Suicide Prevention and How to Support a Friend or Family Member: A Comprehensive Resource Guide

Parent Category: Resource Library
Category: Suicide Prevention

Suicide is one of the leading causes of death in the United States, but it is not inevitable. Decades of research show that suicide is preventable, that most people who experience a suicidal crisis go on to live their lives, and that the people closest to someone in pain play a measurable role in keeping them alive. This guide covers risk factors and warning signs, how to start a difficult conversation, how to build a safety plan, and where to find trained support in Maryland and nationwide.

Why This Guide Exists

The Blue Ribbon Project works at the intersection of childhood trauma, foster care, and family well-being. The research is consistent and difficult: childhood abuse, neglect, and other adverse childhood experiences are among the strongest predictors of suicidal ideation and suicide attempts later in life. A 2020 systematic review and meta-analysis of 79 studies covering more than 337,000 participants found that core forms of childhood maltreatment were associated with up to 2.5 times higher odds of suicidal ideation, and childhood sexual abuse was associated with a 4-fold increase in odds of having a suicide plan in young people (JAMA Network Open). A more recent 2025 meta-analysis confirmed that exposure to any adverse childhood experience nearly doubles the risk of suicidal behavior in people with affective disorders (European Psychiatry).

This means many of the people we serve — survivors of abuse, youth in foster care, families navigating crisis — face elevated risk, often quietly. It also means that people who love them have real influence. Connection, listening, helping reduce access to lethal means, and showing up over time are not soft interventions. They are evidence-based.

This guide is written for the friend, parent, sibling, partner, kinship caregiver, foster parent, mentor, teacher, coworker, or neighbor who suspects someone they care about may be struggling and wants to know what actually helps. It is not a substitute for professional mental health care. It is a starting place — grounded in research, written in plain language, and centered on the dignity of the person at risk.

Understanding Suicide: What the Numbers Tell Us

According to the National Institute of Mental Health, more than 49,300 people in the United States died by suicide in 2023, making it the eleventh leading cause of death overall. Suicide was the second leading cause of death among people ages 10 to 34 and the fourth leading cause of death among people ages 35 to 44. There were more than twice as many deaths by suicide as homicides that year.

The Centers for Disease Control and Prevention describes the broader picture this way: for every death by suicide, there are roughly 10 emergency department visits for self-harm, 48 self-reported suicide attempts in the past year, and 325 people who seriously considered suicide in the past year. In 2024, an estimated 14.3 million U.S. adults had serious thoughts of suicide, 4.6 million made a suicide plan, and 2.2 million attempted suicide, according to NIMH analysis of SAMHSA data.

Suicide rates are not evenly distributed. NIMH data show that in 2023 the suicide rate among males was nearly four times higher than among females, and rates were highest among American Indian and Alaska Native communities and among older men ages 75 and above. Among adults of all ages, young adults ages 18 to 25 had the highest prevalence of serious suicidal thoughts (12.6%) and suicide attempts (2.0%) in 2024.

Children and Adolescents

The picture for young people is sobering. According to the CDC's 2023 Youth Risk Behavior Survey, nearly 40% of high school students reported persistent feelings of sadness or hopelessness in the past year, 20% had seriously considered attempting suicide, 16% had made a suicide plan, and 9% had attempted suicide. Female and LGBTQ+ students consistently report higher rates of suicidal thoughts and attempts than their peers (CDC Newsroom, August 2024).

Researchers at the National Institutes of Health have also documented an alarming trend among preteens. A study using CDC data found that suicide rates among children ages 8 to 12 have been increasing approximately 8% per year since 2008, with the largest increases among female preteens, American Indian/Alaska Native and Asian/Pacific Islander preteens, and Hispanic preteens (NIMH).

Foster Youth and Survivors of Childhood Trauma

Children in foster care face suicide risk well above their peers. According to research published by the California Youth Transitions to Adulthood Study (CalYOUTH), about 24% of young adults in California foster care had attempted suicide and 40% had considered it, compared with roughly 2% and 11% of young adults in the general population (The Imprint, citing CalYOUTH). LGBTQ+ youth in foster care were two to four times more likely to consider and attempt suicide than other foster youth (KFF Health News).

The link between adverse childhood experiences and suicide risk is one of the clearest signals in public health research. Analyses cited by the CDC and Teen Health Connection indicate that individuals who have experienced six or more ACEs are over 24 times more likely to attempt suicide compared with those who report no ACEs. The relationship is dose-response: the more types of childhood adversity, the higher the long-term risk.

None of this is destiny. The same research literature that identifies these risks also identifies what protects against them. Connection, supportive relationships, problem-solving skills, access to mental health care, and reduced access to lethal means all reduce the likelihood that a person in pain will act on suicidal thoughts.

Risk Factors: What Makes a Person More Vulnerable

Suicide is rarely caused by a single event. It is the convergence of multiple factors — biological, psychological, social, and environmental — that build up over time. The American Foundation for Suicide Prevention, the CDC, and the Suicide Prevention Resource Center identify several broad categories of risk.

Health Risk Factors

Environmental Risk Factors

Historical and Personal Risk Factors

Researchers studying age-related patterns have also identified two psychological states that consistently distinguish people at risk: depressive rumination (repeatedly dwelling on negative thoughts) and entrapment (the feeling of being inescapably stuck) (AFSP). When you hear someone describe themselves as trapped, stuck with no way out, or unable to imagine the future, that language matters.

Protective Factors: What Helps People Survive

Protective factors are the conditions, relationships, and skills that buffer against suicide risk. The presence of strong protective factors does not guarantee safety, but their absence is associated with greater vulnerability. Drawing from CDC, SPRC, and American Association of Suicidology guidance:

Notice how many of these protective factors are relational. The person who shows up consistently — without judgment, without conditions, without disappearing — is not a bystander. They are protective infrastructure.

Warning Signs: What to Watch and Listen For

Most people who die by suicide show one or more warning signs. The signs may appear in what someone says, how they behave, or how their mood shifts — particularly when these changes follow a painful event, loss, or life transition. The following list draws from AFSP and the CDC.

What People Say

What People Do

How Mood Shifts

You do not need to see every sign. You do not need to be certain. If something feels off, that intuition is enough to begin a conversation.

How to Talk to Someone You're Worried About

The single most studied framework for friends and family members helping someone at risk is the five-step approach developed by the 988 Suicide & Crisis Lifeline network and promoted by NIMH: Ask, Be There, Help Keep Them Safe, Help Them Connect, and Follow Up (NIMH; #BeThe1To). Each step is supported by published evidence, and together they form a workable script for an ordinary person navigating an extraordinary moment.

Step 1: Ask Directly

Many people hesitate to ask the question — "Are you thinking about suicide?" — out of fear that asking will plant the idea or make things worse. Decades of research have found the opposite. Asking directly does not increase suicidal thoughts or behavior; in fact, multiple studies suggest that acknowledging and discussing suicide may reduce suicidal ideation by giving the person an opportunity to express what they are carrying (NIMH; UC Health).

Be specific. Vague language like "Are you thinking about hurting yourself?" can be misinterpreted. Ask plainly: "Are you thinking about suicide?" or "Are you thinking about killing yourself?" The Mayo Clinic recommends layered questions you can build into a conversation: How are you coping with what's happening? Do you ever feel like just giving up? Are you thinking about dying? Have you thought about how you would do it? Do you have access to anything you could use? (Mayo Clinic).

Before you ask, name what you have noticed and why you care. "I've noticed you haven't been yourself lately. You mentioned last week that you felt like a burden, and I've been worried about you. I love you, and I need to ask directly — are you thinking about suicide?" Then listen. Do not rush to fix, advise, or argue.

Do not promise to keep their answer a secret. If they tell you they are at risk, you may need to involve other people to help keep them safe. Promising secrecy can compromise that ability.

Step 2: Be There

"Being there" can mean physical presence, a phone call, a text thread that stays open through the night, or any other consistent way of communicating that the person is not alone. Research suggests that connectedness and a sense of belonging are among the most powerful protective factors against acting on suicidal thoughts (Rogers Behavioral Health).

Only commit to what you can actually deliver. If you say you will check in tomorrow, check in tomorrow. If you cannot be physically present, help identify another trusted person who can. Ask the person what kind of support feels most helpful — physical company, text messages, sitting in silence, taking a walk — and follow their lead.

While you are with them, listen far more than you talk. Avoid arguing with their pain ("It's not that bad," "You have so much to live for"). Avoid telling them you know how they feel. Reflect back what you hear. Acknowledge that the pain is real, even if you don't share it. Help them focus on their reasons for living rather than imposing yours.

Step 3: Help Keep Them Safe

Once you understand that suicide is on the table, gently learn more about immediate safety. Have they done anything to act on these thoughts already? Do they have a plan? Do they have a method in mind? Do they have access to that method right now? What is the timing?

The answers shape the response. A person with a specific, immediate plan and access to means is in acute danger and needs emergency support. A person with passive thoughts and no plan still needs care, but the immediate action may be different.

One of the most important and underused interventions is lethal means safety — temporarily reducing access to firearms, medications, and other dangerous items during a high-risk period. According to Johns Hopkins Center for Gun Violence Solutions, lethal means safety counseling is a patient-centered, evidence-informed health care intervention that helps reduce suicide, homicide, unintentional gun deaths, and nonfatal firearm injuries. A study cited by Johns Hopkins found that patients who received a safe storage recommendation were three times more likely to make safe changes in firearm storage than patients who did not.

For families, this can look like:

The point is not permanent restriction. The point is to put time and distance between an acutely suicidal moment and a lethal method. Suicidal crises often pass; access to a fast, lethal means during that crisis is what turns thoughts into deaths. The free online tool Lock to Live, developed with University of Colorado researchers, can help families think through specific firearm storage options.

Step 4: Help Them Connect

You are not the only support a person at risk needs. Help them build a wider safety net.

The starting point for most families is the 988 Suicide & Crisis Lifeline. Launched in July 2022 as a federally mandated three-digit number, 988 connects callers, texters, and chatters to a network of more than 200 local crisis centers across the country. The service is free, confidential, and available 24/7. Spanish-language support is available by pressing 2; veterans can reach the Veterans Crisis Line by pressing 1; LGBTQ+-specific support is available by pressing 3 or texting "PRIDE" to 988. Independent evaluations have found that callers feel less suicidal, less depressed, less overwhelmed, and more hopeful after speaking with a Lifeline counselor (988 Lifeline).

Save 988 in your phone — and ask the person you are supporting to save it in theirs. Beyond 988, help them connect to:

One of the most useful things a family member can do during this step is build a written safety plan alongside the person at risk.

Step 5: Follow Up

The follow-up step is the one most often skipped, and it may be the one with the strongest evidence. In the 1970s, psychiatrist Jerome Motto conducted a now-classic study at the University of California, San Francisco, in which he sent simple, non-demanding "caring letters" to patients who had refused follow-up after a suicide-related psychiatric hospitalization. In the first two years after discharge, the suicide rate among those who received the letters was about half the rate of those who did not (Healthline; CBS News).

This intervention has since been replicated in modern formats. A randomized controlled trial of a Caring Contacts text-message intervention with 658 active-duty service members found that augmenting standard care with brief, non-demanding text messages led to a 44% decrease in the odds of suicidal ideation and a 48% decrease in the odds of a suicide attempt during follow-up (FSU Military Suicide Research Consortium).

For a family member, follow-up does not require a research protocol. It can be:

Continuity of care matters. People often feel forgotten once they appear "fine." The friend who keeps showing up — without conditions, without disappearing — is a measurable suicide-prevention intervention.

Building a Safety Plan Together

A safety plan is a written, personalized document that helps a person recognize their own warning signs and respond to them with a sequence of internal and external coping strategies. The most widely studied version is the Stanley-Brown Safety Planning Intervention, developed by Drs. Barbara Stanley and Gregory Brown and used across the Veterans Health Administration, hospitals, crisis centers, and outpatient practices nationally.

Research on safety planning is robust. A large cohort study of 1,640 suicidal patients seen in Veterans Health Administration emergency departments found that the Stanley-Brown intervention combined with structured follow-up was associated with 45% fewer suicidal behaviors in the six months after discharge and approximately double the odds of attending at least one outpatient mental health visit. A meta-analysis found a 43% reduction in suicidal behavior across studies (Safer Society Foundation).

The plan has six core components:

  1. Warning signs. What thoughts, feelings, situations, or behaviors signal that a crisis may be building?
  2. Internal coping strategies. What can the person do alone to take their mind off suicidal thoughts?
  3. Social contacts and settings that provide distraction. Who can the person be around — not necessarily to talk about the crisis but simply to be in human company?
  4. People to ask for help. A short list of trusted people, with phone numbers, who know about the plan and have agreed to be available.
  5. Professionals and agencies to contact in crisis. Therapist, psychiatrist, primary care provider, 988, local crisis line, nearest emergency department.
  6. Means restriction. Specific, written steps to make the environment safer.

The plan should be written down and the person should keep a copy somewhere they can find it during a crisis. Family members can keep a copy too. Revisit it. Update phone numbers. The plan is a living document, not a one-time exercise.

What Not to Say (and What Helps Instead)

Even with the best intentions, certain responses can shut down a conversation or deepen a person's shame. UC Health, the Mayo Clinic, and the DOD Suicide Prevention Office's Safe Messaging Guide consistently flag certain language to avoid:

What helps instead is calm, specific presence: "I hear you. I'm not going anywhere. Let's figure out the next hour together."

If a Crisis Is Happening Right Now

If you believe someone is in immediate danger of suicide:

Special Considerations for Children, Foster Youth, and Survivors

Because The Blue Ribbon Project serves children, youth in foster care, and adult survivors of childhood abuse, it is worth naming a few considerations specific to these communities.

Children and Adolescents

Suicide is the second leading cause of death among children and youth ages 10 to 24 in the United States (NIMH). Warning signs in children may look different from adults — increased irritability rather than sadness, somatic complaints, drop in school performance, changes in eating or sleeping, drawings or stories that reference death, or sudden withdrawal from activities. Pediatricians and school counselors can administer brief validated screening tools (such as the NIMH Ask Suicide-Screening Questions toolkit) and can help connect families to age-appropriate care.

Foster Youth and Kinship Care

Children and youth in foster care experience suicide ideation and attempts at multiple times the rate of their peers. Researchers have called for routine, standardized suicide screening at entry into care and at every placement transition (KFF Health News). Foster parents, kinship caregivers, CASAs, and social workers play central protective roles. The transition out of foster care is a particularly high-risk window — youth who lose housing, healthcare, and support relationships at age 18 to 21 face compounding stressors. Continuity of relationship beyond emancipation matters.

LGBTQ+ Youth

LGBTQ+ youth — and especially LGBTQ+ youth in foster care — face disproportionate suicide risk. The Trevor Project provides 24/7 crisis support specifically trained on LGBTQ+ experience. Family acceptance, school-based GSAs, access to gender-affirming care, and adults who use a young person's chosen name and pronouns are all associated with reduced risk.

Adult Survivors of Childhood Abuse

Adults who experienced abuse or neglect as children carry elevated lifetime risk for suicidal ideation and attempts. The pathway is often mediated by depression, anxiety, post-traumatic stress, alexithymia, and lack of social support (Psychiatry Investigation). The good news is that these mediating factors are treatable. Trauma-focused therapies — including TF-CBT, EMDR, and Cognitive Processing Therapy — have evidence supporting their use with adult survivors. Healing is possible, and seeking help is not weakness; it is informed self-protection.

Supporting Survivors of Suicide Loss

If someone you love has died by suicide, the grief is unlike any other. Survivors of loss often carry guilt, shame, anger, confusion, and trauma simultaneously. Research consistently shows that people who lose someone to suicide are themselves at elevated risk, making support critical (AFSP).

AFSP maintains a network of survivor of suicide loss support groups and a directory of bereavement-trained clinicians. The Alliance of Hope offers an online forum specifically for loss survivors.

Taking Care of Yourself While Supporting Someone Else

Walking with someone through a suicidal crisis is exhausting. It is not selfish to attend to your own well-being. It is necessary.

What Communities Can Do

Suicide is not only a clinical issue — it is a community one. Communities that meaningfully reduce suicide tend to combine several layers of prevention: training gatekeepers; promoting safe storage of firearms and medications; expanding access to mental health care; following safe messaging guidelines; offering peer support; supporting families in crisis; and building connection where isolation grows.

Organizations like The Blue Ribbon Project contribute by reducing the upstream conditions — childhood trauma, foster care instability, isolation, lack of belonging — that elevate lifelong risk. Programs that ensure children entering foster care arrive with dignity, that connect youth with consistent caring adults, and that build community awareness of warning signs are part of the same prevention infrastructure as crisis lines and clinical care.

A Final Word on Hope

The 988 Lifeline notes — and decades of clinical follow-up confirm — that over 90% of people who survive a suicide attempt go on to live out their lives. Suicidal crises, even severe ones, are usually time-limited. The role of the friend, the family member, the kinship caregiver, the foster parent, the mentor, the teacher, the neighbor is to help someone get through the crisis until the crisis passes. That is not a small thing. It is, in many documented cases, the difference between a death and a life.

If you are reading this because someone you love is struggling, you are already doing more than you may realize. Ask the question. Stay present. Help reduce access to lethal means. Connect them to professional care. Keep showing up. Take care of yourself in the process. And know that the work of holding a life together, in ordinary moments and extraordinary ones, is some of the most consequential work a person can do.

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