Mental Health and Suicide

Many mental health disorders—including depression, bipolar disorder, borderline personality disorder, and PTSD—come with a heightened risk of suicidal thoughts or attempts. Symptoms of despair, emptiness, or hopelessness may lead someone with depression, bipolar disorder, or PTSD to consider taking their own life; in disorders such as borderline personality disorder, ADHD, or bipolar disorder, mood swings or impulsivity can contribute to suicidality. While seeking help for suicidal thoughts or behaviors is critical regardless of the cause, securing a specific diagnosis may help the individual receive treatment—especially ongoing treatment—that is best suited to their mental health needs.

It’s also important to remember that while the majority of people who die by suicide have a diagnosable mental health condition of some kind, it is not universally the case. Addressing social, cultural, and economic risk factors is also a critical part of suicide prevention. (To learn more about such factors, visit the Social, Economic, and Genetic Influences page.)

For immediate help in the U.S., 24/7: Call 988 or go to 988lifeline.org. Outside of the U.S., visit the International Resources page for suicide hotlines in your country. To find a therapist near you, see the Psychology Today Therapy Directory.

On This Page

• Depression
• Bipolar Disorder
• Post-Traumatic Stress Disorder (PTSD)
• Borderline Personality Disorder (BPD)
• Substance Abuse
• Other Mental Health Risk Factors

Depression, a mood disorder marked by symptoms of persistent sadness, hopelessness, worthlessness, or emptiness, is a common driver of suicidal thoughts and behaviors. But while many people who die by suicide were depressed or had another mood disorder, the vast majority of people with depression do not attempt or seriously consider suicide. Any warning signs of suicidal ideation in a depressed person should be taken seriously, as they could indicate that the individual is in danger of hurting themselves. Luckily, depression is a highly treatable disorder, and appropriate treatment can greatly reduce the risk of suicidal behavior.

For more on recognizing and treating depression, visit the Depression Center.

Yes. Depression is a key risk factor for suicide, and evidence suggests that a majority of those who take their own life have depression or another mood disorder. Common symptoms of depression—such as feelings of hopelessness or worthlessness—can directly lead to suicidal thoughts or behaviors. However, it’s critical to remember that depression does not automatically mean that someone is thinking about suicide, nor is it true that every person who dies by suicide was depressed.

Depression is often dominated by feelings of hopelessness and despair, coupled with the belief that things will never get better. Someone ruminating on such thoughts for weeks, months, or years may come to believe that taking their own life is the only way to escape the suffering. Depression also limits cognitive flexibility, making it more difficult for depressed people to assess the good elements of their life along with the bad, or take stock of how their death would hurt those they love. Indeed, many depressed people come to believe that others would be “better off without them,” a distortion that can further fuel suicidal ideation.

The vast majority of people living with depression do not take their own lives, and many depressed people who struggle with suicidal thoughts are able to overcome them. However, as many as 60 percent of people who do kill themselves had a diagnosable mood disorder. Studies suggest that approximately 5 percent of clinically depressed people struggle with suicidal ideation. Two percent of people who are treated for depression in outpatient settings die by suicide; in inpatient settings, the rate is approximately four percent.

No. While major depression does increase the risk of suicide, it is not the only cause. Other mental or physical illnesses, relationship problems, or financial or legal difficulties could motivate suicidal behavior in someone who had previously shown no signs of depression.

The additional burden of other mental health concerns—such as PTSD or substance abuse—in a depressed person can increase the risk of attempting suicide. Genetic factors may play a role too; depressed people who have a family history of suicide appear to be at heightened risk of taking their own life. Loneliness or a lack of social support can be a major driving factor, too—depressed individuals who can turn to close others for help are at a lower risk of suicide than those who cannot.

Bipolar disorder is a serious mood disorder characterized by dramatic shifts between periods of depression and high-energy phases (known as mania or hypomania). Both phases of bipolar disorder are associated with a heightened risk of suicide. Bipolar disorder is treatable with medication and/or therapy, but because it often goes undiagnosed or misdiagnosed, some individuals may live with the disorder for years or decades before recieving treatment. Treatment, once initiated, greatly reduces the risk of suicide.

To learn more about symptoms, causes, and treatment for bipolar disorder, see our Diagnosis Dictionary.

Bipolar disorder comes with a significantly heightened risk of suicidal behavior. An alarming body of evidence suggests that between 25 and 60 percent of individuals with bipolar disorder will attempt suicide at some point in their life; up to 20 percent will complete suicide. Because symptoms of untreated bipolar disorder tend to worsen with age, the risk of suicide increases as individuals grow older. Proper treatment, however, can significantly reduce suicidal thinking at almost any age.

Bipolar disorder is divided into two primary types, bipolar I and bipolar II. Bipolar I is considered the more extreme form of the disorder and is characterized by episodes of mania, a state of elevated mood, energy, and behavior. During an extreme manic episode, an individual may be at greater risk of behaving in delusional, dangerous, or suicidal ways. Individuals with bipolar II, by contrast, typically experience hypomania, a much milder form of mania that often does not significantly impair functioning.

However, overall, evidence suggests that the risk of suicide is relatively equal in both forms of bipolar disorder. This is because thoughts of suicide tend to be most likely during depressive episodes, which can be quite severe regardless of what form of the disorder one has.

Lack of treatment is a major risk factor for suicide in individuals with bipolar disorder; most people with bipolar disorder report a wait of almost 10 years after their first mood swing to secure treatment. Beyond that, depressive episodes are often triggers for suicidal ideation or behavior, especially if despair or isolation are more severe. In individuals with bipolar I, manic episodes that are characterized by irritability, delusional thinking, or irrational thinking can significantly heighten the risk of suicide.

Misdiagnosis may also contribute; as many as two-thirds of individuals with bipolar disorder report being diagnosed with another mental health condition (often major depression or ADHD) before finally learning they had bipolar disorder. Treatment for those conditions is often not suited to bipolar disorder, and can worsen symptoms in many cases. (ADHD stimulant medications, for example, can exacerbate symptoms of mania and heighten the risk of delusional behavior.)

It can. While the feelings present in mania can be positive—even euphoric, for some—they can also be tinged with negativity, manifesting as irritation, anxiety, or aggression. As its most extreme, negatively tinged mania can trigger self-harm, violence, or delusions, all of which can increase the chances of intentional or accidental death. In individuals who experience “rapid cycling,” mania and depression may occur in quick succession, increasing mental instability and potentially heightening risk.

Suicidal thoughts or behaviors are more likely to occur during low moods and are considered a defining symptom of bipolar’s depressive phases. However, they may also occur during manic phases or “mixed” phases, which contain features of both mania and depression.

Evidence suggests that there may be brain differences between those with bipolar disorder who attempt suicide and those who don’t. One study found that, among young adults with diagnosed bipolar disorder, those who had previously attempted suicide showed significant reductions in gray matter volume in the hippocampus, frontal cortex, and cerebellum—brain areas that play a role in impulse control and emotion regulation—as well as reduced overall connectivity between brain regions, compared to those with no recorded suicide attempts. Such brain differences could lead to impulsive suicidal behavior or a reduced ability to cope with negative emotions.

Post-traumatic stress disorder, or PTSD, is a mental health condition that develops in the aftermath of a traumatic event such as sexual violence, a natural disaster, military combat, or a serious accident. PTSD is a complex condition that may manifest in several different ways—including depression, anxiety, or dissociation. Because PTSD can cause serious emotional turmoil and markedly reduce someone's quality of life, it is sometimes implicated in suicide. Seeking treatment for PTSD—often a combination of medication and therapy—can help restore emotional well-being and greatly reduce the risk of self-harm.

To learn more about recognizing and managing PTSD, visit Post-Traumatic Stress Disorder.

Yes, people living with post-traumatic stress disorder are at a higher risk of suicide; the risk appears to be especially heightened in those also experiencing depression or substance abuse.

PTSD symptoms such as flashbacks, nightmares, and panic attacks can significantly worsen mental state and lead a person to feel trapped in their past trauma; over months or years of reliving painful memories and coping with the fallout, the individual may come to believe that ending their life is the only way to escape. Severe PTSD can also lead to decreased productivity at work or inappropriate emotional outbursts, both of which can make it harder for someone to maintain a job; the resulting financial and self-esteem difficulties may further worsen the risk of suicidal thoughts. Strained relationships and a lack of social support can engender isolation, further adding to one’s risk. PTSD is also linked to an increased incidence of substance abuse, which can heighten the risk of impulsive, life-threatening behaviors.

Yes. Both active-duty military personnel and military veterans are at heightened risk of suicide compared to the general population. According to the VA, veterans’ overall suicide rate is approximately 1.5 times greater than that of nonveterans. Male veterans are more likely than female veterans to die by suicide. However, the risk for female veterans has been growing rapidly over the last few years; recent evidence suggests that female veterans are currently two to five times more likely to die by suicide than nonveteran women. PTSD is implicated in some veteran suicides, but not all. Depression, physical health problems, economic difficulties, poor social support, or other relationship challenges can all contribute to the heightened risk of suicide among veterans.

Rape and sexual assault are among the most common causes of PTSD in the U.S., and sexual trauma has been identified in research as a significant risk factor for suicide. Invalidation of a rape victim’s experience or trauma from loved ones, medical professionals, or society at large—including implications that they “asked for it” in some way—can lead to victims feeling isolated, shameful, and as if they have no one to turn to. In some cases, inadequate responses from authority figures can further compound trauma and lead victims to feel hopeless or believe that getting justice is impossible. PTSD symptoms such as flashbacks and nightmares can worsen emotional well-being and may lead to the false belief that suicide is the only way to find relief.

Not everyone who attempts suicide ends up dying. While many survivors report feeling immense relief at having survived, there may still be some lingering trauma from the life-threatening attempt. Whether one can develop PTSD directly as a result of that trauma is less clear, however. While some small studies found that a suicide attempt could precede a PTSD diagnosis and could be classified as a significant trauma, it is not yet known whether it can directly trigger classic PTSD symptoms such as flashbacks, nightmares, or anxiety. More research is likely needed to further tease out the link between attempted suicide and PTSD.

Few conditions are as strongly linked to suicide as borderline personality disorder, or BPD, a personality disorder characterized by unstable moods, difficulty maintaining personal relationships, and an intense fear of abandonment. Evidence suggests that approximately 70 percent of those with BPD will attempt suicide, and as many as 10 percent will die by it. While the disorder does present treatment challenges, the majority of individuals with BPD who receive treatment—typically some form of psychotherapy, such as dialectical behavioral therapy, combined with medication—are able to stabilize and live productive, fulfilling lives.

For more on symptoms, causes, and treatment for BPD, visit our Diagnosis Dictionary.

Yes. Recurrent self-harm and/or suicidal behavior are so common in individuals with borderline personality disorder (BPD) that they are part of the condition’s diagnostic criteria in the DSM-5. Evidence suggests that almost 80 percent of those with a BPD diagnosis have a history of suicide attempts; sadly, as many as 10 percent of those with BPD may die by suicide.

Yes. Threats of suicide or of self-harm are a common symptom of BPD, especially in response to perceived abandonment or rejection by friends, romantic partners, or other loved ones. Such threats should be taken seriously, as many people with BPD end up dying by suicide. On the other hand, such threats can create intense emotional strain or frustration for the people on the receiving end, especially if they occur repeatedly over long periods of time. Anyone who feels as if their loved one is at risk of attempting suicide should seek immediate help.

Addiction brings with it many well-known risks, including the risk of accidental death by drug overdose. Less talked about, however, is the heightened risk of suicide that comes with substance abuse. Evidence suggests that those with substance use disorders are approximately 6 times more likely to die by suicide than the general population. While many people with addiction who consider suicide are also struggling with depression or another mental health condition, others are not. Treating both the addiction and any concurrent mental health condition, if present, is the best way to decrease the risk of suicide and help the individual better cope with negative emotions in the future.

To learn more about the causes of addiction and paths to recovery, visit the Addiction Center.

Drug use can itself trigger depressive states or low mood—this is especially common with “downer” drugs such as sedatives or alcohol. Other kinds of drugs can lower inhibitions, leading people to behave impulsively or take dangerous actions that they wouldn’t take while sober.

Drug use may also be an attempt to cope with negative emotions such as depression, low self-esteem, or anxiety. But though substance use may help suppress bad feelings in the short term, it tends to worsen an individual’s emotional state over time—and when the drug runs out and painful emotions come rushing back, the person may feel overwhelmed by sadness and consider suicide as a way out. Relapse—though considered a normal part of the addiction recovery process by most experts—can trigger deep feelings of shame or self-loathing; such feelings can lead to thoughts of suicide for some, especially those without a strong support system.

Suicide and overdose rates have both climbed dramatically in recent years, though the relationship between the two is complex. Many people with substance use disorders who attempt suicide do so while under the influence of drugs; some may intentionally take larger than normal quantities of drugs with the express goal of taking their own life. However, it’s often difficult to tell after the fact whether a fatal overdose was intentional or not—although in cases where the individual survived an overdose, the majority report that it was unintentional. On the other hand, individuals with substance use disorders who attempt suicide are more likely than other users to report past overdoses, suggesting that there may be a relationship of some kind between suicidal behavior and overdoses.

Sometimes, but not always. Accidental overdoses are unfortunately a common risk of drug use—and if an overdose proves fatal, the deceased cannot explain their mindset or motivation. Thus, loved ones left behind, along with medical examiners or police officers, are often left to speculate as to whether the overdose was intentional or accidental. If the individual was talking about death or suicide before the overdose, struggled with other mental health problems, or engaged in common pre-suicide behavior (giving away possessions, saying “goodbye” to loved ones, etc.), it may be that the death was intentional.

Of course, losing a loved one to overdose is incredibly painful regardless of the person’s motivation. Friends, family, and romantic partners of the deceased should not hesitate to seek therapy or social support to help them cope.

The term “deaths of despair” encapsulates suicides, drug overdoses, and drug- and alcohol-related illnesses, such as liver disease and cirrhosis. Such deaths have become significantly more common in the U.S. in recent years and have coincided with bleak economic prospects (particularly for those without a college degree), increased social isolation, and widespread access to opioids and other dangerous drugs.

Financial struggles, few job prospects, loneliness, and drug abuse can all contribute to feelings of despair or the sense that life is meaningless, making both suicide and drug use—which can itself lead to death—more likely. Middle-aged men who live in rural areas and lack college degrees appear to be at the greatest risk. It is estimated that more than 150,000 deaths of despair occurred in the U.S. in 2018.

Other mental health disorders—including ADHD, autism, anxiety, and others—have also been shown in research to confer a heightened risk of suicide. The connection between these disorders and suicidality is typically less well-known than depression or bipolar disorder, and in some cases has not been well-studied. Thus, any signs of suicidal behavior should be taken seriously, regardless of the specific diagnosis involved.

To learn more about the conditions below, visit the ADHD Center, the Autism Center, or the Anxiety Center.

Both children and adults with ADHD do appear to be at markedly increased risk of suicide. Those who struggle with impulsivity may be more likely to engage in self-harming behaviors or consider suicide when faced with a sudden low mood, career setback, or relationship upset. Impulsive individuals may also be more prone to substance abuse, which can in itself increase the risk of suicide. Symptoms of inattention may lead to academic, social, or career-related challenges that damage self-esteem; persistently low self-esteem or feeling that one is a failure can trigger or worsen suicidal ideation. ADHD and depression also frequently appear side by side, further heightening the risk of suicidal thoughts or behaviors.

Untreated ADHD is associated with a heightened risk of suicide and accidental death; however, some also worry that the first-line treatment—stimulant medications—could worsen, rather than ameliorate, the risk. Most experts argue, however, that this worry is based on a fundamental misunderstanding of stimulant medications and is not supported by research. In some cases, it may be fueled by media stories highlighting serious cases of stimulant abuse that ended in suicide.

Indeed, in the long run, most evidence suggests that when used safely and as prescribed, stimulant medication decreases the risk of suicide in most individuals with ADHD by stabilizing symptoms and allowing them to function more effectively in day-to-day life. A 2020 study, for instance, found that in a large sample of children and adults with ADHD, those who were taking stimulant medication were at a 28 percent lower risk of attempting suicide than those who were untreated.

The researchers caution, however, that suicide risk did appear to increase slightly in the first 3 months of using stimulant medication. They speculate that this may be due to the severity of problems in the months leading up to treatment, rather than the treatment itself. Further, too high a dose may also cause agitation or anxiety, which could exacerbate pre-existing suicidal thoughts. Since the positive effects of treatment may not appear immediately, the researchers advise that clinicians closely monitor patients and ask about suicidal thoughts during the early months of treatment.

Autism is not often thought of as a risk factor for suicide. However, evidence suggests that individuals with autism are significantly more likely (approximately 4 to 6 times more likely) to attempt suicide than the general population; the risk appears to be even greater for women with autism. Individuals who also have ADHD, or who also have ADHD and an intellectual disability, may be at even greater risk. The data suggest that clinicians should be especially vigilant for signs of suicidality in individuals with autism, experts argue, particularly if other risk factors are present.

Yes. Evidence suggests that individuals with anxiety disorders are 10 times more likely than the general population to consider suicide or engage in suicide-related behaviors. Anxiety can co-occur with depression, which can further exacerbate suicidality. It can also lead to isolation—particularly social anxiety—or trigger rumination or negative self-talk, all of which can heighten the risk of suicidal thoughts or behaviors.

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• Understanding Suicide
• Risk Factors for Suicide
• Mental Health Conditions and Suicide
• Signs That Someone Is Contemplating Suicide
• Seeking Help for Suicidal Thoughts
• How to Talk About Suicidal Thoughts
• Children, Teens, and Suicide Risk
• Coping After Suicide Loss
• Losing a Spouse, Parent, Child, or Sibling to Suicide
• Surviving a Suicide Attempt
• Media Coverage and Suicide Contagion
• Assisted Suicide
• Suicide Hotlines and Prevention Resources Around the World