Author: Janet McCord, PhD, FT
Published On: April 12, 2024
Every year, over 700,000 people die by suicide around the world. Over half of these deaths were of people under the age of 50, and 77% of suicide deaths happen in low- and middle-income countries. In the United States, over 48,000 people died by suicide in 2021 – one death every 11 minutes. In this same period, 12.3 million American adults thought seriously about suicide, 3.5 million made a plan, and 1.7 million attempted suicide. These are important numbers because many people think seriously about suicide, but most do not attempt or die by suicide. Suicide is, in fact, a comparatively rare cause of death.
Suicide rates differ by age, ability, race, and veteran status. Youth and young adults account for 15% of all suicides. Almost 47% of suicides occur among people between age 35 and 64 years of age. Older adults, age 75 and older, have the highest suicide rate at 20.3 per 100,000, and non-Hispanic white men aged 75 and older have the highest suicide rate at 50.1 per 100,000.
Going beyond age groups, suicide rates are higher among people who identify as lesbian, gay, or bisexual. Suicide is the 13th leading cause of death for veterans, and the second leading cause of death for veterans over age 45. Suicide is the 9th leading cause of death for people who are non-Hispanic Native Americans and Alaskan Natives. Between 2018 and 2021 suicide rates increased among non-Hispanic Native Americans, Alaskan Natives, and non-Hispanic Black people, but declined among non-Hispanic white people. You can read more about suicide rates at the Center for Disease Control: https://www.cdc.gov/suicide/facts/disparities-in-suicide.html
Many people think that the cause of suicide is depression or some other psychiatric illness. Mental health conditions remain a risk factor for suicide, but of people who have died by suicide, research shows that only half had one or more diagnosed mental health condition in the year before death. Universal screening can help healthcare providers identify those who are at risk for suicide and can initiate important and potentially lifesaving conversations.
Suicide risk factors such as prior suicide attempts, a family history of suicide, a mood disorder, history of sexual abuse, or a local cluster of suicides are important to understand. More important, however, is to recognize that every suicide is an individual event, and there are multiple pathways to suicide.
The early thinkers in the discipline of suicidology recognized there were commonalities around suicide such as intense and intolerable psychological pain – which is not the same as depression. Most suicidal people also experience profound constriction leading to either-or thinking. To that person, it feels like they will be condemned to forever feel intense pain in their minds, and killing the body seems the only way to make the pain go away. Suicide is not about death; it is about making the pain stop.
The combination of psychological pain, agitation, a sense of hopelessness, and the life pressures experienced by a person leads to a state of panic, profound helplessness, and a sense that the person must act. These feelings can be worsened by alcohol and drug use. To the person who is in suicidal crisis, suicide does not feel like a choice. It is a perfect storm.
There are a variety of things that drive this level of psychological pain that are specific to and can be described by the individual. These can include poor problem-solving or life skills, developmental factors, interpersonal factors, bullying, academic failure, the end of a close relationship, losing a job, illness, social isolation, financial problems, the conviction they are a burden on others, and more. And, sometimes psychiatric illness, especially if it is not being well managed, can be experienced as intolerably painful to an individual.
The good news is, there are four evidence-based interventions that focus on stabilization and the drivers of suicidal thinking including Dialectical Behavior Therapy (DBT), developed by Marsha Linehan, is effective for people who live with borderline personality disorder; Cognitive Therapy for Suicide Prevention (CT-SP), developed by Greg Brown and Aaron Beck; Brief Cognitive Behavior Therapy (BCBT), developed by David Rudd and Craig Bryan; and Collaborative Assessment and Management of Suicidality (CAMS), developed by David Jobes. All interventions must be delivered by specially trained clinical psychologists.
