Suicide prevention should begin well before someone reaches a crisis, with stronger social ties, practical coping skills and support in the places people already spend time, University of Rochester Medicine researchers say.
In a Suicide Prevention Month guide, Peter Wyman and Kimberly Van Orden of the university's Center for the Study and Prevention of Suicide describe approaches for schools, workplaces, health care and community groups. They also explain how to recognize warning signs and respond when someone may be at risk.
Wyman said prevention must reach people who never enter mental health care or are reluctant to use it. Programs offered in classrooms and other everyday settings can help people build relationships and learn healthy ways to manage difficult periods before urgent care is needed.
Connection and coping skills
Van Orden's research focuses partly on social isolation and loneliness, particularly among older adults. The guide identifies both as important risk factors, while stressing that a meaningful role in a group can offer more than casual contact. Community organizations, shared activities and opportunities to help others can provide belonging and purpose.
Wyman said relationships also matter because peers can model ways to cope. A prevention program developed by Wyman and Anthony Pisani with the U.S. Air Force, Wingman-Connect, uses peer-to-peer teaching to build group connections and coping skills. The researchers say the program reduced suicide risk and depression and is being expanded to 72 Department of the Air Force installations worldwide by the end of 2028.
The researchers caution against a single approach for every age. Classroom programs for children can develop self-control and bonds with classmates and teachers. Young adults may benefit from peer connection and skills for navigating transitions, while workplaces and community settings can provide support in midlife.
Primary care visits are an important opportunity for older adults, the guide says, because many who die by suicide have seen a primary care physician in the preceding weeks or months. Older men have especially high suicide death rates and may be less likely to disclose suicidal thoughts. Those patterns make attention to social connection and routine care particularly important, the researchers said.
Planning for moments of crisis
Prevention does not eliminate every crisis. A written safety plan can identify coping strategies and people or services to contact if suicidal thoughts intensify, when it may be hard to recall those options. University of Rochester researchers have studied safety planning for older adults and how clinicians can use it.
The guide lists possible warning signs including talk of death, hopelessness or being a burden; withdrawal from people and activities; major changes in sleep; increased substance use; and unusual agitation or irritability. Those signs do not by themselves mean someone will attempt suicide, but significant changes should be taken seriously.
Saying goodbye to people or trying to obtain a means of suicide can signal more immediate danger. The researchers advise seeking urgent help in those situations. Someone concerned about another person can ask directly about suicide, listen without judgment, help connect them with professional support and keep checking in after the immediate concern passes.
Anyone experiencing a suicidal crisis, or worried about someone else, can call or text 988 for the Suicide & Crisis Lifeline. If there is immediate danger, call 911 or go to the nearest emergency department.
The university's suicide-prevention center plans to have researchers at the American Foundation for Suicide Prevention's Western New York Out of the Darkness Walk on Oct. 3. The center also is developing a registry for people interested in future suicide-prevention research studies; it said more information will be posted as the registry launches.
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