Suicide is a major, preventable public health problem. In
2004, it was the eleventh leading cause of death in the U.S.,
accounting for 32,439 deaths.1 The overall rate was 10.9
suicide deaths per 100,000 people.1 An estimated eight to
25 attempted suicides occur per every suicide death.2
Suicidal behavior is complex. Some risk factors vary with
age, gender, or ethnic group and may occur in combination
or change over time.
If you are in a crisis and need help right away:
Call this toll-free number, available 24 hours a day, every
day: 1-800-273-TALK (8255). You will reach the National Suicide
Prevention Lifeline, a service available to anyone. You may
call for yourself or for someone you care about. All calls
What are the risk factors for suicide?
Research shows that risk factors for suicide include:
- Depression and other mental disorders,
or a substance-abuse disorder (often in combination with
other mental disorders). More than 90 percent of people
who die by suicide have these risk factors.2
- Stressful life events, in combination
with other risk factors, such as depression. However, suicide
and suicidal behavior are not normal responses to stress;
many people have these risk factors, but are not suicidal.
- Family history of mental disorder
or substance abuse
- Family history of suicide
- Family violence, including physical
or sexual abuse
- Firearms in the home,3 the method
used in more than half of suicides
- Exposure to the suicidal behavior
of others, such as family members, peers, or media figures.2
Research also shows that
the risk for suicide is associated with changes in brain
chemicals called neurotransmitters, including serotonin.
Decreased levels of serotonin have been found in people with
depression, impulsive disorders, and a history of suicide
attempts, and in the brains of suicide victims. 4
Are women or men at higher risk?
was the eighth leading cause of death for males and the
sixteenth leading cause of death for females in 2004.1
four times as many males as females die by suicide.1
suffocation, and poison are by far the most common methods
of suicide, overall.
However, men and women differ in
the method used, as shown below.1
Is suicide common among children
and young people?
In 2004, suicide was the third leading cause of death in
each of the following age groups.1 Of every 100,000 young
people in each age group, the following number died by suicide:1
10 to 14 — 1.3
Adolescents ages 15 to 19 — 8.2 per 100,000
Young adults ages 20 to 24 — 12.5 per 100,000
the general population, young people were much more likely
to use firearms, suffocation, and poisoning than other methods
of suicide, overall. However, while adolescents and young
adults were more likely to use firearms than suffocation,
children were dramatically more likely to use suffocation.1
There were also gender differences in suicide among young
people, as follows:
Almost four times as many males as females ages 15 to 19
died by suicide.1
More than six times as many males as females ages 20 to 24
died by suicide.1
Are older adults at risk?
Older Americans are disproportionately likely to die by
Of every 100,000 people ages 65 and older, 14.3 died by
suicide in 2004. This figure is higher than the national
average of 10.9 suicides per 100,000 people in the general
Non-Hispanic white men age 85 or older had an even higher
rate, with 17.8 suicide deaths per 100,000.1
Are Some Ethnic
Groups or Races at Higher Risk?
Of every 100,000 people in each of the following ethnic/racial
groups below, the following number died by suicide in 2004.1
Non-Hispanic Whites — 12.9 per 100,000
American Indian and Alaska Natives — 12.4 per 100,000
Non-Hispanic Blacks — 5.3 per 100,000
Asian and Pacific Islanders — 5.8 per 100,000
Hispanics — 5.9 per 100,000
What are some risk factors
for nonfatal suicide attempts?
As noted, an estimated eight to
25 nonfatal suicide attempts occur per every suicide death.
Men and the elderly are more likely to have fatal attempts
than are women and youth.2
Risk factors for nonfatal suicide
attempts by adults include depression and other mental disorders,
alcohol abuse, cocaine use, and separation or divorce.5,6
factors for attempted suicide by youth include depression,
alcohol or other drug-use disorder, physical or sexual abuse,
and disruptive behavior.6,7
Most suicide attempts are
expressions of extreme distress, not harmless bids for
attention. A person who appears suicidal should not be
left alone and needs immediate mental-health treatment.
What can be done to prevent suicide?
Research helps determine which factors can be modified to
help prevent suicide and which interventions are appropriate
for specific groups of people. Before being put into practice,
prevention programs should be tested through research to
determine their safety and effectiveness.8 For example, because
research has shown that mental and substance-abuse disorders
are major risk factors for suicide, many programs also focus
on treating these disorders.
Studies showed that a type of psychotherapy called cognitive
therapy reduced the rate of repeated suicide attempts by
50 percent during a year of follow-up. A previous suicide
attempt is among the strongest predictors of subsequent suicide,
and cognitive therapy helps suicide attempters consider alternative
actions when thoughts of self-harm arise.9
Specific kinds of psychotherapy may be helpful for specific
groups of people. For example, a recent study showed that
a treatment called dialectical behavior therapy reduced suicide
attempts by half, compared with other kinds of therapy, in
people with borderline personality disorder (a serious disorder
of emotion regulation).10
The medication clozapine is approved by the Food and Drug
Administration for suicide prevention in people with schizophrenia.11
Other promising medications and psychosocial treatments for
suicidal people are being tested.
Since research shows that older adults and women who die
by suicide are likely to have seen a primary care provider
in the year before death, improving primary-care providers'
ability to recognize and treat risk factors may help prevent
suicide among these groups.12 Improving outreach to men at
risk is a major challenge in need of investigation.
What should I do if I think someone is suicidal?
If you think someone is suicidal, do not leave him or her
alone. Try to get the person to seek immediate help from
his or her doctor or the nearest hospital emergency room,
or call 911. Eliminate access to firearms or other potential
tools for suicide, including unsupervised access to medications.
For More Information About Suicide
Information and Organizations from NLM's MedlinePlus
1. Centers for Disease Control and Prevention, National
Center for Injury Prevention and Control. Web-based Injury
Statistics Query and Reporting System (WISQARS) : www.cdc.gov/ncipc/wisqars
2. Moscicki EK. Epidemiology of completed and attempted
suicide: toward a framework for prevention. Clinical Neuroscience
Research, 2001; 1: 310-23.
3. Miller M, Azrael D, Hepburn L, Hemenway D, Lippmann SJ.
The association between changes in household firearm ownership
and rates of suicide in the United States, 1981-2002. Injury
Prevention 2006;12:178-182; doi:10.1136/ip.2005.010850
4. Arango V, Huang YY, Underwood MD, Mann JJ. Genetics of
the serotonergic system in suicidal behavior. Journal of
Psychiatric Research. Vol. 37: 375-386. 2003.
5. Kessler RC, Borges G, Walters EE. Prevalence of and risk
factors for lifetime suicide attempts in the National Comorbidity
Survey. Archives of General Psychiatry, 1999; 56(7): 617-26.
6. Petronis KR, Samuels JF, Moscicki EK, Anthony JC. An
epidemiologic investigation of potential risk factors for
suicide attempts. Social Psychiatry and Psychiatric Epidemiology,
1990; 25(4): 193-9.
7. U.S. Public Health Service. National strategy for suicide
prevention: goals and objectives for action. Rockville, MD:
8. Gould MS, Greenberg T, Velting DM, Shaffer D. Youth suicide
risk and preventive interventions: a review of the past 10
years. Journal of the American Academy of Child and Adolescent
Psychiatry, 2003; 42(4): 386-405.
9. Brown GK, Ten Have T, Henriques GR, Xie SX, Hollander
JE, Beck AT. Cognitive therapy for the prevention of suicide
attempts: a randomized controlled trial. Journal of the American
Medical Association . 2005 Aug 3;294(5):563-70.
10. Linehan MM, Comtois KA, Murray AM, Brown MZ, Gallop
RJ, Heard HL, Korslund KE, Tutek DA, Reynolds SK, Lindenboim
N. Two-Year Randomized Controlled Trial and Follow-up of
Dialectical Behavior Therapy vs Therapy by Experts for Suicidal
Behaviors and Borderline Personality Disorder. Archives of
General Psychiatry, 2006 Jul;63(7):757-766.
11. Meltzer HY, Alphs L, Green AI, Altamura AC, Anand R,
Bertoldi A, Bourgeois M, Chouinard G, Islam MZ, Kane J, Krishnan
R, Lindenmayer JP, Potkin S; International Suicide Prevention
Trial Study Group. Clozapine treatment for suicidality in
schizophrenia: International Suicide Prevention Trial (InterSePT).
Archives of General Psychiatry, 2003; 60(1): 82-91.
12. Luoma JB, Pearson JL, Martin CE. Contact with mental
health and primary care prior to suicide: a review of the
evidence. American Journal of Psychiatry, 2002; 159: 909-16.