Suicide and Mental Health

In some cases, untreated mental health diagnoses can lead to suicide. This is the greatest risk of all, therefore, please take this advice seriously:

IF YOU OR SOMEONE YOU LOVE IS IN IMMINENT DANGER/AT IMMINENT RISK OF HARM, PLEASE CALL 911 OR GO TO A HOSPITAL EMERGENCY ROOM IMMEDIATELY.

IF YOU OR SOMEONE YOU LOVE IS IN CRISIS BUT NOT IMMEDIATE DANGER/RISK OF HARM, CALL 988 FOR THE NATIONAL MENTAL HEALTH EMERGENCY LINE.

Suicide and Mental Health

When an individual receives a diagnosis for a mental health disorder, they typically engage in treatment in order to reduce the negative consequences associated with that disorder. In most cases, the negative consequences are directly related to the severity of the symptoms.

The symptoms of mental health disorders range from mild to severe.

Mild symptoms are uncomfortable and difficult to manage, but people can learn to manage those symptoms with the right support: think once or twice a week outpatient sessions. Moderate symptoms create more challenges, but people can also learn to manage those with the right level of support: think twice-a-week outpatient sessions, or possibly a more immersive program with afternoon sessions three to five days a week.

Severe symptoms are those that prevent a person from engaging in the typical activities of daily life, such as personal hygiene, eating, working, going to school, and engaging in healthy relationships with family and friends. People with severe symptoms typically need an immersive program and specialized treatment, because there’s another consequence of severe mental health disorders and severe symptoms beyond life disruption: suicide.

The reason most people with a mental health diagnosis seek treatment, at a basic level, it to feel better and learn to manage their days, so their lives improve and they can live a life they choose, rather than one dictated by the symptoms of their mental health disorder. However, for some people, the reason to seek professional treatment and support is more serious: they need support in order to manage symptoms that can lead to suicidality, including suicidal ideation and suicide attempts.

In other words, for some patients, seeking treatment is a matter of life and death: the right treatment at their right time can save their lives.

Suicide in the United States: What Are the Facts?

We’ll make three points right away:

1. People without clinically diagnosed mental health disorders also attempt suicide.
2. Over 80% of people who commit suicide have a mental health diagnosis.

However…

3. Less than 5% of people with a mental health diagnosis attempt suicide.

It’s important to understand that suicide is a public health problem independent of mental illness, but it’s also important to understand that the presence of a mental health disorder increases suicide risk, and some mental health disorders increase risk more than others. This article will discuss the relationship of suicide risk associated with specific mental health diagnoses, based on data from a long-range study on psychiatric patients conducted over a 14-year period.

Before we get to that study, though, we’ll define suicide and present the latest available facts and figure on rates of suicide in the U.S.

What is suicide?

The Centers for Disease Control (CDC) offers this definition of suicide and suicide attempts:

“Suicide is death caused by injuring oneself with the intent to die. A suicide attempt is when someone harms themselves with any intent to end their life, but they do not die as a result of their actions.”

Data from the CDC shows that rates of suicide increased by 36 percent between 2000 and 2021. In the year 2021, over 48,000 people in the U.S. died by suicide. That’s one fatal suicide every 11 minutes. That’s why suicide is considered an ongoing public health crisis: in 2021, it was the second leading cause of death for people age 10-14 and people age 20-34.

Now let’s look at detailed suicide data, as published in the 2021 National Survey on Drug Use and Health (2021 NSDUH), a large-scale survey that collects information from over 70,000 people each year. The size and scope of the NSDUH allows us to make population-level generalizations on important public health topics, such as suicide.

Here’s the latest data from the 2021 NSDUH:

Suicide in 2021: Adults 18+

• 12.3 million had serious thoughts of suicide
  • 8.8 million had serious thoughts of suicide, but did not make a plan or attempt
• 3.5 million people made a suicide plan
  • 1.9 million made a plan, but did not attempt suicide
• 1.7 million people attempted suicide

Suicide in 2021: Adolescents 12-17

• 3.3 million had serious thoughts of suicide
  • 1.8 million had serious thoughts of suicide, but did not make a plan or attempt
• 1.5 million made a suicide plan
  • 714,000 made a plan, but did not attempt suicide
• 892,000 attempted suicide in the past year

Additional Suicide Facts: CDC

• The rate of suicide is four times high among males than females:
  • Males: 22.8 suicides per 100,000 people
  • Females: 5.7 suicides per 100,000 people
• People over age 85 show the highest suicide rates
• Over 50% of fatal suicides involve firearms
• There are differences in the rate of suicide among racial and ethnic groups:
  • American Indian/Alaska Native: 28.1 per 100,000
  • White: 17.4 per 100,000
  • Native Hawaiian/Other Pacific Islander: 12.6 per 100,000
  • Multiracial: 9.7 per 100,000
  • Black: 8.7 per 100,000
  • Hispanic: 7.9 per 100,000
  • Asian: 6.8 per 100,000

That’s the current situation in the U.S. with regards to suicide. Over the past twenty years, rates of suicide have increased significantly. Among specific populations – children 10-14 and adults age 20-34. The bottom line: each year, millions of people think seriously about suicide – and each year, tens of thousands of people in the U.S. die by suicide.

Those are sobering thoughts – but this is a sobering topic, and there’s no way to sugarcoat it. With that said, let’s look at the risk of risk of suicide by specific mental health diagnosis.

Association of Mental Health Diagnosis With Suicide and Suicide Attempts

The study “Comparison of Suicide Risk by Mental Illness: a Retrospective Review of 14-Year Electronic Medical Records” examined hospital records collected between 2003 and 2017 for over 41,000 people who attempted suicide. All people in the study were in psychiatric care and had a primary mental health diagnosis during the study period.

Suicide and Mental Health Diagnoses

(In the data below, SMR means standard mortality risk, and is expressed in terms of fold increase. For instance, a person with a psychotic disorder, with an SMR of 13.03, has a 1300% increased likelihood of dying by suicide than a person without a psychotic disorder)

Psychotic disorder (schizophrenia, borderline personality disorder, psychotic disorder):

• Attempts: 5,853
  • 14.4% of patients in the study
• Deaths: 187
  • 31.3% of patients in the study
• SMR: 13.03

Bipolar disorder (BD I & BD II):

• Attempts: 3,219
  • 7.9% of patients in the study
• Deaths: 68
  • 11.4% of patients in the study
• SMR: 10.26

Substance use disorder:

• Attempts: 970
  • 2.4% of patients in the study
• Deaths: 20
  • 3.4% of patients in the study
• SMR: 6.78

Depressive disorder:

• Attempts: 9,607
  • 23.6% of patients in the study
• Deaths: 138
  • 23.1% of patients in the study
• SMR: 5.69

Unspecified mood disorder:

• Attempts: 1,691
  • 4.2% of patients in the study
• Deaths: 23
  • 3.9% of patients in the study
• SMR: 4.64

Anxiety disorder:

• Attempts: 5,419
  • 13.3% of patients in the study
• Deaths: 39
  • 6.5% of patients in the study
• SMR: 2.45

When the statisticians pooled all these results, here’s what they determined:

Compared to people without a mental health diagnosis, people with a mental health diagnosis have an SMR of 5.13, or a five-fold increased risk of dying by suicide.

We understand that these statistics can be overwhelming and a challenge to understand in practical terms. The data we present above – the CDC and NSDUH data and the data from the study – tell us suicide is a serious problem that needs our attention. It tells us that people with mental health diagnoses are at elevated risk. We’ll end this section with big-picture perspective: worldwide, suicide accounts for 1.4 percent of premature deaths.

Suicide Prevention: Top-Line Goals and Strategies

The first and most important way to prevent suicide is to get people with mental health disorders appropriate, evidence-based care as soon as possible after a diagnosis. A meta-analysis published in 2019 indicates that treatment with either cognitive behavioral therapy (CBT) or dialectical behavior therapy (DBT) can decrease suicidal ideation by 55 percent and decrease suicide attempts by 37.5 percent.

In addition, new, innovative therapies such as psychedelic therapy with SPRAVATO® can reduce suicidal ideation in people with depression, and transcranial magnetic stimulation (TMS) can reduce symptoms of depression, which can lead to suicidal ideation and suicidality.

That’s the first step: supporting the people already at-risk. That’s a one-person-at-a-time approach. The next step is instituting cultural and societal norms that reduce suicide risk at the population level. That’s a big ask and a big task, but it’s well within our teach.

The CDC outlines six areas where we can work to reduce suicide risk on a structural level. Here’s what they recommend.

How We Can Prevent Suicide: Six Ways to Reduce Suicide Rates From the CDC

1. Enhance Financial Stability

• • Help families and households achieve financial security
  • Help families resolve housing instability
  • Address the fundamental needs of families and communities:
    • Food, shelter, medical care

2. Prioritize Safe Homes and Neighborhoods

• • Prevent, reduce, or eliminate access to lethal means for people at elevated suicide risk
  • Prevent and reduce community crime and violence
  • Prevent and reduce alcohol and/or substance use/misuse

3. Increase, Improve, and Enhance Access and Delivery of Mental Health Support

• • Advocate for total mental health coverage by insurance providers
  • Improve mental health treatment access in rural or other underserved areas
  • Create remote infrastructure for emergency care
  • Improve emergency response infrastructure

4. Teach Positive Social Interactions

• • Model and promote healthy peer relationships among people of all ages
  • Encourage all community members to engage in community-based activities and events

5. Teach Stress Management, Coping, and Problem- Solving Skills

• • Enhance social-emotional learning (SEL) programs in schools
  • Help new parents learn essential parenting skills
  • Help parents understand the importance of social and emotional literacy in their children
  • Enhance all public and private sector programs designed to help families become more physically, socially, and emotionally healthy

6. Identify and Support People at Risk

• • Enhance training for crisis responders
  • Improve crisis response systems
  • Make a safety plan for suicidal patients
  • Follow up with suicidal patients after a crisis or suicide attempt

Those steps can help us create an environment where people are not afraid to talk about their feelings, ask for help for mental health issues, or reach out for support when they’re in crisis. The unifying principle is acceptance and understanding. When we accept that suicide is a growing problem and understand that compassion, support, and communication can save lives, we’ll be on the way to reducing the rates of suicide in the U.S.

Resources: Suicide Hotlines

Anyone who needs help managing suicidal thoughts can call or text the following numbers and receive immediate emergency support:

• The National Suicide Prevention Lifeline (24/7/365): 988
• The Trevor Project (designed for LGBTQIA+ Youth and Teens)
  • Phone (24/7/365): 1-866-488-7386
  • Trevor Project Text (7 days/week, 6am-am ET, 3am-10pm PT): Text START to 678678
  • The Trevor Project Chat: CLICK HERE