Promoting a Caring Community - St. Cloud State University
Suicide Prevention Lifeline - 1-800-273-8255

This website was developed [in part] under a grant number SM60479 from the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). The views, policies, and opinions expressed are those of the authors and do not necessarily reflect those of SAMHSA or HHS.

About Suicide

Counseling works and can help students that are struggling.

Suicide is preventable.

Call the National Suicide Prevention Lifeline at 1-800-273-TALK or call SCSU Counseling and Psychological Services at 320-308-3171.

Scope of the problem
Warning Signs of Suicide

Risk and Protective Factors for Suicide
Risk Factors for Suicide

Protective Factors of Suicide
Facts About Substance Use and Suicide
Suicide Behaviors and College Students

Scope of the problem

Suicide occurs when a person ends his or her life. It is the 10th leading cause of death among Americans. But suicide deaths are only part of the problem. Suicide attempts impact a larger population—more individuals survive suicide attempts than die. And they are often seriously injured and in need of medical care.

Suicide Deaths in the United States

  • There are far more suicides each year than homicides. In fact, in 2009, the number of suicides was about twice that of homicides.
  • More than 36,000 people kill themselves each year.

Suicide Attempts in the United States

  • There are an estimated 12 attempted suicides for every one suicide death.
  • More than 374,500 people with self-inflicted injuries are treated in emergency rooms each year.
  • More than 163,000 people are hospitalized each year due to self-inflicted injury.

Young Adult Stats

  • Suicide is the second leading cause of death among 25- to 34-year olds and the third leading cause of death among 15- to 24-year olds.
  • There are an estimated 8 to 25 attempted suicides to 1 completion. (

Gender Disparities

  • Men die by suicide four times as often as women and represent 78.8% of all U.S. suicides.
  • Women attempt suicide two to three times as often as men.

Racial and Ethnic Disparities

  • The highest suicide rates are among American Indian/Alaskan Natives and Non-Hispanic Whites.
  • Asian/Pacific Islanders have the lowest suicide rates among males while Non-Hispanic Blacks have the lowest suicide rate among females.

*SOURCE: Reproduced from the Suicide Prevention Resource Center. Retrieved on September 13, 2012 from

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Warning Signs of Suicide

Suicide can be prevented. While some suicides occur without any outward warning, most people who are suicidal do give warnings. Prevent the suicide of loved ones by learning to recognize the signs of someone at risk and taking those signs seriously.

Risk factors are often confused with warning signs of suicide, and frequently suicide prevention materials mix the two into lists of “what to watch out for.” But the two are very different. Warning signs indicate an immediate risk of suicide, whereas risk factors indicate someone is at heightened risk for suicide, but indicate little or nothing about immediate risk (Rudd et al., 2006). Warning signs are only applicable to individuals, whereas risk and protective factors are found in individuals and communities.

Observable signs of serious depression:

  • Unrelenting low mood
  • Pessimism
  • Hopelessness
  • Desperation
  • Anxiety, psychic pain and inner tension
  • Withdrawal
  • Sleep problems
  • Increased alcohol and/or other drug use
  • Recent impulsiveness and taking unnecessary risks
  • Threatening suicide or expressing a strong wish to die
  • Making a plan
  • Giving away prized possessions
  • Sudden or impulsive purchase of a firearm
  • Obtaining other means of killing oneself such as poisons or medications
  • Unexpected rage or anger

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Risk and Protective Factors for Suicide:

Risk and protective factors provide areas of emphasis for interventions that help prevent suicide. Simply stated, decreasing risk factors and/or increasing protective factors should decrease suicide risk.

Risk and protective factors play a critical role in suicide prevention. For clinicians, identifying risk and protective factors provides critical information to assess and manage suicide risk in individuals. For communities and prevention programs, identifying risk and protective factors provides direction about what to change or promote.

Risk and protective factors are found at various levels: individual (e.g., genetic predispositions, mental disorders, personality traits), family (e.g., cohesion, dysfunction), and community (e.g., availability of mental health services). They may be fixed (those things that cannot be changed, such as a family history of suicide) or modifiable (those things that can be changed, such as depression).

*SOURCE: Adapted from the Suicide Prevention Resource Center. Retrieved on September 13, 2012 from

Key points about risk and protective factors for suicide prevention

Risk and protective factors play a critical role in the prevention of suicide for both individuals and communities.
Risk factors are not warning signs.
Major risk factors include prior suicide attempt(s), mood disorders, substance abuse, and access to lethal means.

Major protective factors include effective mental health care, connectedness, problem-solving skills, and contacts with caregivers.
Risk and protective factors provide targets for intervention in both individuals and communities: Decreasing risk factors generally decreases risk, and increasing protective factors generally decreases risk.

*SOURCE: Reproduced from the Suicide Prevention Resource Center. Retrieved on September 13, 2012 from

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Risk Factors of Suicide

Risk factors are characteristics that make it more likely that individuals will consider, attempt, or die by suicide.

A risk factor is an aspect of personal behavior or lifestyle, an environmental exposure, or an inborn or inherited characteristic that has been shown to be associated with an increased occurrence of death by suicide. People “possessing” the risk factor are considered to be at greater potential for suicidal behavior. Risk factors are not predictors or causes of suicide.

Major risk factors for suicide include the following:

  • Prior suicide attempt(s)
  • Substance abuse
  • Mood disorders
  • Access to lethal means
  • Recently Divorced or Separated
  • Feelings of Victimization
  • Suicide Ideation (Threatened, Communicated, planned, or Prepared for)
  • Current Self-Harm Behavior
  • Excessive or Increased Use of Substances (alcohol or drugs)
  • Psychological Pain (severe distress in response to loss, defeat, rejection, etc.)
  • Anger, Rage, Seeking Revenge
  • Aggressive Behavior
  • Withdrawal from Usual Activities, Supports, Interests, School or Work
  • Isolation (e.g. lives alone)
  • Anxiety, Panic
  • Agitation
  • Insomnia
  • Persistent Nightmares
  • Suspiciousness, Paranoia (ideas of persecution or reference)
  • Severe feelings of confusion or disorganization
  • Hallucinations Urging Suicide
  • Intense affect states (e.g. desperation, intolerable aloneness, self-hate…)
  • Dramatic Mood Changes (in either direction)
  • Hopelessness
  • Poor Problem-solving (thinking in black and white terms, not able to see gray areas, alternatives…)
  • Few Reasons for Living and inability to Imagine Possibly Positive Future Events
  • Perceived Burdensomeness
  • Recent diagnosis of terminal condition
  • Feeling Trapped, Like There is No Way Out (other than death)
  • Sense of Purposelessness or Loss of Meaning
  • Negative or mixed attitude toward help-receiving
  • Recklessness or Excessive Risk-Taking Behavior, Especially if Out of Character or
  • Impulsivity (without thinking of consequences)

*SOURCE: Adapted from the Suicide Prevention Resource Center. Retrieved on September 13, 2012 from and
American Association of Suicidology. The Risk Factors for Suicide. Retrieved on September 13, 2012 from

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Protective Factors of Suicide

Protective factors are characteristics that make it less likely that individuals will consider, attempt, or die by suicide.

Major protective factors include the following:

  • Effective mental health care
  • Connectedness to individuals, family, community, and social institutions
  • Problem-solving skills
  • Contacts with caregivers

*SOURCE: Reproduced from the Suicide Prevention Resource Center. Retrieved on September 13, 2012 from

Personal Protective Factors

  • Attitudes, values, and norms prohibiting suicide e.g. strong beliefs about the meaning and value of life
  • Social skills e.g. decision-making, problem-solving, and anger management
  • Good health and access to mental and physical health care
  • Strong connections to friends, family, and supportive significant others
  • Cultural, religious or spiritual beliefs that discourage suicide
  • A healthy fear of risky behaviors and pain
  • Hope for the future; optimism
  • Sobriety
  • Medical compliance and a sense of the importance of health and wellness
  • Impulse control
  • Strong sense of self-worth or self-esteem
  • Sense of personal control or determination
  • Access to a variety of clinical interventions and support for help seeking
  • Coping skills
  • Resiliency
  • Reasons for living
  • Being married or a parent

External/Environmental Protective Factors

  • Strong relationships, particularly with family members
  • Opportunities to participate in and contribute to school and/or community projects/activities.
  • A reasonably safe and stable environment
  • Restricted access to lethal means
  • Responsibilities/duties to others
  • Pets

*SOURCE: Information was adapted from origional sources:
Center for Disease Control and Prevention. Suicide Prevention Scientific Information: Risk and Protective Factors. Retrieved on September 13, 2012 from and
Suicide Prevention Resource Center. Risk and Protective Factors for Suicide. Retrieved on September 13, 2012 from

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Facts About Substance Use and Suicide

Substance use as it is used here includes intoxication, binge drinking, withdrawal, as well as substance dependence and substance abuse.

  • Suicide risk is increased by both legal and illicit substance use. Research has addressed the increased risk for particular substance use (e.g., alcohol), as well as multiple drug use.
  • Substance use disorders and suicide occur more frequently among youth and adults, compared to older persons.
  • For particular groups at risk, such as American Indians and Alaskan Natives, depression and alcohol use and abuse are the most common risk factors for completed suicide.
  • Alcohol and substance abuse problems contribute to suicidal behavior in several ways.
    • Persons who are dependent on substances often have a number of other risk factors for suicide (e.g., runaway and homeless youth).
    • In addition to being depressed, they are also likely to have social and financial problems.
    • Substance use disorders can be common among persons prone to be impulsive, and among persons who engage in many types of high-risk behaviors that result in self-harm.

Alcohol-related Suicides

  • Between 40 and 60% of those who die by suicide are intoxicated at the time of death.
    • An estimated 18-66% of those who die by suicide have some alcohol in their blood at the time of death.
  • An estimated 1-6% of individuals with alcohol dependency will die by suicide.
    • People who are addicted to alcohol are at higher risk if they also suffer from depression. At the time of death by suicide, 50-75% of alcohol-dependent individuals are suffering from depression.
  • Adolescents who die by suicide are more likely to use a firearm than another method if they have alcohol in their blood at the time of death.
  • Suicide rates among 18-20 year-olds were found to decrease among several states where the minimum legal drinking age was raised to 21.

Other Substance Use Disorders

  • Intoxication by drugs or alcohol may increase suicide risk by decreasing inhibitions, increasing aggressiveness and impairing judgment. Additionally, substance use such as alcohol increases the lethality of some medications, making it more likely that a suicide attempt via overdose will be lethal.
  • Research suggests that adolescents who use marijuana and/or cigarettes are at increased risk of suicide. Studies have also found that as many as 20% of those who die by suicide have used cocaine in the days prior to death.

To find treatment facilities in your area click on the following link:
SAMHSA Treatment Facility Locator:

*SOURCE: Information was reproduced from the original source:
National Strategy for Suicide Prevention. Retrieved on September 13, 2012 from

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Suicide Behaviors and College Students

Suicide is a leading cause of death among youth attending colleges and universities in the United States; however, despite a rise in previous decades the rate has been stable or decreasing since the early 90s (Schwartz, 2006; Schwartz, 2011). College and university students have significantly lower risk of suicide than peers their age not in school (Schwartz, 2011).

  • Male students (ages 18 to 24) are more than twice as likely as female students to have died by suicide (Drum, Brownson, Burton, Denmark, & Smith, 2009). However, female graduate students aged 25 and older die by suicide at a rate similar to their male counterparts (SPRC, 2004).
  • A recent large-scale study found that approximately 18% of undergraduates reported having seriously considering a suicide attempt at some point, while 6% reported serious suicidal ideation in the past 12 months (Drum et al., 2009). A 2005 study by Westefeld and colleagues found that 24% of college youth considered suicide. Another study found that suicidal ideation among college students ranged from 32% to 70% (Gutierrez, Osman, Kopper, Barrios, & Sacks, 2000).
  • Estimated rates of suicide attempts by college youth range from about 1% (American College Health Association, 2009; Furr, Westefeld, McConnell, and Jenkins, 2001) to 5% (Westefeld et al., 2005).
  • Commuter students; older students; gay, lesbian, bisexual, and transgender students; and international students are groups that face a higher risk for suicide and have less adequate services available to them than the general population of college students (Russell, Van Campen, Hoefle, & Boor, 2011; SPRC, 2004).

Suicide Risk and Protective Factors Among College Young Adults

  • A key risk factor for suicide death is previous attempts. All attempts should be taken seriously, and youth who have attempted suicide need follow-up care.
  • Most people who die by suicide have a mental illness and/or substance use disorder. College students who attempt suicide are significantly more likely to suffer from depression and eating disorders than those who don’t (Haas et al., 2008).
  • A major suicide risk factor for college youth is substance or alcohol abuse (Lamis & Bagge, 2011; Westefeld et al., 2006). Numerous studies have shown that alcohol and substance abuse increases the risk of attempting suicide (Arria, O'Grady, Caldeira, Vincent, Wilcox, & Wish, 2009; Lamis, Malone, Langhinrichsen-Rohling, & Ellis, 2010). College students who binge drink alone are more likely than their counterparts who drink socially to experience depression and suicidal ideation. Students who are solitary binge drinkers are more than four times as likely to have made previous suicide attempts (Gonzalez, 2012).
  • College youth who have reported suicidal ideation are significantly more likely to engage in risky behavior such as carrying a weapon, fighting, boating or swimming after drinking alcohol, driving after consuming alcohol or riding with a driver who has consumed alcohol, and rarely or never wearing seat belts (Barrios et al., 2000).
  • There is much less research on protective factors, but a number of studies have found that social support, such as having an emotional connection to friends and family and being involved in extracurricular activities, is one of the important protective factors for college youth (Marion & Range, 2003; Westefeld et al., 2006).
  • Another protective factor for college youth is having a reason for living, especially having feelings of responsibility towards family or friends, fear of social disapproval, or moral objections to suicide (Ellis & Lamis, 2007; Westefeld et al., 2006). One study found that in preventing suicide in college students, it was more important to have a reason to live than to have a reason not to die (Westefeld, Scheel, & Maples, 1998).
  • Having reduced access to lethal means, especially firearms, is also a protective factor for college students (Schwartz, 2011).

The majority of students who contemplate suicide do not seek professional help (Drum et al., 2009), and nearly 80% of students who die by suicide never received services at their campus counseling centers (Kisch, Leino, and Silverman, 2005). This may be due in part to the fact that only 26% of college youth are aware of their campus mental health resources (Westefeld et al., 2005).

*SOURCE: Information was adapted from the original source:
National Center for the Prevention of Youth Suicide: College Youth Fact Sheet. Retrieved on September 13, 2012 from

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