This article, in a slightly edited form, first appeared on Pain News Network on September 19, 2020.

September is National Suicide Prevention Month. It is also Pain Awareness Month. It may appear coincidental or ironic that we recognize suicide and pain during the same month. However, there is an unfortunate association between the two: pain, either emotional or physical, too often leads to suicide.

Conversely, awareness, and treatment, of either types of pain can prevent suicide.

Insufficient Mental Health Care

According to the World Health Organization (WHO), 800,000 people take their own lives each year. The number of suicide attempts is many times greater. Suicide is the leading cause of death for men under the age of 50. Suicide is a serious problem globally, and it is often linked to mental health problems.

Veterans, who frequently experience pain as part of their military service, often do not get the mental health treatment they need, because the military’s mental health system may not take veterans’ struggles seriously. The military has even discriminated against veterans with psychological and emotional injuries. Many veterans, like civilians, suffer from both physical and emotional pain. This can lead to substance abuse.

Transitioning to civilian life after leaving the military is a suicide risk factor for those who are vulnerable. Between 6 and 12 months after they separate from the military, veterans experience a greatly increased risk.

Suicides associated with serving in the military are at a crisis level—perhaps because of a lack of pain awareness and a failure to acknowledge it on an institutional level. Every day, approximately 20 veterans commit suicide. Veterans’ suicides account for 18% of all suicides in the U.S., even though veterans only make up 8.5 percent of the adult population.

More and More People Are At Risk

Suicide rates had increased steadily by 1.8% each year between 2012 and 2017. The coronavirus has added to the problem. According to the Centers for Disease Control and Prevention, adults in the U.S. have recently reported considerably increased adverse mental health conditions associated with COVID-19. Groups that are suffering the greatest numbers of COVID-19 cases, including minorities and essential workers, have also experienced the worst “mental health outcomes, increased substance use, and elevated suicidal ideation.”

People with substance use disorders (SUD) are also more likely to contract the virus. Those who do become infected bear the double burden of COVID-19 and addiction.

All suicides are tragic, and the losses affect families and entire communities. But suicides can be prevented by understanding the warning signs. Aggression, mood changes, relationship problems, prolonged stress, another person’s suicide, and access to firearms or lethal drugs are also risk factors. Intractable pain, too, is a red flag. According to the American Foundation for Suicide Prevention, depression, substance use disorders, bipolar disorder, and schizophrenia all elevate the possibility of suicide.

Suicidality has become omnipresent in our society. We probably all know of someone who has committed suicide. Even worse, we may have lost a family member or loved one due to suicide. It affects people of all socio-economic levels.

The National Suicide Prevention Lifeline (1-800-273-8255) provides a hotline for anyone who is having a mental health crisis or suicidal thoughts. Free, confidential help for a loved one, or for you, is only a phone call—or online chat—away.

We may not always know who is struggling with emotional pain, but it is generally apparent when someone experiences insufferable physical pain. The partnership between suicide ideation and severe untreated pain can be mitigated if society will see people in pain as deserving of treatment.

Lynn R. Webster, MD, is a vice president of scientific affairs for PRA Health Sciences and consults with the pharmaceutical industry. He is author of the award-winning book, “The Painful Truth,” and co-producer of the documentary, “It Hurts Until You Die.” Opinions expressed here are those of the author alone and do not reflect the views or policy of PRA Health Sciences.

You can find him on Twitter: @LynnRWebsterMD.