Opinion | An Age-Old Tool for Suicide Prevention

In early fall, a team of psychiatry clinicians and researchers joined several hundred people on the lakefront path in Chicago for the American Foundation for Suicide Prevention’s (AFSP) annual Out of the Darkness Chicagoland Walk to fight suicide. The sense of community connection was strong, evident in the matching T-shirts worn by groups of people walking together, in the beads and pictures commemorating lives lost, in the cheering by AFSP volunteers.

Social connection has long been noted as a key factor in suicide risk and prevention. In 1897, the French sociologist Emile Durkheim published his classic text in sociology, Le Suicide. In this body of work, he argued that in addition to psychological and emotional factors, social factors could also contribute to suicide. These include a sense of social isolation, a certain disconnection and detachment from society with suicide being an extreme response to these pressures. He argued that the more integrated a person was to society, the less likely they are to complete suicide. He reported that suicide was more common among single people than those with partners and families, and less frequent in Catholics than Protestants. In doing so, he identified mitigating factors in addition to risk factors, with social integration and connectedness serving as critical protective factors and emotional anchor points. While Durkheim described several subtypes of suicide, driven by different circumstances, the common thread across groups was the influence of social and societal factors. Several of his early prescient observations have been confirmed over time. In addition, they represent a call to action that we have yet to fully realize.

Modern suicide statistics are staggering. For individuals 10 to 34 years, suicide ranks as the second leading cause of death, according to the CDC. Across ages, suicide is the tenth leading cause of death. Suicide contributes to more deaths in our country than homicide and HIV combined. In 2019 alone, more than 47,500 individuals died by suicide. We are just beginning to understand the psychological footprint of the COVID-19 pandemic — and the associated social isolation and disconnection — on suicide risk. As Durkheim may have predicted, early data indicate that one in four young adults ages 18 to 24 considered suicide because of the pandemic in 2020.

Suicide is a complex phenomenon, and while there is no single cause, several important correlates have been identified. These include major depressive disorder, substance abuse, a family history of suicide, terminal illness and unrelenting pain, and lack of social support, among others. Genes and biology play important roles, as do life events. Changes in neurotransmitters — chemicals in the brain responsible for mood, behavior, and cognition — have been identified as contributing to suicide, as have molecular changes identified in postmortem brain tissue examination of individuals who died by suicide. We are only beginning to grasp the complexities of the human brain and the mind and how the “perfect storm” of biological predispositions and psychosocial stressors can, on occasion, result in tragic outcomes.

As the science continues to advance, the Out of the Darkness march is a reminder of a powerful prevention tool already in our possession: social connection. An individual at risk of suicide exists within a family, a support network, and a community; protective factors at each of these levels can be leveraged to bridge suicide prevention efforts. While there are pharmacological and psychological interventions that can reduce suicidal thoughts and behavior, friends and family — not mental health professionals — are often the front line of defense. We have learned through research that if an individual can get through the initial moments of an active suicidal crisis, the odds indicate they will not die by suicide.

By asking our friends, family, and loved ones about distress and suicidal thoughts, we can offer support in these initial moments of darkness. Within the community, having open dialogues about mental health through universal risk screening in primary care settings can raise awareness and target resources to those in need. The “if you see something wrong, say something, do something” doctrine applies. We have the tools and can make a difference.

Let us, together, march out of the darkness into the light.

Sally Weinstein, PhD, is associate professor in the Department of Psychiatry at the University of Illinois at Chicago. Anand Kumar, MD, MHA, is professor and head of the Department of Psychiatry at the University of Illinois at Chicago. They are associate director and director, respectively, of the University of Illinois Center for Depression and Resilience.