Suicide continues to be a significant global public health issue. According to the World Health Organization, suicide claims more than 700,000 lives annually and impacts many more people through non-fatal attempts.
To understand why suicide occurs, it is essential to examine the individual, social and systemic determinants that contribute to it. This knowledge is crucial for developing evidence-based, research-informed prevention strategies.
Suicide doesn’t end the chances of life getting worse; it eliminates the possibility of it ever getting any better.” – Unknown
Mental Health Disorders and Suicide
One of the most significant individual-level risk factors for suicide is the presence of mental health disorders, such as:
- Depression
- Anxiety
- Post-traumatic stress disorder (PTSD)
- Bipolar disorder
- Schizophrenia
- Substance use disorders
A majority of individuals who die by suicide have a diagnosable psychiatric condition. Major depressive disorder is strongly associated with suicidal ideation and behavior in general, and psychiatric disorders are strong predictors of suicidal behavior.
How Adverse Childhood Experiences Affect Suicide Risk
Also, adverse childhood experiences (ACEs) have been linked to an elevated risk of suicide across the human lifespan. In fact, individuals exposed to ACEs are significantly more likely to experience mental health disorders that are well-established precursors to suicidal behavior.
Also, early-life adversity has an impact on later-life suicidality. A study found that individuals with four or more ACEs were found to be over 12 times more likely to attempt suicide compared to those with no ACEs.
Further studies on ACEs and adult mental health have demonstrated that ACEs contribute to the development of psychiatric disorders that predispose individuals to suicidal thoughts and behaviors. Exposure to ACEs has been associated with changes in brain structures such as the hippocampus and amygdala.
These areas of the brain are involved in emotional regulation and stress response. Changes to these parts of the brain may predispose individuals to emotional dysregulation and an increased vulnerability to suicide.
Social Isolation and Social Support
Social isolation is another significant risk factor for suicide, particularly among older adults. For example, social isolation, characterized by limited social interactions and support, is associated with increased suicide risk. Social isolation also contributes to feelings of loneliness and depression, which can elevate suicide risk among older adults.
Lack of social support is another critical determinant of suicide risk. Individuals with low levels of social support are more likely to experience suicidal thoughts and behaviors. Conversely, high social support significantly reduces the risk of suicidal ideation, plans and attempts.
Furthermore, the risk of suicide increases with the severity of depressive symptoms and decreased as social support – particularly from family –increased.
Stress and Suicide Risk
Unemployment, financial hardship and job insecurity are stressors that contribute to individuals wanting to commit suicide, particularly during economic downturns. According to a study published by the British medical journal The Lancet, increases in suicide rates follow economic recessions since stressors exacerbate feelings of hopelessness and reduce self-worth. Workplace stressors have also been linked to suicidal outcomes.
Restricting Access to Dangerous Products and Suicide Prevention
According to the National Action Alliance for Suicide Prevention, access to firearms, pesticides and other lethal means greatly increases the likelihood of fatal suicide attempts. However, restricting access to such products can significantly reduce suicide rates.
Means restriction is one of the most effective public health strategies to reduce suicide deaths. Interventions targeting access to common, highly lethal methods of committing suicide resulted in significant declines in suicide rates. These methods include:
- Firearms
- Pesticides
- Toxic gas
- Bridges
Restricting access to firearms can be a particularly useful form of suicide prevention. According to researchers, the presence of firearms in a home increases suicide risk by approximately three to five times. Higher state-level firearm ownership rates are consistently correlated with increased firearm and overall suicide rates.
What Prevents People from Seeking Help?
Cultural stigma around mental illness and help-seeking can discourage individuals from accessing support services. Also, societal attitudes toward gender roles can influence suicide patterns as well. Men, for example, often die by suicide at higher rates, partly due to societal expectations regarding masculinity and emotional expression.
Certain cultural life events, such as minority stress and family conflict, predict suicidal ideation and attempts both directly and indirectly via depression, hopelessness, and idioms of distress. Also, cultural sanctions can moderate stress-suicidality links.
For instance, a large-scale study of older Japanese adults showed that perceiving restrictive community gender norms was associated with:
- Increased depressive symptoms
- Suicidal ideation
- Suicide attempts
- Reduced help‑seeking for both men and women
Generally, culture shapes the symbolic meaning of suicide. In different societies or subcultures, suicide is perceived as dishonorable, rational or even heroic.
Suicide Risk and Prevention Strategies
Effective suicide prevention requires a public health strategy that integrates individual-level clinical risk factors with the social, economic, and commercial determinants of suicide to guide interventions across universal, selective, and indicated levels.
Universal interventions target an entire population, regardless of individual risk, to create environments that reduce suicide risk and promote mental well-being. Universal interventions include:
- Legislated means restriction – Policies that reduce access to highly lethal means of committing suicide, such as firearm safety laws, restrictions on toxic pesticides and bridge barriers, are among the most evidence-based suicide prevention measures.
- Poverty-alleviation policies – Economic stability programs, including unemployment support, housing assistance and living wage policies, reduce the social determinants of distress that contribute to suicide risk.
- Stigma reduction campaigns – Public awareness efforts, such as anti-stigma media campaigns and national mental health education programs, can be highly effective. They normalize help-seeking behavior, reduce shame, and encourage early intervention.
Selective interventions can focus on groups known to be at higher-than-average risk but not yet displaying acute warning signs. These interventions may include strategies such as:
- Gatekeeper training – Community leaders, educators, clergy, first responders, and other frontline workers can be trained to recognize warning signs of suicide, engage at-risk individuals in supportive conversations, and connect them to care. Programs such as QPR (Question, Persuade, Refer) and ASIST (Applied Suicide Intervention Skills Training) are some popular examples.
- Community-based outreach – Efforts tailored to high-risk groups (such as veterans, LGBTQ+ youth, Indigenous populations or rural residents) can build trusted networks of support where formal healthcare may be limited.
Indicated intervention strategies are useful for individuals who are already at an elevated risk or imminent risk of suicide. These intervention strategies include:
- Health system-based screening – Routine suicide risk screening in primary care, emergency departments and behavioral health settings helps identify individuals who might otherwise go unnoticed.
- Follow-up and safety planning – Evidence-based practices such as developing individualized safety plans, proactive caring contacts (phone calls, texts, or letters following a crisis), and structured follow-up after emergency visits reduce the likelihood of repeat suicide attempts.
- Comprehensive mental health treatment – Access to timely, evidence-based therapies such as Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP), Dialectical Behavior Therapy (DBT) and appropriate drug interventions can directly reduce suicidal ideation and behaviors.
Suicide remains an ongoing problem in many societies around the world. However, using a multilevel approach can prevent pathways to suicidal crises, support those individuals in distress, and strengthen protective social and policy environments.
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