing intense emotional pain, or are struggling with an undiagnosed mental health disorder. Mental health conditions are just one of many factors that can contribute to a person’s mental state during these difficult moments.

Myth: People End Their Lives Because They Do Not Want To Seek Help

The overwhelming majority of people who die by suicide seek help before attempting or completing this action. More than half of all victims of suicide sought medical care within 30 days prior to their death, and over 90% sought medical care within the year leading up to their death.

Myth: We Shouldn’t Talk About Suicide Because We Will Put the Idea Into People’s Heads

Talking about suicide doesn’t make people more likely to take their lives. The reverse is true. By talking honestly about issues that lead to suicide, it is possible to convince people to get the help they need.

Changing Our Current Thinking About Suicide

To reduce suicide rates, it is important to change the way we talk about those affected by suicide.

Sadly, there is a stigma related to suicide, and the people impacted by this stigma include friends and family of those who have died as well as those who have survived a suicide attempt. The causes of this type of stigma often include misunderstanding, fear, and ignorance.

Society can view those who attempt or die by suicide as “not normal” and therefore apply this view onto the survivors. Avoidance, shaming, stereotyping, and distrust toward those affected by suicide only help to reinforce the idea that they are different, even though suicide can affect any family at any time.

So what can be done to dispel stigma? The following are some of the ways we can reduce the stigma surrounding suicide:

1. Spread the Word: Suicide Is Complex

It is usually caused by multiple factors. There is often no single cause of suicide.

2. Be Aware That People With Suicidal Thoughts Don’t Always Go On To Take Their Lives

Many people do not realize just how common suicidal ideation is. They are only aware of instances when someone has died by suicide.

3. Let Everyone Know Support Is Available

If people understand that mental health resources exist, the stigma surrounding suicide and suicidal ideation will begin to fade.

4. Be Honest and Upfront About the Grieving Process for People Who Died by Suicide

It’s important that people understand the severe impacts of suicide loss on survivors, including dealing with a sudden loss and the questions that are often left unanswered.

5. Use Nonjudgmental Language When Discussing Suicide

If we change the language we use to discuss suicide, we can also shift thoughts about suicidal behavior.

Helping a Loved One Who Is Struggling

What should you do if a loved one is thinking about harming themselves or taking their own life?

Do not argue with someone who is suicidal. Let them know that their feelings are valid. This is not about you. It’s about them.

Do not act shocked or let your emotions take over. It is common for people to be surprised when they hear someone is thinking about taking their own life because it is hard to put yourself in their shoes. Do everything you can to remain emotionally grounded.

Do not promise to keep their suicidal thoughts to yourself. Even though you want the other person to open up to you, you will have to tell someone else about what they are going through. That is the only way you can get them the help they need.

Do not promise to fix everything for them. Even a psychiatrist cannot singlehandedly help someone with their suicidal thoughts. Remember that you will need to ask for help from other people.

Do not say you understand what the other person is going through. Unless you are having suicidal thoughts yourself, you cannot understand what they are experiencing.

Do not blame yourself. You are not responsible for someone else’s actions. Your loved one’s problems are much bigger than yourself.

While the list of things not to do can seem like a lot, there are easy ways to show your support as well.

Try to be yourself. Simply let the other person know that they do not have to go through this alone. If you cannot find the right words, start by saying that.

Make sure to listen. Make sure the other person knows that you are listening to what they have to say. No matter how heartbreaking it is to hear, they need you to listen.

Be nonjudgmental. Be aware of your body language and remain as open as you can. The other person is doing the right thing by telling you what they are experiencing.

Make sure the other person knows there is hope. Reassure them that help is available. Let them know that they have something to look forward to.

Take what they have to say seriously.

You should make sure the other person gets help. Calling a suicide hotline, taking them to an emergency room, or dialing 911 are all good starting points.

Contributors

Mark Longsjo, LICSW