Suicide Risk Factors and Signs

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Suicidal crises are often brief, but the pain can feel endless and overwhelming.

Restricting access to lethal means and building a safety plan saves lives.

Asking directly about suicide, listening, and validating experience are crucial steps.

Have you ever thought about taking your own life? Worldwide, about 9.2 percent of people experience thoughts about suicide at some point, and in the United States, 15.6 percent of adults report lifetime suicidal ideation (Nock et al., 2008). In a given year, about 4.3 percent of the U.S. population experiences these thoughts (Ivey-Stephenson et al., 2022). Of those who contemplate suicide, roughly a third make a plan, and nearly 29 percent attempt suicide (Nock et al., 2008). Suicide remains a top cause of death in Europe and North America, and is the leading cause of death among young people (Baryshnikov & Isometsä, 2022).

Risk Factors for Suicide

What risk factors contribute to suicide?

A recent review of 46 meta-analyses found major risk factors for suicide mortality include justice system involvement (especially after release), exposure to suicide of a close family member or friend, firearm accessibility, divorce, foster care experience, and unemployment in midlife. The strongest risk factors for suicide attempt and ideation are childhood maltreatment, sexual assault, LGBTQ+ identification, homelessness, and incarceration (Na et al., 2025). In European and North American psychological autopsy studies, about 90 percent of people who died by suicide had a mental disorder, and about 60 percent had mood disorders (Baryshnikov & Isometsä, 2022).

While these risk factors tell us who might be prone to consider suicide, they don’t tell us when suicide might be imminent.

Suicide Crisis Syndrome

Galynker (2017) proposed an emotional state called the “suicide crisis syndrome” (SCS) to help us understand what people are thinking, feeling, and wanting to do when considering suicide. He explained that trait vulnerabilities contribute to unhelpful narratives, which then contribute to suicide crisis.

Trait vulnerabilities: Traits that increase vulnerability include a history of prior attempts or loved ones dying by suicide, impulsivity, hopelessness, perfectionism, fearlessness, and cultural acceptability. Joiner’s Interpersonal Theory of Suicide (Joiner et al., 2009) explains that exposure to violence or death (combat, abuse, self-injury, painful medical procedures, or certain jobs) increases the capability for suicide. In my research with veterans, cultural values—like selflessness, pride, or a personal relationship with suffering—can increase vulnerability to suicide (Lusk et al., 2015).

Unhelpful narratives: Certain thought patterns can lead to suicidal ideation. The SCS identifies ruminating on unrealistic life goals, feeling entitled to happiness, humiliation, perceiving no future, thwarted belonging, and perceived burdensomeness. In my qualitative research with veterans (Lusk et al., 2015, 2018), these narratives often sounded like:

“Civilians don’t understand you, and you don’t understand them, and you feel . . . alone.”

“Now that I am out of the Army . . . I feel like an outsider.”

“I try not to get too close to people unless I have to, just so that if they do die, randomly . . . it just doesn’t bother me as much.”

“Nothing mattered to me. My grandchildren didn’t matter. My daughter didn’t matter. I just wanted the pain to end.”

“It is a sin to commit suicide . . . But then there are times when I just don’t care. You know, I don’t care, send me to hell, and you know, so it kind of scares me. It’s just . . . you know, my problems are just a lot stronger than the faith.”

Suicide crisis: Galynker (2017) identified five warning signs for imminent suicide risk:

Entrapment: Feeling trapped in an unbearable situation with no escape.

Affective disturbance: Emotional pain that feels unmanageable—panic, dissociation, overwhelming shame, guilt, humiliation, loneliness, fear, angst, hopelessness, helplessness, extreme dissatisfaction with everything, dread of growing old/dying badly, etc.

Loss of cognitive control: Rumination, cognitive rigidity, racing thoughts.

Hyperarousal: Agitation, insomnia, irritability, constant vigilance.

Social withdrawal: Isolation, avoidance, and evasive communication.

Suicide Risk Factors and Signs

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Suicide crisis syndrome has been shown to predict suicide attempts and behaviors even after accounting for other risk factors (Melzer et al., 2024).

Have you experienced this? We may not be able to modify traits and history, but we can modify unhelpful narratives and help you avoid a suicide crisis.

The Importance of a Safety Plan

During a suicide crisis, creative thinking is impaired. In one qualitative study, people who attempted suicide described tunnel vision and a dazed state; unexpected stimuli—a call, a sound—sometimes was enough to interrupt their attempt (Heesen et al., 2024). So, do your creative thinking ahead of time and build your safety plan:

Step 1: Identify triggers and warning signs. Notice stories like “I don’t matter”; struggles with isolation, trauma, loss, or moral injury; strong emotions (fear, anger, guilt, shame); and body sensations (tightness, heaviness, agitation).

Step 2: Internal coping strategies. Prepare a self-soothing kit: favorite scents, music, photos, books, or videos that remind you of connection or awe (check out the Virtual Hopebox app to help you with both this and your safety plan).

Step 3: Social distraction. Go to a park, coffee shop, or social group. Visit with kids, pets, nature, or find something awe-inspiring to shift your focus.

Step 4: Supportive people. Identify who you can tell that you’re in crisis. Who is calm and nonjudgmental, and can help with practical steps (like holding onto firearms or taking you to the emergency room [ER])?

Step 5: Crisis resources. Call or text 988, or go to your nearest ER.

Step 6: Make the environment safe. Restrict access to lethal means—give someone your firearm or medication, or have someone take your car keys. This isn’t forever, just until the crisis passes.

Building a Life Worth Living

Why not try to build a life worth living, where you don’t want to die? Find a therapist to help you explore unhelpful narratives. Change what you can in your life—even if that is radical acceptance of some hard things that cannot be changed. Marsha Linehan, Ph.D., founder of dialectical behavior therapy, who has helped thousands of individuals work through their own suicidality, wrote:

The desire to commit suicide . . . has at its base a belief that life cannot or will not improve . . . Death, however, rules out hope in all instances. We do not have any data indicating that people who are dead lead better lives. (Linehan, 1993)

The desire to commit suicide . . . has at its base a belief that life cannot or will not improve . . . Death, however, rules out hope in all instances. We do not have any data indicating that people who are dead lead better lives. (Linehan, 1993)

She emphasized the importance of accepting where you are right now, even with all of your pain:

If you don’t accept that your tire is flat, you’re not going to be able to change it . . . There may be constraints on what your life can look like, but there are no constraints on whether your life is worth living. (DeAngelis, 2009)

If you don’t accept that your tire is flat, you’re not going to be able to change it . . . There may be constraints on what your life can look like, but there are no constraints on whether your life is worth living. (DeAngelis, 2009)

Linehan chronicles her journey to build a life worth living in a book by the same title. Check it out!

If Someone You Love Is in Crisis (from S.A.V.E. Training).

Spot the signs: See above. Think hopelessness, increased substance use, withdrawal, or talking about death.

Ask directly: “Are you thinking about killing yourself?” Stay calm, listen, don’t argue.

Validate and support: “I hear how much you’re hurting. You’re not alone, and help is available.”

Encourage them to seek help: Will they call the hotline with you? Go to the ER? Allow you to help them restrict means of suicide?

If you’re struggling, sit with that part of you that wants to die. Ask what it needs. Do what you can to meet these needs! The urge to die is often temporary, even when the pain feels endless. Make a plan, reach out, and take the risk to build a life you want to show up to. Maybe something needs to die—a story about you, the world, and others that no longer works; the way your life is set up; an expectation you have for your future. Many people have faced this moment and found a way out. You matter, and help is available. Why not see what is still possible?

If you or someone you know is in crisis, call or text 988, or visit the 988 Suicide & Crisis Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.

Baryshnikov, I., & Isometsä, E. (2022). Psychological pain and suicidal behavior: A review. Frontiers in Psychiatry, 13, 981353. https://doi.org/10.3389/fpsyt.2022.981353

DeAngelis, T. (2009, April 1). Practice profile: Fostering lives worth living. Monitor on Psychology, 40(4). https://www.apa.org/monitor/2009/04/linehan

Galynker, I. (2017). The Suicidal Crisis: Clinical Guide to the Assessment of Imminent Suicide Risk. Oxford University Press.

Heesen, K., Mérelle, S., van den Brand, I., van Bergen, D., Baden, D., Slotema, K., Gilissen, R., & van Veen, S. (2024). The forever decision: a qualitative study among survivors of a suicide attempt. EClinicalMedicine, 69, 102449. https://doi.org/10.1016/j.eclinm.2024.102449

Ivey-Stephenson, A. Z., Crosby, A. E., Hoenig, J. M., Gyawali, S., Park-Lee, E., & Hedden, S. L. (2022). Suicidal Thoughts and Behaviors Among Adults Aged ≥18 Years—United States, 2015–2019. Morbidity and Mortality Weekly Report. Surveillance Summaries, 71(1), 1–19. https://doi.org/10.15585/mmwr.ss7101a1

Joiner, T. E., Van Orden, K. A., Witte, T. K., Selby, E. A., Ribeiro, J. D., Lewis, R., & Rudd, M. D. (2009). Main predictions of the interpersonal-psychological theory of suicidal behavior: Empirical tests in two samples of young adults. Journal of Abnormal Psychology, 118(3), 634–646. https://doi.org/10.1037/a0016500

Linehan, M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. Guilford Press.

Lusk, J.L., Dobscha, S., Kopacz, M., Ritchie, M., Ono, S. (2018). Spirituality, religion and suicidality among veterans: A qualitative study. Archives of Suicide Research, 22(2), 311–326.

Lusk, J.L., Brenner, L.A., Betthauser, L.M., Terrio, H., Schwab, K., Scher, A. (2015). A qualitative study of potential suicide risk factors among Operation Iraqi Freedom/Operation Enduring Freedom Soldiers returning to the Continental United States (CONUS). Journal of Clinical Psychology, 71(9), 843–855.

Melzer, L., Forkmann, T., & Teismann, T. (2024). Suicide Crisis Syndrome: A systematic review. Suicide and Life-Threatening Behavior, 54, 556–574. https://doi.org/10.1111/sltb.13065

Na, P. J., Shin, J., Kwak, H. R., Lee, J., Jester, D. J., Bandara, P., ... & Jeste, D. V. (2025). Social determinants of health and suicide-related outcomes: a review of meta-analyses. JAMA Psychiatry, 82(4), 337–346. doi:10.1001/jamapsychiatry.2024.4241

Nock, M. K., Borges, G., Bromet, E. J., Alonso, J., Angermeyer, M., Beautrais, A., ... & Williams, D. (2008). Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. The British Journal of Psychiatry, 192(2), 98–105.

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