Provisional data suggests that US suicide rates reached record highs in 2022. How can doctors help drive them down?

Suicide rates are rising in the United States.

According to provisional data from the Centers for Disease Control and Prevention (CDC), 2022 marked a record high for US deaths due to suicide: 49,449. These numbers have largely increased over the last decade, though the nation experienced brief and modest declines between 2018 and 2020, according to the CDC.^[][]

Moving forward, steering rates downhill will require multiple hands on the wheel, including those of medical professionals and physicians. Doctors can play a significant role in identifying risk factors for suicide and supporting patients who experience suicidal thoughts.

Doctors as first-line mental health check-point

Carlos Escobar, LMHC, Clinical Director of Real Recovery, a mental health treatment center in Florida, says that “doctors, especially primary care physicians, are often the first point of contact for individuals struggling with mental health issues.”

With this placement comes responsibility, like providing mental health screenings and check-ins, along with routine physicals, he adds.

“Routine screening for depression and suicidal thoughts during appointments can be a life-saving measure,” Escobar says. 

He encourages doctors to be vigilant when checking for signs of mental distress, which can include “changes in mood, behavior, and expressions of hopelessness.”

Asking questions and listening to replies

Matt Burghdoff, a mobile crisis counselor in Northern Virginia who provides crisis intervention for youths and adults, says that asking questions can be “simultaneously the simplest, most effective and hardest” task of suicide prevention.

“Suicidal thoughts are terrifying, overwhelming, and generally not something comfortable for those struggling with them to bring up in conversation,” Burgdoff says. “If you ask, it takes the pressure off them and can demonstrate that you care.”

Depending on time and bandwidth, doctors can give patients written questionnaires or ask them about their mood on a number scale.

Ashley Murry, Chief Clinical Officer at Sana Lake Recovery Center, a mental health and addiction recovery center with multiple locations in Missouri, uses forms and number-based questionnaires at the center, where she says “heightened awareness surrounding suicide is intrinsic.”

Number-based questionnaires, such as asking patients how much they are contemplating self-harm of suicide on a scale from one to ten, can be important in identifying suicidal tendencies, she says.

After asking, it is important to listen to—or read—responses.

“High numbers are immediately flagged, but consistent low numbers are also noted, recognizing that it's unrealistic for individuals to consistently rate their self-harm or doubtful thoughts as a one out of 10,” Murray says.

“Vocalizing thoughts of suicide can be a cry for help, and it's crucial to pay attention. Conversely, individuals who downplay their emotions and consistently claim everything is 'fine' may warrant closer observation,” she explains.

If a number-based questionnaire feels unnatural, doctors can also conduct more personal conversations with patients.

Rod Mitchell, MC, MSc, a registered psychologist with the Calgary Emotions Clinic in California, says that a “sensitive and balanced conversation” about how a patient is feeling and why can be a good place to start.

Learning from history

Despite years of medical school, doctors are always learning.

When it comes to suicide prevention, Murry stresses the importance of learning about and from past suicide cases.

“Leveraging the past to inform the present is an effective strategy for identifying suicide risks proactively,” Murry says. “Reviewing the history of a suicide case forensically, including timelines of meetings, doctor appointments, and self-assessment forms, can reveal vital trends and patterns. This knowledge can then be applied to current patients to recognize familiar trends and intervene earlier.”

Working with a team

Doctors have the potential to greatly impact someone’s mental health, but they are not the be-all and end-all when it comes to suicide prevention. Calling in help from other professionals in your practice can help ease the burden on you specifically. Further educating the public—which you can take part in but are not fully responsible for—on the risks of suicide and the seriousness of mental healthcare may encourage others to get involved.

“Many of our practices can be extended to the general public,” Murray says. “Doctors and medical professionals should strive to be more attuned and familiar with suicidal tendencies and behaviors, especially in the broader population where such risks may go unnoticed.”

It can be important to educate people on the signs and risks of substance use, which can also play a role in suicidal ideation and can increase risks for adverse health outcomes. 

Making a doctor's office a ‘safe space’

Some people are scared to open up to their doctors, while others feel more comfortable. Creating or maintaining a safe space for patients can increase the chances they open up to you about mental health concerns, which can then enable you to direct them to appropriate treatment options.

Burghdoff says that “many individuals are more comfortable speaking with their primary or urgent care doctor about symptoms than reaching out to a mental health therapist.”

“That's not to say that doctors need to all be mental health experts as well, [but they should be] able to recognize potential signs and connect with other experts as needed,” Burghdoff adds. “In my work, I have collaborated with multiple physicians to jointly build and track holistic treatment plans. The doctors have identified physical symptoms and concerns for treatment, but also mental health challenges that required my expertise to help treat.”

Burghdoff encourages building a network of mental health collaborators so that doctors can refer or provide patients in need with references to outside care. Along with your choice of mental health experts, this may include the national crisis support hotline 988, an emergency contact for the patient, and local suicide prevention hotlines.