Every 40 seconds, someone loses their life by suicide. Suicide is a global epidemic, with over 800,000 people worldwide dying by suicide annually (Harmer et al., 2025). Within the U.S., suicide is the leading cause of death in the 10-24-year-old age group, and overall, age-adjusted suicide rates have increased in the last 25 years (Harmer et al., 2025). These numbers are intimidating, but genetic counselors possess a unique skillset to help patients experiencing suicidal ideation before it is too late. In response to this rising concern, genetic counselors have a responsibility to recognize the signs of suicidal ideation, discuss concerns directly with our patients, and use our skills in advanced empathy and care coordination to guide patients to appropriate resources. 

Within health care, assessment for suicidal ideation is a vital but underutilized tool. In primary care, as many as 80% of people who died by suicide had been seen in a clinic within one year of their death (Stene-Larsen & Reneflot, 2019). Clinical touchpoints provide an opportunity to assess for suicidal ideation and risk factors, so that timely intervention can be implemented. Genetic counselors are uniquely positioned in health care settings to balance psychosocial concerns with clinical care, making us ideal providers of this assessment.

Genetic counselors are already concerned about suicidal ideation in their patients. Eighty percent of genetic counselors reported previously worrying that a patient may harm themselves or be considering suicide (Hershman et al., 2024). Some genetic conditions may be associated with predisposing factors such as neuropsychiatric disorders and chronic pain, which are known risk factors for suicidal ideation and attempt. Further, some genetic conditions, including Huntington's disease, early-onset Alzheimer's disease, cystic fibrosis and sickle cell disease, are directly associated with higher rates of suicide (Reyes-Domínguez et al., 2023; Sexton et al., 2021; Hershman et al., 2025). Genetic counselors should be aware of these associations, and keep a keen eye for signs of suicidal ideation, particularly for individuals with a family history of suicide themselves, another known risk factor. Recent diagnoses of serious illness and stressful life events, which are frequent occurrences in genetic counseling settings, are precipitating factors that progress suicidal ideation to an attempt (Harmer et al., 2025). 

In terms of scope of practice, genetic counselors have professional training in delivering unexpected news and managing uncertainty. We are prepared to help patients in crisis due to medical emergencies, but we must consider how to expand our skillset to those in mental health emergencies. While our role is not as comprehensive as emergency mental health professionals, genetic counselors possess key skills in Rogerian relationship principles of accurate empathic understanding, unconditional positive regard and genuineness that can significantly aid patients who experience suicidal ideation. 

Despite our strengths, most genetic counselors are not currently leveraging this skill set in practice to assess for suicidal ideation (Hershman et al., 2025). Lack of training is the primary barrier genetic counselors identify for not assessing suicidal ideation and risk, followed by low self-efficacy and personal discomfort (Hershman et al., 2025). These barriers are not insurmountable. Many validated suicidal risk assessments are freely available online (ex: ASQ Toolkit) and have free training options (ex: Columbia- Suicide Severity Rating Scale). In terms of low self-efficacy and personal discomfort, I hope this article will empower you to see how genetic counselor psychosocial skills can support patients experiencing suicidal ideation. 

While these cases may not occur daily, I am passionate about being prepared to care for patients experiencing suicidal ideation when these cases do emerge. I believe the following suggestions can be readily implemented into practice. As a genetic counseling trainee, I believe these steps can save a life and can be utilized by genetic counselors at every level.

So, how can we support patients experiencing suicidal ideation? Here are a few suggestions to keep in mind:

1. Recognize the signs: In your psychosocial assessment, look for warning signs such as expressions of hopelessness, extreme mood swings, and increasing anger. In building rapport, pay attention to mentions of social withdrawal, feeling like a burden, or feeling trapped. Take notice if the family history reveals family members who died of suicide, or if the personal history mentions any previous suicide attempt.  
2. Discuss your concerns directly with your patient: If your patient's language or behavior worries you, do not glaze over them. Asking your patient directly if they are having thoughts of ending their own life will not spark new thoughts of suicidal ideation. Inviting them to discuss their thoughts about suicide is paramount to their safety. If you don't know how to broach the topic, here are some ideas. Additionally, using a suicide risk assessment tool, if it is within your practice, can be a quick and effective method for understanding their level of risk. 
3. Provide a safe space: Listen to your patients empathetically, and do not turn to toxic positivity when they share thoughts of suicide. Reach into your psychosocial toolbox to show your concern and emotional commitment. Additionally, find ways to build trust and establish therapeutic rapport. For example, if you are concerned about your patient's safety, try to get their permission to involve other members of their health care team.
4. Make appropriate referrals and share resources: Take signs of suicidal ideation seriously and assess if your patient is actively at risk of an attempt. For active suicidal ideation, involvement in emergency services may be necessary. Understand your professional responsibilities, particularly in terms of confidentiality, as most health care providers are considered mandated reporters. For passive suicidal ideation, where your patient is not actively considering suicide, referral to mental health services may be helpful. Ensure your patient has the information for local and national suicide hotlines, and provide additional identity-centric resources if available. If possible, start a discussion around restriction to lethal means and create a safety plan. 

If incorporating these suggestions into your sessions feels uncomfortable, I encourage you to lean into that discomfort. Through our emphasis on the therapeutic relationship and our power as connectors within the larger health care system, genetic counselors can play a crucial role in the care and safety of patients experiencing suicidal ideation. 

References:

Harmer, B., Lee, S., Rizvi, A., & Saadabadi, A. (2025). Suicidal Ideation. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK565877/

Hershman, E., Fernandes, S., Ceulemans, S., & Platt, D. (2025). Genetic Counselors’ attitudes & perceptions regarding suicide risk assessment and identification in practice. Journal of Genetic Counseling, 34(2), e1956. https://doi.org/10.1002/jgc4.1956

Reyes-Domínguez, Y. A., Figuera, L. E., & Brambila-Tapia, A. J. L. (2023). Perceptions of Knowledge, Disease Impact and Predictive Genetic Testing in Family Members at Risk to Develop Early-Onset Alzheimer’s Disease (EOAD) and Their Levels of Suicidal Ideation: A Mixed Study. Brain Sciences, 13(3), 501. https://doi.org/10.3390/brainsci13030501

Sexton, A., West, K., Gill, G., Wiseman, A., Taylor, J., Purvis, R., Fahey, M., Storey, E., Walsh, M., & James, P. (2021). Suicide in frontotemporal dementia and Huntington disease: Analysis of family-reported pedigree data and implications for genetic healthcare for asymptomatic relatives. Psychology & Health, 36(11), 1397–1402. https://doi.org/10.1080/08870446.2020.1849700

Stene-Larsen K, Reneflot A.. (2017). Contact with primary and mental health care prior to suicide: A systematic review of the literature from 2000 to 2017. Scandinavian Journal of Public Health. 2017;47(1):9-17. https://doi.org/10.1177/1403494817746274

Photo by Raghavendra V. Konkathi on Unsplash

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