World Suicide Prevention Day 2025: Everyone has a role to play in changing the narrative

*** Content Warning *** This blog discusses topics in relation to suicide and so may be triggering or uncomfortable for some. Please use your own discretion when engaging with it. The blog does not replace professional advice and the findings discussed are from studies published in PLOS Mental Health as opposed to representing the perspectives of the journal, PLOS or any of its affiliated Editors. If you are affected by any of the content, please seek professional support in a way that is safe for you. 

Today is Word Suicide Prevention Day and as highlighted last year, the day is currently aiming to change the narrative on suicide and shift from silence to openness, empathy and support. 

Every nation and community can be affected by suicide. The 2024-2028 Organizational Strategy Report from the International Association for Suicide Prevention (IASP) estimates that there are at least 700,000 suicides in just one year and that almost 77% of these occur in low- and middle-income countries (LMICs). That figure of 700,000 is an underestimation of impact – not just because not all suicides will be reported, but because for every one person who dies by suicide, whole families and communities are profoundly affected. Together, we have to do more to reduce the number of suicides and this means creating a world in which people can ask for and access help when it is needed, everyone is represented, and people are not exposed to circumstances that trigger or exacerbate suicidal thoughts and actions. This is a very big ask but it is not impossible if everyone takes responsibility for the world we live in.

Everyone has a role to play and as a journal, one of things that we can do is to keep the conversations going and to disseminate the work of our authors so that we help to increase awareness, reduce stigma and inform interventions. 

Understanding the risk factors for suicide in LMICs

As mentioned above, almost 77% of reported suicides occur in LMICs. There are many potential reasons for this and to progress, we must understand these reasons and respond accordingly, with full commitment. In a paper published in PLOS Mental Health in May of this year, an international collaboration between Dr Ismail Amiri and colleagues at Duke University, Kilimanjaro Christian Medical Centre and Washington University in St. Louis explored experiences of suicidal ideation among people living with HIV in Kilimanjaro, Tanzania. Suicide is reported to be the leading cause of death among those with HIV and in Tanzania, there are only 55 psychologists and psychiatrists for the whole nation, which was estimated in 2024 to be around 69 million people.

The authors report that participants experienced high levels of societal stigma, financial stress, low levels of support, and a variety of socio-economic challenges. Addressing these challenges will require a comprehensive and holistic approach that not only tackles the physical and mental health of the individual, but also the underlying socioeconomic challenges that affect the entire community. The authors specifically call for active involvement from religious leaders in implementing new interventions – a call that demonstrates how important it is that actions are culturally-informed in order to be more readily adopted by communities. Each community will have its own needs and require a unique combination of approaches. This is why, although generalizable results have great value, we absolutely need studies that focus on the specifics of communities.

In November last year, PLOS Mental Health published an Opinion from Dr Anil Fastenau and colleagues at University of Bremen, Harvard Medical School, University of Cologne, and Lepra that discussed the risk factors for suicide among South-East Asian women. Suicide is one of the leading causes of death among women in South East Asia, which the authors attribute to a combination of socioeconomic, cultural, patriarchal and psychological factors. In their Opinion, the authors call for:

• The implementation of gender-specific suicide prevention strategies
• A strengthening of legal protections and gender equality
• An improvement in mental health service accessibility
• Rural vulnerability to be addressed (with most suicides in this region occuring in rural areas)
• The promotion of education and empowerment

Suicide prevention needs all of these actions, and more, to come together. It needs human rights to be at the center of all efforts.

Suicidality and Menopause

High suicide rates are of course not exclusive to women in South East Asia. Although suicide-related death rates are higher in men, suicide attempts are more frequent in women. A Systematic Review published in PLOS Mental Health last November also highlights that suicide attempts occur most frequently in women during their midlife and this is also the time at which menopause typically occurs. In light of this, Professor Sabine Bahn and colleagues at University of Cambridge specifically examined suicidality in relation to menopause. The authors report that very few studies have explored the link between menopause and suicide with most focusing on suicidal thoughts as opposed to attempts. Furthermore, within the small number of studies that met the selection criteria, there were very mixed results. Whilst some studies provided evidence for an increase in suicidality during menopause, other studies observed an increase either before or after menopause. Some studies even reported no link at all between menopause-related hormonal changes and suicidality. So why do we see such heterogeneous results? Aside from the discrepancies in terms of what researchers have been looking at (suicidal thoughts Vs attempts for instance), the authors also point out that age can sometimes be used as a proxy for menopause, which is flawed given the fact that women go through menopause at different ages. The authors therefore call for a more consistent exploration of the relationship between suicide and menopause. In addition, a consistent observation they made is that the studies were not usually longitudinal nor did they involve people with lived experience. These are two key ingredients that are missing and are needed to ensure both effective and inclusive research.

Community-based support for men experiencing suicidal crisis.

As mentioned above, suicide rates are higher in men despite women reportedly carrying out a higher number of attempts. This could suggest that the window of opportunity to support men in crisis is smaller. In April of this year, we published a study from Dr Claire Anne Hanlon, Professor Pooja Saini, and colleagues at Liverpool John Moores University that explored the perceptions of the James’ Place Model (JPM), a therapeutic intervention delivered within a community-setting for men experiencing suicidal crisis. They specifically explored its effectiveness over the course of 6 months. The authors monitored risk factors associated with suicide (including distress, loneliness, entrapment) as well as protective factors (including self-compassion, hope, resilience, social support and self-efficacy). The participants reported that self-compassion increased in the first 3 months of the intervention whilst feelings of entrapment decreased and continued to decrease at the 6 month follow-up. 

Although the sample size was small, causality could not be confirmed, and the results may be susceptible to some bias (e.g. self-selection of participants and re-call bias) it is still so important not just to carefully develop interventions but to just as carefully evaluate the impact that they have. This study represents a great starting point for following up on community-based interventions and considering what can be done moving forward in accordance with the feedback obtained through a lived experience lens.

Non-verbal predictors of suicidal ideation in LGBTQ+ adults

Communicating suicidal thoughts is extremely difficult and many who know someone who has tragically died by suicide will often say that they had no idea that their loved one was suffering. Even mental health professionals will sometimes miss the signs. In addition, suicidal thoughts are disproportionately high among marginalized groups given the adversity and discrimination that they face. This is why being able to pick on all cues, in all communities, not just marginalized groups, could save someone’s life. At the start of this year, Dr Mollie Ruben and colleagues at University of Rhode Island, Boston University Chobanian & Avedisian School of Medicine, and City University of New York, explored whether nonverbal expressions of shame could be used to help predict suicidal ideation among LGBTQ+ adults. They closely observed over 130 people in the US who identified as being part of the LGBTQ+ community during their recollections of experiences of feeling shame associated with their identities. Body language was observed and self-reported feelings of shame and suicidal ideation were measured at the time of the recording and three months later. Interestingly, the study revealed that among its participants, nonverbal signs of shame were more likely to predict increased suicidal ideation at the time of follow up in people who identified as being part of the LGBTQ+ community living in a rural setting specifically. This was not the case for those living in urban settings. Although the study has limitations including a small sample size, it nonetheless highlights the potential importance of recognizing nonverbal cues in context when assessing mental health risks. Picking up on certain cues in certain contexts could save lives.

Supporting mental health professionals 

Picking up on any cues that could indicate someone is at risk, as discussed above, requires acute awareness. Supporting people who experience suicidal ideation can be emotionally draining and triggering, and requires mental health service providers to be at their best. Suicide prevention is therefore also about supporting those who support others – something which is often overlooked when considering suicide prevention approaches. Back in June of last year, Dr Celine Larkin and colleagues from UMass Chan Medical School explored the perspectives of clinicians on suicide risk management and their readiness to support those who may need it. What stood out to the authors was how consistently clinicians reported that clinics were extremely busy and constrained in terms of the resources that they could offer to service users. However, they did observe a consistent expression of commitment to helping people experiencing suicidal ideation and their families. So in this instance, a limiting factor is the resources that service providers have at their disposal, which directly counters their intentions and likely elevates their levels of stress and guilt.

Not only do we need to ensure that mental health professionals, and indeed all healthcare workers are at their best for the safety of patients, but we also need to support them for their own safety too. As part of our World Mental Health Day content and activities last year, we published an Opinion from Dr Heliana Ramirez in which she calls for a reframing of mental health in the workplace to help combat workplace-related suicides. Specifically, she explains the importance of shifting from the perception of mental illness to mental injury in the workplace, which could help to ensure accountability. In addition, Dr Ramirez shares some recommendations for individuals and healthcare systems that could help to prevent suicide

Suicide prevention is therefore also about supporting those who support others – something which is often overlooked when considering suicide prevention approaches.

Providing new tools for mental health professionals and service users

As well as ensuring that mental health professionals feel supported enough to be at their best and support those in need, the development and evolution of tools can also help towards suicide prevention efforts.  Eye Movement Desensitization and Reprocessing (EMDR) psychotherapy is a type of treatment that is usually used for those experiencing posttraumatic stress disorder (PTSD). In August of this year, Dr Sidney Yap, Dr Lisa Burback and colleagues at University of Alberta explored whether EMDR could also be used to support those experiencing suicidal ideation. Not only that, but EMDR was delivered online (over zoom), which, if effective, could be highly beneficial for those who may struggle with accessing in-person therapy.

The authors report that the overall experience of online EMDR was beneficial for participants however one of the strongest determinants of success was the therapeutic relationship and the capacity for personalization – which can probably be said for all forms of talking therapy. The study is limited by a small sample size and the qualitative nature of the exploration as well as a lack of exploration of participant perceptions of suicide, suicidal ideation and help-seeking. However, the authors propose that this is the first study to explore web-based EMDR for the purpose of supporting those with suicidal ideation and serves as an important foundation for future research. 

Preventing suicide requires a multifaceted approach that includes understanding the risk factors, community specific needs, determinants of help seeking, destigmatization, optimization of resources, supporting mental health professionals and developing new tools that predict suicidal thoughts and serve as mental health interventions. PLOS Mental Health will continue to publish and disseminate studies that contribute to suicide prevention. We are using today as an opportunity to highlight some of these papers but will consistently help to tackle stigma and increase awareness throughout the year.