In 1999, US Surgeon General David Satcher identified suicide as a serious public health problem in the U.S., reaching epidemic proportions in some groups. Over 30,000 Americans die by suicide each year. In 2002, suicide was the 11th leading cause of death overall; while for youth, suicide was the third leading cause of death. Some groups with higher suicide rates are people with mental illness, elderly, Native Americans, and white males. Over half of suicides are by firearms. Although homicides get more media attention than suicides, for every two homicide victims there are three people who die by suicide.

The measures of completed suicides portray only one perspective of suicidal behavior. Suicide attempts that don’t result in death are estimated to be 25 times the number of suicide deaths, with a much higher multiple for youth. The National Hospital Ambulatory Medical Care Survey estimates that 671,000 visits were made to U.S. hospital emergency departments for self-directed violence in 1998. Many individuals who make suicide attempts – perhaps as high as 70% - never get professional care. It is estimated that there are as many as three quarters of a million suicide attempts each year in the US. And an estimated 5 million living Americans have attempted to kill themselves.

Suicide’s most obvious cost is the loss of individuals who die by suicide, the loss of their participation in and contribution to family, friends, communities, and society generally. There are also tremendous health care costs associated with suicidal behavior. Hospitals as well as therapists and doctors treat people who have made attempts. Some individuals suffer long-term health consequences from attempts. Beyond the financial impact on health care, there is an impact on emergency services. There is also an emotional impact on health and emergency services staff. Suicides cost employers: Reducing Suicide: A National Priority (Institute of Medicine, 2002) reports that the annual cost of workforce-related suicides has been calculated to be approximately $11.8 billion in 1998 dollars. Harder to measure is the cost to employers of lower productivity of workers who are considering or who have attempted suicide.

The National Strategy for Suicide Prevention sites one economic analysis that estimated the total economic burden of suicide in the U.S. in 1995 to be $111.3 billion; this includes medical expenses of $3.7 billion, work-related losses of $27.4 billion, and quality of life costs of $80.2 billion (Miller et al., 1999).

Beyond the people whose lives are lost, the costs of health care and emergency services, and workplace losses, suicide has an enormous effect on communities. For each death, there are an estimated six survivors of suicide - the family and close friends of someone who died by suicide – who have a uniquely difficult loss to mourn and who are at higher risk for suicide themselves.

Suicide is a complex phenomenon with many factors entering into an individual’s taking his or her life. One obvious way to save lives is for people with emotional disorders to get effective treatment and support; however, for many the US health care system is inadequate, under funded, inaccessible, or ineffective.

Some prevention strategies are designed to reach people who are in crises and for whom suicide risk is imminent. Many people have received support to get through suicide crises or had their crises averted and have gone on to lead productive lives. Examples of effective programs include suicide hotlines, counseling suicidal patients and families to remove firearms and prescription drugs from their homes, and construction of barriers on bridges that have a history of suicides.

Other strategies take a public health approach and identify approaches for groups that are at particular risk. For example, elderly have higher rates of suicide. In the month before their suicide, three quarters of elderly persons had visited a physician. Teaching physicians to ask about depression and suicide and treat or make referrals is another example of an effective strategy.

Other prevention targets a broader group and prevents a wide range of negative outcomes such as aggressive behavior, dropping out of school, and substance use as well as suicide. Examples of these programs include life skills training (problem-solving, conflict resolution, and asking for help) or screening for emotional disorders and referring youth for help before problems escalate. Many of these programs build protective factors such as increased help-seeking, stronger communities, or nonviolent handling of disputes.