Suicide Prevention: How to Help When Social Determinants Spiral

September is National Suicide Prevention Month, when mental health advocates, prevention organizations, survivors, allies and community members unite to promote suicide prevention awareness. Relias is one such ally. We admire the strength of our clients who work daily to help prevent suicide and are committed to supporting other organizations doing the same. Relias is participating in National Suicide Prevention Month through September and beyond, by sharing helpful information, tools and resources across a variety of settings so that we can help to meet the needs of individuals where they live, work and learn.


The rate of suicide in the U.S. has risen by 30% over the past 20 years. As a care professional in the health and human services industry, you are most likely familiar with the common risk factors and warning signs for suicide, but there are other important factors to consider, like social determinants of health (SDoH), which play a very large role in substance use disorders (SUDs) and depression. These determinants feed off one another and produce a downward spiral effect that increase the risk of suicide. It is important for you to become familiar with SDoH and their impact so they can better inform the way you provide care—and possibly save lives.

Social Determinants of Health

Determinants of health include the availability of health care, individual behavioral choices, and biological and genetic factors. A subcategory of this was created called social determinants of health, which the World Health Organization defines as “the conditions in which people are born, grow, live, work, and age” that are “shaped by the distribution of money, power, and resources at global, national, and local levels.”

Social determinants of health contribute to health disparities among various groups of people based on gender, race, and class. They are also an underlying factor in the development of major health concerns in the U.S. including obesity, heart disease, and depression.

There are complexities that exist in social determinants of health that cause a feedback loop of hardship, as shown in the diagram below. It is easy to see how each hardship can lead to the next, finally resulting in unhealthy coping mechanisms that may lead to substance use disorders, and so on.

social determinants of health feedback loop

Substance Use Disorders, Depression, and the Downward Spiral

downward spiral for social determinants of health

Compared with the general U.S. population, people with substance use disorders have a 10 to 14 times greater risk of death by suicide, and more than 50% of individuals who die by suicide suffer from major depression. Substance use and depression, however, are only two routes that could lead to suicide. There are many other paths. When an individual with a substance use disorder is also suffering from major depression, it is possible for another cycle to enter the picture. While all people with a substance use disorder are not depressed and while all people with depression do not have a substance use disorder, when the two are combined, the individual suffering from depression may want to numb the effects of it with drugs or alcohol, only to discover it could worsen their depression, which then may lead to more substance use and possibly addiction.

Left unattended, the feedback loops for SDoH, SUDs and depression overlap, forming a tightly interlocked relationship that creates a downward spiral. A person suffering from a substance use disorder who can’t seem to get out of the loop becomes hopeless. Hopelessness may lead to worsened depression, which could then lead to thoughts of suicide and possibly dying by suicide.

How to Make a Difference

There are several resources available to help prevent suicide, but it is critical that we use those resources collectively, across a wide variety of settings. We need a comprehensive approach to suicide prevention that meets individuals who are struggling where they are.

Suicidal thoughts and behaviors can be reduced with the proper mental health support and treatment and are not weaknesses or flaws. Ensuring your colleagues and staff are properly trained on how to identify suicide risk factors and how to intervene when risk is present are important steps in preventing suicide.


Learn how Relias provides suicide screening, assessment and treatment training for all employees, whether direct care, support, administrative or supervisory staff.


If you are in crisis or know someone who is, please call or share the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or contact the Crisis Text Line by texting TALK to 741741.

Jeanine D’Alusio

Senior Content Marketing Manager, Relias

Jeanine spends her days writing for the Health and Human Services industry at Relias. Before her career in marketing, she worked extensively in human resources and learning and development. Jeanine has more than 10 years of nonprofit experience, including as an HR Director at a multiservice behavioral health and community services organization. Jeanine is also a licensed massage therapist who enjoys helping her clients feel better in her spare time.

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