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.
Following-Up With Suicide Survivors
Draper said that post cards, phone calls and personal visits to those who are suffering from depression can help. "Check in with individuals who are trying to hurt themselves and say, 'How are you doing? I'm still thinking of you.'"
He cited research in New Zealand that shows such communications from hospital emergency departments reduced suicide attempts "by 50 percent."
Beyond showing those who are troubled that they are valued, Draper said providing counseling and guidance is critical to recovery -- "teaching them skills to manage their thoughts and feelings."
Availability of lethal weapons can also make the difference between life and death. Substance abuse also "clouds" a person's ability to make good decisions.
Triggers can also include life events like the loss of a child or a scandal that make a person feel "humiliated and shamed," according to Draper.
"A person feels they are never going to recoup their sense of dignity, never hold their head up, or a loss in life that they will never recover from and imagine an unending future that is hopeless," he said.
Often these triggers are combined with other mental health issues or poor emotional management skills. "They often don't know how to seek help and are feeling trapped and alone," he said of those with suicidal thoughts. "They don't reach out."
"There is a difference between a person who is in crisis or has a precipitating event as opposed to people who are chronically depressed," said Draper. "A lot of people exposed to trauma or a history of mental illness or have not learned how to manage their emotions."
Those who are bipolar or have schizophrenia are often predisposed to suicidal thoughts. In those cases, cognitive behavioral therapy in conjunction with medication have shown to be effective.
"We can get them to a place where they see hope," said Draper. "It can be the difference between rolling a boulder or kicking a pebble up the hill."
For help or to report a suicide, contact the National Suicide Prevention Center Lifeline at 1-800-273-TALK (8255).
The following are signs that might indicate the risk of a suicide attempt:
Talking about wanting to die or to kill themselves;
Looking for a way to kill themselves, such as searching online or buying a gun;
Talking about feeling hopeless or having no reason to live;
Talking about feeling trapped or in unbearable pain;
Talking about being a burden to others;
Increasing their use of alcohol or drugs;
Acting anxious or agitated; behaving recklessly;
Sleeping too little or too much;
Withdrawing or isolating themselves.
Showing rage or talking about seeking revenge.
Displaying extreme mood swings.