Suicide claims about 50,000 lives each year in the United States, nearly double the homicide rate. According to the most recent full-year statistics from the U.S. Centers for Disease Control and Prevention, another 2.2 million people attempted suicide in 2024, 14.3 million adults seriously thought about suicide, and 4.6 million planned a suicide attempt. Worldwide, approximately 720,000 people take their own life each year.
For the past 18 years, September has been Suicide Prevention Awareness Month in the
U.S., coinciding with World Suicide Prevention Day on September 10. It’s a time to educate people and draw attention to the crisis. As in many mental health issues, the community plays a significant role in prevention — in this case by recognizing suicide risk factors, those characteristics of a person or the environment that increase the likelihood that a person will take his or her own life.
Risk factors may include prior suicide attempts, mental disorders such as depression, social isolation, chronic disease and disability, misuse or abuse of drugs or alcohol, access to lethal means of taking one’s life, knowing someone who died by suicide, as well as lack of access to behavioral or mental health care.
Here on the North Shore, we’re extremely fortunate to have many avenues to find help, including MCC and other area mental health professionals, the National 988 Suicide Hotline and local 911 professionals — even a dedicated mental health counselor at the Marblehead Police
Department.
Unfortunately, even though we may recognize many factors as indicators of suicide, a common refrain among friends and family of those who die by or attempt suicide, is “I didn’t know.” In fact, about half of people who commit suicide have no documented or diagnosed psychiatric risk factors, and that’s leading researchers around the world to investigate new ways of identifying and helping potential suicides.
Uncovering hidden risk
One key question for researchers is whether a suicide has simply not been diagnosed yet as being ‘at risk’. Dr. Hillary Coon of The Utah Suicide Mortality Research Study analyzed genetic data from 2,700 people who died by suicide and found that people in this group of ‘unexpected suicides’ have underlying risk factors that may be fundamentally different than others. Her research found that people who die by suicide without prior non-fatal suicidal thoughts or behaviors have fewer psychiatric diagnoses and fewer underlying genetic risk factors for psychiatric conditions, such as depressive disorder, anxiety, Alzheimer’s disease and PTSD, as compared to people who had shown these warning signs before dying by suicide. The data also suggests this ‘unexpected suicide’ group is no more likely than the general population to have milder conditions, such as depressed mood and neuroticism.
Coon emphasizes that no single gene or gene combination causes suicide, and that individual genetic risk factors related to suicide seem to have a very small effect on risk. Her team believes environmental and societal contexts are crucial contributors to suicide, and that the interplay between environment and underlying biology will be essential to discovering who’s at risk going forward. The group is also investigating the ways in which physical disorders, such as inflammation and respiratory conditions may affect suicide risk.
The biological link
Researchers are increasingly looking to our physical health as a factor in suicide. A recent meta-analysis of research in the “Annals of General Psychiatry, Inflammatory Markers and Suicidal Behavior” suggests that inflammation and its effects on the complex neurobiological processes of the immune, endocrine and nervous systems may hold clues into suicide.
Researchers have found that chronic inflammation may be a key driver of changes in the brain, especially in the areas involved in emotion regulation, impulse control and response to stress. Inflammation seems to divert the amino acid tryptophan away from the synthesization of serotonin, which is critical for mood stability. This shift not only affects serotonin, it leads to the production of neurotoxins and neuroinflammation. Researchers think this may contribute to the
development of depressive symptoms and impulsivity — both of which are linked closely
to suicide.
Chronic physical pain may also be a risk factor for suicide, particularly when chronic pain sufferers feel there is no hope of a reprieve, according to a recent study in the “European Journal of Pain.” In a 12-month study of 340 participants suffering with chronic pain, researchers found an increase of suicidal thoughts over the course of the year, especially when coupled with depression. Researchers say that ‘mental defeat’ should be considered a potential risk factor for suicidal thoughts and behaviors in populations with chronic pain.
Social influences
Exposure to others who have committed suicide, sometimes called “contagion,” can also
have an enormous impact on suicide rates, particularly among young people. In a recent multi-year study of more than 2,000 13–22 year olds with no previous history of suicide attempts, researchers found those exposed to a suicide attempt were significantly more likely to attempt suicide themselves in the two years following exposure. They were also more likely to develop more severe symptoms of depression, confirming existing research into suicide and young people. When researchers controlled for depressive symptoms, participants still had a higher risk of attempting suicide.
Interestingly, in a study out this month by the Utah Department of Health and Human Services about the causes of teen suicide, mental illness was not as big a factor as expected. The study found that childhood maltreatment was a far more common cause of suicide, including physical abuse, sexual abuse and emotional abuse. Almost 80% of youth respondents had experienced at least one form of child maltreatment, and 15% had experienced all three. Risk factors also included heavy use of alcohol and drugs, with about 40-45% using alcohol or marijuana at levels researchers described as “problematic” to self-medicate their trauma, depression, anxiety or loneliness and not for recreational use.
The study also found one of the highest risk factors for teens was relationship status. About half of those in the study were in a romantic relationship at the time of or leading up to the time they died by suicide, with two-thirds of those relationships on the verge of breaking up or having just ended.
In a small study of 79 adults with recent suicidal thoughts, researchers looked at how late-night phone use affected thoughts of suicide. Those using phones from 11 p.m. to 1 a.m. had an associated higher next-day suicide risk, whereas keyboard based activity during the middle of the night, from approximately 1-5 a.m., had lower risk. Though a tiny sample, these findings align with growing concerns that the late-night hours prior to bedtime may represent a critical risk window, potentially due to reduced social support, increased cognitive rumination or exposure to distressing content.
Researching biomarkers for clues
Researchers trying to identify objective, reliable factors that indicate risk of suicide are also analyzing and comparing postmortem suicide cases to other deaths in search of answers. Scientists at the University of Pittsburgh Medical Center recently examined hair cortisol as an objective marker of risk for suicidal behavior. They found that hair cortisol concentrations were significantly lower in those who died by suicide, compared with those with suicide attempts, suicidal ideation, and those with psychiatric disorders but no current history of suicidal ideation and behavior. They also found those who died by suicide to have lower hair cortisol concentrations compared to accidental deaths.
At the Netherlands Institute for Neuroscience, researchers have identified a possible biological marker linked to severe suicidal thoughts. They hope the finding may help explain why some people recover from these thoughts, opening a new path for research into resilience and suicide prevention. And researchers at the National Institute of Mental Health have been comparing the genetic markers of 120 people given the drug citalopram for treatment of depression who experienced treatment-emergent suicidal ideation with the markers of 1,700 patients who received the same treatment but did not experience these symptoms.
As researchers and organizations continue to work on understanding the science of suicide, it’s heartening to know that the most significant ways to help are within our reach. Make sure your loved ones have access to mental health services, and normalize their use. Stay connected to individuals, family, community and social institutions, and help others remain in those loops, too. Teach your kids life skills, including problem solving and coping skills. Model the ability to adapt to change.
Refresh your own coping skills in these areas if needed. Help your loved ones find a purpose in life and make sure they know they are valued. Connect to cultural, religious or community groups that promote self esteem and discourage suicide.
For more information about suicide Prevention, please check out the links below. If you or someone you know is in a mental health crisis, call the Suicide Prevention Hotline at
988, 24 hours a day, seven days a week.
Other resources:
— There is also the Trevor Project’s 24/7 Suicide Hotline for Lesbian, Gay and Bisexual Youth: Call 1-866-488-7386 or text START to 678-678.
— Disaster Distress Helpline: Call or text 1-800-985-5990.
— Veteran’s Crisis Line: 988, then select 1, or Crisis Chat, or text: 838255
Gregg Mulford is LMHC clinical director at Marblehead Counseling Center. He is a licensed mental health counselor, and has specialized in both short and long-term therapy for a wide range of life challenges including anxiety, depression, addictions and trauma. He has more than 30 years of experience working with individuals, couples and families in outpatient, inpatient and crisis settings.
Pamela Wheaton Shorr is a board member of Marblehead Counseling Center and a former print journalist.
