A S A P

 Applying Science. 

Advancing Practice.

Suicide Prevention:

A Public Health Issue

The economic and human cost of suicidal behavior to 

individuals, families, communities and society makes 

suicide a serious public health problem around the 

world. In the US, suicide is one of the leading causes of 

death among young people. It is the third leading cause 

of death among 15-24 year olds and the second leading 

cause of death among 25-34 year olds. What’s more, in 

2009, almost 1 in 7 high school students (grades 9-12) 

reported that they had seriously considered suicide in the 

past year (CDC, 2010). That is equal to three students in a 

typical classroom of 20 (U.S. Dept. of Education, 2009).

The Enhanced Evaluation and Actionable Knowledge project is part of an intra-agency agreement between CDC and the Substance Abuse 

and Mental Health Services Administration (SAMHSA). The purpose of this project was to engage three Garrett Lee Smith Memorial Act

grantees* in a process to create products that apply evaluation findings to strengthen suicide prevention practice. 

TM

National Center for Injury Prevention and Control

Division of Violence Prevention

Enhanced Evaluation and Actionable Knowledge for Suicide Prevention Series

In the past, suicide was addressed by providing mental 

health services to people who were already experiencing 

or showing signs of suicidal thoughts or behavior. While 

services such as therapy and hospitalization are critical for 

those who may be thinking about or who have made a 

suicide attempt, they do not prevent suicidal thoughts or 

behaviors from happening in the first place. There are also 

other factors besides mental health, which place people 

at risk for suicide. A public health approach to suicide 

prevention can address these factors in many ways.

First, public health uses a population approach to 

improve health on a large scale. A population approach 

means focusing on prevention approaches that impact 

groups or populations of people, versus treatment of 

individuals. Second, public health focuses on preventing 

suicidal behavior before it ever occurs (primary 

prevention), and addresses a broad range of risk and 

protective factors. Third, public health holds a strong 

commitment to increasing our understanding of suicide 

prevention through science, so that we can develop 

new and better solutions. Finally, public health values 

multi-disciplinary collaboration, which brings together 

many different perspectives and experience to enrich 

and strengthen the solutions for the many diverse 

communities.

* The three Enhanced Evaluation Actionable Knowledge grantees were 1) Tennessee Lives Count 2) Maine Youth Suicide Prevention 

Program and 3) the Native American Rehabilitation Association of the Northwest (NARA-NW).

Suicidal Behavior

Suicidal behavior includes:

•	 Suicidal ideation (thinking about ending one’s life)

•	 Suicide attempt (non-fatal suicidal behavior)

•	 Suicide (ending one’s life)
Applying Science. Advancing Practice.

Population Approach

Part of public health’s broad view is an emphasis on 

population health—not just the health of individuals. 

While suicide is often thought of as an individual 

problem, it actually impacts families, communities, and 

society in general. The long-term goal of public health is 

to reduce people’s risk for suicidal behavior by addressing 

factors at the individual (e.g., substance abuse), family 

(e.g., poor quality parent-child relationships), community 

(e.g., lack of connectedness to people or institutions), and 

societal levels (e.g., social norms that support suicide as 

an acceptable solution to problems; inequalities in access 

to opportunities and services) of the social ecology. 

What does this look like?

The Native American Rehabilitative Association of the 

Northwest (NARA) has developed the Life is Sacred 

Starter Kit, with resources for youth service providers. 

These resources focus on the core message of “culture 

as prevention” and provide concrete actions parents 

and family members can take to promote resilience in 

American Indian/Alaska Native youth.

Primary Prevention

Public health emphasizes efforts to prevent violence 

(in this case, toward oneself) before it happens. This 

approach requires addressing factors that put people 

at risk for, or protect them from, engaging in suicidal 

behavior.

What does this look like?

The Tennessee Lives Count initiative conducted 

Gatekeeper Training - training of service providers 

who typically interact with youth (e.g., teachers, 

social workers, juvenile justice staff) on identifying 

and referring youth at risk for suicide before suicide 

occurs. As opposed to traditional mental health 

approaches where youth are typically identified and 

treated after suicidal behavior has happened, this 

model empowers adults who come into contact 

with youth on a daily basis to identify the very early 

warning signs of suicide and get help for youth 

before suicidal behavior has occurred.

Commitment to Science

Public health is responsible for tracking suicide trends 

and identifying risk and protective factors for suicidal 

behavior. From this information, suicide prevention 

strategies are developed and evaluated to identify 

the most effective interventions. Finally, public health 

is responsible for learning how to put in place these 

effective interventions on a wide scale. All of these 

scientific activities increase our understanding of suicidal 

behavior and the most effective ways to prevent it.

What does this look like? 

Three Garrett Lee Smith Memorial Act grantees 

conducted enhanced evaluations of youth suicide 

prevention programs and strategies. Survey data 

collected through these evaluations revealed: 1) 

trends in suicidal behavior and culturally-specific 

risk and protective factors among a sample of 233 

American Indian/Alaska Native youth, 2) information 

on how to put in place early identification and 

referral data systems for school-based gatekeeper 

training programs, and 3) key factors important for 

successful implementation of gatekeeper training 

across different settings/populations. 

Multi-disciplinary Perspective

Public health includes many disciplines (e.g. psychology, 

epidemiology, sociology) across multiple sectors (e.g. 

health, media, business, criminal justice, education). 

Public health often serves as a convener of these diverse 

perspectives in order to best address complex problems 

like suicide. Suicide is related to other forms of violence 

(for example: exposure to violence as a child is associated 

with suicidal behavior as an adult; Dube et al., 2001), as 

well as other health problems, which makes this multidisciplinary approach critical.

What does this look like?

The Maine Youth Suicide Prevention Program uses 

a multi-disciplinary referral network as an essential 

component of a comprehensive school-based suicide 

prevention program. The network includes the 

school, the local crisis response agency, community 

mental health providers, substance abuse treatment 

providers, and hospitals. The collaboration of 

organizations across these different sectors has been 

important for addressing challenges by coordinating 

services, resources, and solutions necessary for the 

success of the suicide prevention program.
A S A P

Population Approach. Part of public 

health’s broad view is an emphasis 

on population health—not just the 

health of individuals. Suicide has 

been typically treated as an individual 

experience (e.g. hospitalization, 

individual therapy); however, its 

consequences and potential solutions 

also affect society in general (e.g. 

economic impact of loss to labor force).

What does a population approach look like?

It goes beyond a focus on the individual to include peers, family, community, 

and society as a whole. (Example: District-wide training on suicide awareness/

prevention for all teachers, administrators and other school personnel. )

What can my community or organization do?

Primary Prevention. Public health 

emphasizes efforts to prevent suicide 

before it occurs. This approach requires 

not only reducing the factors that 

put people at risk, but also increasing 

the factors that protect people from 

engaging in suicidal behavior.

What does primary prevention look like?

It occurs before harm is done. (Example: Prevention program for parents and 

youth that focuses on building positive relationships and the protective benefits 

of family and community support (connectedness).) 

What can my community or organization do?

Commitment to Science. Public 

health monitors and tracks suicide 

trends, researches risk and protective 

factors, evaluates interventions, and 

determines how best to implement 

effective interventions, moving science 

to action and vice versa.

What does commitment to science look like? 

Knowing where to look for community data and research information about risk 

and protective factors for suicidal behavior. Examples:

•	 State and National Data: 

www.cdc.gov/injury/wisqars/index.html

• Risk and Protective Factors: 

 www.cdc.gov/ViolencePrevention/suicide/riskprotectivefactors.html

• Registry of Evaluated Programs:

www.nrepp.samhsa.gov/

Where are your sources for local data? (youth risk behavior surveys, hospital/

emergency room records, etc.)

Multi-disciplinary Perspective. Public 

health includes many disci¬plines 

and perspectives, which helps when 

addressing complex problems like 

suicide. Public health often serves a 

convening role in bringing together 

representatives from sectors such as 

health, media, business, criminal justice, 

behavioral science, epidemiology, 

social science, advocacy, and education, 

which all have important roles to play 

in suicide prevention.

What does a multi-disciplinary perspective look like? 

Strategies addressing suicide prevention include many types of organizations. 

(Example: A small school district convenes a suicide prevention advisory council 

that includes the local public health department, hospitals, law enforcement, 

211 crisis line, mental health providers, the local chamber of commerce, faithbased community, youth serving organizations and substance abuse treatment 

providers.) 

Which organizations are or should be included in suicide prevention planning 

activities in my community?

What can you do to promote a public health approach to suicide prevention in your community or organization? The 

table below may be a helpful as a conversation starter with others who share an interest in addressing this issue. Think 

about what your community or organization is already doing that is in line with a population approach and focus on 

primary prevention. Then brainstorm ideas for what can be added to existing programs or activities in schools, faith 

organizations, youth serving organizations, or other organizations in your community.
For more information, please contact:

Centers for Disease Control and Prevention

1-800-CDC-INFO • www.cdc.gov/violenceprevention • cdcinfo@cdc.gov 

A S A P Applying Science. Advancing Practice.

References

Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance—United States, 2009. Surveillance Summaries, June 4. MMWR 2010; 59(No. SS-5).

Dube, S., Anda, R., Felitti, V., Chapman, D., Williamson, D., & Giles, W. (2001). Childhood abuse, household dysfunction, 

and the risk of attempted suicide throughout the life span: Findings from the Adverse Childhood Experiences study. 

Journal of the American Medical Association, 286, 3089-3096.

U.S. Department of Education, National Center for Education Statistics. (2009). Characteristics of Public, Private, 

and Bureau of Indian Education Elementary and Secondary Teachers in the United States: Results from the 2007-08 

Schools and Staffing Survey (NCES 2009-324).