Paths Out of Darkness

Jennifer Couzin Frankel

When my younger sister died by suicide 7 years ago, at age 30, the loss was shattering. If I considered the role of science at all, it was through the lens of failure—its failure to save her, along with the thousands who died before and after. More often, I pushed science aside. Given the mysteries of brain chemistry and its confluence with life experience, could science really decipher what drives an individual to want to die? Could it predict who is most at risk and find ways to intervene in the face of grim obstacles? I was doubtful.

At first glance, statistics seemed to back this gloomy outlook. The suicide rate in the United States is rising, and more than 47,000 people died in 2017. Among 10- to 34-year-olds in the United States, suicide is the second leading cause of death; for 35- to 54-year-olds, it ranks fourth.

Yet, in most countries, suicide rates are dropping. Sri Lanka, Cuba, Switzerland, and Mauritius are among the many places marked by optimism. Multipronged efforts across Denmark dramatically cut its rate, which used to be one of the world’s highest (see Editorial, p. 725). In the United States, too, there are bright spots, and simple strategies can have a big effect: Crisis hotlines, standardizing mental health care, and restricting lethal means are all saving lives.

As we learned in developing this package, science is making headway, as well. Efforts to untangle the evolutionary biology and neurobiology of depression and suicide may offer clues to combatting them. Dozens of teenagers and adults, many of whom have attempted suicide, are signing on for 24-hour-a-day digital tracking to help researchers decipher patterns that precede suicidal behavior.

Scientists still have a long way to go. Sometimes it’s clear what works, but the political or community will to implement it is lacking. And recognition is growing that given the many paths to distress, we need a variety of strategies to ease it. The stories that follow show how researchers and people at risk are working to reshape trajectories from hopelessness to hope, one life at a time.