In 2020 alone, 45,979 people in the U.S. died by suicide, and 12 million seriously considered it.1 Nonetheless, suicide is a preventable tragedy, and the misconceptions and stigma surrounding suicide can play a big role in how and if at-risk individuals seek help. Research shows that certain groups are likely more at risk than others and can show unique warning signs. Our guide delves into at-risk groups, warning signs, and how to help someone who may be contemplating suicide or suffering from suicidal thoughts.
When speaking about suicide, there are a few key terms to cover. According to the National Institute of Mental Health (NIMH), suicide is defined as an act of self-harm that is done with the intention of ending one’s life. A suicide attempt also involves the intention of ending one’s life. However, an attempt does not result in death, though it may cause physical injuries and emotional distress. Suicidal ideation is the contemplation or planning of suicide.2
During 2020, suicide claimed the life of one person every 11 minutes.3 Although it was the 12th leading cause of overall death in the United States, when stratified by age, it was the second leading cause of death in people between the ages of 10-14 and 25-34, the third leading cause in people aged 15-24, and the fourth in people aged 35-44.2
Among adult women aged 35-64, non-Hispanic white women and non-Hispanic American Indian or Alaska Native women have the highest suicide rates — 10.7 per 100,000 and 12.8 per 100,000, respectively. In youth and young adults aged 10-24, girls and young women visited the ER for self-harm injuries in 2020 at nearly double the rate seen in 2001. Female youth also attempt suicide at a higher rate than male youth.4
Suicide prevalence is unequal; age, sex, gender, sexual orientation, race, and ethnicity all impact suicide risk. To put it into perspective, the average suicide rate in the United States, without accounting for these factors, is 13.9 suicide deaths per 100,000 people.4 At its most recent peak in 2020, the suicide rate was four times higher in men than in women; 22 per 100,000 and 5.5 per 100,000, respectively. Males account for more than 80% of suicides despite only making up 49% of the population.1 Suicide rates are highest in non-Hispanic American Indian/Alaska Native (AI/AN) people (28.1 per 100,000) and non-Hispanic white people (17.4 per 100,000). When examined more closely, non-Hispanic AI/AN males aged 15-34 had a staggering rate of 82.1 suicide deaths per 100,000 people.4
Suicide deaths in youth aged 10-24 occur at a rate of 11 per 100,000, which is lower than both the national average and the rate of other age groups. However, the rate of ER visits due to self-harm in the 10-24 age group is far greater than the rate of middle-aged adults, 354 per 100,000, compared to 129 per 100,000. Female youth are of particular concern, as their self-harm ER visits occur at a rate of 514 per 100,000, which is more than twice the rate of young men.4 Other at-risk groups include LGBTQ+ youth, whose reported suicide attempts are almost four times higher than those of cisgender heterosexual youth.
Veterans have a 57.3% increased risk of suicide compared to the civilian, nonveteran population, and they make up 13.9% of all adult suicide deaths in the United States. Veterans often find themselves with little to no psychosocial support and have difficulty transitioning back into civilian life.5 Because they may be less likely to seek support due to shame or stigma, communities have started offering programs specifically to encourage veterans to seek help or treatment.4
Older adults 65 and older face the highest rate of suicide, according to the National Council on Aging. Older adults are more decisive about suicide and often use more lethal means than younger populations. Due to their age and potential health conditions, they are less likely to recover from a survived attempt and may later die from injury complications. To put it into perspective, 1 in 200 young people die from a suicide attempt, but 1 in 4 older adults die from their attempt.6
Those with hazardous occupations also experience higher suicide rates, with mining, quarrying, and oil and gas extraction having the highest suicide rate of 54.2 per 100,000. Although there is limited data on the suicide rates of people with disabilities, some research suggests that they experience suicidal ideation at higher rates than people without disabilities.4
While it may seem like suicide is often preceded by a mental health condition, such as severe clinical depression, this is not always the case. Research shows that more than 54% of those who died by suicide had not been diagnosed with a prior mental health condition. A catastrophic or unexpected life event, such as a death of a loved one, may trigger a suicidal episode in a person who does not see another way out of their situation.
Popular culture and misconceptions may have you believe that suicide is the culmination of weeks or months of depression, but for most individuals, active suicidal ideation is not a long-term process. You may also have heard bereaved family members of those who died by suicide say that they didn’t notice any warning signs. However, this does not mean that the warning signs weren’t there; it just means that they were likely missed or that the active ideation period was short.7 Paying close attention to changes in the behavior, language, and demeanor of your loved ones is critical in pinpointing suicidal ideation and preventing suicide.
Active suicidal ideation is not permanent. These feelings, though difficult and intrusive, are short-lived and can be resolved with proper care. 90% of people who survive a suicide attempt will not die by another suicide attempt.3 Those who resort to suicide are not seeking an easy way out of difficult circumstances; they are in debilitating mental or even physical anguish and seeking relief from their pain. Opening lines of communication without judgment and stigma can help a person in crisis feel seen and heard.7
According to the Centers for Disease Control, risk factors for suicide are multilevel and are seen at the individual, relationship, community, and societal levels. For example, a recovering single mother facing eviction due to financial problems may become overwhelmed with stress and may feel hopeless. The choice to die by suicide comes from many places; the difficulty in overcoming addiction, lack of resources, and lack of family support all contribute to choosing suicide. Some examples of factors that may raise the risk of suicide are listed below.7 8
Death of a loved one, oppression, persecution, legal issues, eviction, trauma, history of depression or other mental illness, prior suicide attempt, financial problems, sexual abuse, aggression, severe illness, being a perpetrator or victim of violence, or substance use.
Conflict, violence, bullying, and becoming socially isolated within relationships.
High rates of suicide, violence, trauma, and discrimination in the community. Lack of healthcare access.
Stigmatization of mental illness or suicide in society and media, and access to lethal means in areas with high suicide rates.
Though suicide might seem sudden and without warning, it’s more often that the warning signs are not recognized or are even missed altogether. Unfortunately, if someone lives alone, is socially isolated, or is naturally reserved, it can be hard to notice these telltale behaviors. Paying attention to changes in a loved one’s behavior and demeanor is critical in preventing suicide. If you know someone who is socially isolated, or if you know your friend or loved one has been going through something difficult, the following behaviors might signal active suicidal ideation and may lead to a suicide attempt.9 10
It’s also important to note that some people may go to great lengths to conceal their feelings, meaning they present outwardly as happier or more at ease. This is often due to not wanting to cause others distress or be seen as a burden.
Certain groups have risk factors and warning signs unique to their age or situation. Closer attention to the behaviors and demeanors of these groups can help prevent suicide.
|Struggle with sexual orientation or gender identity in an unsupportive environment, family history of suicide, bullying, substance use, disciplinary problems, high-risk behaviors, low self-esteem11
|Neglect of personal appearance, loss of interest in hobbies and prior activities, change in personality, substance use, physical pain12
|Death of loved ones, chronic pain or illness, cognitive impairment, loss of self-sufficiency, depression, financial problems6
|Increase in substance use, self-harm,12 neglect of personal appearance and hygiene, not taking medication, changing their will, lack of regard for personal safety, avoiding social situations6
|Being an older white male, depression, access to and knowledge of firearms, homelessness, being unmarried,5 frequent deployments, injuries, length of deployments, physical or sexual assault during service13
|Rage, seeking revenge, threatening self-harm or suicide, substance use, dramatic mood changes, other general warning signs13
Just as suicide is a problem that has multiple factors at every level of society, so does its prevention. Improving financial security and providing stable housing is a societal goal identified by the CDC as a primary means of preventing suicide in low-income populations. Communities can increase outreach for at-risk populations and provide them with educational and mental health resources.14 Gatekeeper training is a widely used prevention method for businesses and communities with at-risk populations. Gatekeepers are professionals and people in the community who are most likely to encounter a person in crisis, such as teachers, clergy, coworkers, doctors, and mental health professionals. Training involves showing these individuals how to:15
At the individual level, there’s a lot you can do to identify at-risk persons and prevent suicide. You can take a gatekeeper training course from institutes like the QPR institute or others. Otherwise, you can practice the following.
If you notice your friend or loved one exhibiting concerning behaviors and you think they might be contemplating suicide, the best thing to do is to ask them. Choose a time and place that is private, and make sure you’re not in a rush. Express concern over the behaviors you’ve noticed and ask them if they might be considering suicide. Don’t beat around the bush, but be gentle. Hearing your concern and knowing that they're cared for can make more of a difference than you may realize.12
It may be difficult, but it's important to listen to your friend or loved one without judgment. Validate their reasons for wanting to live and wanting to die, but emphasize their reasons for living. Tell them you are concerned, want them to get help, and are there for them.12
Once you’ve listened and your friend or loved one is openly communicating, ask if they have any lethal means of suicide in their house and determine if you can remove them. These could be pills, firearms, lengths of rope, or other things they could use to end their life. You may need to involve authorities or family members to help, but if you feel like you might be in danger, call 911 immediately. It’s important for someone in crisis to no longer have access to lethal means. If your friend or loved one is prone to drinking or doing drugs, ask them to avoid doing these things unless supervised by a trusted friend.12
A safety plan is a list a person can use when in crisis. It contains coping strategies and contact information for trusted individuals and professionals. Sit down with your loved one and create a plan together that they can use.16 Safety plans vary from person to person and can be tailored to fit each person’s needs. For example, a spiritual person may be able to take their mind off suicide by visiting a place of worship, or someone who enjoys nature may find relief in being outdoors during a crisis. Safety plans often involve reasons to live, and you can help your loved one identify and write down these reasons. A safety plan should also include contact numbers for the local suicide prevention hotline, your loved one’s primary care physician and/or therapist, and the closest emergency room.17
Referring your friend or loved one to the right resources can be tricky. They may be hesitant or feel that it won’t help. Reassure them that seeking help is the right thing to do and that there are many resources. Offer to be with them as they call or text 988 to reach the Suicide & Crisis Lifeline. Help them find a counselor, set up an appointment, and remind them to use their safety plan if necessary in the days before an appointment.16
As inclusivity increases, so does general sensitivity and understanding of how words affect others. When speaking to someone in crisis, remember that words have a profound impact. Stigma and misconceptions surround suicide, and it can be easy to say something hurtful without intending to. Read on for our breakdown of what to say and what not to say to a person experiencing a crisis.
When addressing suicide with a loved one experiencing a crisis, be direct. Offer open communication and emotional support, and promise to be there for them.18 For example, you might say, “I’ve noticed you’ve been having a hard time. You’re quiet, and I don’t see you around as much. Whenever we talk, you mention feeling hopeless and not seeing the point of anything. I’m worried about you. Are you thinking of ending your life?”12
You can also implement some of the strategies mentioned previously in the above section on preventing suicide, including speaking up, listening, and acting.
Instead of promising to keep their feelings a secret, tell them, “I can’t do that. You’re too important to me to keep this a secret. Let me help you get the help you need.”12
Avoid using phrases that can further stigmatize suicide and mental health. For example, referring to suicide as selfish, stupid, or “the easy way out” can cause more harm by creating unnecessary and irrational feelings of guilt and shame.12
Try not to use the phrase “commit/committing suicide” as it implies that the act is illegal, sinful, or repulsive. Instead, choose a neutral phrase, such as “death/dying/died by suicide.” This relieves a person of shame and the burden of choice, as many often feel that they have no other escape from their crises except through suicide.18
Similarly, instead of saying someone is “suicidal,” say “contemplating suicide,” “thinking about suicide, or “having suicidal thoughts.” Saying someone is suicidal makes suicide sound like it’s part of their identity rather than a crisis they are struggling with. A person is more than their current suicidal ideation and shouldn’t be identified by it.18
If you or a loved one is in a crisis and considering suicide, there are many resources that can help. Call or text 988 to reach the Suicide and Crisis Lifeline. In the case of an emergency, dial 911 or go to your nearest emergency room. You are not alone. There’s hope for a better tomorrow, and there is always help. Suicide is never the answer.
988 Suicide & Crisis Lifeline - Call 988 or chat online.
Crisis Text Line - Text HOME to 741741.
The Trevor Project - For LGBT+ young people under 25. Call 1-866-488-7386 or text START to 678678.
LGBT National Help Center - The group offers several different hotlines. Call 1-888-843-4564 for the default helpline; 1-888-688-5428 for the coming out support hotline; 1-800-246-7743 for LGBT+ youth; or 1-888-234-7243 for LGBT+ older adults.
Trans Lifeline - Facilitates community aid for transgender people. Open 24/7 and available in both the U.S. (1-877-565-8860) and Canada (1-877-330-6366).
Veterans Crisis Line - Free, confidential assistance from people qualified to support Veterans. Call 988 and press 1 or text 838255. Online chat is also available.
Innerbody uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Centers for Disease Control and Prevention. (2022). Suicide Data and Statistics. CDC.
National Institute of Mental Health. (2022). Suicide. NIH.
Centers for Disease Control and Prevention. (2022). Facts About Suicide. CDC.
Centers for Disease Control and Prevention. (2023). Disparities in Suicide. CDC.
Lambert, M. T., & Fowler, D. R. (1997). Suicide risk factors among veterans: risk management in the changing culture of the Department of Veterans Affairs. Journal of Mental Health Administration, 24(3), 350–358.
National Council on Aging. (2021). Suicide and Older Adults: What You Should Know. National Council on Aging, Inc.
Fuller, K. (2020). 5 Common Myths About Suicide Debunked. NAMI: National Alliance on Mental Illness.
Centers for Disease Control and Prevention. (2022). Suicide Prevention - Risk and Protective Factors. CDC.
National Institute of Mental Health. (n.d.). Warning Signs of Suicide. NIH.
NAMI California. (n.d.). What You Can Do to Prevent Suicide: Warning Signs, Risk Factors, Support in a Crisis. NAMI: National Alliance on Mental Illness.
Kaslow, N. (2023). Teen Suicides: What Are the Risk Factors?. Child Mind Institute.
California Mental Health Services Authority (CalMHSA). (n.d.). Know the Signs. Take Action for Mental Health Campaign.
The California Department of Veterans Affairs (CalVet). (n.d.). Suicide Prevention. State of California.
Centers for Disease Control and Prevention. (2022). Prevention Strategies. CDC.
Hawgood, J., Woodward, A., Quinnett, P., & De Leo, D. (2021). Gatekeeper Training and Minimum Standards of Competency. Crisis (2021), 43(6), 516-522.
Stanley, B., & Brown, G. (2008). Safety Planning Guide: A Quick Guide for Clinicians. The Suicide Prevention Resource Center at the University of Oklahoma Health Sciences Center (SPRC).
Your Life Your Voice. (n.d.). Creating a Safety Plan. American Association of Suicidology.
NAMI New Hampshire. (n.d.). Your Language Matters. NAMI: National Alliance on Mental Illness.