suicide

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Introduction

also see suicidal ideation

Etiology

Epidemiology

  • 33% of people have suicidal ideation during their lifetime
  • 9th leading cause of death
  • 3rd leading cause of death in adolescents (age 15-24)
  • white males > 85 years of age have highest rate
  • rates in elderly tend to be underestimated because they are easily confused with medical complications
  • 20 cases per 100,000 in > 65 age group vs 12 per 100,000 in younger population
  • deteriorating physical health is more important than psychiatric illness in predicting self-harm in the elderly[7]
  • 2nd leading cause of death among persons 10-24 years of age[15]
  • one person dies by suicide every 40 seconds worldwide[13]
  • increase in suicide in U.S. from 1999-2014
    • suicide among people 35-64 years of age increased 28% from 1999 to 2010[11]
    • ~2% yearly increase in suicides from 2004-2013[24]
  • suicide rate in 2014 3-fold greater in males than females (20.7 vs 5.8 per 100,000) [19
  • increase in suicide 1999-2016[26]
    • suicide rate increased > 30% in 25 states
    • North Dakota with highest increase of 58%
    • in 2015, 18% of suicides had served in the military
    • >50% of cases had no documented mental health disorder
  • suicide among U.S. health care workers 2008-2019 higher than among non-health care workers for registered nurses, health technicians, & health care support workers, but not physicians[44]

Pathology

Diagnostic criteria

* USPSTF concludes that current evidence is insufficient to assess the balance of benefits & harms of screening for suicide risk in the adult population, including pregnant & postpartum women & older adults[43]

Complications

Management

More general terms

More specific terms

Additional terms

References

  1. ↑ Contributions from Linda Kuribayashi MD, Dept of Medicine, UCSF Fresno
  2. ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  3. ↑ Jump up to: 3.0 3.1 UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  4. ↑ Jump up to: 4.0 4.1 4.2 Carter GL, Clover K, Whyte IM, Dawson AH, D'Este C. Postcards from the EDge project: randomised controlled trial of an intervention using postcards to reduce repetition of hospital treated deliberate self poisoning. BMJ. 2005 Oct 8;331(7520):805. Epub 2005 Sep 23. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16183654
  5. ↑ Jump up to: 5.0 5.1 Eddleston M, Dissanayake M, Sheriff MH, Warrell DA, Gunnell D. Physical vulnerability and fatal self-harm in the elderly. Br J Psychiatry. 2006 Sep;189:278-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16946365
  6. ↑ Jump up to: 6.0 6.1 Bolton JM and Robinson J. Population-attributable fractions of axis I and axis II mental disorders for suicide attempts: Findings from a representative sample of the adult, noninstitutionalized US population. Am J Public Health 2010 Dec; 100:2473. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21068419
  7. ↑ Jump up to: 7.0 7.1 Oude Voshaar RC et al First episode of self-harm in older age: A report from the 10-year prospective Manchester Self-Harm project. J Clin Psychiatry 2011 Jun; 72:737. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21733475
  8. ↑ Jump up to: 8.0 8.1 Maguen S et al. Killing in combat may be independently associated with suicidal ideation. Depress Anxiety 2012 Apr 13 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22505038 <Internet> http://onlinelibrary.wiley.com/doi/10.1002/da.21954/abstract
  9. ↑ Jump up to: 9.0 9.1 Barr B et al. Suicides associated with the 2008-10 economic recession in England: Time trend analysis. BMJ 2012 Aug 13; 345:e5142 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22893569
  10. ↑ Jump up to: 10.0 10.1 O'Connor E et al Screening for and Treatment of Suicide Risk Relevant to Primary Care: A Systematic Review for the U.S. Preventive Services Task Force. Ann Intern Med. 23 April 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23609101 <Internet> http://annals.org/article.aspx?articleid=1681063
    U.S. Preventive Services Task Force Screening for Suicide Risk in Adolescents, Adults, and Older Adults: U.S. Preventive Services Task Force Recommendation Statement. DRAFT http://www.uspreventiveservicestaskforce.org/draftrec3.htm
    LeFevre ML et al Screening for Suicide Risk in Adolescents, Adults, and Older Adults in Primary Care: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2014;160(10):719-726. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24842417 <Internet> http://annals.org/article.aspx?articleid=1872851
  11. ↑ Jump up to: 11.0 11.1 Centers for Disease Control and Prevention Suicide Among Adults Aged 35-64 Years - United States, 1999-2010. MMWR. May 3, 2013 / 62(17);321-325 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6217a1.htm
  12. ↑ Jump up to: 12.0 12.1 Tsai AC et al. Social integration and suicide mortality among men: 24-year cohort study of U.S. health professionals. Ann Intern Med 2014 Jul 15; 161:85 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25023247
  13. ↑ Jump up to: 13.0 13.1 First WHO report on suicide prevention WHO calls for coordinated action to reduce suicides worldwide News release. Sept 4, 2014 http://www.who.int/mediacentre/news/releases/2014/suicide-prevention-report/en/
    Preventing suicide. A globabl imperative. World Health Organization. 2014. http://apps.who.int/iris/bitstream/10665/131056/1/9789241564779_eng.pdf?ua=1&ua=1
  14. ↑ Vyssoki B et al. Direct effect of sunshine on suicide. JAMA Psychiatry 2014 Sep 10 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25208208 <Internet> http://archpsyc.jamanetwork.com/article.aspx?articleid=1901524
  15. ↑ Jump up to: 15.0 15.1 15.2 Sullivan E et al Suicide Trends Among Persons Aged 10-24 Years - United States, 1994-2012 MMWR Weekly. March 6, 2015 / 64(08);201-205 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6408a1.htm
  16. ↑ Jump up to: 16.0 16.1 Guldin MB et al Incidence of Suicide Among Persons Who Had a Parent Who Died During Their Childhood. A Population-Based Cohort Study. JAMA Psychiatry. Published online November 11, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26558351 <Internet> http://archpsyc.jamanetwork.com/article.aspx?articleid=2469106
  17. ↑ Jump up to: 17.0 17.1 Armitage CJ et al. An exploratory randomised trial of a simple, brief psychological intervention to reduce subsequent suicidal ideation and behaviour in patients admitted to hospital for self-harm. Br J Psychiatry 2016 Jan 7. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26743808
  18. ↑ Jump up to: 18.0 18.1 Fralick M, Thiruchelvam D, Tien HC, Redelmeier DA. Risk of suicide after a concussion CMAJ February 8, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26858348 <Internet> http://www.cmaj.ca/content/early/2016/02/08/cmaj.150790
  19. ↑ Jump up to: 19.0 19.1 Curtin SC, Warner M, Hedegaard H Increase in Suicide in the United States, 1999-2014 NCHS Data Brief No. 241, April 2016 Centers for Disease Control & Prevention (CDC) http://www.cdc.gov/nchs/products/databriefs/db241.htm
  20. ↑ Jump up to: 20.0 20.1 Franklin JC, Fox KR, Franklin CR et al. A brief mobile app reduces nonsuicidal and suicidal self- injury: Evidence from three randomized controlled trials. J Consult Clin Psychol 2016 Jun; 84:544 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27018530 <Internet> http://psycnet.apa.org/?&fa=main.doiLanding&doi=10.1037/ccp0000093
  21. ↑ Jump up to: 21.0 21.1 Lund-Sorensen J, Benros ME, Madsen T et al A Nationwide Cohort Study of the Association Between Hospitalization With Infection and Risk of Death by Suicide. JAMA Psychiatry. Published online August 10, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27532502 <Internet> http://archpsyc.jamanetwork.com/article.aspx?articleid=2542681
    Brundin LC, Grit J Ascertaining Whether Suicides Are Caused by Infections. JAMA Psychiatry. Published online August 10, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27533721 <Internet> http://archpsyc.jamanetwork.com/article.aspx?articleid=2542678
  22. ↑ Jump up to: 22.0 22.1 Bostwick JM et al. Suicide attempt as a risk factor for completed suicide: Even more lethal than we knew. Am J Psychiatry 2016 Aug 13 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27523496
  23. ↑ Jump up to: 23.0 23.1 Kahn MW Psychocatalytic Benefits of the Unexpected. N Engl J Med 2017; 376:205-207. January 19, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28099822 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMp1611557
  24. ↑ Jump up to: 24.0 24.1 24.2 Olfson M, Blanco C, Wall M et al. National trends in suicide attempts among adults in the United States. JAMA Psychiatry 2017 Sep 13; PMID: https://www.ncbi.nlm.nih.gov/pubmed/28903161
    Caine ED. Suicide and attempted suicide in the Unites States during the 21st century. JAMA Psychiatry 2017 Sep 13 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28903162
  25. ↑ Jump up to: 25.0 25.1 Caputi TL, Smith D, Ayers JW Suicide Risk Behaviors Among Sexual Minority Adolescents in the United States, 2015. JAMA. 2017;318(23):2349-2351 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29260214 https://jamanetwork.com/journals/jama/article-abstract/2666491
  26. ↑ Jump up to: 26.0 26.1 Stone DM, Simon TR, Fowler KA, et al. Vital Signs: Trends in State Suicide Rates - United States, 1999-2016 and Circumstances Contributing to Suicide - 27 States, 2015. MMWR Morb Mortal Wkly Rep 2018;67:617-624
  27. ↑ Jump up to: 27.0 27.1 Stanley B, Brown GK, Brenner LA et al Comparison of the Safety Planning Intervention With Follow-up vs Usual Care of Suicidal Patients Treated in the Emergency Department. JAMA Psychiatry. Published online July 11, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29998307 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2687370
  28. ↑ Jump up to: 28.0 28.1 Madsen T, Erlangsen A, Orlovska S et al Association Between Traumatic Brain Injury and Risk of Suicide. JAMA. 2018;320(6):580-588. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30120477 https://jamanetwork.com/journals/jama/fullarticle/2697009
    Goldstein L, Diaz-Arrastia R. Traumatic Brain Injury and Risk of Suicide JAMA. 2018;320(6):554-556 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30120461 https://jamanetwork.com/journals/jama/fullarticle/2696989
  29. ↑ Jump up to: 29.0 29.1 Petrosky E, Harpaz R, Fowler KA et al Chronic Pain Among Suicide Decedents, 2003 to 2014: Findings From the National Violent Death Reporting System. Ann Intern Med. 2018. Sept 11. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/30208405 <Internet> http://annals.org/aim/fullarticle/2702061/chronic-pain-among-suicide-decedents-2003-2014-findings-from-national
    Ilgen M Pain, Opioids, and Suicide Mortality in the United States. Ann Intern Med. 2018. Sept 11. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/30208406 <Internet> http://annals.org/aim/fullarticle/2702063/pain-opioids-suicide-mortality-united-states
  30. ↑ Jump up to: 30.0 30.1 Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
  31. ↑ Sall J, Brenner L, Bell AMM, Colston MJ. Assessment and Management of Patients at Risk for Suicide: Synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines. Ann Intern Med. 2019. Aug 27 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31450237 https://annals.org/aim/fullarticle/2748922/assessment-management-patients-risk-suicide-synopsis-2019-u-s-department
    D'Anci KE, Uhl S, Giradi G, Martin C. Treatments for the Prevention and Management of Suicide: A Systematic Review. Ann Intern Med. 2019. Aug 27 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31450239 https://annals.org/aim/fullarticle/2748923/treatments-prevention-management-suicide-systematic-review
    Caine ED Seeking to Prevent Suicide at the Edge of the Ledge. Ann Intern Med. 2019. Aug 27 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31450242 https://annals.org/aim/article-abstract/2748925/seeking-prevent-suicide-edge-ledge
    Hogan M. Veteran Suicide: Not Just a VA Issue; It's a U.S. Issue. Ann Intern Med. 2019. Aug 27 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31450241 https://annals.org/aim/article-abstract/2748924/veteran-suicide-just-va-issue-s-u-s-issue
  32. ↑ Jump up to: 32.0 32.1 Kaufman JA, Salas-Hernandez LK, Komro KA, Livingston MD Effects of increased minimum wages by unemployment rate on suicide in the USA. BMJ. Journal of Epidemiology and Community Health. Jan 2020 https://jech.bmj.com/content/early/2020/01/03/jech-2019-212981
  33. ↑ Fazel S, Runeson B. Suicide. N Engl J Med 2020; 382:266-274. Jan 16. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31940700 PMCID: PMC7116087 Free PMC article https://www.nejm.org/doi/full/10.1056/NEJMra1902944
  34. ↑ Jump up to: 34.0 34.1 Grant K Dementia, Mild Cognitive Impairment Tied to Suicide Risk. Cohort study analyzing VA healthcare data found that those recently diagnosed have greater risk. MedPage Today March 24, 2021 https://www.medpagetoday.com/psychiatry/dementia/91783
    Gunak MM, Barnes DE, Yaffe K et al Risk of Suicide Attempt in Patients With Recent Diagnosis of Mild Cognitive Impairment or Dementia. JAMA Psychiatry. 2021 Jun 1;78(6):659-666 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33760039 PMCID: PMC7992018 (available on 2022-03-24)
  35. ↑ Talebraza S et al Geriatrics Evaluation & Management Tools American Geriatrics Society. 2021 https://geriatricscareonline.org/ProductAbstract/geriatrics-evaluation-management-tools/B007/
  36. ↑ Safety Planning Intervention A brief intervention for reducing suicide risk. http://www.suicidesafetyplan.com/Home_Page.html
  37. ↑ Jump up to: 37.0 37.1 37.2 Dong XQ, Xu Y, Ding D. Elder self-neglect and suicidal ideation in a U.S. Chinese aging population: findings from the PINE study. J Gerontol A Biol Sci Med Sci. 2017;72(suppl 1):S76-S81 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28575261 PMCID: PMC5861963 Free PMC article https://academic.oup.com/biomedgerontology/article/72/suppl_1/S76/3859671
    Dong XQ. Associations between the differential definitions of elder mistreatment and suicidal ideation outcomes in U.S. Chinese older adults: do the definitions matter? J Gerontol A Biol Sci Med Sci. 2017;72(suppl 1):S82-S89 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28575267 PMCID: PMC5861847 Free PMC article https://academic.oup.com/biomedgerontology/article/72/suppl_1/S82/3859677
    Li LW, Gee GC, Dong XQ. Association of self-reported discrimination and suicide ideation in older Chinese Americans. Am J Geriatr Psychiatry. 2018;26(1):42-51 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28917505 PMCID: PMC5725252 Free PMC article https://www.ajgponline.org/article/S1064-7481(17)30421-9/fulltext
    Wei JW, Zhang J, Deng Y, et al. Suicidal ideation among the Chinese elderly and its correlates: a comparison between the rural and urban populations. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29495615 PMCID: PMC5876967 Free PMC article https://www.mdpi.com/1660-4601/15/3/422
  38. ↑ Jump up to: 38.0 38.1 Brooks M Ketamine Fast, Effective for Suicidal Crises. Medscape. February 10, 2022 https://www.medscape.com/viewarticle/968269
  39. ↑ Jump up to: 39.0 39.1 Watts BV et al. Association of medication treatment for opioid use disorder with suicide mortality. Am J Psychiatry 2022 Apr; 179:298. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35360916 https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2021.21070700
    Mooney LJ. Medication treatment for opioid use disorder reduces suicide risk. Am J Psychiatry 2022 Apr; 179:262. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35360917 https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.20220173
  40. ↑ Jump up to: 40.0 40.1 Alothman D, Card T, Lewis S et al Risk of Suicide After Dementia Diagnosis. JAMA Neurol. Published online October 3, 2022. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36190708 https://jamanetwork.com/journals/jamaneurology/article-abstract/2796654
  41. ↑ Jump up to: 41.0 41.1 Schmutte T, Olfson M, Maust DT et al. Suicide risk in first year after dementia diagnosis in older adults. Alzheimers Dement. 2022. Feb;18(2):262-271. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34036738 PMCID: PMC8613307 (available on 2023-02-01)
  42. ↑ Jump up to: 42.0 42.1 DePeau-Wilson M Abortion Access Tied to Suicide Rates Among Young Women. Enforcing restrictions on reproductive care linked with nearly 6% rise in suicide rate. MedPage Today December 28, 2022 https://www.medpagetoday.com/obgyn/abortion/102418
  43. ↑ Jump up to: 43.0 43.1 43.2 US Preventive Services Task Force Screening for Depression and Suicide Risk in Adults; US Preventive Services Task Force Recommendation Statement. JAMA. 2023;329(23):2057-2067 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37338872 https://jamanetwork.com/journals/jama/fullarticle/2806144
    Simon GE et al. Reframing the key questions regarding screening for suicide risk. JAMA 2023 Jun 20; 329:2026. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37338888 https://jamanetwork.com/journals/jama/fullarticle/2806177
  44. ↑ Jump up to: 44.0 44.1 Olfson M et al. Suicide risks of health care workers in the US. JAMA 2023 Sep 26; 330:1161-1166. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37750880 PMCID: PMC10523169 (available on 2024-03-26) https://jamanetwork.com/journals/jama/fullarticle/2809812
  45. ↑ Turecki G, Brent DA. Suicide and suicidal behaviour. Lancet. 2016 Mar 19;387(10024):1227-39. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26385066 PMCID: PMC5319859 Free PMC article. Review.
  46. ↑ Jump up to: 46.0 46.1 Alexopoulos GS, Raue PJ, Banerjee S et al Modifiable predictors of suicidal ideation during psychotherapy for late-life major depression. A machine learning approach. Transl Psychiatry. 2021 Oct 18;11(1):536. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34663787 Free PMC article. Clinical Trial.
  47. ↑ Jump up to: 47.0 47.1 Chitavi SO, Patrianakos J, Williams SC, et al. Evaluating the Prevalence of Four Recommended Practices for Suicide Prevention Following Hospital Discharge. Jt Comm J Qual Patient Saf. 2024;50(6):393-403 PMID: https://www.ncbi.nlm.nih.gov/pubmed/38538500 Free article
  48. ↑ Jump up to: 48.0 48.1 48.2 Ostergaard SD, Momen NC, Heide-Jorgensen U, Plana-Ripoll O Risk of Suicide Across Medical Conditions and the Role of Prior Mental Disorder. JAMA Psychiatry. Published online September 4, 2024 PMID: https://www.ncbi.nlm.nih.gov/pubmed/39230910 https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2822967
  49. ↑ Fernandez-Rodrigues V, Sanchez-Carro Y, Lagunas LN et al Risk factors for suicidal behaviour in late-life depression: A systematic review. World J Psychiatry. 2022 Jan 19;12(1):187-203. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35111588 PMCID: PMC8783161 Free PMC article.
  50. ↑ Raue PJ, Ghesquiere AR, Bruce ML. Suicide risk in primary care: identification and management in older adults. Curr Psychiatry Rep. 2014 Sep;16(9):466. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25030971 PMCID: PMC4137406 Free PMC article. Review.
  51. ↑ Van Orden K, Conwell Y. Suicides in late life. Curr Psychiatry Rep. 2011 Jun;13(3):234-41. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21369952 PMCID: PMC3085020 Free PMC article. Review.
  52. ↑ Jump up to: 52.0 52.1 George J Headache Diagnosis Tied to Suicide Trigeminal autonomic cephalalgia, post-traumatic headache have strong links MedPage Today February 3, 2025 https://www.medpagetoday.com/neurology/migraines/114054
    Elser H, Farkas DK, Fuglsang CH et al Risk of Attempted and Completed Suicide in Persons Diagnosed With Headache. JAMA Neurol. 2025 Feb 3. PMID: https://www.ncbi.nlm.nih.gov/pubmed/39899309 https://jamanetwork.com/journals/jamaneurology/fullarticle/2829961
  53. ↑ Jump up to: 53.0 53.1 Angerhofer Richards J, Cruz M, Stewart C, et al. Effectiveness of Integrating Suicide Care in Primary Care : Secondary Analysis of a Stepped-Wedge, Cluster Randomized Implementation Trial. Ann Intern Med. 2024 Nov;177(11):1471-1481 PMID: https://www.ncbi.nlm.nih.gov/pubmed/39348695 https://www.acpjournals.org/doi/10.7326/M24-0024
    Singh M; ACP Journal Club Editorial Team at McMaster University. Integrated suicide care in primary care improved safety planning and reduced suicide attempts at 90 d. Ann Intern Med. 2025 Feb 4. PMID: https://www.ncbi.nlm.nih.gov/pubmed/39899867 https://www.acpjournals.org/doi/10.7326/ANNALS-24-03874-JC
  54. ↑ National Institute of Mental Health Suicide Prevention https://www.nimh.nih.gov/health/topics/suicide-prevention/index.shtml

Patient information

suicide patient information

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