A suicide attempt is a self-directed action that a person takes with the expectation that it will end their life. In the United States alone, roughly 1.5 million people attempt suicide each year, and globally the World Health Organization estimates that for every person who dies by suicide, many more make an attempt. What separates an attempt from other forms of self-injury is intent: the person, at the time they acted, believed or hoped the action would be fatal.
How an Attempt Differs From Self-Harm
The distinction between a suicide attempt and non-suicidal self-injury comes down to what the person intended. A suicide attempt involves at least some desire to die. Non-suicidal self-injury, by contrast, is deliberate damage to the body carried out to relieve emotional pain, shift a negative mental state, or resolve interpersonal distress. The person engaging in self-injury does not want to die from the act.
This difference matters because the two behaviors involve different levels of risk and call for different kinds of support. One influential theory in the field, the interpersonal theory of suicide, proposes that a suicide attempt requires two things to come together: the desire to die and a reduced fear of death or pain. People who engage in self-injury without suicidal intent may have one of those elements but not both. That said, a history of self-injury does increase the likelihood of a future attempt, so it is never something to dismiss.
Warning Signs That Typically Precede an Attempt
Most suicide attempts don’t come entirely without warning, though the signs can be subtle. The National Institute of Mental Health identifies several behavioral and emotional changes to watch for:
- Talking about wanting to die, feeling like a burden to others, or expressing intense guilt or shame
- Emotional shifts such as feeling empty, hopeless, trapped, or experiencing unbearable emotional or physical pain
- Behavioral changes like withdrawing from friends, giving away meaningful possessions, saying goodbye, making a will, or researching methods
- Increased recklessness, including dangerous driving, escalating drug or alcohol use, or extreme mood swings
- Changes in basic routines like sleeping or eating significantly more or less than usual
No single sign confirms that a person will act. But when several of these appear together, especially in someone already dealing with depression, substance use, or a recent major loss, the risk is considerably higher.
What Increases the Risk
The CDC breaks risk factors into four levels: individual, relationship, community, and societal. At the individual level, the single strongest predictor of a future attempt is a previous attempt. Beyond that, depression and other mental health conditions, chronic pain or serious illness, substance use, impulsive or aggressive tendencies, job or financial loss, criminal or legal problems, and a history of childhood adversity all raise a person’s vulnerability.
Relationship factors include social isolation, high-conflict or violent relationships, bullying, and having a family member who has died by suicide. At the community level, limited access to healthcare, exposure to a cluster of suicides, community violence, and discrimination all contribute. At the broadest level, stigma around seeking mental health help, unsafe media coverage of suicide, and easy access to lethal means among people already at risk play a role.
What Happens in the Brain
Research has identified several biological patterns that appear more frequently in people who attempt suicide. The brain’s mood-regulating chemical system tends to function differently. Specifically, levels of the chemical that helps regulate impulse control (serotonin) are often lower, which may contribute to greater impulsivity and aggression, including aggression directed at oneself.
At the same time, levels of stress-related chemicals (norepinephrine) tend to be elevated, and the body’s central stress-response system can become overactive. One finding stands out: when the hormonal stress system is chronically ramped up at baseline, the risk of eventual suicide may increase by as much as 14 times. Higher levels of dopamine, a chemical linked to motivation and reward, have also been associated with more aggressive behavior and with violent attempts. None of these changes cause suicidal behavior on their own, but they help explain why some people are more biologically vulnerable when life circumstances become overwhelming.
What Happens After an Attempt
When someone arrives at an emergency department after a suicide attempt, the first priority is treating any physical injuries or the effects of an overdose. Medical staff perform what’s called a focused medical assessment: a physical exam, a review of the person’s mental and emotional state, and identification of anything (drug ingestion, head trauma, intoxication) that might be affecting their thinking. Routine lab panels or imaging aren’t standard unless there’s a specific clinical reason.
Once the person is medically stable and cognitively able to participate, a mental health professional, typically a psychiatrist, psychologist, or social worker, conducts a thorough risk assessment. The person is not allowed to leave until this evaluation is complete, and the environment is kept free of anything that could be used for self-harm. If the risk is judged to be moderate to high, psychiatric hospitalization is the usual next step. If the risk is considered low enough, outpatient care with close follow-up may be appropriate.
The Highest-Risk Period for a Repeat Attempt
The weeks and months immediately following an attempt are the most dangerous window for another one. Research on mood disorder patients discharged from psychiatric hospitals found that nearly 40% of all repeat attempts within a year happened in the first 90 days after discharge. Among those who ultimately died by suicide within that year, 57% did so in the first 90 days, and one person died just five days after leaving the hospital.
The risk declines steadily over the course of the year, but that early cluster means the first three months demand the most intensive monitoring and support. This is the period when follow-up appointments, safety planning, and strong social connections matter most.
Treatment Approaches That Help
Several therapeutic approaches have shown promise in reducing repeat attempts. Cognitive behavioral therapy adapted specifically for suicide prevention helps people identify the thought patterns and situations that led to their crisis, then build concrete coping strategies. Dialectical behavior therapy, originally developed for people with intense emotional instability, teaches skills for tolerating distress, regulating emotions, and improving relationships. In studies of suicidal adolescents, those receiving dialectical behavior therapy had fewer subsequent attempts and fewer hospitalizations than those receiving standard care.
Family-based treatments also play a role, particularly for younger people. Multisystemic therapy, which works with the person’s family and broader environment, has been linked to fewer repeat attempts. For adolescents who aren’t also dealing with depression, home-based family interventions have shown benefits for reducing suicidal thinking. One approach that involved helping young people identify trusted adults in their lives showed particular benefit for reducing suicidal thoughts in girls and young women.
No single therapy works for everyone, and most treatment plans combine several strategies. What the research consistently shows is that staying connected to care after an attempt, particularly during those first 90 days, meaningfully reduces the chance of another crisis.
Suicide Is the Third Leading Cause of Death in Young People
Globally, suicide is the third leading cause of death among people aged 15 to 29. In the U.S., over 49,000 people died by suicide in 2023. For every death, many more people survive an attempt and live with its physical and emotional aftermath. The ratio of attempts to deaths varies by age and method, but the gap is significant enough that suicide attempts represent a major public health concern distinct from completed suicides.
If you or someone you know is in crisis, the 988 Suicide and Crisis Lifeline is available 24 hours a day by calling or texting 988.