How to Spot the Potential Warning Signs of Suicide

Despite growing public attention and efforts to curb the country’s suicide rate, the statistics are sobering: Suicide is the 11th-leading cause of death in the United States, according to the Centers for Disease Control. In 2023, more than 49,000 people died by suicide in the U.S., compared to about 29,000 in 2000. The same year, it was the second leading cause of death for individuals ages 10 to 34 years.

“The increase in suicide rates over the past 25 years is driven by many factors, and many people are reluctant to seek help in part because there is still a lot of stigma around the issue,” says Dr. J. John Mann, a psychiatrist at NewYork-Presbyterian/Columbia University Irving Medical Center. “If someone is experiencing depressive or suicidal thoughts, they should immediately seek help from a mental health provider.”

Public awareness of suicide risk, as well as the availability of effective treatment, increases the likelihood that people experiencing suicidal ideation will get better, explains Dr. Mann.

“I want people to understand that depression is fixable,” says Dr. Mann. “Many people become convinced that their suicidal thoughts will never go away — but you can get better with the right help.”

How do you know if someone you love is considering taking their life? And is there a way to help? Health Matters spoke with Dr. Mann to better understand what may drive someone to take their life, and potential warning signs of suicide.

Why do you think the suicide rate is rising?
Dr. Mann: The suicide rate is rising because of many factors, and we don’t know all of them. Prevention requires people reporting when they are experiencing suicidal thoughts. The incidence of adolescent depression has been on the rise, and new research has shown that there is a link between addictive screen use and suicidal behavior in youths. Financial concerns are also a more ubiquitous stressor for people.

Who is most at risk?
As of 2023, individuals aged 85 and older experienced the highest rates of suicide, followed by individuals aged 75 to 84. The rates were also highest in white, Native Hawaiian/Pacific Islander, and American Indian/Alaska Native groups. Across both age groups and racial groups, suicide rates are disproportionately higher among men.

Socioeconomic and educational status also play a role, as well as access to health care. Suicide is highest in people with existing mental and psychiatric disorders. We believe that there is a genetic component to suicide risk, and we know from studies that suicide can run in families.

What could trigger suicide?
Any kind of loss or interpersonal conflict is potentially a trigger for thinking about ending one’s life. It’s important to note that there is no absolute scale for loss. You can’t judge the meaning or impact of a loss to an individual. What one person may think of as just a part of life, another person may find devastating.

What are some warning signs that someone is suicidal?

• A change in someone’s mood or behavior, particularly along depressive and anxious lines, or isolating themselves. This can come across as either a sad mood, a feeling of disconnection, or social withdrawal. People at risk for suicide may isolate themselves. They may be quieter or not enjoy things the way they used to.
• Any statements that express a sense of hopelessness, helplessness, or worthlessness are evidence the individual may be becoming depressed. People may make a direct or indirect comment about suicide. Often, they may use statements like “I can’t take this anymore,” “I’m at the end of my rope,” “I’m a burden,” “You’re better off without me,” or “Not sure how much longer I can go on.”
• Changes in intake of alcohol or use of illicit drugs.
• Signs of intense agitation, anxiety, or feelings of tremendous inner pain. This is a warning sign for suicide because it is hard to tolerate such feelings.

What do you do if you see these warning signs for suicide?
The first step is to consider the possibility that suicide is among the potential outcomes of the situation and to listen very carefully. People may deny that they or a loved one could be considering suicide because it’s too painful a thought. 

It’s OK to come out and ask, “Are you feeling suicidal?” A common misconception is that speaking directly about suicide will lead a person to make an attempt, but that is not true. In fact, a conversation about suicide may actually decrease suicidal ideation and increase the likelihood that someone will seek help. It’s not going to put the idea in their head if it wasn’t there before.

Some may  be embarrassed because of the stigma associated with mental illnesses and suicide. Sometimes, it’s better to ease into the question by using terms that are less charged, like “Are you feeling overwhelmed?” or “Are you feeling that you can’t go on?” The idea is to normalize the experience and show that it’s understandable for someone who has gone through something difficult to have these thoughts.

What else can someone do to help if they suspect someone is considering taking their life or see a potential warning sign of suicide?
It’s OK to come out and ask “Are you feeling suicidal?” It’s not going to put the idea in their head if it wasn’t there before. Some may say they don’t have suicidal thoughts because it may be too painful to admit or it may be embarrassing because of the stigma associated with mental illnesses and suicide. Sometimes, it’s better to ease into the question by using terms that are less charged, like “Are you feeling overwhelmed?,” “Are you feeling that you can’t go on?,” or “Are you feeling at the end of your rope?” The idea is to normalize the experience and show that it’s understandable for someone who has gone through something difficult to have these thoughts.

What else is important to know?
The best thing you can do is try to get that person into treatment. It may range from providing a suicide hotline number to actually calling the police and an ambulance to bring them to the emergency room, depending on the acuity of the circumstance.

Getting someone professional help is critical. You don’t want to be in a situation where you are the lifeline for another human being. That is fraught with danger for that person and for you.

What if someone has ongoing feelings of suicide?
In addition to treatment, it’s important to create a safety plan.

A safety plan should be a very clear, and preferably written, point-by-point plan of what a person will do if they feel suicidal. This is hopefully done in the context of treatment, but it’s important for the family to be aware of it whenever possible. The plan can include anything from providing a suicide hotline number to engaging in coping mechanisms they’ve learned as part of therapy, going to an ER, or calling a therapist, friend, or parent. Having a list of activities and steps that they are going to take before they act or harm themselves is useful and important.

We should have the expectation that they’re going to feel this way again and help them anticipate the circumstances under which these thoughts or feelings are likely to emerge.

Is suicide an impulsive act?
Yes and no. Some people think about suicide for a very long time, plan carefully, and basically make a decision that they feel is rational, although others would not agree, that their life is just not worth living. Their decision to act on these feelings, thoughts, and plans can ultimately be quite sudden. After contemplating suicide for weeks or months, a person can decide in minutes that this is the moment to act. Others may be more impulsive, and the suicidal act may come with little or no planning or preparation. In general, the decision to act comes at a moment of heightened emotion, in particular heightened emotional pain also known as psychic angst — a pain in your being that just feels unbearable in the moment and may push someone to act.

Can you predict who will take their life?
Although most people who die by suicide have a psychiatric illness, we cannot predict who is going to die by suicide. Most people who report thoughts of suicide don’t take their lives. There are many risk factors, but there is a lack of specificity in those risk factors. Many people who are depressed or go through periods of hopelessness never attempt suicide. For statistical reasons having to do with the relative infrequency of suicide and insufficient specificity of any risk factor or group of risk factors related to suicidal behavior, it is difficult to predict who will die by suicide.

 We look for triggers and warning signs that have been associated with suicide risk in vulnerable individuals because it makes common sense to do so and can save lives. But in the end, we don’t know what is in the mind of that person who ultimately decides to take their own life.

Is there still a stigma around mental illness and suicide?
I think it’s getting better very slowly, but it is still a huge problem. Efforts of organizations like the National Alliance on Mental Illness are making an impact, and public figures coming out and sharing their mental health struggles helps too. But I think that the stigma remains a problem, particularly in some communities more than others. When there are cultural prohibitions or consequences to having a mental illness or getting treated for one, it makes it that much more difficult to access care.

How can people who have lost someone to suicide cope?
Be aware of your feelings and understand and accept the fact that you are going to have very strong feelings about what happened. That’s normal and appropriate, and you will need support, and that may include joining support groups or getting into therapy.

There is no constructive role for guilt or self-blame — there has already been one casualty, and we need not create any more. Feelings of guilt, loss, anger, and, of course, tremendous sadness are all natural feelings that can be dealt with and understood in the context of the circumstance.