Suicide is the 11th leading cause of death in the United States, taking the lives of more than 32,000 Americans every year. To better understand the scope of this public health concern, consider these facts:

• Nearly 4 times as many men as women die by suicide; women report attempting suicide during their lifetime about 3 times as often as men.¹
• Men in the middle years of life (25-54) bear the largest public health burden due to suicide, in terms of potential years of life lost or potential earnings lost.²
• Suicide is the third leading cause of death among 10- to 24-year olds.³ Every day, 10 young people between the ages of 15 and 24 die by suicide.⁴
• Among males, adults ages 75 years and older have the highest rate of suicide (rate 37.97 per 100,000 population).⁵
• Among females, those in their 40s and 50s have the highest rate of suicide (rate 7.53 per 100,000 population).⁶
• For every individual who dies by suicide, many others are affected—family, friends and co-workers. Estimates indicate that each suicide intimately affects at least 6 other people. At least 4.5 million Americans (or 1 of every 65 Americans) are survivors of a loved one's suicide.⁷

It is difficult to know exactly why an individual may attempt suicide. We do know that those who attempt suicide do so because they cannot see or feel a change in circumstances—depression won’t lift, stressors won’t end. For others, an impulsive act results in death.

Suicide can be prevented when we understand the nature of suicide and suicide risk factors, and intervene early.

Risk factors
While adverse life events in combination with other risk factors such as depression may lead to suicide, it is important to keep in mind that suicide and suicidal behavior are not normal responses to stress. Many people experience 1 or more risk factors and are not suicidal.

Understanding risk factors can help dispel the myths that suicide is a random act or results from stress or depression alone. Suicide is a continuum event, not a “yes”/”no” event. Some persons are particularly vulnerable to suicide and suicidal self-injury because they have more than 1 mental disorder such as depression with alcohol abuse, may be very impulsive and/or aggressive, and use highly lethal methods to attempt suicide. The importance of certain risk factors and their combination vary by age, gender and ethnicity.

The impact of some risk factors can be reduced by interventions such as providing effective treatments for depressive illness. Those risk factors that cannot be changed, for example, a previous suicide attempt can alert others to the heightened risk of suicide during periods when a mental or substance abuse disorder recurs or following a significantly stressful life event. Risk factors include:

• previous suicide attempt
• mental disorders—particularly mood disorders such as depression (including postpartum depression) and bipolar disorder
• co-occurring mental and alcohol and substance abuse disorders
• family history of suicide
• hopelessness
• impulsive and/or aggressive tendencies
• barriers to accessing mental health treatment
• relational, social, work or financial loss
• physical illness
• easy access to lethal methods, especially guns (particularly true among certain job professions)
• unwillingness to seek help because of stigma attached to mental and substance abuse disorders and/or suicidal thoughts
• influence of significant people—family members, celebrities, peers who have died by suicide—both through direct personal contact or inappropriate media representations
• cultural and religious beliefs—many cultures and religions hold differing views of suicide, for instance, the belief that suicide is a noble resolution of a personal dilemma or an appropriate response to an act that has perhaps caused family shame or disappointment
• local epidemics of suicide that have a contagious influence
• isolation, a feeling of being cut off from other people

Protective factors
Protective factors can include an individual’s genetic or neurobiological makeup, attitudinal and behavioral characteristics, and environmental attributes. Measures that enhance resilience or protective factors are as essential as risk reduction in preventing suicide. Positive resistance to suicide is not permanent, so programs that support and maintain protection against suicide should be ongoing. Protective factors include:

• effective and appropriate clinical care for mental, physical, and substance abuse disorders
• easy access to a variety of clinical interventions and support for help seeking
• restricted access to highly lethal methods of suicide
• family and community support
• support from ongoing medical and mental health care relationships
• learned skills in problem solving, conflict resolution, and nonviolent handling of disputes
• cultural and religious beliefs that discourage suicide and support self-preservation instincts

Identifying and addressing risk
Unfortunately, it is difficult to identify particular individuals at greatest risk for suicidal behaviors or completed suicide. Measures to screen the general population for suicide risk lack the precision needed to identify in advance only those people who eventually would die by suicide. That’s why it is especially important for suicide prevention programs to include broader approaches that benefit the whole population as well as efforts focused on smaller, high-risk subgroups that can be identified. Within those subgroups, a different approach to screening—screening programs for specific risk factors, like depression or difficulty managing stress, that are associated with suicide—can be used to identify and direct people to highly effective treatments that may lower their risk of suicide. Also, since these risk factors are not exclusively associated with suicide, but represent conditions of vulnerability for a variety of behavioral and physical problems, an educational campaign can have a broad reach in getting people who need help of some kind to seek it.

Current suicide prevention efforts across the nation are directed primarily at improving clinical care for the individual struggling with suicidal ideas or the individual requiring medical attention for a suicide attempt. In the following section, “Helping Individuals,” we’ve outlined how ValueOptions^® is serving these vulnerable individuals.

Suicide prevention also demands approaches that reduce the likelihood of suicide before vulnerable individuals reach the point of danger. And it’s important to note that many individuals who attempt or die by suicide never seek help. ValueOptions^® would like to work with you to help identify those at risk, reduce modifiable risk factors and enhance protective factors within your employee population. The sections “Building Organizational Support” and “Creating a Communication Strategy” describe these initiatives.

¹Centers for Disease Control and prevention, www.cdc.gov/ViolencePrevention/pdf/Suicide-DataSheet-a.pdf
²”Preventing Suicide, Attempted Suicide, and Their Antecedents Among Men in the Middle Years of Life (Ages 25-54 Years),” Executive Summary of a Scientific Consensus Conference developed by the UR Center for the Study and Prevention of Suicide, 11-12 June 2003, Washington, D.C., www.sprc.org/library/middle_years.pdf
³National Institute of Mental Health
⁴Centers for Disease Control and Prevention
⁵Centers for Disease Control and prevention, www.cdc.gov/ViolencePrevention/pdf/Suicide-DataSheet-a.pdf
⁶Centers for Disease Control and prevention, www.cdc.gov/ViolencePrevention/pdf/Suicide-DataSheet-a.pdf
⁷The American Association of Suicidology