Suicide remains a global public health crisis, claiming over 800,000 lives each year and leaving millions more to struggle with attempts, ideation, or the ripple effect of loss. Traditional prevention strategies often focus on crisis intervention and identifying “warning signs,” but these approaches overlook the many who suffer in silence. Drawing on personal experience of suicide loss and a decade-long journey toward suicide literacy, the author argues for a reframing of suicide prevention. She challenges stigma-driven assumptions, underscores the power of honest storytelling, and introduces the concept of “preemptive, protective conversations” as a vital upstream prevention tool. By empowering ordinary people to become suicide prevention advocates equipped with knowledge, compassion, and a willingness to talk openly, we can build stronger connections, dismantle stigma, and create a broader societal safety net. Suicide is preventable, and each of us has a role to play in saving lives.

There are few evidence-based suicide prevention interventions tailored for adolescents living with HIV (ALWH) in sub-Saharan Africa. The safety planning intervention targets acute suicidal behavior through co-creation of actionable coping strategies for use at the onset of suicide-related distress. We utilized the Assessment-Decision-Adaptation-Production-Topical Experts-Integration-Training–Testing framework to adapt and integrate safety planning into an existing Friendship Bench + peer support model for depressed ALWH in Malawi. We conducted interviews with ALWH who reported suicidal ideation or behaviors, their caregivers, healthcare facility leadership and police officers, and focus group discussions with healthcare facility staff, community and religious leaders and teachers in Lilongwe. The study team produced adapted manuals, sought and integrated expert topical feedback, trained interventionists using a training-of-trainers model and theater tested the protocol. Formative data yielded insights into acceptability, feasibility, delivery, content and implementation of safety planning. The final safety planning + Friendship Bench + peer support program consists of one safety planning session, five problem-solving sessions with suicide risk assessment and six peer support sessions. We revised the written Safety Plan to account for limited emergency services, modified the protocol for engaging guardians, integrated suicide assessment into the problem-solving sessions and incorporated suicide prevention activities into the peer support sessions.

International students frequently report suicidal thoughts and behaviours, but often do not seek help. We evaluated the feasibility, acceptability, and preliminary effectiveness of an adapted version of safeTALK suicide prevention training for international students. Eight workshops were delivered in Melbourne, Australia (N = 128; 62.5% female, M age = 23.4). In this single-arm study, surveys were completed pre-, post-, and three months post-training, and 17 participants completed follow-up interviews. The training was rated as acceptable, helpful, and safe. Linear mixed models indicated increased confidence to intervene and stronger intentions to refer individuals to formal help sources, with improvements sustained at follow-up. Suicide stigma showed a small post-training reduction that was not sustained. Suicide literacy only improved three months post-training. Attrition limited inferences about long-term effects. Qualitative feedback supported the training’s value but highlighted the need for further cultural adaptation. Findings support adapted gatekeeper training as a promising strategy for suicide prevention among international students.

Background. Despite the growing recognition of adolescent suicide as a pressing concern, traditional methods for identifying suicide risk often fail to capture the complex interplay of socio-ecological and psychological factors. The advent of machine learning (ML) offers a transformative opportunity to improve suicide risk prediction and intervention strategies. Objective. This study aims to utilize ML techniques to analyze socio-ecological and psychological risk factors to predict suicide ideation, plans and attempts among a nationally representative sample of Ghanaian adolescents. Methods. A cross-sectional survey was conducted with 1,703 adolescents aged 12–18 years across Ghana measuring psychological factors (depression symptoms, anxiety symptoms etc) and socio-ecological factors (bullying, parental support etc) using validated measures. Descriptive statistics were conducted and random forest and logistic regression models were employed for suicide risk prediction, i.e., ‘ideation, plans and attempts’. Model performance was evaluated using accuracy, sensitivity, specificity and feature importance analysis. Results. Psychological factors such as depression symptoms (r = .42, p < .01), anxiety (r = .38, p < .01) and perceived stress (r = .35, p < .01) were the strongest predictors of suicide ideation, plans and attempts, while parental support emerged as a significant protective factor (r = −.34, p < .01). The random forest model demonstrated good predictive performance (accuracy = 78.3%, AUC = 0.81). Gender differences were observed. Conclusions. This study is the first to apply ML techniques to a nationally representative dataset of Ghanaian adolescents for suicide risk prediction, i.e., ‘ideation, plans and attempts’. The findings highlight the potential of ML to provide precise tools for early identification of at-risk individuals.

Adolescent girls and young women (AGYW) living with HIV are at increased risk of developing suicidality. Yet little is known about the effects of HIV-related stigma, mental health challenges and social support on suicidality among AGYW living with HIV. We analysed cross-sectional data from 711 AGYW living with HIV who participated in two large prospective South African cohort studies, Mzantsi Wakho (2017–2018) and HEY BABY (2018–2019). Standardised and validated questionnaires were used to measure HIV-related stigma, mental health symptomology (mediator), social support (moderator) and suicidality (outcome). A moderated mediation analysis was used to investigate (1) the direct effects of HIV-related stigma on suicidality, (2) the indirect effects as mediated through mental health symptomology and (3) the moderating effects of social support on mental health issues and suicidality, adjusted for potential confounders. Higher HIV-related stigma (β = 0.45 [0.13, 0.78], p < 0.001) was directly associated with higher suicidality. Mental health symptomology was associated with increased risk of suicidality (β = 1.05 [0.66, 1.44], p < 0.001) and partially mediated the effect of HIV-related stigma on suicidality. Social support buffered the indirect effects of HIV-related stigma on suicidality (β = 0.86, bias-corrected 95% CI [0.01, 2.41]). HIV-related stigma is associated with higher suicidality. Programmes that simultaneously address stigma and strengthen social support services may improve mental health and reduce suicidality among AGYW living with HIV.

Youth who are lesbian, gay, bisexual, transgender, queer or questioning, and other diverse sexual and gender identities (LGBTQ+) experience disproportionately high rates of suicidal thoughts and behaviors compared to heterosexual and cisgender peers, yet many face barriers to care. Data came from a national online survey of 18,663 LGBTQ+ youth aged 13–24 years in the United States (September–December 2023). Analyses focused on participants who reported wanting mental health care in the past year and assessed access, barriers, service modalities and suicidal ideation/attempts. Half of LGBTQ+ youth who wanted mental health care did not receive it. The most common barrier was fear of talking about mental health concerns (42%). Among those who received care, one-on-one therapy was most common (69% in-person and 53% online). Suicidal ideation was lower among youth in therapy (46% in-person and 40% online) compared to those using crisis lines (75%). After adjusting for demographics, hotline use remained strongly associated with elevated risk: adjusted odds ratio (aOR) = 3.77 (95% confidence interval [CI]: 3.11–4.56) for suicidal ideation; aOR = 3.21 (95% CI: 2.62–3.94) for attempts. Despite strong willingness to seek care, structural and identity-related barriers leave many needs unmet. Expanding culturally competent services is essential to reducing suicide risk.

This study examined trends in adolescent self-harm incidence rates and associated contextual factors among 77 low- and lower-middle-income countries. Annual sex-specific self-harm incidence rates for ages 10–19 years were obtained from the Global Burden of Disease 2021 database. Joinpoint regression assessed trends while country and year fixed-effects models examined their association with self-harm incidence rates. Median incidence rates declined from 35.9 to 35.3 per 100,000 among males and from 40.8 to 38.1 among females. Average annual percentage changes (AAPCs) among males were negative in 40 countries and positive in 37 (maximum 2.16%); among females, AAPCs were negative in 47 and positive in 30 (maximum 3.64%). Male self-harm incidence rates were positively associated with drug use exposure, adolescent fertility, new HIV infections, rule of law and unemployment, and negatively with control of corruption, alcohol use and urban population. Female incidence rates were positively associated with adolescent fertility rates, drug use, rule of law, mean years of schooling and labor force participation, and negatively with alcohol and tobacco use exposure, control of corruption, regulatory quality and sociodemographic index. These sex-specific differences in trends and contextual factors emphasize the need for integrated reproductive, mental and substance use targeted country-level prevention strategies.

Suicide remains one of the leading causes of death globally, with growing evidence that humanitarian emergencies and fragile states, most of which unfold in low- to middle-income countries (LMICs), are associated with elevated risk of suicide. However, the few suicide-targeted interventions for use in humanitarian contexts remain both sparse and fragmented. This scoping review aims to identify and synthesise evidence from suicide and self-harm prevention interventions implemented in all types of humanitarian settings, globally, that have been evaluated for their effectiveness in improving suicide and self-harm-related outcomes. We systematically searched eight electronic databases, including two grey literature databases, and relevant organisational websites for records published through November 2024 and in any language. Screening was done using the Covidence platform, with each record independently screened by two reviewers. Among other preselected inclusion criteria, studies must have conducted a quantitative evaluation of the effectiveness of an intervention on improving suicide and self-harm-related outcomes during a humanitarian crisis to be included for data extraction. Data extraction and quality assessment were both conducted by two authors. In all, 6,209 records were screened at the title and abstract phase; 104 were included for full text screening; and 23 studies were included for data extraction. Most studies were conducted during the coronavirus disease 2019 pandemic (COVID-19), and in high-income countries. Evaluated interventions encompassed various approaches, including psychotherapeutic, practical, and pharmacological assistance, often employing multiple components. The majority targeted the general population, were delivered via remote modalities and relied on mental health specialists for their administration. Overall, 15 (65.2%) interventions were associated with statistically significant positive effects on suicide and or self-harm-related outcomes. Promising approaches include cognitive behavioural therapy-based text services, skills-building programmes, and strategies that foster supportive environments for high-risk individuals. These findings highlight both promising approaches and critical gaps in suicide prevention efforts in humanitarian settings. The limited evidence base – particularly in LMICs and with particularly at-risk populations – alongside the increasing frequency of humanitarian crises, underscores the urgent need for future implementation and associated research of suicide and self-harm prevention initiatives within humanitarian contexts.

There is limited post-pandemic youth mental health data in low- and middle-income countries. This study describes the prevalence of suicidal ideation, suicidal attempt, and self-harm since the COVID-19 pandemic among young Filipino adolescents. Adolescents aged 13-16 years old from public and private high schools in Cavite, Philippines were recruited for a cross-sectional school survey conducted from May 2023 to February 2024. Suicidal behaviours and self-harm since the pandemic were determined using a self-administered questionnaire alongside sociodemographics and internalising and externalising symptoms. Of the 1,229 13-16-year-olds who completed the survey, 54.0% experienced suicidal ideation, 24.2% attempted suicide, and 34.2 % reported self-harm between 30 January 2020 and the date when they completed the survey. The prevalence of suicide attempts was higher among females (29.6%) than males (13.1%). Parental absence was associated with suicidal attempts (ARRR=2.93) and self-harm and/or suicidal ideation (ARRR=2.00) while living with either the biological mother or father was moderated by gender. Internalising and externalising symptom scores increased the risk for both outcomes by ≥15%. This study revealed a high prevalence of suicidal and self-harming behaviours among young adolescents in the Philippines. This calls for action to implement population-based strategies in suicide prevention, early screening, and cross-sectoral intervention.

Suicide prevention is a global health priority. This learning paper examines how the World Health Organization’s (WHO) Special Initiative for Mental Health (SIMH) has supported suicide prevention through the integration of the Mental Health Gap Action Programme (mhGAP) across six countries. A survey with 295 mhGAP-trained health worker respondents described the impacts of training at individual, facility and system levels. Descriptive results showed improvements in clinical confidence and capacity to manage suicide risk, indicating strong alignment for the LIVE LIFE intervention to support early identification and support for people affected by self-harm/suicide. Thematic qualitative analysis, deductively framed by WHO’s LIVE LIFE implementation guide, revealed four themes of mhGAP trainee experiences related to suicide prevention: (1) clinical action and improved services; (2) awareness, advocacy and collaborative capacity; (3) service organisation and delivery; and (4) foundational resources. These themes showed mhGAP training is also aligning with several LIVE LIFE cross-cutting foundations. Overall, WHO SIMH learnings suggest mhGAP is a strategic enabler of suicide prevention within broader mental health reforms. Sustained investment and intersectoral collaboration are needed to maximise its impact and strengthen suicide prevention under universal health coverage.