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Suicide is a significant public health problem affecting countries worldwide. Globally, approximately 800,000 suicides occur every year, making it the 17th leading cause of death in the world. In 2016, the international annual age-adjusted suicide rate was 11.2 per 100,000 population.1 In the United States, suicide resulted in over 48,000 deaths in 2018, and it has been one of the top ten leading causes of death for the country since 2008.2 While suicide rates have been declining globally, rates in the United States have been rising since the late 1990s (Fig. 175-1).3–5 In fact, the overall decrease in Americans’ average life expectancy in 2015–17 has been attributed in part to increasing suicide rates, which rose by 33% from 1999 to 2017,2,6,7 underlining the public health significance of the growing problem.

FIGURE 175-1

Suicide rates by year and by sex, United States, 1999–2018. (Source: CDC, National Center for Health Statistics (NCHS), National Vital Statistics System, produced by National Center for Injury Prevention and Control (NCIPC), Web-based Injury Statistics Query and Reporting System [WISQARS].)

Unfortunately, suicide is simply the tip of the iceberg contributing to the public health problem encompassing all self-directed violence (SDV). Indeed, many more people attempt suicide than die by suicide every year, and even more contemplate suicide than attempt it. In fact, for every one suicide in the United States, there are an estimated 29 suicide attempts, and 248 people who seriously consider suicide.2,8 Ultimately, every year, over 1.4 million American adults attempt suicide, and almost 12 million seriously consider suicide.8,9 Because suicidal ideation and suicide attempts in particular are strong predictors of suicide, suicide prevention efforts must take into account the full spectrum of suicidal thoughts and behavior to be effective.

Research indicates that suicide is not just a mental health problem, but that it is generally the influenced by risk factors at the individual, relationship, community, and societal levels.10 Problems such as substance use, intimate partner and other relationship problems, exposure to adverse childhood experiences, financial problems, job problems, and physical health issues also serve as risk factors for suicide.10–12 Given all of these risk factors, a comprehensive public health approach is needed that prevents suicide risk in the first place through upstream prevention, that identifies and supports people at increased risk of suicide, prevents reattempts, and assists people who are survivors of suicide loss. The purpose of this chapter is to describe the nature and burden of the problem of suicide, identify risk and protective factors, and highlight evidence-based prevention strategies.


Suicide is but one behavior encompassed by a broad range of SDV, which includes fatal and nonfatal suicidal behavior. Suicidal ideation—that is, thoughts about or plans for suicide—is also associated ...

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