Earlier this year, the World Health Organization (WHO) released its Suicide worldwide in 2021: global health estimates report. In 2021, an estimated 727,000 people died by suicide — an increase of 3.4% from 2019. Suicide remains the third leading cause of death among those 15–29 years of age, and 73% of these deaths occur in low- and middle-income countries (LMICs). It is a stark reminder of the broad reach of suicide: a global public health burden and a toll taken on families and communities.

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Suicidal behavior is both complex and multifactorial. It emerges from the interplay between social determinants — inequality, limited education, racial and ethnic disparities, restricted access to healthcare, and occupational pressures — and individual risk factors such as mental illness, childhood trauma, serious illness, legal problems, substance use, violence and abuse. Because these factors interact differently for individual people and across cultural and social contexts, suicide prevention requires nuanced, evidence-based interventions, the involvement of multiple stakeholders, and a commitment to capacity building, financing and ongoing evaluation. Initiatives such as the WHO’s LIVE LIFE incorporate this multisectoral approach paired with suicide-prevention strategies, such as limiting access to the means of suicide, responsible media coverage, socioemotional skill development and early risk identification. Despite the availability of guidance and frameworks for suicide prevention, organizing strategic action and increased advocacy are necessary.

Each year, the International Association for Suicide Prevention organizes World Suicide Prevention Day on 10 September to raise awareness and to improve understanding about suicide. This year’s campaign is ‘Change the Narrative’. It is a simple phrase designed to spur more honest and open discussion about the entrenched stigma associated with suicide and suicidal behavior and to underscore the idea that suicide can be prevented. In addition to the yellow and orange ribbon signifying suicide-prevention awareness, the campaign is using ‘#StartTheCoversation’ on social media to inspire people to speak out, to challenge barriers and to elevate support for people who are suffering. It is often believed that speaking about suicide to a person in crisis may worsen their state; instead, offering a non-judgmental and empathetic conversation about it can reduce risk and provide a crucial opportunity for intervention.

In recognition of the need to amplify suicide-prevention awareness, the September 2025 issue of Nature Mental Health features several pieces focusing on different aspects of suicidality and suicide prevention and those who are most affected. In an Article by Hyeon Kim and collaborators, updated estimates are presented for global suicide mortality from 1990 to 2021 and for projected future suicide rates until 2050. Using the WHO Mortality Database, the analysis points to a significant decline in mortality over the period examined and predicts a modest decrease in mortality up to 2050. Although these data support the idea of a global trend in decreased mortality from suicide, they fall short of the aim of the 2030 WHO Sustainable Development Goals to reduce suicide deaths by a third. The authors emphasize differences between LMICs and high-income countries (HICs): although the majority of suicide deaths occur in in LMICs, which contain a greater proportion of the world’s population, suicide mortality rates are higher in HICs. It is a pattern that reinforces the need to better understand social determinant drivers of suicide regionally and calls for tailored suicide-prevention strategies.

A Perspective by Daiane Borges Machado invites us to rethink suicide-prevention strategies by bringing insights derived from the global south. The piece discusses how strategies developed by LMICs with limited resources can also inform the suicide-prevention agendas in HICs — a shift in how implementation strategies developed by the global north are often applied in the global south context. Machado presents a thought-provoking argument that many global guidelines are rooted in high-quality evidence-based programs developed in HICs but may neglect knowledge of the global south or lack culturally informed strategies that support economic improvement or community empowerment. Machado advocates for epistemological decolonization through the involvement of local stakeholders to develop and deliver co-designed interventions that are culturally appropriate.

Co-designed research is a powerful way to incorporate otherwise overlooked or underutilized sources of expertise. An example of co-designed research can be found in a Comment by Eve Griffin and coauthors describing the partnership between the Irish charity HUGG, which provides support to people bereaved by suicide, and a research team from the National Suicide Research Foundation. Their collaboration resulted in the design and conducting of the AfterWords Survey, which collected data on a national level to understand the needs of and experiences lived by people bereaved by suicide. Suicide bereavement profoundly impacts mental and physical health, with those affected facing a higher risk of suicide themselves. The authors argue that supporting ‘postvention’ research should be included as part of the suicide-prevention agenda, including funding for ‘postvention’ services and new research initiatives.

Another Comment in the issue by Jo Robinson and colleagues discusses how co-production should be included in the development of suicide-prevention programs for young people in schools. Suicide is the third leading cause of death among young people globally, especially among LGBT+ youth, and suicide-related thoughts and behaviors are on the rise. The authors emphasize the school setting as a rich environment for such programs, but also point to the challenges of implementing school-based programs where there are limited resources. They advocate for better integration of health and education departments for joint efforts in reducing suicide in young people through the implementation of evidence-based programs in schools.

Suicide risk, however, extends beyond school settings. Occupational settings can impart enhanced risk as well, including the medical, agriculture and construction industries. A Correspondence by Olivia Remes unpacks the ‘silent crisis’ in the construction industry, which faces alarmingly high rates of suicide among male workers. The authors conducted a survey of over 2,000 construction professionals, revealing that 26% had suicidal thoughts and 91% felt overwhelmed within a year, citing stressors such as poor communication, unrealistic deadlines, and unsafe and inadequate facilities. The piece emphasizes the need for cultural shifts, safer workplace environments, and further research to effectively address the mental health challenges of one of the largest occupational sectors.

This month’s issue also presents a Q&A with Lakshmi Vijayakumar, a psychiatrist, academic and founder of SNEHA, a non-governmental organization in Chennai, India, that works as a helpline for suicide prevention. In an inspiring conversation, she shares how she transformed personal encounters with tragedy into research and nation-level policy reform. This piece also includes her emphasis on the notion that suicide is not only about mental health but also about social factors, making suicide prevention a collective work.

A common denominator to each of the pieces featured in the September issue is that suicide prevention is most effective when it is collaborative and culturally informed and works to address mental health and the social determinants of mental health and wellbeing. Changing the narrative in suicide prevention also means changing who is involved in the conversation. Whether through global strategies, community-led initiatives and interventions, or co-designed research, success depends on bringing stakeholders together to create suicide-prevention solutions that are relevant, inclusive and grounded in real-world experiences.