This is Part One of a four-part series that explores why construction has the highest rate of suicide of any industry and what can be done about it.
The construction industry is well versed in the “fatal four” – the main causes of jobsite deaths.
But when it comes to an even bigger killer than falls or being struck, crushed or electrocuted, the industry has been largely silent.
According to the Centers for Disease Control and Prevention, more construction workers die from suicide each year than every other workplace-related fatality combined.
Five times as many workers – more than 5,000 – die by suicide annually than from OSHA's fatal four. That compares to about 1,000 fatalities a year from physical injuries on the job.
Download the Mental Health Survey
The Mental Health in Construction Survey conducted by Equipment World was taken by 269 construction industry professionals from May 4 to June 1, 2023. Responses that did not fit the primary business criteria were not included in the results, and the observations drawn from the results were limited to responses from qualified individuals only.
Participants across the U.S. answered more than 20 questions about their current mental health, the most significant stressors in their lives, and the resources – or lack thereof – available to them.
It’s a statistic that is causing more people within the construction industry and those who care about it to take notice and try to do something about it.
"Many of us are well aware that the deaths of despair, suicides, overdoses and the consequences of addiction far outweigh the number of deaths from the fatal four," says Dr. Sally Spencer Thomas, a clinical psychologist and workplace mental health and suicide-prevention advocate.
"Statistics are merely aggregate numbers with the tears wiped away," she adds. "Behind every percentage point, bar chart, pie graph, there have been lives lost. Some people have suffered greatly, and there are people up at 3 a.m. wondering if tonight is it."
But how to combat that statistic is a much greater challenge and hits to the heart of what many believe makes the construction industry great. Its trademark bravery and go-get- ‘em attitude can also put some workers at risk of dying by suicide, they say.
"When you think of people showing strength, determination and grit, all of those great character traits that get the job done," says Michelle Walker, vice president of operations at SSC Underground, a Phoenix-based underground construction and consulting company. "Those same traits are what can set somebody up for being at risk of suicide if they're going through something and not asking for help.”
Construction sites are often a whirl of activity, where workers put in 60- to 80-hour weeks during peak seasons. They often miss out on family time and vacations. Schedules are tight with little room for downtime or errors. On top of that, the work is always changing as contractors wrangle with clients, subcontractors, suppliers and other challenges.
Construction sites are also full of dangers that can quickly become deadly if someone on the job is suffering from a mental health problem and not getting help.
"Do you think they're focused on being productive and safe? Absolutely not," says Aaron Witt, CEO of BuildWitt, a construction training solutions and marketing company. "If I'm the guy on the ground, for example, and I know that that guy in the loader is not all in, that's a serious concern for my well-being and their well-being."
Struggling workers may fear being seen as weak. They may feel ashamed for wanting to seek help. They don’t know where to turn and hold in their pain.
“That is a serious gap that we need to fill,” Thomas says. “This is hitting people way before their time, people who should have lived decades longer.”
A survey on mental health in the construction industry by Equipment World this past spring found that 73% of respondents knew someone who had died by suicide and 46% know someone who survived a suicide attempt.
According to the CDC, “suicide risk is associated with low-skilled work, lower education, lower absolute and relative socioeconomic status, work-related access to lethal means and job stress, including poor supervisory and colleague support, low job control and job insecurity.”
That statement may be true for some in the construction industry, but not all. Pay today is much higher than in years past and so are skill levels. Workers can often quickly hop to another employer if they feel they’re being treated poorly or not being supported on the job.
With such a high-stress and dangerous environment, construction has a long list of factors that make suicide more prevalent than that of the general population, mental health advocates say.
Equipment World’s 2023 survey found that financial issues, a consistently intense workload, injuries or illness, and relationship issues or pressures are among the top stressors.
Two underlying factors within construction are the perceived lack of control by employees and society’s perception of the industry, says Walker, who is also one of the founders of the Construction Industry Alliance for Suicide Prevention.
She’s seeing change in the industry, one that gives everyone on the job a voice in safety, and career paths are being created. There’s a focus on promoting the industry as one “where you have hope and a future."
Mandi Kime, founding member of Associated General Contractors of America’s Mental Health Suicide Prevention Task Force, says the industry needs to better empower its workforce. “They need to feel heard, and they need to feel respected,” Kime says.
Walker adds that general perceptions of the construction industry can weigh heavily on workers.
“If they're working in a position that the world deems low skill or low quality or a dead end, that can impact somebody’s mental health,” she says. That low self-esteem becomes compounded if they’re experiencing other problems like marital trouble or substance abuse.
Many in construction are working to change those misperceptions.
“Those of us in the industry don't believe those things and are trying to change that perception more broadly in society,” Walker says.
Drug and Alcohol Use
Another factor some see is the high rate of injury that can lead to opioid use and subsequent addiction.
Citing a data bulletin released by CPWR in January 2023, Thomas says there were over 14,000 overdose deaths in construction in 2020 with no specific indication of intent and an untold number of deaths from the consequences of addiction.
And it’s not just low-level workers who are suffering.
“People think this is maybe just kind of entry-level or unskilled laborers or maybe it's just the management, but it really is throughout the industry,” Walker says.
The Equipment World survey found that 44% of respondents admitted to struggling with anxiety, depression or distress.
The survey also revealed that 84% say they can deal with their daily stress. Of respondents, 38% admitted to drinking alcohol for stress relief. Another 6% said they use marijuana and 2% opioids.
Other studies have shown that employees in the construction industry have nearly twice the rate of substance use disorder as the national average. Approximately 12% of construction workers reportedly have a substance abuse problem compared to the 7.5% average.
Work Loss from Injury
The physically demanding nature of the job can also lead to stress.
“Those physical things definitely can create some mental health issues,” Walker says, “just from the fear and worry of what they might be facing. How are they going to keep providing for the family if they can’t work?”
There is often fear that if productivity slows or if they are not at 100% performance, they’ll be first on the potential chopping block if there is a layoff. During busier times, depending on the nature of the injury and a worker’s financial needs, they may work through the pain and plan to deal with the injury later.
Being out of work for physical recovery can lead to depression if it lasts more than 30 days, Walker notes.
While doctors and insurance providers have improved in addressing worker's compensation claims, the participation of the employer in the return-to-work plan is key to reassuring the worker. "It's doing what you can to work within the parameters of keeping them well and getting them well, but also keeping them engaged in the workplace as much as possible," Walker says.
Men Most at Risk
Construction's Silent Killer Pt. 2:
Contractor Garret Wilson recounts his suicide attempt to help fellow suffers. Read More
Construction is consistently ranked a top-two industry by the CDC for men dying by suicide. The rankings by industry are for men because 80% of those who die by suicide are male. Female construction workers also die by suicide at a slightly higher-than-average rate. Nine out of 100,000 female construction workers die by suicide compared to the national average of eight. Only the mining, quarrying and gas and oil extraction industry has a higher rate of suicide.
Analysis from multiple studies shows that men in middle age are the most at risk and make up a significant portion of the construction workforce.
The Bureau of Labor Statistics states that nearly 90% of the U.S. construction workforce is male. According to the American Foundation for Suicide Prevention, 38% of construction workers in the U.S. in 2018 were between the ages 45 and 64.
Within such a male-dominated industry, there is often a pervading sense of bravado, in which workers feel as though they must appear strong and not talk about their problems.
"You pile all those on top of each other, and it really kind of creates this environment where people, who are not apt to ask for help or admit when they need help with something, can end up in a situation of harm," Walker says.
The sometimes transient or isolating nature of construction also can impact the mental well-being of construction employees. Workers can become lonely and isolated from family and friends when working out of town for long periods. For those in recovery, attending addiction or group therapy meetings can be difficult.
“It’s easy (for leadership) to sit back and say ‘Oh, he’s a dude; he can handle it,’” Kime says.
Whether it’s a distanced jobsite or just a daily commute, she says, everything must be considered for the workers’ well-being.
"We're not thinking about the human element of the construction machine,” says Mandy McIntyre, owner of Level Up Consultants, a construction leadership and culture consulting services company. “These are human beings out in the elements in dangerous, stressful situations. We are pushing those machines as fast as we can to meet deadlines, to make customers happy, to stay on schedule, to stay on budget, and we're not allowing them the time to get help if they need it.”
Equipment World’s 2023 survey indicated that approximately 50% of contractors offer some kind of mental health assistance in the form of an Employee Assistance Program or benefits through a group health program.
Most of the remainder, another 40%, indicated that they or their employer did not offer any mental health services.
“They want to do the right thing,” Kime says of construction company leadership. “I have seen the hearts of our industry. I have seen what they do when somebody gets injured on the job, and they pass the hard hat. They look out for one another.”
However, when it comes to mental health, suicide or addiction, many aren’t comfortable talking about them.
“It’s not because they're against it, or they're upset about it,” Kime says. “It's because they don't want to say or do the wrong thing.”
To overcome that barrier, change is needed, advocates say.
“At the end of the day, we're all human beings sharing workplaces, and one of the things that we've not done super well is treating people as whole humans,” Kime says. "We treat them as the work that they accomplish for us, so connecting on a human level is critically important."
Walker emphasizes that the intent is not to change the industry, but to change the culture and the approach to mental health.
"We are still construction, and the same things that make the industry what we love and the people in the industry what we love, we want to maintain those,” she says. “We just need to have those be assets and not liabilities.
"There are answers, and there is hope if you'll adapt and start having the tough conversations in the workplace and encourage people to start caring for each other in this way."
Help is Available
If you are experiencing a suicidal crisis or mental health-related distress, call or text “988” to connect to the 988 Suicide and Crisis Lifeline, a national network of more than 200 crisis centers providing 24/7 confidential support from mental health professionals. Veterans can press "1" after dialing 988 to connect directly to the Veterans Crisis Lifeline, which also serves active service members, National Guard and Reserve members, and those who support them. For texts, veterans should text the Veterans Crisis Lifeline short code: 838255.