By Mauro Proença —
Suicide awareness campaigns can start conversations—but do they actually save lives? Looking beyond visibility and good intentions, the evidence points to a more complex picture in which effective prevention depends on concrete interventions, from mental health treatment and crisis follow-up to restricting access to lethal means.
This September, I cried at a rock festival.
I went to Rock in Rio on the 4th and 5th for a simple reason: three of my five favorite artists were on the lineup. The song that hit hardest was "Make It Stop (September's Children)" by Rise Against, written in response to the wave of teenage suicides in September 2010 involving victims of bullying based on their sexual orientation.
As someone who has faced, and continues to face, episodes of depression and suicidal ideation, I can say that therapy, medication, social support, and even these songs were part of the mix that helped me get through those periods. Without that combination, my story might have turned out differently.
Unfortunately, many people still suffer without adequate access to treatment, support, and other resources that could help them navigate a crisis. Instead of demanding greater access to care, early identification, and evidence-based prevention strategies as a society, I most often see awareness campaigns. While these can reduce stigma, increase knowledge, and, in some contexts, encourage people to seek help, they do not necessarily lead to a reduction in the number of suicides.
This distinction is important because suicide remains a serious public health issue in the United States. Recent CDC data recorded 48,824 suicide deaths in 2024, with an age-adjusted rate of 13.7 deaths per 100,000 people.
Three decades of campaigns and increased awareness of mental health have not made suicide disappear as a public health issue. However, that alone does not tell us whether these campaigns have been effective. After all, we do not know what the figures would look like without them. To answer that question, we need to look directly at the evidence. What factors are associated with suicide? And, even more importantly, which strategies have evidence showing that they actually help prevent it?
Risk factors
An umbrella review published in The Lancet Public Health evaluated 33 meta-analyses and 38 individual-level risk factors associated with suicide mortality. Overall, the evidence quality was predominantly low. Still, the strongest associations involved prior suicide attempts and suicidal ideation, with effect sizes 6 to 16 times higher, and psychiatric disorders as a whole, with effect sizes 4 to 13 times higher, particularly mood and psychotic disorders. Among physical factors, epilepsy, concussion, COPD, and cancer also showed strong associations, although they were weaker than those linked to psychiatric conditions. Sociodemographic factors showed more moderate associations.
Consistent with these findings, another article, published in BMJ Mental Health, found seven out of ten individuals who died by suicide had a mental disorder at the time of death, compared with 22% of controls, and nearly 30% had a history of suicide attempts, compared with 6% of controls. Social isolation, unemployment, and low socioeconomic status were among the sociodemographic factors most strongly associated with suicide, while adverse events occurring in the month before death were associated with an approximately tenfold increase in risk.
However, we must interpret these results with caution. Psychological autopsy studies are limited by control selection, selective non-response, and the risk of recall and measurement bias when researchers obtain data from informants. In the adjusted analysis, estimates for most factors decreased, particularly within the clinical domain, and many factors are not independent of one another, as with psychiatric comorbidities. About one-third of the estimates showed considerable heterogeneity, and signs of publication bias emerged for several factors, including social isolation, unemployment, depression, substance use, and financial problems.
Despite these limitations, both reviews reinforce the importance of considering psychiatric disorders and social factors in suicide prevention.
How effective are awareness campaigns?
To be completely honest, before delving into this topic, I strongly believed that awareness campaigns, such as Brazil’s "Yellow September," would help people going through difficult times seek assistance by raising the issue's profile. However, after reading the article on the impact of the program on suicides, I began to have doubts.
For context, "Yellow September" began gaining national reach in Brazil in the mid-2010s, with the participation of organizations such as the Brazilian Psychiatric Association and the Federal Council of Medicine. The campaign uses social media, informational booklets, graphic materials, and educational content to raise awareness, reduce stigma, and encourage people to seek help.
The analysis found that between 2000 and 2019, Brazil recorded 195,047 suicides, with an estimated 57% increase in suicide rates. This increase was most pronounced among people aged 20 to 29, while the highest rate in 2019 occurred among individuals aged 70 to 79. Rates were higher among men and in the South region, which reached 10.5 deaths per 100,000 inhabitants.
Joinpoint regression (which identifies significant shifts in time series) identified a change in the curve's slope starting in 2015, marked by an acceleration in the rate of increase in suicides. The authors also found an association between the period around September and suicide rates. However, this does not establish causality, since the study design cannot disentangle the campaign's effects from other changes that occurred during the same period. One might imagine that these results were specific to the Brazilian context. However, international literature presents a similarly inconclusive picture.
A systematic review published in Health Communication analyzed 20 studies on suicide-prevention media campaigns. The most consistent evidence showed improvements in knowledge and awareness, while effects on attitudes were predominantly positive. In contrast, results regarding concrete behaviors, such as seeking help, varied significantly. Few studies had sufficient statistical power to assess mortality, but those that did reported reductions.
A 2024 article published in BMC Psychiatry evaluated a media campaign featuring outdoor posters, feature articles, film clips, and online banners across print, digital, and social media in the Mid-Norway region in late autumn 2022. The study found only marginal changes in attitudes and help-seeking literacy.
These mixed results suggest that campaign design matters, including the message, medium, and audience.
This last point is particularly important. A study published in 2025 in the American Journal of Geriatric Psychiatry, for example, evaluated the websites of seven prominent suicide prevention organizations in the United States. Five recognized older adults as a high-risk group, yet none featured a public campaign specifically targeting them, and only two offered specific resources. This suggests that even preventive communication must consider the intended audience.
In other words, while campaigns can increase visibility and knowledge, there is insufficient evidence to consider them, in isolation, a strategy capable of reducing deaths. Ultimately, as might be expected with such a complex phenomenon, prevention is unlikely to be achieved through a single strategy.
Evidence-based strategies
Arguably one of the best articles summarizing the effectiveness of various suicide prevention strategies was published in The Lancet Psychiatry in 2016. It reviewed 164 studies up to 2014. The most robust evidence supported restricting access to lethal means, such as medications, firearms, and pesticides, with no strong indication that individuals simply switch methods when the original one becomes unavailable. Antidepressants, lithium, and clozapine also showed favorable evidence in specific groups, as did effective talk therapies that connect your thoughts, feelings, and actions, when administered for an adequate duration.
Community and family interventions yielded more variable results. This does not mean social support is unimportant, but that its effects are harder to measure in controlled studies. Studies involving ketamine and electroconvulsive therapy suggested rapid reductions in suicidal ideation in some cases. A recent scoping review published in the American Journal of Psychiatry also found that somatic treatments can reduce suicidal ideation and, in some instances, the risk of suicidal behavior, with effects primarily mediated by antidepressant or mood-stabilizing mechanisms. Clozapine and lithium may reduce suicidal behavior, whereas intravenous ketamine may reduce suicidal ideation through additional effects on suicidal diathesis.
Active follow-up after a crisis is also supported by evidence. Phone calls, in-person contacts, and messages following a suicide attempt or hospital discharge have been associated with fewer subsequent attempts in various studies.
Taken together, this body of evidence suggests that no single intervention can address every aspect of such a multifactorial phenomenon. Strategies supported by evidence address different aspects of the problem, ranging from restricting access to lethal means to treating mental disorders and maintaining contact with people at risk.
We must avoid blaming people going through such situations and, as a society, invest in evidence-based strategies, such as restricting access to lethal means, treating disorders associated with suicide risk, and providing follow-up care after crises. Perhaps the main lesson is simple: raising awareness can be part of prevention, but it is no substitute for giving people concrete ways to keep living.
As the song I opened this piece with concludes, "I plan to go on living." It may sound sentimental, but if you are in a dark place, know that you are not alone. In the United States, you can call or text the 988 Suicide & Crisis Lifeline, which is available free of charge 24 hours a day.
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