'When you picture someone at risk of dying by suicide, who do you picture?' asked Dr. Mary Kimmel.
Dr. Kimmel is an associate professor of psychiatry at Washington University School of Medicine in St. Louis. She presented 'Suicide risk in midlife women: Recognizing the warning signs during the menopause transition' at The Menopause Society 2026 Annual Meeting, held October 20 to 24, 2026, in San Diego, California. Her talk was part of the plenary symposium, ‘Mind the gap: mood disorders, suicide risk, and the menopause transition.' She called for a sex and gender lens on suicide risk in midlife.
Epidemiology points to older men, Dr. Kimmel noted, but midlife women deserve attention. She cited a radio interview in which Dolly Parton recalled a period of suicidal thinking while 'going through the change of life.' 'Suicide rates are actually rising faster in women in midlife than in other populations and in men,' Dr. Kimmel said.
Why suicide risk assessment in midlife may need ongoing conversations
Suicidal ideation, intent, behavior, and death are related but distinct. Screening tools such as the Patient Health Questionnaire-9 and the Columbia-Suicide Severity Rating Scale can open the discussion, but Dr. Kimmel called them only a beginning. 'People move back and forth across this spectrum, and mental health is very dynamic,' she said. In a moment, things can change. Simple questions, such as what someone is looking forward to, can reveal a great deal.
How personality, experiences, behavior, and medical conditions may shape risk
She framed risk around four areas. For personality, she highlighted perfectionism, which can be both a strength and a challenge. Experiences include how society treats women in midlife. Midlife women who self-harmed more often reported financial, alcohol, and health problems in a study. Behavior includes alcohol use, which can be disinhibiting.
Recalling advice from her residency, she said, 'If a woman has increasing alcohol use, you'd better be looking for the anxiety and depression.' Coping behaviors matter as well, although 'self-care is a luxury to some women.'
Medical conditions raised the most open questions. Studies of perimenopause and suicide have shown conflicting results. Among people with bipolar disorder, attention deficit/hyperactivity disorder (ADHD) was a risk factor for suicide attempts and death in women but not in men. Women also face a heightened risk of psychosis in midlife.
Dr. Kimmel closed with Dolly Parton's song 'Light of a clear blue morning' as a message of hope: ‘It's been a long dark night, and I've been a-waitin' for the morning’. She urged clinicians to screen everyone, keep the conversation going, and frame challenges as strengths. 'I charge The Menopause Society to be a leader in advocating for more time in our clinical settings to talk about mental health, for finding novel treatments that span from biologics to social support to therapies, and to helping individuals better understand their own dynamic hormones and their own dynamic mental health,' she said. Treatment settings, she added, need to account for all that midlife women are doing for their families and communities.