While the global suicide rate is gradually decreasing, in Ukraine, as in many Eastern European countries, it remains one of the highest in Europe (approximately 12–14 cases per 100,000 people). The risk is most often elevated among elderly men and people living in rural areas.

Most suicide cases are linked to mental disorders, especially depression. The more severe the depression, the greater the risk. At the same time, most people with this diagnosis do not take their own lives. According to statistics, about 5% of people with depression have suicidal thoughts, but only a small fraction of them take actual steps toward suicide.

Depression changes thoughts and feelings in a way that makes a person unable to see a way out of their current state or imagine a future without pain. Constantly remembering failures, losses, and childhood traumas, combined with a sense of hopelessness, pushes them toward the thought that the only way out is to end the suffering.

How common is suicide among people with depression?

Approximately 2% of people treated as outpatients for depression eventually end their lives by suicide. Among those who were in a psychiatric hospital, the rate is twice as high—4%. If a person was hospitalized due to a suicide attempt or strong suicidal thoughts, the risk reaches 6%.

About 60% of people who die by suicide had a diagnosed affective disorder (such as depression or bipolar disorder). In younger age groups, alcohol or drug abuse often becomes an additional factor.

When does emotional pain become unbearable?

Suicide is sometimes viewed not as a desire to die, but as an attempt to escape mental pain: endless negative thoughts, self-blame, and a sense of hopelessness.

Social rejection or isolation is an especially dangerous factor. Breaking off a relationship, being ignored by friends, or facing social rejection activates the same parts of the brain as physical pain. Unlike a physical injury, psychological pain is often “replayed” over and over, which intensifies the suffering.

What factors increase the risk of suicide?

• Heredity (a family history of suicide);
• A combination of PTSD and depression;
• Childhood trauma and abuse;
• Alcohol or drug abuse;
• Social isolation and loneliness;
• Chronic pain or serious illness.

Men are more likely to die by suicide, while women make more non-fatal attempts.

How to recognize the risk?

The clearest signal is talking about death or a desire to die. Other warning signs include:

• A sense of hopelessness or feeling like “a burden to others”;
• Isolation and avoiding contact;
• Saying goodbye to loved ones or giving away possessions;
• Searching the internet for suicide methods;
• A sudden improvement in mood after a long period of depression (this may mean the person has already made a decision and feels relief).

Important: Asking directly if a person is thinking about suicide will not do harm; instead, it often provides relief and opens the door to help.

Do “anti-suicide contracts” help?

In psychotherapy, anti-suicide agreements are often used. The person commits to not harming themselves and to calling a therapist or a loved one during a crisis. This can be a written or oral agreement.

These contracts are often made not only between patients and psychiatrists but also involve emergency responders, military personnel, and family members of those in crisis. The most effective agreements are written safety plans that include contact information for a doctor, a hotline, or trusted individuals.