Thirty years ago, my youngest sister, then 27 years old, jumped off a roof in New York and fell to her death. That anniversary and a new report from the US surgeon general have got me thinking about suicide prevention.

Suicide is a big public health problem. It is the 10th leading cause of death worldwide, accounting for about one million deaths a year.1 In the United States there were over 38 000 suicides in 2011.2 Men are 3-4 times as likely as women to kill themselves, though women attempt suicide much more often.

Risk factors for suicide have long been known. Psychiatric disorders are present in around 90% of people who kill themselves, and more than half of those who die by suicide meet criteria for a current depressive disorder. Other leading mental disorders associated with suicide include substance misuse, schizophrenia, and personality disorders. The problem, of course, is that while the vast majority of people who kill themselves have a mental disorder, only …