Numerous studies show that trauma is a primary risk factor for suicidal ideation and behavior. Estimates suggest that over 50% of the population has experienced at least one trauma. In this blog, Clinical Therapist Laurie Harris, Psy.D., discusses these statistics, risk factors, and why having conversations about mental health, suicide, and trauma are helpful ways to increase awareness toward changing these devastating statistics.

Did You Know Trauma is a Primary Risk Factor for Suicidal Ideation and Behavior? 

The statistics are alarming and speak for themselves regarding the need for continued attention, research, and concern around suicide. However, there are concrete steps to take in order to feel more confident in being able to identify when and how to ask for or provide help.  

The most recent national study, which occurred in 2020, indicated that in the United States general population, approximately every 11.5 minutes someone dies by suicide (1). Shocking, isn’t it? Moreover, within certain subsets of the population, these statistics become more and more alarming. For example, Veterans of the U.S. Military comprise 22 of the daily deaths attributed to suicide (2). In addition to symptoms and disorders caused by extreme and specific traumatic events, such as experiences of war, physical and sexual assault, or car accidents, statistics show trauma has become a ubiquitous societal issue, in general.  

Estimates suggest a minimum of 60% of men and 50% of women have experienced at least one trauma (6). The true public health burden and cost of trauma, suicidal behaviors, and suicide has not yet been easily quantifiable; however, it can accurately be assumed as enormous (3). Importantly, there is a significant lack of research regarding suicide statistics for nonbinary, gender-fluid, and gender nonconforming individuals. This data is of significant concern and points to why it is incredibly important that we all have access to information about the resources and suggestions provided below. 

Passive or Active Suicidal Ideation 

To better understand suicidal ideation, it is necessary to understand related terms and concepts. Suicidal ideation can be either passive or active in nature. Passive suicidal ideation can resemble fantasies of escape and thoughts centered on ending pain and suffering. Examples of passive suicidal ideation include thoughts such as, “I just want this all to end,” and “If I just didn’t wake up, that would be great, this would all be over.” Alternatively, active suicidal ideation involves the specific desire and possible intent to kill oneself, ideas or fantasies around a particular method and plan. It is helpful to note that suicidal ideation is quite common in fleeting and transient form. It can be normal to experience passive ideation in response to periods of intense stress, pain, and suffering.  

Suicidal ideation becomes concerning when it is active in form and/or persists into chronicity. In addition to the frequency and intensity of individual thoughts themselves, other elements are considered in the assessment of suicidality risk. Related factors assessed by clinicians include one’s intent to take their own life, a thought-through plan of action, and whether one has access to the means needed to carry out their contemplated plans.  

If you or someone you know is experiencing suicidal ideation, the signs to seek help include increasing frequency to persistence, active form of ideation, and potential plans, intent, and/or access to means. At this point, knowing when to call 988, the Suicide and Crisis Lifeline, and/or reaching out to your local mental health professionals is key. Additionally, it is important to know that merely talking about it with a supportive person can prevent suicidal ideation from escalating.  

Warning Signs for Active Suicide Ideation  

There are specific signs that have been identified through research that can indicate a person is preparing to commit suicide. This is not a comprehensive list and even the best clinicians cannot always identify when a person is planning to commit suicide. Below is a list of important potential warning signs that can be used as indicators for when to begin a conversation about potential suicidality.  

Some behavioral and more observable warning signs to be aware of include:  

  • A sudden, unexplainable improvement in mood and depressive symptoms 
  • Spontaneous or unexpected planning of end-of-life affairs, such as wills and insurance policies, without clear reason (e.g., terminal diagnoses) 
  • Reaching out to friends from the past, making amends, or spending increased time with family and loved ones that is out of character for the individual 
  • Uncharacteristically withdrawing from family and loved ones 
  • Giving away prized possessions and other valuable items seemingly carelessly 
  • Changes in eating and sleeping patterns 
  • Sudden interest in death and ways to die, or researching ways to die or commit suicide 
  • Increased or risky use of substances 
  • Increased dangerous and risky behaviors, such as carelessly driving extremely fast 
  • Obtaining weapons, medications, substances, or other means to end one’s life 
  • Saying “Goodbye” to others intentionally and uncharacteristically (4) 

Trauma as a Primary Risk Factor for Suicide 

There have been numerous studies investigating the etiology of suicidal ideation and behavior, and, as is aforementioned, aside from the symptoms of depression, trauma has been identified as a primary risk factor (4). That is to say that a significant number of those who attempt or die by suicide have histories of one or more traumas. In breaking this data down further, certain traumas are found to be more likely to result in suicidal ideation and behavior.  

Additional risks include but are not limited to the following (1): 

  • Comorbid mental health disorders: 
    • Mood Disorders 
    • Trauma-Related Disorders 
    • Anxiety-Related Disorders 
    • Substance Use Disorders 
      • Almost 50% of suicides involve some form of substance use (7) 
    • Personality Disorders involving emotional dysregulation and instability 
    • Conduct-Related Disorders 
    • Disorders of Attachment 
      • Family history of mental health disorders 
  • Serious physical and medical conditions or disabilities 
  • Traumatic Brain Injury (TBI) 
  • Family history of suicide 
  • Previous suicide attempts 
  • Access to lethal means 
  • Being of male sex and middle-aged (women more likely to attempt, men more likely to succeed) 
  • Living alone 
  • Having little to no support system or access to healthcare/ mental health services 
  • History of legal, financial, professional/academic problems 
  • Hopelessness 

Approaching Treatment of Suicide from a Trauma-Informed Lens 

The intersectionality of suicide and trauma may be most noticeable in the evidence-based guidelines indicating the treatment of suicide and suicidal behavior should be approached from a trauma-informed lens. Trauma-Informed Care involves the assumption that an individual presenting for treatment in any setting has some sort of trauma history. Trauma-Informed Care dictates that all patients should therefore be treated in a sensitive manner so as not to re-traumatize them. Given the overlap of trauma and suicidality, it is easy to see why Trauma-Informed Care is the practice standard for treatment of mental health problems, such as suicidal ideation and behavior (4).  

There are several evidence-based practices (EBPs) proven to successfully treat trauma-related symptoms, such as suicidal ideation and behavior (4). Cognitive-Behavioral Therapy (CBT) is one of the most empirically supported EBPs, involving a focus on maladaptive thinking and core beliefs to facilitate emotional and behavioral changes (1). Other evidence-based therapeutic approaches attending to both suicidality and trauma include Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), and Cognitive Processing Therapy (CPT).  

No medication exists targeting suicidal ideation and behaviors in isolation, but there are medications that can treat associated disorders and symptom clusters to improve those issues, such as antidepressants (4). An approach gaining increasingly more attention in the field for the treatment of mental health issues such as suicidal ideation and behaviors is Mindfulness-Based Cognitive Therapy (MBCT), which focuses on the use of present-mindedness in combatting symptoms (3).  

Check-in on Your Loved Ones 

You might be asking yourself, “How can I help? I’m just one person and this is such a huge problem! Is there anything I can do?” YES! Everyone can help alter these statistics for the future. The first step is to look inward and ensure you are taking care of yourself, such as living in a value-aligned way that facilitates mental health. Additionally, there are several identified protective factors to consider. For example, family connectedness is a protective factor related to better prognostic outcomes of almost all adverse childhood experiences (3).  Knowing this information hopefully encourages you to check-in on your loved ones more frequently. Related preventative and early intervention efforts encourage increased attention to the children and people in our communities (3). The adage “if you see something, say something,” applies here.  

Know Your Local and Other Available Resources 

You can independently contribute to the normalization of mental health problems and assist in reducing the stigma of seeking help by having conversations with your family, friends, colleagues, and neighbors. You can also explore local volunteer, outreach, and support efforts. 

Helpful websites and phone numbers: 

  • Organizations and websites, such as the American Foundation for Suicide Prevention (AFSP) – https://afsp.org/  
  • 988 – Suicide and Crisis Lifeline 
  • 911 (request a Crisis Intervention Team) or report to your nearest Emergency Room (5) 

Every Effort, Every Action, Every Person Matters 

Having conversations about mental health, suicide, and trauma, and volunteering are great places to begin to support this very important cause and to begin changing the devastating statistics into action. Every effort, every action, every person can matter greatly in the fight against suicide. Please see below for links for additional resources and information.  

If you or someone you know are experiencing suicidal ideation, dial 988 to receive support from the Suicide and Crisis Lifeline.

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References 

  1. Suicide Awareness Voices of Education (SAVE). (2022). 2020 Official Fact Sheet. SAVE. Retrieved from: https://save.org/about-suicide/suicide-statistics/
  2. Office of Mental Health and Suicide Prevention. (2021). 2021 National Veteran Suicide Prevention Annual Report. U.S. Department of Veterans Affairs. Retrieved from: https://www.mentalhealth.va.gov/docs/data-sheets/2021/2021-National-Veteran-Suicide-Prevention-Annual-Report-FINAL-9-8-21.pdf
  3. Knox, K.L. (2008). Epidemiology of the Relationship Between Traumatic Experience and Suicidal Behaviors. PTSD Research Quarterly, 19(4). 
  4. References 1, 2, 3, 6, & 7
  5. American Foundation for Suicide Prevention (AFSP). 2022. Out of the Darkness Chicagoland Walk. AFSP. Retrieved from: https://supporting.afsp.org/index.cfm?fuseaction=donorDrive.event&eventID=8339
  6. U.S. Department of Veterans Affairs (2022). How Common is PTSD in Adults? U.S. Department of Veterans Affairs. Retrieved from: https://www.ptsd.va.gov/understand/common/common_adults.asp#:~:text=Going%20through%20trauma%20is%20not,assault%20and%20child%20sexual%20abuse
  7. Substance Abuse and Mental Health Services Administration (SAMHSA). (2016). In Brief: Substance Use and Suicide: A nexus requiring a public health approach. Department of Health and Human Services (DHHS). Retrieved from: https://store.samhsa.gov/sites/default/files/d7/priv/sma16-4935.pdf