We Need to Talk About Suicide Prevention for Midlife Women

Content warning: Suicide

In the United States, suicide is a serious public health issue. According to provisional data from the Centers for Disease Control and Prevention (CDC), nearly 50,000 Americans died by suicide in 2022. That’s an increase of 2.6 percent from 2021, and it doesn’t account for the millions of American who seriously think about suicide each year.

For about 20 years, the national suicide rate has risen consistently, save for 2019 and 2020, which saw decreases two years in a row. Unfortunately, it looks like rates are now “on the upward rise again,” Dr. Christine Yu Moutier, Chief Medical Officer at the American Foundation for Suicide Prevention (AFSP), tells Flow. “And if the provisional data for 2022 holds true, then it might be an all-time, 40-year high for our national rate of suicide.”

Most U.S. deaths by suicide occur among middle-aged white men, but this isn’t the only affected demographic. Women in their 30s, 40s, and 50s also experience relatively high rates of suicide — and in recent decades, those numbers have increased substantially. However, since they are less likely to die by suicide than their age-matched male peers, their struggles aren’t talked about as much. Suicide risk and protective factors for women “aren’t the best-studied topic,” either, notes Moutier.

With America’s loneliness epidemic worsening, and suicide rates poised to reach record numbers, it’s time to open up this important dialogue. Talking about suicide isn’t just a means of reducing stigma. Research indicates that these conversations may actually reduce suicidal ideations in at-risk groups. 

Flow spoke to multiple mental-health experts to better understand suicidality among mid-life women. Here’s everything you need to know about the unique challenges faced by this under-discussed demographic, as well as strategies for suicide prevention.

What are the national suicide rates for midlife women?

According to CDC data, midlife women have lower rates of death by suicide than their age-matched male peers. Although suicide may seem like less of a concern for this demographic, that isn’t necessarily true if you examine year-over-year trends. Since 1999, rates have soared, particularly among white women.

From 2010 to 2017, U.S. suicide rates for women ages 30 to 49 rose virtually every year. That appears to have changed in recent years, notes Moutier. As of 2020, the rate for this demographic is now 7.6 per 100,000 people, down from 8.8 at its peak in 2017. 

Moutier isn’t surprised given the context of the global COVID-19 pandemic. “In times of crisis, communities are so attuned to getting through it that interestingly, even for people who have suicide risk factors, their rates go down during those periods,” she explains. “But the trouble is oftentimes, there’s a rebound [effect] later on.” As such, Moutier is interested to see what post-pandemic data will reveal.

Split the data further by factoring in race and time ethnicity, and another story emerges: White women ages 30 to 49 are significantly more likely to die by suicide than Black and AAPI women their age. This has held true consistently, notes Moutier. Although it’s impossible to pinpoint a single explanation, she says that cultural differences — including “norms around connection and community” in Black churches, salons, and neighborhoods — could be a protective factor.

On the flip side, LGBTQ+ people experience elevated rates of suicidal ideation. Queerness itself isn’t linked to an increased risk of suicide; rather, it’s “experiences of violence and structural discrimination” that cause mental and emotional anguish among LGBTQ+ people, says Moutier.

Related story Got the Winter SADs? Understanding & Dealing With Seasonal Affective Disorder

Across the board, “there was a dip [in deaths by suicide] during COVID, understandably, and now we are seeing it start to climb again,” adds Dr. Tia Dole, Chief 988 Lifeline Officer at Vibrant Emotional Health. “So when people ask me, ‘Who are you worried about?’ — everybody, because I don’t think that there is a single group that’s not having an uptick.”

Are there any unique protective or risk factors for suicide for midlife women?

There is no single cause of suicide; however, there are a number of characteristics that increase a person’s risk. These risk factors alone can’t predict a suicide attempt, but they’re still important to recognize. Certain underlying mental health conditions — such as depression, bipolar disorder, and substance use disorders — are noted suicide risk factors, as is having a family history of suicide or a personal history of trauma or abuse.

Social and interpersonal factors typically play a role, too. Dole cites the Surgeon General’s social connection advisory from May, which sounded the alarm on America’s “urgent public health issue” of loneliness and isolation. “Research shows that adults are more disconnected than ever from other adults, and not specifically just women,” she explains. “But humans are pack animals. We need other people, and the less time that we spend with people, the lonelier we are.”

For midlife women, challenging life circumstances — think divorce, job loss, or financial strife — can take a drastic toll on their mental health, which may increase their risk of suicide in some instances. Many parents of children with disabilities also experience heightened isolation, which may increase their risk, says Dole.

Since many women in their 30s and even 40s can get pregnant, postpartum depression (PPD) is another noteworthy risk factor — and a “very, very potent” one, according to Moutier. “When you look at the life-cycle of women and their mortality, you see this big spike in deaths around the childbearing years. That’s due to suicide and overdoses.”

In suicide-prevention circles, friendships and community connections are said to be powerful protective factors. The ways that women are socialized may support them in this regard: In the U.S., “women do tend to congregate and share and disclose more,” says Moutier. “And vulnerability amongst women is not as taboo as vulnerability amongst men in relationships.”

But PPD and other postpartum mental health conditions are so potent that they can override these protective factors. This underscores the importance of taking a “multi-pronged approach” to suicide prevention, adds Moutier. “There are moments where someone really does require immediate intervention and support and medical treatment.”

These are the general warning signs to look out for — and how to address them

Suicide is not inevitable for anyone, and experts view it as a fundamentally preventable public health issue. Part of this work involves addressing systemic issues within our country’s healthcare infrastructure. For the 27.6 million Americans who don’t have health insurance, it may be impossible to access affordable mental healthcare. Since suicide is so strongly associated with certain mental illnesses, this care can be life-saving.

On an individual level, it behooves us all to know the common warning signs. “Withdrawal is generally your biggest clue,” says Dole. Someone who is seriously thinking about suicide may self-isolate or act out of character in social settings. Dramatic behavioral changes, such as recklessness or giving away your possessions, can also be an indicator.

If you think someone you love is seriously considering suicide, what should you do? The answer is simple, says Dole: Talk to them. Check in with your loved one about what’s going on, and try your best to hold space for what they’re feeling. “One of the big reasons why people don’t talk about their suicidal thoughts is that they fear being a burden on the people in their lives,” she explains. By initiating that difficult conversation, you send the opposite message.

“Trust your gut,” adds Moutier, “and use your social-emotional radar.” It’s a popular misconception that talking to a loved one about suicide will plant the idea in their head. “You don’t have to have training to do this. You just have to be a caring friend or spouse, or whatever your relationship is to this person, to open up a safe and inviting dialogue.”

AFSP offers a helpful online guide for starting a conversation. If you need further guidance, consider calling the 988 Suicide & Crisis Lifeline at 988. The Lifeline is a national network of local crisis care centers that provide free, confidential support to people experiencing mental health crises. It’s available in the U.S. 24/7 via phone, text, and web chat.

“We get a lot of calls from loved ones,” says Dole. “We don’t give advice, but we can give guidance — ‘Where do you live? Here’s a clinic,’ or ‘Here’s an online resource.’ Even coaching people through talking to their loved one can be incredibly helpful.”

​​If you or someone you know is at risk of suicide, call the 988 Suicide & Crisis Lifeline at 988. If you’re a young LGBTQ person and need to talk to someone, call The Trevor Project’s 24-hour crisis hotline for youth at 1-866-488-7386 and/or The Trans Lifeline at 877-565-8860.