Suicide and suicide attempts are serious public health problems and issues of societal concern. Rates of suicide have been on the rise for more than a decade and the costs stretch well into the billions of dollars each year. While suicide is a rare outcome statistically, it has a far-reaching effect. Each of us likely interacts with suicide survivors and with those who think of suicide on a daily basis—at home, at work, and in our communities.
Suicide rates are highest among American Indian, Alaska Native, and White populations, consistent with national rates. However, these broad categorizations can mask lower or higher rates in certain subgroups.
As a healthcare professional, it isn’t easy to ask a patient about suicide. How you structure the interview and how you assess safety, lethality, and intent is important. Asking about and reducing a person’s access to lethal means can prevent a suicide.
Healthcare providers can be more effective understanding suicide warning signs and recognizing when a person is at imminent risk for self-harm. Understand that your patient may feel ashamed and stigmatized and may be reluctant to ask for help. Educating yourself about risk factors and the lethal objects that are commonly used in suicide attempts can help you identify when someone is at risk.
Because risk occurs on a continuum, assessment, management, and referrals are different for each situation. A number of barriers have affected our ability to reduce suicide in the U.S., including stigma, lack of access to mental illness treatment, and fear of discussing suicidal thoughts. Fortunately, suicide is preventable, and there has been some success with prevention programs, education, community support programs, and mental health management.
Pharmacologic treatment can include medications, addressing substance use disorders, and developing and monitoring a safety plan. Pharmacologic treatment may be helpful in managing underlying mental disorders and the danger of repeated or more dangerous self-directed violence.
Peer support, community engagement and intervention programs, and tribal programs have had success in addressing and reducing the impact of suicide in our communities. Within these programs, as well as the larger medical community, continuity of care has proven to be a critical component of suicide prevention programs.
Military personnel and veterans are at higher risk than the general population for suicidal ideation and suicide. Research has indicated that safe storage of guns, addressing depression and PTSD, and encouraging participation in health-promoting behaviors can reduce suicide in this populations.
Finally, the Veterans Crisis Line and the newly launched 988 Crisis Line provide critical support for people experiencing a psychological crisis that might lead to suicide.