The statistics are sad: According to the Center for Disease Control, suicide remains the fourth leading cause of death for adults ages 35-54, and the second leading cause of death for youth and young adults ages 10-34. The suicide rate increased 35% from 1999 to 2018.

In 2019, there were close to 47,000 deaths by suicide in the U.S. compared to nearly 39,000 who died in car accidents.

Yet consider how much thought, engineering and safety resources go into the prevention of automobile accidents compared to suicide prevention. Nations that have made suicide prevention a public health priority have seen drops in suicide rates over time.

A close friend and teacher of mine killed himself when he was in his late 50s. Like many survivors of suicide, I felt a deep sadness and regret that I was unable to help him. His life had gone off the rails — he lost his job and his partner, brought about by years of alcohol dependence. I imagine he had feelings of hopelessness and despair.

A 2017 survey conducted by Rasmussen Reports, a national polling firm, found that 55% of adults know of someone who had died by suicide. It’s a cause of death that impacts millions of lives.

There is never a single cause of suicide. There are often multiple risk factors including health issues (depression, substance abuse, mental illness and serious physical health conditions), environmental factors (stressful life events like divorce, job loss, financial problems or relationship issues) and historical factors (previous suicide attempts, a family history of suicide, or childhood abuse or trauma).

Lack of access to affordable mental health care is a huge barrier. It’s difficult to find providers who have openings, and frequently there is a long wait, which can result in patients getting into a deeper and deeper depressive state. Our health care system has a long way to go to improve access to mental health care.

And, unsurprisingly, our once-in-a-hundred-years global pandemic has made a big dent in our mental well-being. A study, commissioned by the CDC this summer, surveyed over 5,400 adults during the week of June 24-30. Over all, 41% of the respondents reported at least one adverse mental or behavioral health issue, including depression, anxiety or a stress-related disorder.

Over 25% of youth aged 18-24 reported serious suicidal thoughts. Over all, 13% reported either the start of or increases in substance use. The prevalence of symptoms of anxiety disorder was about three times those reported in the second quarter of 2019, and the prevalence of depressive disorder was four times that reported in the second quarter of 2019.

All of this should alert us to be on the lookout for potential signs of suicide in our friends and relatives. These signs include:

• Talk about killing oneself, hopelessness, being a burden to others, having no reason to live, feeling trapped or experiencing unbearable pain.

• Behaviors that include increased use of alcohol or drugs, social withdrawal, giving away possessions, visiting or calling others to say goodbye, insomnia, aggression, looking online for ways of killing oneself, or isolating oneself from friends and family.

• Moods such as depression, anxiety, feelings of shame or humiliation, loss of interest, agitation, anger or sudden improvement of mood.

If a friend or relative is exhibiting some of the above signs, don’t be afraid to ask them if they are having suicidal thoughts. There is no evidence that asking someone if they are feeling suicidal results in a greater likelihood of making a suicide attempt. Indeed, it’s our connection with each other, the availability of social support, and the concern of loved ones that can make all the difference.

For more information or for help, call the National Suicide Prevention Lifeline at 800-273-8255. They have services available 24/7 for calls or online chats.

Paul Schoenfeld is a clinical psychologist at The Everett Clinic. His Family Talk blog can be found at www.everettclinic.com/family-talk-blog.