Suicide and Self-Harm

It can be hard to understand what would drive someone to take his or her own life. Suicide is a desperate attempt to escape suffering. Many people with suicidal thoughts do not want to die – they want to end their pain. Suicidal people can be blinded by their despair and see no other option.

This is a serious, but preventable, mental health issue that affects people of any age, gender, sexuality, and race. Approximately 33,000 Americans die each year from suicide, 1.1 million attempt suicide and more than 8 million adults report having serious thoughts about suicide. Suicide is an increasing problem among youth and young adults. In 2010, suicide was the second leading cause of death among 10–24 year olds (after unintentional injury) and continues to be one of the top three leading causes of death for adolescents.

Suicidal thoughts result from extreme emotional distress and are not necessarily signs of mental illness. This is a common misconception. Abuse, bullying, family stress and sexual orientation are all risk factors for suicide, especially among teenagers.

Severe distress and emotional pain can also manifest in other unhealthy ways. Self-harm, intentionally inflicting pain on one’s self, is a negative coping mechanism and emotional outlet. Approximately 1 in 100 people hurt themself on purpose. Self-injurious behaviors are very complex. There are a multitude of reasons why adolescents self-harm, including desperation, anger, anxiety, a cry for help, and the desire to “feel something” in those who may feel otherwise “numb” to emotions. While these individuals are at a higher risk of suicide, self-injury is often unrelated to suicidal ideation. One of the most common forms of self-injury is cutting, the act of making small cuts on one’s body. Like other forms of self-harm, some youth report that this provides a sense of relief from overwhelming negative feelings.  Self-harm should be taken seriously. 

Facts & Statistics About Suicide

  • In 2011, more than 5,000 young people under age 25 committed suicide, according to the CDC’s Fatal Injury Reports. 2,000 youth were 19 years or younger.
  • Suicide attempts among black and Hispanic youth are almost 2 times higher than white youth.
  • There are as many as 25 attempted suicides for every death by suicide.
  • LGB youth are 4 times more likely to attempt suicide as their straight peers.
  • Studies show that 45% of suicide victims had contact with primary care providers within 1 month of suicide
  • Having a gun in the home, regardless of storage practice, type of gun, or number of firearms, is associated with an increased risk of firearm suicide.
  • States implementing universal background checks and mandatory waiting periods prior to the purchase of a firearm show lower rates of suicides than states without this legislation. To read more about suicide and firearms, click here.

Suicide Prevention: Know the Warning Signs

The best way to prevent suicide is to recognize the warning signs, including but not limited to:

  • Talking about suicide, dying, or self-harm
  • Looking for access to guns, pills, or other lethal means
  • Unusual preoccupation with death, dying, or violence
  • Talking about feeling hopeless or having no reason to live
  • Talking about feeling trapped or in unbearable pain
  • Talking about being a burden to others
  • Expressing feelings of self-loathing, worthlessness, guilt, and shame
  • Increasing the use of alcohol or drugs and other self-destructive behaviors
  • Sleeping too little or too much
  • Withdrawing from friends and family
  • Showing rage or talking about seeking revenge
  • Loss of touch with reality, seeing things or hearing voices
  • Displaying extreme mood swings.

These can be easy to miss. An estimated 70% of children suffer with untreated mental health problems. Routine behavioral health (BH) screening in emergency and primary care settings would help reduce the number of adolescents with unmet mental health needs. Researchers at The Children’s Hospital of Philadelphia (CHOP) developed the Behavioral Health Screen (BHS), a comprehensive, web-based tool, to assess and identify BH symptoms among adolescents such as depression, anxiety and suicidal risk. The screening also identifies potential urgent risks, such as suicide attempts and sexual abuse. A study found that the application of BHS in the Emergency Department increased the identification of mental health problems by 8%. When tested in primary care settings, they found that 9.2% of adolescent patients admitted to having suicidal thoughts.

Even though screening tools, such as BHS, have proven to be an important first step to address our country’s growing mental health problem, the barriers to implementation (e.g., lack of time, training, and capacity) hinder integration into the primary and emergency care settings. Overcoming these barriers is the goal of several researchers at CHOP who aim to fully integrate BH screening into medical settings and establish its importance as a clinical practice. CHOP is also a site for a National Institute of Mental Heatlh study to develop and validate a suicide-specific screening tool.

Suicide Prevention: Increase Awareness

In 2012, the National Action Alliance for Suicide Prevention and U.S. Surgeon General released a national strategy for suicide prevention. The report focuses on four main priorities to reducing the number of deaths by suicide –

  1. Integrating suicide prevention into health care policies
  2. Encouraging the transformation of health care systems to prevent suicide
  3. Changing the way the public talks about suicide and suicide prevention
  4. Improving the quality of data on suicidal behaviors to develop increasingly effective prevention efforts.

If you, or someone you know, are in crisis, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255)


Read Research in Action blog articles about suicide prevention.

Recommended Reading & Resources

suicide prevention lifeline number

The American Foundation for Suicide Prevention

National Institute of Mental Health: Suicide Prevention

Yellow Ribbon Suicide Prevention Program

Feeling Blue Suicide Prevention Program

The Relationship Between Bullying and Suicide

Preventing Suicide: Program Activities Guide

The Trevor Project

National Strategy for Suicide Prevention 2012: Goals and Objectives for Action.

Suicide and Depression Awareness for Students

Suicide Prevention in College

Research Articles

Bevans, KB, Diamond G, Levy S. Screening for Adolescents' Internalizing Symptoms in Primary Care: Item Response Theory Analysis of the Behavior Health Screen Depression, Anxiety, and Suicidal Risk Scales. Journal of Developmental and Behavioral Pediatrics, 33(4), May 2012.

Diamond G, Levy S, Bevans KB,  Fein JA, Wintersteen M, Tien A, Creed T. Development, Validation and Utility of Internet-based, Behavioral Health Screen for AdolescentsPediatrics. 2010;126(1):e163-70.

Fein JA, Pailler M, Diamond G, Wintersteen M, Tien A, Hayes K, Barg F. Feasibility and Effects of a Web-based Adolescent Psychiatric Assessment Administered by Clinical Staff in the Pediatric Emergency DepartmentArchives of Pediatric and Adolescent Medicine 2010;164(12):1112-1117.

Pailler ME, Fein JA. Computerized Behavioral Health Screening in the Emergency DepartmentPediatric Annals, 38(3), March 2009.