Editors' Note: This is the final story in a three-part series during National Suicide Prevention Week. ABCNews.com explores not only what motivates people to kill themselves, but highlights those who survive suicide attempts, witness them or work to prevent them.
Suicide is never painless. It not only robs family members of loved ones, but affects all of American society when otherwise productive individuals see no worth to their lives.
Broadly speaking, a federal study shows, 8.3 million Americans -- 3.7 percent of all adults -- have serious thoughts of suicide each year; 2.3 million make a plan and 1.1 million attempt suicide, resulting in an estimated 37,000 suicide deaths each year.
In some ways, that's the good news, according to John Draper, director of the National Suicide Prevention Lifeline Most who consider suicide do not follow through.
"People with the highest probability of killing themselves have tried before," he said. "The data shows about 7 percent who try to kill themselves will later die by suicide."
"The important thing is that 93 percent go on to live their lives," he said. "It's saying that even though this is a high-risk scenario, the overwhelming majority are doing OK or better and find ways to turn it around. How do they do that?"
Acts as simple as "checking in" with someone who is struggling with suicidal thoughts or depression can be an effective deterrent to suicide, according to Draper.
Early research shows that follow-up calls to those who have contacted the suicide lifeline can cut deaths in half.
"First and foremost is the sense of meaningful connection in life," he said. "Someone or somebody who makes them feel they are cared about."
Researchers have looked at a number of multi-pronged approaches to suicide prevention, including two cited in stories this week by ABCNews.com.
Monday, ABCNews.com reported that more than 230 people have taken their lives at Seattle's Aurora Bridge, making it the second-deadliest "suicide bridge" in the United States, behind the Golden Gate Bridge. In 2006, a record nine people jumped to their deaths.
Some studies, including those by the national Lifeline show that iconic bridges and other physical structures draw those with suicidal impulses, but if barriers are in place, many deaths can be prevented.
Suicide hotline boxes on the structures proved to be a failure, so an advocacy group pushed Washington state to erect barriers last year, and now the number of suicides has dropped.
"We are very aware of how hotlines can prevent suicide and emotional distress, but there is a limitation on every intervention," said Draper. "You can't apply the same medical procedure for every problem."
According to Dr. Joseph Shrand, a Harvard Medical School psychiatrist who treats at-risk youth at the CASTLE program in Boston, barriers cannot address all the causes of suicide. In an interview this week, he said barriers are a "metaphor."
"It is really quite stunning to try to put up a structure to prevent suicide," he said. "The real barriers to people not getting help has to do with the entire stigma of mental illness -- treating people as if they have a deviation and must pull themselves up by the bootstraps instead of a tie around their neck."
His novel approach, called imax, is based on a simple theory that, "It all starts with respect."
From a biological standpoint, suicidal tendencies can be seen as a coping mechanism to external influences, or domains -- family, social groups, environmental influences, as well as a person's own biology -- over which people have no control.
"It is always remarkable that people are not doing worse," Shrand said. "The imax approach truly sees people doing the best they can."
The underlying sense of trust and caring are at the root of other interventions that show promise, according to Lifeline's Draper.
Preliminary research from a SAMHSA-funded team at Columbia University and NY State's Psychiatric Institute shows that follow-up calls with consenting Lifeline callers at suicide risk can help keep them safe.
More than half of the persons at risk who were contacted after suicide threats reported that the calls "kept them from killing themselves," according to the as yet unpublished study.
"Our results highlight the role that crisis centers can play to enhance the continuity of care for individuals at risk of suicide," said author Madelyn S. Gould, deputy director of the Research Training Program in Child Psychiatry at Columbia University.
"Crisis centers are well-positioned to provide this service to their own callers and patients discharged from emergency rooms," she said.