An official website of the United States government
NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
National Strategy for Suicide Prevention [Internet]. Washington (DC): US Department of Health and Human Services; 2024.
Every community across the United States includes individuals who have experienced suicidal thoughts, attempts, and deaths. However, some populations are disproportionately impacted (Stone et al., 2021).
Ensuring equity in a public health approach to suicide prevention requires active collaboration to assess and meet the needs of all individuals and communities. These include those with:
Health equity requires a commitment to recognize conditions in individuals’ environments that influence their long-term health outcomes, such as suicide, and to address social determinants of health within prevention efforts (Liburd et al., 2016; U.S. Department of Health and Human Services, 2020).
Populations in the United States disproportionately impacted by suicide include non-Hispanic American Indian and Alaska Native (AI/AN) youth, middle-aged and older adults, non-Hispanic White males, rural populations, and Veterans, among others (CDC, 2023a). Suicide thoughts and attempts remain high among lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQI+) high school students (The Trevor Project, 2023). LGBTQI+ adults also experience higher rates of suicide thoughts and attempts than non-LGBTQI+ identifying adults (James et al., 2016).
In recent years (2018–2021), suicide increased significantly among females and non-Hispanic Black youth ages 10–24. Rates also increased among non-Hispanic Black persons, non-Hispanic multiracial persons, and Hispanic young adults ages 25–44 years (see Table 5; Stone et al., 2021).
Disparities in suicide deaths and attempts.
Suicide attempts disproportionately impact youth ages 15–19, especially females (CDC, 2024b) and LGBQ+ young people (CDC, 2023g). Attempt rates have increased among children and youth (CDC,2024b), including non-Hispanic Black youth (CDC, 2023g).
Limited data are available on suicide among people with disabilities. However, according to a recent CDC report (Czeisler et al., 2021), during the COVID-19 pandemic, adults with disabilities were more likely to report serious suicide ideation, new or increased substance use to cope, and symptoms of anxiety and depression in the past month, compared with adults without disabilities. A study examining data from the 2015–2019 National Surveys of Drug Use and Health found that adults with a disability were over two times more likely than adults without a disability to report suicidal ideation, planning, and attempts; and adults with more limitations had progressively increased risk (Marlow et al., 2021).
While there are multiple contributors to suicide, many of these groups experiencing rapidly increasing suicide trends represent groups that have been historically marginalized (see Table 5; National Academies of Sciences, Engineering, and Medicine et al., 2017a; Saunders & Panchal, 2023). When considering these groups, it is critical to know that being of a certain age, race, ethnicity, and/or sexual or gender minority identity does not put an individual at risk. Rather, there are life experiences and circumstances that impact the lives of those individuals that increase risk (Ndugga & Artiga, 2023; The Trevor Project, 2023).
Also see Table 4 in the introduction for factors that may increase or decrease risk of suicide.
Since the release of the 2012 National Strategy for Suicide Prevention, promising work to address health disparity groups in suicide prevention was completed. Examples include the following:
Much more work is needed to address populations disproportionately impacted by suicide to reduce and eliminate health disparities. Strategic Direction 4 includes ways that various sectors and communities can engage in this important work.
Goal 12 emphasizes including voices of suicide-centered lived experience and populations disproportionately affected by suicide in all suicide prevention planning, practice, and partnerships in the public and private sectors. This goal focuses on upstream suicide prevention that addresses social determinants of health and emphasizes effective youth-, peer-, and community-run interventions.
Goal 13 outlines the need for comprehensive suicide prevention strategies specifically developed for a range of populations disproportionately impacted by suicide and historically marginalized populations at risk. Specific populations need effective interventions that consider their unique strengths, community barriers, and resources.
Multigenerational trauma can be experienced by people from a particular cultural, racial, or ethnic group. American Indian and Alaska Native (AI/AN) people are one such group. Clinician and researcher Maria Yellow Horse Brave Heart describes such trauma as historical trauma and defines it as “cumulative emotional and psychological wounding over the life span and across generations, emanating from massive group trauma experience” (Brave Heart, 2003). The impacts on communities experiencing historical trauma are profound.
For Indigenous people, specifically, the historical trauma of colonization, intergenerational grief, forced removal from ancestral lands, violence, boarding schools, and cultural assimilation, combined with poverty, institutional racism, and discrimination negatively impact overall physical and mental health and may increase risk for suicide and suicide attempts (Big Foot, 2021; Ehlers et al., 2022).
Tribes and tribal organizations are addressing prior and present harm by establishing and offering culturally-based services. Tribal organizations have long provided the necessary Indigenous knowledge and findings, and critical cultural-based approaches that are effective in Indian country to prevent and reduce suicide (Cwik et al.,2016). Casey Family Programs and the Johns Hopkins Center for Indigenous Health conducted a two-year study that found, “The well-being of the individual is inseparable from the well-being of the community. Individual healing and the healing of the entire community must go hand in hand,” (Johns Hopkins Bloomberg School of Public Health, n.d.) https://cih.jhu.edu/programs/cultureforward/ .
Multiple federal agencies (e.g., SAMHSA, NIH, CDC) support studies in which tribes are strengthening culturally relevant practices in order to reduce suicidal thoughts and attempts, as well as substance use, in their communities. Some of these activities include traditional drumming and dance, sweat lodges (Schiff & Moore, 2006), use of Native languages (Hilf, 2017), beading, and traditional hunting, fishing and planting practices to improve food sovereignty (U.S. Department of Agriculture, n.d.).
Federal agencies are committed to recognizing the systemic inequities experienced by Indigenous communities. Examples include the Administration for Children and Families resources on historical trauma (https://www.acf.hhs.gov/trauma-toolkit/trauma-concept) and SAMHSA’s tribal-specific focus on suicide and substance use prevention as part of Native Connections and many other grant-funded programs. See https://www.samhsa.gov/native-connections for more information.
Goal 14 seeks to increase and enhance diversity in the suicide prevention workforce. Cultivating an inclusive pool of professionals trained in health equity and suicide prevention best practices who provide a range of perspectives will facilitate the success of prevention, intervention, and postvention efforts described here and throughout the strategy.
Finally, Goal 15 highlights ways to improve surveillance and suicide prevention practices to better meet the needs of the diversity of populations disproportionately affected by suicide. As mentioned in Strategic Direction 3, suicide-specific data that accounts for factors such as race, ethnicity, geographical location, disability, occupation, Veteran status, sexual orientation, and gender identity can signal to prevention staff where efforts would be most effective in reducing suicidal thoughts, attempts, and deaths.
There remains a need to conduct research dedicated to developing culturally-specific and effective interventions, including among groups largely left out of suicide prevention research and engagement. These populations include individuals with disabilities, such as the deaf and hard of hearing communities; people with neurodiverse conditions; and certain industries and occupational groups, such as construction and mining, health care workers, and first responders. As the demographics of our country continue to change, the need for a wide array of culturally responsive and tailored approaches in suicide prevention is increasing.
Social determinants of health can impact multiple health outcomes including suicidal thoughts, attempts, and deaths. Differences in the distribution of formal policies, programs, institutional practices, and access to resources resulted in suicide health disparities (National Academies of Sciences, Engineering, and Medicine et al., 2017b). Groups experiencing disparities can be identified by characteristics such as age, race, ethnicity, sexual orientation, gender identity, disability, chronic conditions, and geographical location, among others. Engaging people in communities where they live, work, learn, play, and/or worship and addressing health equity throughout the planning, implementation, and evaluation of comprehensive suicide prevention helps reinforce protective factors and break down prevention barriers, thereby paving the way for improved success (CDC, 2023b; Office of the Surgeon General, 2021).
Social determinants of health: A comprehensive approach to suicide prevention considering changes over the life span help embed health equity into prevention efforts. As people age, they interact in different settings and may face additional or new risk and protective factors leading to changes in prevention needs. For example, risk and protective factors for suicide will likely differ between youth and adults or between middle-aged and older adults. These changes may differ further still among people with serious mental or physical illness. As mentioned in Strategic Direction 1, the impact of social determinants of health as risk and protective factors can be compounded over time and affect people different over the course of their lives. When developing prevention strategies, consider developmental and/or transitional periods when unique risk and protective factors are present.
Suicide prevention planning: Many states, tribes, local communities, and territories develop suicide prevention plans outlining goals and strategies to reduce suicidal thoughts, attempts, and deaths within the jurisdictions and populations they serve. Goals and objectives related to effective policies, programs, and practices for populations disproportionately impacted by suicide thoughts, attempts, and deaths can increase the likelihood of preventing suicide. This also ensures health equity remains a priority (Perry et al., 2022). Research suggests that addressing the role that discrimination and racism play in increasing suicide risk can increase help-seeking behaviors and reduce the risk of suicide thoughts and behaviors for disproportionately underrepresented groups (Saewyc, 2014; Child Trends, 2022).
Community and youth engagement: When focusing on specific populations, include community leaders and individuals with lived experience from those populations. Doing so can help improve intervention success by identifying and addressing barriers in prevention implementation that might not be currently known or visible. It can increase the credibility of prevention messages and programs. For example, firearm owners can provide insight on how to talk about safe and secure storage in a culturally sensitive and inclusive way. People with lived experience can offer culturally specific perspectives about the social and structural factors that contribute to suicide risk and protection.
Similarly, suicide prevention efforts that engage and empower public and private sector community partners can improve the likelihood of success, especially for historically marginalized and disproportionately affected populations. For example, connecting with partners who can address social determinants of health, such as unemployment and housing or food insecurity, can be instrumental in addressing upstream challenges that may increase suicide risk.
Success for this goal will look like comprehensive suicide prevention efforts that include attention to health equity from initial planning through implementation and evaluation. This includes collaborating with partners to address social determinants of health and engaging populations disproportionately affected by suicide. Programs and resources will be focused on community-defined needs, decreasing health disparities and improving prevention outcomes.
Below are the objectives for Goal 12 that will help advance the National Strategy to improve suicide outcomes in the country.
Preventing suicide requires focusing on populations disproportionately affected or where suicide rates are increasing. Effective prevention efforts require considering unique strengths, challenges, barriers, and resources. The Cultural Theory and Model of Suicide includes three considerations for understanding how culture impacts suicide, as follows:
The model was developed by analyzing suicide research among African American, Asian American, American Indian and Alaska Natives, and LGBTQ+ adults, but culture expands beyond race and ethnicity, sexual orientation, and gender identity. Other groups may also fit the model based on the above characteristics, including people with disabilities (Marlow et al., 2021), rural populations, and Veterans, among others. Collaborating with people who are part of these groups can help address suicide risk factors, develop focused interventions, improve risk assessment tools, and improve communication regarding suicide prevention activities.
Developing focused prevention and intervention strategies: It is important to consider current and historical events impacting broad population risk like the COVID-19 pandemic or culturally specific risk such as historical trauma experienced by racial/ethnic groups. These events not only can impact people now, they can also impact future generations. CDC’s 2022 data indicate that older adults above the age of 75 had the highest suicide rates among all age groups (CDC, 2024a). Developing suicide prevention protocols for older adults where they live and receive care could decrease their risk.
Rural communities continue to see increases in suicide rates (CDC, 2023e). Suicides in non-urban environments increased 46% between 2000 and 2020 (CDC, 2023e). Non-Hispanic White males and American Indian and Alaska Native people are disproportionately represented in rural suicides (CDC, 2023e). Improving systems to address the needs of rural communities remains a key priority in suicide prevention plans and efforts. Evaluation of SAMHSA’s Garrett Lee Smith State and Tribal Youth Suicide Prevention grants found reductions in youth suicide in counties implementing grant-funded activities were greater in rural counties than in urban counties, although sparsely populated rural counties with less than 2,000 youth were excluded from the analyses (Walrath, 2015).
Those experiencing barriers to care and support may use social media sites to connect, especially youth and young adults. These networks present opportunities to provide support and resources. For example, online settings can offer safe spaces for LGBTQI+ persons to access effective care services.
Perspectives from lived experience: Recognizing the strengths and challenges associated with specific populations reflects cultural humility and respect. Including people from historically marginalized groups in program development and delivery supports the dignity of individuals by countering negative stereotypes and perceived limitations. Individuals who have been impacted by suicide have key roles to play in informing suicide prevention efforts. These include persons with lived experience, persons in groups disproportionately impacted by suicide, associated family members/caregivers and peers, those overseeing and providing programs and health care.
Suicide prevention initiatives will reflect the characteristics and circumstances of specific populations, build on their strengths, and address their unique barriers and challenges. The result will be tailored interventions that directly address community needs and decrease suicide risk.
Below are the objectives for Goal 13 that will help advance the National Strategy to improve suicide outcomes in the country.
Diversifying the behavioral health workforce, expanding multilingual services, and improving inclusivity in health care workplaces can help provide support for individuals of various cultures to receive the best standard of care. Approaches that emphasize cultural humility and inclusivity can help break through the structural aspects of social determinants of health. Formal training and organizational leadership support can help professionals embrace principles of cultural respect and responsiveness. Mental health treatment research shows people of color who match their providers’ racial identity are more satisfied with their care and perceive better quality of care (Meyer & Zane, 2013). However, many racial and ethnic groups are underrepresented among mental health professionals, especially psychiatrists (Wyse, et al., 2020). The suicide prevention workforce will benefit from tools and resources that help them more effectively serve communities.
Improving workforce training in settings where people are disproportionately impacted by suicide can also be an effective suicide prevention strategy. For example, youth who are involved with the child welfare system are 3–5 times more likely to die by suicide compared to youth in the general population (Katz, et al., 2011; Segal, et al., 2021). Risk factors may include the experience of interpersonal violence; abuse or neglect; housing, economic, and caregiving instability; and low levels of connectedness (Castellví, et al., 2017). Child welfare leadership and staff are natural partners for suicide prevention due to their unique access to this grouped disproportionately impacted by suicide.
Addressing bias: Many historically marginalized groups experience bias and discrimination in mental health care settings (Mays, et al., 2017). These encounters can create a lack of trust and impact future help-seeking practices. In one study, reported LGBTQ+ individuals who reported a lack of trust with their mental health providers were less likely to be satisfied with their care and less likely to seek further mental health treatment (Schuller & Crawford, 2022). These experiences show the need for change in cultural responsiveness because health care services play a vital role in suicide prevention as described in Strategic Direction 2. Cultural responsivity requires examining institutional policies and practices to identify barriers to health equity. Increasing training around cultural humility and anti-bias work to reduce the likelihood of adverse experiences for people receiving mental health care. Including cultural responsiveness in professional standards will convey the importance of education about health equity. Training and technical assistance can further enhance the knowledge and skills of professional education.
Perspectives from lived experience: People from historically marginalized groups can contribute important information to education and training for other professionals. As partners or independent training providers, individuals from racial, ethnic, and historically marginalized groups can contribute to the cultural education of suicide prevention professionals. Topics could include insights about culture-specific lived experience and appropriate supports for social connections. It is essential this work is mutually beneficial for both the suicide prevention field and historically marginalized groups, rather than the latter individuals only offering their expertise.
Success for Goal 14 will mean an increasingly knowledgeable and diverse workforce in suicide prevention. Initiatives will have enhanced capability for serving racial, ethnic, and historically marginalized communities. As a result, program outcomes will match the unique needs and challenges that contribute to suicide risk in populations disproportionately impacted by suicide.
Below are the objectives for Goal 14 that will help advance the National Strategy to improve suicide outcomes in the country.
Quality data form the foundation for effective initiatives. These data can help identify problems and track changes over time. In some cases, increasing access to existing data sources is needed, while in other instances, the data have yet to be collected (e.g., improving equity in recruitment in clinical trials) (Buffenstein et al., 2023). Accurate assessment of health disparities can focus efforts for improving research and evaluation with populations disproportionately affected by suicide. Improving suicide prevention initiatives will depend on awareness and dissemination of evidence-informed best practices.
Collaboration: Intervention trials and community surveys contribute to better understanding of populations disproportionately impacted by suicide. They improve recruitment and collection of demographic data of understudied groups. Changes in organizational policy or infrastructure and resources may be necessary to optimize the benefits of enhanced data collection. Partnerships between agencies that collect suicide-related surveillance data and community organizations that include people disproportionately affected by suicide can improve available data. As previously mentioned, collaboration with tribal nations’ must consider the authority of tribes to administer the collection, ownership, and application of their own data.
Universities and other higher education institutions play a major role in developing research projects throughout the country. More data are needed to better understand risk and protective factors, unique warning signs, and effective interventions for populations disproportionately impacted by suicide. Also, more research is needed regarding the impact of structural issues such as racism and discrimination on suicide risk among various racial and ethnic groups and LGBTQI+ individuals to inform mental health-interventions and policies. To support this work, research teams may consider including co-leads and/or advisory groups from disproportionately affected populations in planning and implementation as part of community-based participatory research approaches.
Informing clinical care: Health care systems play a crucial role in multiple areas of suicide prevention, as noted in Strategic Direction 2 and Goal 14. Existing practices and requirements tracking health indicators and maintaining documentation creates possibilities for collecting and utilizing data related to health equity. In many cases though, screening and assessment tools being used were not tested or validated among people of different race, ethnicity, age, or groups of disproportionately affected people. Suicide prevention work can be improved with data collection and clinical practice that use culturally appropriate screening and assessment tools.
Perspectives from lived experience: Incorporating perspectives from individuals within the community provides insights into the research and evaluation priorities most relevant for populations disproportionately affected by suicide. Lived experience can also help identify new possibilities for disseminating and implementing culturally appropriate evidence-based programs. These types of collaborative partnerships can generate increased funding and resources for suicide prevention.
Success of Goal 15 means that more complete demographic characteristics would be included in all major surveillance, research, and evaluation projects related to suicide. Health care settings would employ culturally appropriate screening and assessment tools and people with lived experience would contribute to research development, implementation, and evaluation. As a result, suicide prevention would experience more rapid progress in understanding and addressing the needs of populations that are disproportionately affected by suicide.
Varied frameworks
Known best practices in the field of suicide prevention or related fields such as substance use or violence prevention
Culturally relevant approaches and local knowledge
The BPR allows users to search listed programs by those that have been tested with different populations and in different places and settings. This enables users to choose programs that better align with their local cultures, populations, and contexts. To visit the SPRC BPR, visit https://bpr.sprc.org/.
NIMH encourages applicants to identify strategies for facilitating research participation among Black youth and their families and strategies to engage diverse research professionals representing the fields of minority mental health, health disparities research, and suicide research, among others. To view the funding announcement, visit https://grants.nih.gov/grants/guide/rfa-files/RFA-MH-22–141.html.
The report also includes data-informed calls to action that both the military and broader community agencies can take up to help prevent suicide. To read the most current National Veteran Suicide Prevention Annual Report, visit https://www.mentalhealth.va.gov/suicide_ prevention/data.asp.
Below are the objectives for Goal 15 that will help advance the National Strategy to improve suicide outcomes in the country.
The National Strategy provides a framework and foundation to organize action on suicide prevention across the United States. It allows people to work together in large organizations and small to identify what actions have the greatest potential to reduce the impact of suicide for Americans. The associated Federal Action Plan represents the federal government’s first three years of actions to implement the strategy. It also represents a starting point for other organizations and communities to develop their own plans—a way for the whole nation to work together to reduce the toll of suicide.
Public Domain Notice: All material appearing in this publication is in the public domain and may be reproduced or copied without permission from HHS. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the U.S. Department of Health and Human Services Office of the Assistant Secretary for Public Affairs.
Your browsing activity is empty.
Activity recording is turned off.
See more...
