Suicide and self-harm are significant public health concerns in the U.S. and in many other nations. Mental health professionals and other working to eliminate these threats often encounter two obstacles: determining who’s at greatest risk and understanding how best to help them.
Recent research suggests that a surprising factor – supplemental folic acid – could play a significant role in this effort.
The Scope of the Problem
According to the U.S. Centers for Disease Control and Prevention (CDC), the United States averaged one suicide death every 11 minutes in 2021.
The CDC also reported the following statistics about suicide in the U.S. in 2021:
- There were 48,183 suicide deaths in the United States. 38,358 of these deaths (or 79.6% of the annual total) involved men, while 9,825 (20.5%) involved women.
- The suicide rate among men (22.8 per 100,000) was almost four times higher than the rate among women (5.7 per 100,000).
- The national suicide rate in the U.S. was 14.5 per 100,000 people.
- Three states (Wyoming, Montana, and Alaska) reported 30 or more suicide deaths per 100,000 residents.
- Only four states (Maryland, Massachusetts, New Jersey, and New York) reported fewer than 10 suicide deaths per 100,000 residents.
The CDC also reported the following about suicidal ideation in 2021:
- Experts estimate that more than 12 million adults in the U.S. seriously considered suicide.
- Research indicates that about 3.5 million adults made a suicide plan, and about 1.7 million adults attempted to end their own lives.
Since people often go to great lengths to hide evidence of self-harm, determining the true prevalence of the behavior present challenges.
- CDC data indicates injuries due to intentional self-harm accounted for about 660,000 emergency room visits in the U.S. in 2021.
- The American Psychiatric Association (APA) reports that about 17% of adolescents and about 15% of college students engage in intentional self-harm.
- The APA also places that the lifetime rate of self-harm among adults at about 5%.
Risk Factors for Suicide & Self-Harm
Suicide and self-harm are often (but by no means always) associated with mental health disorders. Bipolar disorder, schizophrenia, depression, and posttraumatic stress disorder (PTSD) are among the diagnoses that increase risk of suicide and self harm.
However, mental illness isn’t the sole cause of suicide. The American Foundation for Suicide Prevention (AFSP) identifies the following risk factors:
- Substance abuse and addiction
- Traumatic brain injury
- Prolonged exposure to overwhelming stress
- Negative life experiences such as divorce or financial losses
- Family history of suicide
- Personal history of being abused or neglected during childhood
- Substandard coping skills
- Lack of effective personal support and appropriate mental health care
A meta-analysis of data from more than 55,000 people who engage in non-suicidal self-injury (NSSI) determined that the strongest risk factors for NSSI include:
- Being female
- History of adverse childhood experiences (ACEs)
- Low health literacy
- Being a victim of bullying
- Mental illness
In addition, recent research suggests that insufficient folic acid may also increase risk.
Folic Acid, Self-Injury, and Suicide
In September 2022, the Journal JAMA Psychiatry published a study that addressed this question:
“Is folic acid associated with decreased suicide attempts and intentional self-harm?”
This research team, led by Robert Gibbons, PhD, analyzed data from more than 866,000 adults with insurance claims for inpatient treatment, outpatient care, or prescription medications. The data include information from over 100 private insurance companies in the United States.
They found that cases of attempted suicide or intentional self-harm were 44% lower among adults who filled prescriptions for folic acid.
An article published by the University of Chicago website noted the following:
- The researchers controlled for factors such as the subjects’ age, sex, mental health status, use of other central nervous system drugs, and conditions that could affect folic acid metabolism.
- The research team found that the length of time a person took folic acid correlated with their suicide risk. During the two-year follow-up period, they determined that every month a person took folic acid reduced their suicide risk by 5%.
- A similar review that focused on vitamin B12 use instead of folic acid revealed no change in suicide risk.
“There are no real side effects [to folic acid supplements], it doesn’t cost a lot of money, you can get it without a prescription,” Gibbons said in Burton’s article. “This could potentially save tens of thousands of lives.”
Folic Acid: Impact on High-Risk Individuals
Gibbons also participated in another study on folic acid and suicide, published in August 2023 by the journal BJ Psych Open.
The researchers reviewed the same data that Gibbons and his team used in their original exploration of folic acid’s effects on suicidality. However, this time, they focused on individuals with an elevated risk of suicide.
This included subjects who met one or more of the following criteria:
- Previously suicide attempt
- Diagnosed with a major psychiatric disorder
- Currently taking a selective serotonin reuptake inhibitor (SSRI)
The goal of this effort was to determine whether people most likely to attempt to end their own lives had a folic acid deficiency. The result of their analysis, the researchers reported, was that taking folic acid had the same effect on high-risk individuals as on the general population from the first study.
“Folic acid prescription is robustly associated with lower suicidal event rates in higher suicide risk populations,” they wrote.
The researchers added that, for high-risk individuals, folic acid may be a complement to, not a replacement for, antidepressants and other medications – though they noted that considerable study remains to be done.
“It is notable that this putative benefit of folic acid works independently of current psychotropic medications and thus may enhance suicide prevention benefit for high-risk patients beyond that offered by psychotropic medications,” they wrote. “The robustness of our findings supports the merit of designing research clinical trials to test the efficacy of folic acid in reducing suicide risk in high-risk psychiatric populations.”
What Is Folic Acid?
Let’s backtrack for a moment to review what, exactly, this substance is.
The National Institutes of Health (NIH) describes folic acid as a form of vitamin B9 included in fortified foods and supplements. Vitamin B9 (folate) plays a key role in vital functions such as cell growth and the production of red blood cells.
The U.S. Food and Drug Administration requires manufacturers to add folic acid to several food products, including enriched cereals, pastas, rice, and flours.
In addition to folic acid’s possible influence on suicide and self-harm, the NIH reports that abnormal folate levels may also be linked with several other conditions, including:
- Autism spectrum disorder (ASD)
- Some forms of cancer
- Cardiovascular disease
- Congenital heart disease
- Neural tube defects
- Alzheimer’s disease
- Depression
While most people get an ample amount of folic acid or folate through their diet, those who meet the following criteria have an elevated risk of folate deficiency:
- Individuals with alcohol use disorder (alcoholism)
- Pregnant people
- Women of reproductive age
- People with celiac disease, inflammatory bowel disease, or other malabsorptive disorders
- Individuals with a genetic mutation known as an MTHFR polymorphism
Does Folic Acid Prevent Suicide?
At this point, researchers have yet to definitively established the link between folic acid deficiencies and suicidality or self-harm. This means that calls for supplemental folic acid as a suicide prevention measure are premature.
Another reason to exercise caution regarding folic acid supplements is that excess folate can also be problematic. The NIH notes that ingesting too much folic acid is associated with:
- Risk of certain cancers
- Diminished cognition in young children
- Cognitive impairments in older adults
- Dysfunction of the immune system
Excessive folic acid may also mask vitamin B12 deficiency, which can lead to anemia, impaired balance, fatigue, and memory problems.
If you consider taking folic acid supplements, please consult with your doctor first. Even though supplemental folic acid is available without a prescription, getting a medical opinion before making any significant changes is important.
Help for Suicidal Ideation and Self-Harm
If you experience thoughts of suicide or engage in acts of intentional self-harm, or you believe that you or someone that you care about is in imminent danger of suicide or harming themselves, please get help immediately.
- If you live in the United States, you can reach the 988 Suicide & Crisis Lifeline by calling or texting 988 from any phone.
- You can also access the lifeline online at https://988lifeline.org/.
- This free resource is staffed 24/7 by trained professionals who can talk to you about what you have been experiencing and connect you with appropriate resources near you.
If you’re at risk of thoughts of suicide or engage in acts of intentional self-harm, but you don’t think you are in immediate danger, please consult with your doctor or with another qualified healthcare provider as soon as possible. They can assess your needs and recommend appropriate treatment options for you.
Depending on the results of your assessment, comprehensive care at Crownview Psychiatric Institute may be an appropriate option. To learn about more about treatment options at CPI, please visit our Contact Us page or call our center today.
Gianna Melendez
Jodie Dahl, CpHT