Suicide Risk Factors

Suicide is a complex public health issue influenced by numerous interconnected factors. To understand what causes someone to want to commit suicide, one needs to examine psychological, biological, social, and environmental elements that contribute to suicidal thoughts and behaviors. Suicide risk factors are characteristics associated with an increased likelihood of suicidal behaviors. By recognizing these risk factors, it’s possible to identify those who may be more vulnerable and to provide targeted support before a crisis occurs.

What are Risk Factors?

Risk factors for suicide, or characteristics associated with an increased likelihood of suicidal behaviors, are often organized into categories such as health, environmental, and social dynamics. In contrast, protective factors are characteristics that reduce the risk of suicide. While they never guarantee safety, they can limit risks. Meanwhile, there are also warning signs of suicide, which is another important term. These are immediate indicators that someone may be at a high risk of suicide. The distinctions between factors and warning signs establish subtle differences between long-term vulnerability and immediate danger. 

While understanding these risk factors provides a foundation for prevention, alarming statistics emphasize just how widespread suicidal ideation remains in society. According to the 2023 National Survey on Drug Use and Health (NSDUH), just shy of 13 million adults in the United States had serious thoughts of suicide in the last year, 3.7 million made suicide plans, and more than 49,000 died by suicide in 2023 ^[1]. These statistics emphasize the significance of identifying risk factors early and providing appropriate interventions. 

Suicide Risk Factors

Suicide risk factors can be divided into various categories, which vary by organization. However, the Centers for Disease Control and Prevention (CDC) offers risk factors organized into four broad categories ^[2].

Individual Risk Factors

Including everything from psychological risk factors for suicide to substance use and job loss, the following personal factors can increase the likelihood of suicide:

• Substance misuse
• Previous suicide attempt
• History of mental illnesses
• Serious illness, such as chronic pain
• Legal issues, financial difficulties, or job loss
• Impulsiveness, aggressiveness, or hopelessness
• Victim or perpetrator of violence 
• Adverse childhood experiences

Community Risk Factors

The following problematic conditions and circumstances can heighten vulnerability to suicidal behavior:

• Community violence
• Inadequate access to healthcare
• Suicide cluster within the community
• Stress from adjusting to a new cultural environment
• Historical trauma
• Discrimination

Societal Risk Factors

Broader societal and environmental elements that affect social cohesion, access to resources, and overall well-being can significantly influence suicide vulnerability within populations. The following macro-level factors create conditions that may increase suicide risk across communities:

• Negative perceptions of mental health treatment
• Easy access to lethal means of suicide 
• Problematic representations of suicide in media

Relationship Risk Factors

When occurring within relationships, the following harmful experiences can increase the risk of suicidal behaviors:

• Social isolation
• Bullying
• History of suicide by a family member or loved one
• Relationship loss
• Violent or high-conflict relationships

Suicide Protective Factors

While risk factors increase vulnerability to suicide, protective factors can help buffer against these risks and promote resilience. These factors don’t guarantee safety but can significantly reduce the likelihood of suicidal behavior.

Strong and supportive relationships play a critical role in suicide prevention. People with positive connections to family, friends, community, or cultural groups tend to have lower suicide rates. These relationships provide emotional support, practical assistance, and a sense of belonging that can counteract feelings of isolation often associated with suicidal thoughts ^[2]. 

Effective coping and problem-solving skills also serve as important protective factors. People who can manage stress, regulate emotions, and develop practical solutions to life challenges are better equipped to navigate difficult circumstances without turning to suicide. These skills can be learned and strengthened through therapy and other supportive interventions.

In terms of community-related factors, access to quality mental health care is paramount. When people can readily obtain effective treatment for mental health conditions and suicidal thoughts, including both emergency services and ongoing care, their risk decreases significantly ^[3]. What’s more, cultural and religious beliefs that discourage suicide and support self-preservation can also protect against suicidal behaviors, as can restricted access to lethal means, such as firearms or large quantities of substances of misuse.

Warning Signs of Suicide

Unlike risk factors, which indicate long-term vulnerability, warning signs of suicide suggest immediate danger and require prompt attention. Recognizing these signs can save lives by enabling timely intervention. Warning signs of suicide include ^[4]:

• Verbal Signals: Verbal cues often provide direct insight into suicidal thinking. Statements like “I want to die,” “I’m a burden to others,” or “There’s no way out” should never be dismissed. Even less direct comments about having no purpose or feeling trapped warrant serious concern.  
• Behavioral Signs: Warning signs include giving away prized possessions, making a will, saying goodbye to loved ones, withdrawing from normal activities, increasing substance use, or engaging in reckless behavior. A sudden sense of calm or happiness following a period of depression can actually indicate that a person has made the decision to attempt suicide and feels relief.
• Extreme Moods: Dramatic mood swings, unexplained anger, irritability, humiliation, or anxiety may indicate elevated risk. Similarly, hopelessness, the belief that things will never improve, strongly correlates with suicidal thoughts and attempts.

Mental Health and Suicide Risk

The relationship between suicide and mental health disorders (e.g., depression, anxiety, post-traumatic stress disorder, bipolar disorder, and more) is well-documented. In fact, some research indicates that up to 90% of people who die by suicide have been diagnosed with at least one mental health condition ^[5]. Understanding this connection aids the development of effective prevention strategies.

Among mental health disorders, depression is strongly associated with suicide ideation and attempts. People with major depressive disorder experience persistent feelings of sadness, hopelessness, and worthlessness that can lead to suicidal thoughts. According to an Australian mental health study, the severity of depression correlates to the likelihood of suicidality ^[5]. Along these same lines, bipolar disorder may also be associated with suicide risk, particularly during depressive episodes or mixed states where symptoms of depression and mania occur simultaneously ^[6]. 

Schizophrenia and other psychotic disorders can also increase suicide risk through various mechanisms, including hallucinations, paranoid delusions, and cognitive distortions. In fact, one study found that people with schizophrenia were 15 times more likely to die by suicide. The same study also revealed that those with bipolar disorder were 13 times more likely to perish by suicide ^[6]. 

Substance Use and Suicide Risk

Substance use disorders are associated with a significant risk of death by suicide ^[7]. While substances can worsen underlying mental health conditions like depression or anxiety, they also impair judgment and increase impulsivity, potentially leading to suicidal behavior during intoxication. Additionally, substance use disorders often cause social, financial, and legal problems that create additional stress and hopelessness. 

The Substance Abuse and Mental Health Services Administration (SAMHSA) has researched the  percentage of suicide deaths associated with various substances ^[7]: 

• Alcohol: 22%
• Opioids: 20%
• Marijuana: 10.2%
• Cocaine: 4.6%
• Amphetamines: 3.4%

When substance use disorders co-occur with other mental health conditions, a situation known as dual diagnosis, the risk of suicide is particularly concerning. In fact, research shows that having a dual diagnosis creates a substantially higher suicide risk than having either condition alone ^[8]. 

Crisis Intervention

For many people, helping someone who is suicidal can be scary. However, recognizing and responding appropriately when someone shows warning signs of suicide may save their life. 

The 988 Suicide and Crisis Lifeline offers the following five steps to support someone experiencing suicidal thoughts:

• Ask.  “Are you thinking about suicide?” or “Are you having thoughts about ending your life?” Your job isn’t to identify what causes someone to want to commit suicide. Rather, it’s to listen without judgment, allowing the person to express their feelings fully. 
• Be there.  Stop what you’re doing and give the person your full attention by phone or in person.
• Keep them safe. Reduce access to lethal means for those at risk. If the person seems to be in crisis, call the 988 Suicide and Crisis Lifeline, or if the situation is life-threatening, call 911 or take the person to an emergency room.
• Help them connect with ongoing support. Seek out resources to offer immediate and long-term support.
• Follow up. Send a text or an email, or visit them in person, to let them know they’re not alone.

Once the crisis has passed, reach out for support from others and consider joining a support group for friends and family of those experiencing suicidal thoughts.

Treatment for Suicidal Ideation

Effective treatment for suicidal ideation often begins with a thorough assessment by a qualified mental health professional. This evaluation helps identify specific risk factors, co-occurring conditions, and appropriate treatment options. Based on this assessment, mental health professionals can develop a personalized treatment plan, which may include various therapeutic approaches. 

Psychotherapy plays a central role in treating suicidal ideation. Among therapy options, cognitive behavioral therapy (CBT) helps people identify and change negative thought patterns contributing to suicidal thinking. Meanwhile, dialectical behavior therapy (DBT) teaches skills for emotional regulation, distress tolerance, and interpersonal effectiveness. 

For some, medication may be prescribed to address underlying mental health conditions such as depression, bipolar disorder, or anxiety. Antidepressants, mood stabilizers, and antipsychotics can help reduce symptoms that contribute to suicidal thoughts. However, medication typically works best when combined with psychotherapy rather than used alone. 

Whatever the course of care, ongoing support is critical. This includes regular follow-up appointments, crisis planning, and connection to community resources. In particular, family involvement, when appropriate, can strengthen recovery by improving understanding and communication, and support groups offer validation and practical coping strategies from others with similar experiences. With comprehensive treatment and support, many people can overcome suicidal thoughts and develop a renewed sense of hope and purpose.

Healing and Support

Understanding suicide and its risk factors, warning signs, and protective factors provides a foundation for effective prevention and intervention. While the statistics on suicide may seem alarming, prevention efforts do work, and help is available.

Research consistently shows that most people who experience suicidal thoughts do not go on to die by suicide, especially when they receive appropriate support and treatment. In fact, many people who have attempted suicide report feeling grateful to have survived and go on to build meaningful lives. 

If you or someone you know is experiencing thoughts of suicide, reach out immediately for help. Call or text 988 to reach the 988 Suicide and Crisis Lifeline, which provides free, confidential support 24 hours a day, 7 days a week. Trained counselors can provide immediate assistance, emotional support, and connections to local resources. Remember: You are not alone. Hope and help are within reach.