Preventing Suicide
Program Activities Guide
National Center for Injury Prevention and Control
Division of Violence Prevention
TM
Preventing Suicide
The Facts
Someone dies by suicide every 15 minutes. In 2007,
more than 34,000 Americans took their own lives.
Suicide is the third leading cause of death among 15to 24-year-olds, the fourth leading cause among 25- to
44-year-olds, and the eighth leading cause among
45- to 64-year-olds. Though suicide is a serious problem among youth, death rates are highest for people
between the ages of 45 and 54 (about 17 per 100,000).
When rates are examined by sex, women in the 45 to
54 age group are at greater risk for suicide, while men
over the age of 75 are at greatest risk.
One of the greatest challenges in the field of suicide
prevention is identifying promising strategies and programs. CDC must continue to research effective prevention strategies and to develop and evaluate new ones.
CDC will communicate information about what works
to practitioners in the field as data become available.
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A population approach. Part of public health’s broad
view is an emphasis on population health— not
just the health of individuals.
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Measuring impact
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Creating and evaluating new approaches to
prevention
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Applying and adapting effective practices
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Building community capacity for implementing
prevention strategies.
Additional information about CDC’s suicide prevention programs and activities is available at www.cdc.gov/
violenceprevention.
CDC’s Role
CDC’s violence prevention activities are guided by four
key principles:
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A cross-cutting perspective. Public health encompasses
many disciplines and perspectives, making its approach well suited for examining and addressing
complex problems like suicidal behavior.
CDC’s strategic direction for suicide prevention is
to promote and enhance connectedness within and
among individual persons, families, and communities.
CDC is particularly focused on interrupting the development of suicidal behavior, integrating approaches
to preventing suicidal behavior for those faced with
interpersonal violence, and addressing vulnerable
populations. CDC’s strategy is organized around these
four general priorities:
The number of deaths from suicide reflects only a
small portion of the impact of suicidal behavior. In
2007, 165,997 people were hospitalized following suicide attempts. More than 395,320 were treated in hospital emergency departments for self-inflicted injuries.
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Key Partners
An emphasis on primary prevention. CDC seeks to stop
suicidal behavior before it occurs. This involves
reducing the factors that put people at risk for experiencing violence. It also includes increasing the
factors that protect people or buffer them from
risk.
Preventing suicide and suicidal behavior requires the
support and contributions of many partners:
federal agencies, state and local health departments,
nonprofit organizations, academic institutions, international agencies, and private industry. Partners
help in a variety of ways, including collecting data
about suicide, learning about risk factors, developing
strategies for prevention, and ensuring that effective
prevention approaches reach those in need.
A commitment to developing a rigorous science base. CDC’s
approach includes defining the problem through
surveillance, using research to identify risk and
protective factors, developing and evaluating new
prevention strategies, and ensuring widespread
adoption of effective programs.
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Monitoring, Tracking, and Researching the Problem
National Violent Death
Reporting System
Linking NVDRS data to Department of
Defense and Veteran Affairs (VA) Data
State and local agencies have detailed information
from medical examiners, coroners, law enforcement,
crime labs, and death certificates that could answer
important, fundamental questions about trends and
patterns in violence. However, the information is
fragmented and difficult to access. Eighteen states are
currently part of the National Violent Death Reporting System (NVDRS)—Alaska, Colorado, Georgia,
Kentucky, Maryland, Massachusetts, Michigan, New
Jersey, New Mexico, North Carolina, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia, and Wisconsin. These states gather, share, and
link state-level data about violence. NVDRS enables
CDC and states to access vital, state-level information
to gain a more accurate understanding of the problem of violence. This will enable policy makers and
community leaders to make informed decisions about
violence prevention strategies and programs, including those that address suicide.
CDC is working to enhance the National Violent
Death Reporting System (NVDRS) to better characterize the nature of suicides among current and
former military personnel. Specifically, CDC is attempting to link data provided by the Department of
Defense Suicide Event Report (DoDSER) and the
Department of Veterans Affairs (VA) to NVDRS.
CDC is also assessing the feasibility of linking VA
data to NVDRS through state NVDRS programs.
Having a better understanding of the most common
contributing factors could help focus military suicide
prevention initiatives.
National Electronic Injury Surveillance
System - All Injury Program
The National Electronic Injury Surveillance System –
All Injury Program (NEISS-AIP) is operated by the
U.S. Consumer Product Safety Commission in collaboration with the National Center for Injury Prevention and Control. It provides nationally representative
data about all types and causes of nonfatal injuries
treated in U.S. hospital emergency departments. CDC
uses NEISS-AIP data to generate national estimates
of nonfatal injuries, including those related to suicide.
National Survey on Drug Use
and Health Data Analysis
CDC is working with the Substance Abuse and Mental Health Services Administration to analyze data
from the suicide-related items on the National Survey
on Drug Use and Health (NSDUH). The survey is
the leading source of information on the prevalence
and incidence of the use of alcohol, tobacco, and
illicit drugs in the United States. Suicide-related items
were changed in calendar year 2008 to allow national
and state estimates of suicidal thought and behavior
among U.S. adults. Scientists are analyzing the data to
identify patterns of suicidal thought and behavior as
they relate to demographic and social characteristics
and associations with substance abuse. This information will allow state and federal decision-makers and
prevention program practitioners to make informed
judgments about where to focus prevention resources.
Youth Risk Behavior Survey
CDC’s national Youth Risk Behavior Surveillance
System Survey (YRBSS) monitors six categories of
priority health-risk behaviors among youth and young
adults that contribute markedly to the leading causes
of death, disability, and social problems among youth
and adults in the United States. A national survey is
conducted every two years and provides data representative of 9th through 12th grade students in public
and private schools in the United States. The YRBSS
examines several types of violence-related behaviors
including physical fighting, weapon carrying, dating
and sexual violence, and suicidal behavior.
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relation to dating violence and suicidal thoughts and
behaviors. The Healthy Teens Project is a longitudinal
study of about 700 students and uses multiple methods of data collection such as student surveys, teacher
ratings, archival data on academic achievement and
discipline, focus groups, and interviews. The project
includes random and high-risk samples of students
and evaluates a large number of violence-related
constructs and behaviors. The project is designed
to enhance the understanding of the development
of dating violence and its interrelation with suicidal
thoughts and behaviors and to inform the development of prevention strategies.
Defining and Measuring Connectedness
Connectedness is the degree to which a person or
group is socially close, interrelated, or shares resources with other persons or groups. A wide range of
connectedness concepts have been linked to suicide
and self-directed violence, including social support,
social participation, social isolation, social integration,
social cohesion, and social capital. CDC is conducting
a literature review to identify definitions of connectedness and has convened a panel of experts to
develop a practical definition of connectedness that
could be used to refine the measurement of connectedness as it relates to self-directed violence. The goal
is to improve the utility, measurement, and monitoring of connectedness and resilience factors.
Injury Control Research Centers
CDC funds several Injury Control Research Centers
(ICRCs) to address training and research in an integrated manner that will impact the field of injury and
violence prevention. Activities include a range of
research, education, and prevention projects that address unique problems of injury and violence prevention at the state, local and national levels. Two of the
ICRCs, Colorado State University and West Virginia
University, have a special focus on suicide-related
projects. For example Colorado State focuses on
community partnerships among underserved populations, such as Native Americans, Hispanics and rural
residents. West Virginia has a research project examining risk and protective factor differences for suicide
among Whites and Blacks.
Prospective Risk and Protective Factors
for Suicide and Co-occurring
Risk Behaviors
CDC is funding researchers from Kent State University to explore differences in risk and protective
factors across diverse samples of adolescents and
young adults. Previous studies have identified risk and
protective factors for suicide. However, relatively few
studies have attempted to compare the influence of
specific risk and protective factors across samples of
youth in different contexts and with different risk exposures. By considering the relationship between risk
characteristics and socioenvironmental context, the
results of the study could have direct implications for
the development of targeted prevention and intervention efforts designed to reduce adolescent and young
adult suicide.
School-Associated Violent Death Study
In partnership with the Department of Education,
CDC monitors school-associated violent deaths at the
national level. Information is collected from media
databases, police, and school officials. Only violent
deaths associated with U.S. elementary and secondary
schools are included. This ongoing study plays an important role in monitoring trends in school-associated
violent deaths, identifying risk factors, and assessing
the effects of prevention strategies.
Developmental Pathways to Dating
Violence and Suicidal Behavior:
The Healthy Teens Project
CDC is funding researchers from the University
of Georgia to examine the risk and protective factors that influence the developmental pathways that
adolescents follow from 6th through 12th grade in
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Developing and Evaluating Prevention Strategies
by linking socially disconnected seniors with peer supports through the pre-existing Retired and Senior Volunteers Program. Participants in the evaluation will be
followed over the course of 24 months to determine
whether TSC is effective in reducing risk for suicidal
behaviors.
Links to Enhancing Teens’ Connectedness
(LET’s CONNECT)
CDC is working with researchers at the University of
Michigan to evaluate the Links to Enhancing Teens’
Connectedness (LET’s CONNECT) program. LET’s
CONNECT pairs adolescents who are at risk of
suicidal behavior (e.g., due to low interpersonal connectedness or a recent history of bullying or being
bullied) with peer and community mentors. Together,
these mentors will support and engage the adolescents
in community organizations and activities. The intervention aims to increase individual and community
connectedness, decrease the likelihood of engaging in
suicidal behaviors, and enhance overall well-being of
youth in the program.
Enhanced Evaluation of
Youth Suicide Prevention
CDC is working with the Substance Abuse and Mental Health Services Administration to evaluate the
implementation and outcomes of three state-based
youth suicide prevention programs funded under the
Garrett L. Smith Memorial Act. Findings from the
enhanced evaluation will allow researchers to assess
the implementation and outcomes of suicide prevention activities and better understand the process of
implementing widespread strategies and their impact
on prevention. CDC researchers will also work with
the enhanced evaluation sites to translate and make
actionable the sites’ evaluation results, lessons learned,
and recommendations for use by suicide prevention
researchers and practitioners to improve future evaluation efforts.
The Senior Connection (TSC)
CDC is working with researchers at the University of
Rochester to evaluate The Senior Connection (TSC), a
preventive intervention focused on increasing connectedness among older adults. The long-term goal of
TSC is to reduce the risk of suicide-related morbidity
and mortality among older adult primary care patients
Supporting and Enhancing Prevention Programs
U.S. Department of Defense and
Army Suicide Prevention Program
Department of Veterans Affairs
Suicide Prevention Program
CDC is working with representatives from the Department of Veterans Affairs and the National
Institute of Mental Health to provide consultation to
the Department of Defense and the US Army in the
development of a coordinated, service-wide suicide
prevention program. CDC researchers are providing
suggestions on data collection, prevention program
components, and program evaluation. This effort will
lead to relevant and evidence-based suicide prevention policies and practices that reduce suicidal behaviors among U.S. military service personnel.
CDC is working with the Department of Veterans
Affairs to develop an agency-wide suicide prevention
program for veterans. CDC researchers are serving on
the advisory committee and Blue Ribbon panel and
are providing input on definitions application, data
collection, and program evaluation. This effort will
lead to better understanding of the magnitude of the
problem of suicide among veterans, the interaction
of risk and protective factors, and successful suicide
prevention efforts.
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Federal Steering Group for the
National Strategy for Suicide Prevention
federal and non-federal partners to advance Strategy
goals and objectives, which were published early 2001.
They included promoting awareness about suicide as
a preventable public health problem; developing and
evaluating prevention programs; improving the portrayal of suicide, mental health, and drug use in the
entertainment and news media; promoting research
about suicide and its prevention; and enhancing tracking systems for suicide.
CDC plays a key role in the Federal Steering Group
for the National Strategy for Suicide Prevention. This
Group provides recommendations and guidance for
implementing the National Strategy; coordinates federal initiatives to prevent suicide; and collaborates with
Key Publications
Uniform Definitions for
Self-Directed Violence
Strategic Direction for the
Prevention of Suicidal Behavior
CDC has developed Self Directed Violence Surveillance:
Uniform Definitions and Recommended Data Elements
to improve and standardize data collected on selfdirected violence. Consistent data allow researchers to
better gauge the scope of the problem, identify highrisk groups, and monitor the effects of prevention
programs. The definitions and data elements were
developed in collaboration with the Department of
Veterans Affairs and the Department of Defense.
The strategic direction for preventing suicidal behavior
describes a five-year vision for CDC’s prevention work.
The overall strategy for preventing suicide is to promote individual, family, and community connectedness.
National Strategy for Suicide Prevention
The National Strategy for Suicide Prevention (NSSP) is the
first attempt in the United States to prevent suicide
through a systematic approach. It lays out a framework for developing an array of suicide prevention
services and programs. The NSSP emphasizes coordination of resources and the application of culturally
appropriate services at all levels of government and in
the private sector.
State Suicide Prevention Planning
State Suicide Prevention Planning: A CDC Research Brief
summarizes the results of a CDC research study
conducted to describe the key ingredients of successful state-based suicide prevention planning. The
study’s major objectives were to document the processes involved in developing state suicide prevention
plans and to compile these findings into a template
for decision making. The results of this study do not
provide a universal blueprint for suicide prevention,
but the insights garnered provide states with valuable
information for effective planning, implementation,
and evaluation.
School Health Guidelines to Prevent
Unintentional Injuries and Violence
CDC’s School Health Guidelines to Prevent Unintentional
Injuries and Violence include information about preventing adolescent violence, suicide, and unintentional
injury; why it is important to focus on schools; and
what schools can do to prevent injuries and violence.
www.cdc.gov/HealthyYouth/injury/guidelines
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Centers for Disease Control and Prevention
National Center for Injury Prevention and Control
Division of Violence Prevention
4770 Buford Highway, NE, MS F64
Atlanta, Georgia 30341
1-800-CDC-INFO
cdcinfo@cdc.gov
www.cdc.gov/violenceprevention
National Center for Injury Prevention and Control
Division of Violence Prevention
TM
2010
