Understanding Suicide: Unraveling Vulnerabilities and Fostering Early Intervention

Sep 14, 2023

According to the American Foundation for Suicide Prevention, suicide is the 11th leading cause of death in the U.S., claiming the lives of over 48,000 Americans in 2021 and resulting in an average of 132 deaths by suicide every day. Looking closer at various subsets of our population, we can see based on the data, that vulnerabilities exist. 

Death by suicide, for example, is the second leading cause of death in those aged 10-34; males are 3.5 times more likely to die by suicide, with those over 75 years old being the most vulnerable; LGBTQ youth are four to six times more likely to attempt suicide than their peers; an alarming percentage of trans individuals (18-45%) have attempted suicide; and since 9/11, four times as many U.S. service members and veterans have died by suicide than have been killed in combat.

Adding to these disturbing statistics, according to SAMHSA, 22 percent of deaths by suicide in the U.S. involve alcohol intoxication. Further, opiates, including heroin and prescription painkillers, are present in 20 percent of deaths.

Suicide: Where to intervene

To determine where to intervene so that we can improve upon suicide prevention efforts, it is first necessary to understand the myriad factors that might make certain groups more vulnerable than others. Across groups, there are several life experiences, or situations, that can help us pinpoint those who might be at greater risk for dying by suicide.

Situations that increase suicide risk include:

  • History of suicide attempt or suicide in the family
  • Substance use
  • Mental health diagnosis
  • Major life transition (job loss, divorce) or financial hardship
  • Multiple health comorbidities and/or chronic pain
  • Trauma history
  • History of non-suicidal self-injury
  • Interpersonal conflict

When considering various subsets of our population who might be more vulnerable to death by suicide, it is not uncommon to find one or more of these risk factors present. Looking at risk across the lifespan, for example, younger individuals who have experienced recent conflict with friends, family, or a romantic partner or who are experiencing insomnia might be at-risk.

Adults who are at greater risk are male, may be using substances, and have had a recent marital or job loss. Older individuals are at risk for death by suicide if they are experiencing multiple health comorbidities, are isolated, or are feeling hopeless.

Those who are transgender are at higher risk for suicide than their non-trans peers. While the high rate of suicide attempts in this population has been established, estimates on death by suicide are challenging to find, likely resulting from the dearth of research on this marginalized population.

However, a study conducted in Sweden showed that trans individuals who are undergoing gender-affirming surgery are at 19 times greater risk than the general population. Factors involved in understanding risk for this population are biopsychosocial in nature. That is, they include a variety of things like internalized homophobia or transphobia, being assigned female sex at birth, multiracial identity, or being HIV+.  The biopsychosocial risks further include being low income as well as psychological factors like depression, substance use, or body dissatisfaction.

In addition, a number of factors are associated with suicide attempt for the transgender population, including victimization experiences like childhood maltreatment, bullying, harassment, and sexual or physical violence. There are challenges in accessing these individuals to better research suicide risk, and it is a worthy cause given the particular vulnerabilities the trans population experiences.

Trauma increases risk

Considering the impact that trauma can have on suicide risk, the Costs of War Project at Brown University found an estimated 30,177 active duty personnel and veterans who have served in the military since 9/11 have died by suicide.  This is in comparison to the 7,057 who have died in military operations during this time. The majority (over 22,000) of suicides in this group were attributed to veterans.

Factors that impact suicide risk include increasingly traumatic injuries from improvised explosive devices like roadside bombs, posttraumatic stress resulting from high exposure to trauma, and, unfortunately, the subjective experience in which soldiers encounter a lack of care and care services for their situations upon re-entry into U.S. civilian life. Additional mental health factors may also have a causal link to suicide in this population.

2012 surveillance report of all active duty U.S. Armed Forces personnel found annual counts and rates of mental health diagnoses among active duty service members increased by 65 percent from 2000 to 2011. Suicide rates nearly doubled in that time and the mental health concerns for active duty personnel became more of a focus as a result.

The main issues noted included:

  • Adjustment disorders (26 %)
  • Depressive disorders (17 %)
  • Alcohol abuse and dependence (13 %)
  • Anxiety disorders (10 %)
  • PTSD (6 %)

Each of these mental health issues has an association with suicide risk. For example, approximately 15-20 percent of those with depression die by suicide.

Understanding the factors that create vulnerabilities for subsets of our population is crucial to improving upon our ability to make a difference when it comes to screening and early intervention efforts. Knowing that there are commonalities across the population as well as factors that are specific to various groups, we can focus efforts accordingly.

While there remains a myth that asking about or talking about suicidal thoughts can trigger someone who is already at risk, on the contrary, routine screening and discussion about suicide risk serves to decrease stigma around the topic, instead making it a routine part of the healthcare experience. If providers demonstrate a willingness and level of comfort asking about mood functioning and suicide risk, then patients come to see the topic as both acceptable and important, resulting in an increased likelihood they will seek help when it’s needed.

As calls to suicide hotlines were up between 47% and 300% nationally during the Covid-19 pandemic, and the new suicide & crisis hotline (988) has been established, this national public health crisis is well worthy of this month dedicated to suicide awareness while also remaining priority all year long.


Call or text: 988 or text TALK to 741741

Having Thoughts:

When someone is at risk: 

About The Author

Cori McMahon, Psy.D., NCCE, Chief Clinical Officer at ERPHealth

Dr. Cori McMahon is a digital health clinical leader and clinical health psychologist with over 20 years’ experience across academic, clinical, and behavioral health tech industries. She was most recently a key member of the senior team taking a SaaS-based behavioral health organization to acquisition at 12x its valuation. Dr. McMahon is the former Director of the Division of Behavioral Medicine at Cooper University Hospital and maintains part-time work in integrated primary care as a Ryan White-funded psychologist serving persons living with HIV. She has presented 40+ peer-reviewed projects nationally and chaired multiple panel discussions as SME on measurement-based care, integrated behavioral health, and patient-reported outcomes in digital health.

Dr. McMahon is an Associate Professor of Clinical Medicine at Cooper Medical School of Rowan University and serves as lead for the Trauma-Informed Care project in the Department of Infectious Disease in collaboration with the state of NJ.