The Facts about Suicide in America
September is National Suicide Prevention Month, a designation made in 2008 to help raise awareness and acknowledge those who have been impacted by suicide and help honor those who have been lost. Since its inception, suicide rates in the United States have hovered between 10 and 14 per 100,000 residents, reaching 14.21 per 100,000 residents by 2022, the highest rate since World War II. That rate increased again in 2023. There are roughly twice as many suicides in America every year than there are homicides.
Despite efforts to raise awareness and increase access to mental healthcare and support services, the United States has been grappling with suicide as a public health issue for decades, with some successes. The rate of suicide among those under 35 has declined since 2010, while it has increased for those over 35. The rate of suicide for Indigenous People and Alaskan Natives has declined, while remaining the highest of any racial group in the country. The risk of death by suicide appears to be decreasing for males, while that risk has increased for females.
Research suggests that suicidal ideation, or thoughts about death and self-harm, are a fairly common experience at some point over the life span. Passive suicidal ideation refers to thoughts of death or self-injury that are vague and do not include a clearly formed plan. Active suicidal ideation refers to the same thoughts with a defined plan or designated method. Acute suicidal ideation encompasses thoughts, a plan, and immediate access to means. It often precedes a deliberate act of self-harm that has lethal intent.
One 2016 study of individuals seeking medical care at an emergency clinic following a suicide attempt found that time between the onset of acute suicidal ideation and an act of self-harm ranged from five to 200 minutes, with a median time of only 30 minutes (Kattimani, Sarkar, Menon, Muthuramalingam, & Nancy). Another study found that approximately half of all clients referred to an emergency psychiatric facility following a suicide attempt reported only 10 minutes between onset of acute suicidal ideation and the self-harming behavior (Deisenhammer, Ing, Strauss, Kemmler, Hinterhuber, & Weiss, 2009). This is an extremely brief window of opportunity to avert lethal harm.
Many suicide prevention efforts focus on identifying the onset of active suicidal ideation and intervening prior to an act of self-harm or an attempt. Deisenhammer et al. (2009) found that just over half of those admitted for treatment after an attempt had contact with a mental health professional in the immediate weeks prior. This suggests that intervening at the active phase may have some prevention benefits. It is the acute phase where we are still struggling to save lives.
If someone expresses an immediate intent to self-harm, take it seriously. With an intervention window of only five to 30 minutes on average, do not leave a person who is experiencing acute suicidal ideation alone with those thoughts. If you are physically present, keep them within sight and hearing. Talk to them calmly. Do not touch them without permission or consent. If they agree to go to a hospital or mental health emergency clinic, try to avoid transporting them yourself, especially if there is no one else available to help supervise them during the car ride. If necessary, call 911 and ask for a mental health transport to the nearest facility with psychiatric and mental health services. Do not call the therapist or psychiatrist who has been treating the person until after the acute state has passed. Most treatment professionals in private practice are not equipped to provide emergency intervention services in an acute crisis.
If you are feeling uncertain or overwhelmed by the situation, call or text 988, the national Suicide and Crisis Lifeline. They are equipped to offer intervention to both the person experiencing acute suicidal ideation and the people who are supporting them. If you are the only person available to offer support, then the lifeline staff can provide crisis intervention services while you handle the logistics of getting your loved one to a safe and secure environment where they can be evaluated and treated. Even if you have already called 911 and transport is on the way, 988 staff are available to offer care.
If you learn that a family member, friend, or loved one is experiencing suicidal ideation, talking to them directly and calmly about what they are thinking and planning is important. Vocalizing the thoughts and ideation will often be a relief for the person who is experiencing them. Talking about it can sometime diffuse the impulse to self-harm, but further evaluation and care is necessary. Sitting with the person until they are through the crisis is sufficient in the moment, but it does not address or prevent the next crisis, which may come when that person is alone and without any support.
Blocking or diverting access to certain instruments of self-harm appears vital to saving lives. In 2022, just over half of all suicides in the United States involved the use of a firearm, and men are more likely to utilize guns. Ingesting poison or a lethal dose of medication was the third most common method and was often the dominant mode used by females. During an episode of acute suicidal ideation, access to a firearm or potentially lethal substance is highly correlated with a fatal outcome. Properly securing these high-risk items may provide the deterrent effect to keep acute ideation from progressing to a fatality, but this is only a temporary diversion. Experiencing one episode of acute suicidal ideation is a strong predictor of a future acute episode. When the immediate crisis has passed, the work to prevent and cope with the next one needs to begin or continue under the care of a qualified healthcare team.
Deisenhammer, E.A.; Ing, C.M.; Strauss, R.; Kemmler, G.; Hinterhuber ,H. and Weiss, E.M. (2009). The duration of the suicidal process: How much time is left for intervention between consideration and accomplishment of a suicide attempt? Journal of Clinical Psychiatry, 70 (1): 19-24.
Kattimani, S.; Sarkar, S.; Menon, V.; Muthuramalingam, A. and Nancy, P. (2016). Duration of suicide process among suicide attempters and characteristics of those providing window of opportunity for intervention. Journal of Neuroscientific Rural Practice, 7(4), 566-570.
Written by Deanna Diamond, LPC
