Every 11 minutes, someone in the US dies by suicide. The heartbreak of losing someone this way is profound, and often, those left behind are left asking: How did this happen without any warning?
Historically, suicidality has been branded a symptom of other mental health issues, especially depression. During my medical training, we were taught that if a patient expressed suicidal thoughts, we should treat their depression. Fix the mental illness, and the suicidality would go away. But time has shown that this doesn’t always work.
Truth be told, many patients who struggle with depression never consider suicide, while more than half of those who do take their own lives have never been diagnosed with a mental health condition. This disconnect tells us something important: suicide isn’t just a symptom of depression. If we truly want to prevent suicide, we have to understand it as something separate and unique.
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As one of America’s leading causes of death, this understanding needs to come quickly. Suicide takes too many lives, often without warning. But those closest to the edge seem the furthest from not because they are — but because we’ve been looking through the wrong lens.
Suicide isn’t just depression in disguise
Suicidal behavior comes from a complex mix of factors — everything from biological to neurological and situational triggers. For many, it’s not about depression; it’s about unbearable psychological pain. Feelings of shame, fear, loneliness, guilt, and hopelessness can weigh so heavily on a person that suicide starts to feel like the only escape. Sometimes, it is just the confluence of several negative events at once such as loss of a relationship and job leading to a brief period of hopelessness.
Interestingly, data from the Crisis Text Line reveals that people at risk of suicide are more likely to use words like ‘ibuprofen’ and ‘800mg’ than words like ‘sad’ or ‘depressed’ when reaching out for help. It’s a reminder that hopelessness—the belief that there’s no way out of a problem — can be a more reliable indicator of suicide risk than any mental health label.
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The science of suicide: What we’re learning
As our understanding of suicide deepens, we begin to see it also has biological roots. A study of over 29,000 individuals who attempted suicide uncovered a genetic link, suggesting a predisposition to suicidality. This genetic link overlaps with other issues like sleep disorders, chronic pain, and substance abuse, which often co-occur with suicidality, even without the presence of depression.
In addition to genetics, there are also physical changes in the brain we’re starting to understand better. People who die by suicide often show differences in the prefrontal cortex, the area responsible for decision-making, as well as lower levels of serotonin, which regulates mood. We see these brain changes irrespective of whether or not the individual was ever diagnosed with a mental illness, emphasizing that suicide must be viewed as its own distinct condition.
The healthcare system Is missing key opportunities
Even with all we’ve discovered about the complexities of suicide, the healthcare system still isn’t fully equipped to handle it. Almost half of all people who die by suicide have visited a doctor within the last month of their life, yet their risk wasn’t flagged. Often, these patients don’t present with apparent mental health symptoms, so the critical warning signs get overlooked.
Worse, most mental health professionals aren’t explicitly trained in suicide risk assessment or treatment. And when patients are hospitalized for suicidality, their risk often increases after discharge — research shows that the chance of suicide rises by 400% immediately following a psychiatric hospitalization. Unfortunately, many people are released into communities unprepared to support them through this critical period.
Our diagnostic practices also fall short. Screening for suicide risk usually focuses on explicit suicidal thoughts, but what about the deeper feelings of hopelessness or the genetic and neurological factors that aren’t as obvious? We need a broader, more nuanced approach.
Suicide prevention: What needs to change
To truly make a difference, we need to start by ensuring that healthcare providers are better trained in suicide prevention. Right now, only nine states require suicide-specific training for clinicians. Expanding that training nationwide is critical. And we need more than just risk identification skills; healthcare providers should be trained in treating suicidality as a condition in its own right.
Additionally, there’s already evidence that specialized suicide prevention programs can dramatically reduce attempts and deaths. Clinically validated care pathways can cut suicide attempts when compared to standard treatments. This is a massive step in the right direction, and it underscores the need for suicide-specific care — just like how someone with a heart condition would be referred to a cardiologist, someone at risk of suicide should be seen by a professional trained specifically in managing suicidality.
Finally, we must shift the way we view suicide prevention. It’s not just about addressing depression or anxiety — it’s about interpreting the full range of factors, from biology to life circumstances, that can push someone to the edge. It’s about creating a system where those at risk feel seen, heard, and supported in ways tailored to their unique experiences.By moving toward this more comprehensive, empathetic, and investigative approach, we can begin to change the outcomes for countless individuals and their families. The time to act is now, and the lives we could save are worth every effort to change our perspective.
Photo: Wacharaphong, Getty Images
Neil Leibowitz MD, JD is a physician executive and the Chief Medical Officer at Vita Health, a telehealth company that provides complex care and in addressing the suicide epidemic. There, he oversees enterprise sales, account management and psychiatry. He was previously the Chief Medical Officer for Behavioral Health at Elevance/Carelon where he led Medical Affairs, the product team and care delivery team. His focus is on the intersection of technology and care delivery. Prior roles include Chief Medical Officer at Talkspace and Senior Medical Director at Optum. Neil has been part of teams that have grown companies leading to both public and private exits. He is currently on the board of VIP, a large Federally Qualified Health Center in NY. He received his BA from Johns Hopkins University, his MD from New York Medical College and his JD from New York University.
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