Suicide Prevention - Know the Warning Signs Before It’s Too Late

Pradeep Khatiwada^a

^a B.P. Koirala Institute of Health Sciences, Dharan, Nepal

Background

Suicide is a growing public health crisis in the United States. In 2022 alone, more than 49,000 people lost their lives to suicide, the highest number ever recorded. [1] It is now the second leading cause of death among people aged 10–34 and the fifth leading cause among those aged 35–54. [2] These numbers serve as a powerful reminder of why prevention must center on awareness, compassion, and making timely support accessible to everyone.

The theme of World Suicide Prevention Day 2025, “Changing the Narrative: Compassion in Action,” reminds us that stigma can be replaced with empathy. Even small, caring steps taken by each of us: listening, reaching out, and checking in can make a life-saving difference.

The Subtle Signs That Point to Suicide Risk

Suicide often leaves quiet warnings along the way. Some of the most common red flags include:

• Opening up about feeling life isn’t worth living or feeling deeply hopeless.
• Using more alcohol or drugs than usual to cope.
• Pulling away from friends, family, or activities once enjoyed.
• Sudden or extreme changes in mood or behavior.

When these signs are noticed and met with compassion and support, a life can be saved. [3]

Can One Conversation Really Make a Difference in Suicide?

In the U.S., stigma still stops many people from openly talking about suicidal thoughts. Evidence suggests that asking someone about suicide does not make it more likely to occur.  In fact, it helps reduce feelings of isolation and encourages people to seek help. [4]  At the same time, showing understanding and support can help someone feel less alone, but dismissive words can deepen their pain. [5] Problems can feel less overwhelming when broken into smaller, manageable parts, making solutions clearer and next steps easier to follow. [6]

National campaigns like #BeThe1To emphasize the power of simple actions: ask, listen, and connect someone to care.

Why Some Struggle and Others Stay Strong?

In the U.S., several issues can raise the risk of suicide. These include mental health conditions, substance use problems, access to firearms, financial stress, and past experiences of trauma. [7]

On the other hand, certain protective factors can help people feel safer and supported. Supportive family and friends, practical problem-solving skills, and access to good mental health care can make a real difference.

Suicide prevention works best when it addresses both sides: reducing risks while providing the support people need to cope and stay safe.

Step In, Speak Up: Five Ways to Protect a Life

Studies show that small acts of care and support can truly save lives.  Here are five steps anyone can take:

Figure 1.

1. Ask Directly: Don’t be afraid to ask if someone is thinking about suicide.
2. Be There: Offer your presence and listen without judgment.
3. Keep Them Safe: Reduce access to things they could use to harm themselves.
4. Help Them Connect: Link them to crisis lines, mental health professionals, or trusted support networks.
5. Follow Up: A call, text, or visit shows that you still care and that they’re not alone. [8]

What Really Works: 3 Proven Suicide Prevention Strategies

1. Limit Access to Lethal Means: Especially firearms, which are involved in over 50% of suicide deaths.
2. Use Crisis Resources: The nationwide 988 Suicide & Crisis Lifeline offers immediate, free, and confidential support.
3. Evidence-Based Therapies: Treatments like Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) reduce risk and build coping skills. [9]

Reaching Out, Lifting Up: Support Makes the Difference

Using available resources is one of the most important steps in suicide prevention. In the United States, immediate help is available through the 988 Suicide & Crisis Lifeline and the Crisis Text Line (text HOME to 741741). [10]

On a personal level, prevention also means checking in on loved ones, listening without judgment, and encouraging mental health care as a normal part of well-being. Even small acts of care can make a powerful difference.

Questions to Ask Your Doctor

1. What can I do if I feel like I might hurt myself?
2. How do I look after my own mental health while supporting someone else?
3. If someone denies suicidal thoughts, are they safe?
4. Are there daily steps to prevent a crisis?
5. Does having gone through this before put me at more risk?

Conflict of Interest

The authors have no conflict of interest to declare.

Acknowledgment

The authors utilized generative artificial intelligence(ChatGPT, Grammarly) to enhance language editing and readability. All medical information, interpretation, and conclusions were developed, verified, and approved by the authors.

References

1. Centers for Disease Control and Prevention. Fast Facts [Internet]. www.cdc.gov. 2021. Available from: https://www.cdc.gov/suicide/facts/
2. National Institute of Mental Health. Suicide [Internet]. National Institute of Mental Health. 2025. Available from: https://www.nimh.nih.gov/health/statistics/suicide
3. American Foundation for Suicide Prevention. Risk factors and warning signs [Internet]. American Foundation for Suicide Prevention. 2019. Available from: https://afsp.org/risk-factors-and-warning-signs
4. Dazzi T, Gribble R, Wessely S, Fear NT. Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine [Internet]. 2014 Jul 7;44(16):3361–3. Available from: https://pubmed.ncbi.nlm.nih.gov/24998511/
5. Spiekerman AM, Rose AJ. Associations between adolescent friends’ responses during problem talk and depressive symptoms. Developmental Psychology. 2024 Jan 8; Available from: https://psycnet.apa.org/doiLanding?doi=10.1037%2Fdev0001685
6. Dietz L, Marshal MP, Burton CM, Bridge JA, Birmaher B, Kolko DJ, et al. Social problem solving among depressed adolescents is enhanced by structured psychotherapies. Journal of Consulting and Clinical Psychology. 2014 Feb 3;82(2):202–11. Available from: https://psycnet.apa.org/doiLanding?doi=10.1037%2Fa0035718
7. Stone DM. Changes in Suicide Rates — United States, 2018–2019. MMWR Morbidity and Mortality Weekly Report [Internet]. 2021;70(8). Available from: https://www.cdc.gov/mmwr/volumes/70/wr/mm7008a1.htm?s_cid=mm7008a1_w
8. Jobes DA, Joiner TE. Reflections on Suicidal Ideation. Crisis. 2019 Jul;40(4):227–30. Available from: https://econtent.hogrefe.com/doi/10.1027/0227-5910/a000615
9. Mann JJ, Michel CA, Auerbach RP. Improving suicide prevention through evidence-based strategies: A systematic review. American Journal of Psychiatry [Internet]. 2021;178(7):611–24. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9092896/
10. Substance Abuse and Mental Health Services Administration (SAMHSA). (2023). 988 Suicide & Crisis Lifeline. Available from: https://988lifeline.org/