EVANS CITY — Each February holds new meaning and difficult emotions for Deb and Jim Smith, whose 28-year old son, A.J., died by suicide in February eight years ago.

In every photograph of him displayed in his parents’ home, A.J. is smiling. The U.S. Army veteran’s dog tags hang around one picture on the mantle, below a family photo where he has been superimposed. In another picture, he holds his niece, Taylor, at Myrtle Beach.

His parents said A.J. — who had been deployed to Iraq — struggled with post-traumatic stress disorder. He had joined the military to increase his chances of working as a professional fireman, a position that is increasingly scarce in the United States, and a job A.J. had coveted from the time he was a little boy.

When he was injured on the job in South Carolina and told he would never again be able to fight a fire, A.J.’s PTSD was “set off,” Jim Smith said.

On Feb. 21, 2016, A.J. took his own life.

“February’s my hard month,” Deb Smith said. “It’s still, it’s not as hard as it used to be, but we still have days. You hear a song, you think of him and it can make you tear up.”

Jim Smith said “there’s no catalyst” for when memories of A.J. spring up unexpectedly.

“It just happens,” he said. “Out of the blue. I think in the beginning, there was more bad than good. Now there’s more good than bad.”

Eight years later, he said bouts of depression still linger.

“I’ll even say it’s like a PTSD, because it’s with you forever,” he said.

“You’re going to have days like that and feelings, so you just accept them and take the tears,” he said.

While there is a chronology of the events leading up to A.J.’s death, there is still no clear cut answer as to why he died by suicide.

Mental health experts emphasize there is never one singular reason behind a person’s death by suicide, but that it is a culmination of factors, some of which remain unclear after death.

Jesse Putkowski, area director of the American Foundation for Suicide Prevention’s Western Pennsylvania chapter, said a number of things can contribute to suicidality.

These include mental illness, substance use disorder, chronic illnesses, environmental factors that cause prolonged stress and historical factors, such as a family history of mental illness or previous suicide attempts.

“It’s never one of these,” Putkowski said. “It’s a conversion of all these factors coming together to create an even more stressful environment. It’s more than one (factor) coming together to create a sense of hopelessness that can cause something like this to happen.”

“People will see someone go through a breakup and see them die by suicide and think, oh, it was because of the divorce or because of a job loss or something else,” she said. “But that’s never the full story. There’s something else going on they don’t know about … there are other things going on we don’t always see or understand that we need to take into consideration.”

For families, the question of why their loved one died by suicide can lead to more questions than answers.

“I think suicide is a very complicated death compared to other deaths,” Deb Smith said. “I think with other deaths, you have an answer immediately. If you lose somebody to cancer or a car accident, you know why they died. When somebody dies by suicide, you don’t have your answers.”

A week after her son died, Deb Smith she began attending a support group for people whose loved ones have died by suicide. The group is held from 7 to 8 p.m. on the third Wednesday of each month at St. Peter’s Reformed Church in Zelienople, a familiar space where they attended services.

Deb and Jim’s former pastor, Jim Bertoti, who Deb Smith said visited the couple’s home the day they learned of AJ’s death, and was part of the family’s “circle of support,” facilitated the group.

About four years ago, Bertoti left to minister in Reading in Berks County, Deb Smith said. Since then, the group has been headed by herself and community member Ryan Strength.

“I think everybody thinks that a facilitator can give them an answer,” Deb Smith said. “You’ll never get an answer. A facilitator, basically, is just trying to help them get through the steps of their grief and understand that there are no answers. But there’s hope.”

“You never get your life back how it was before you lost that person,” she said. “But you start to have a new normal, you know, and your life goes on. You have to embrace the new life that you have without that person.”

In the aftermath of their son’s suicide, Deb and Jim Smith founded A.J.’s Stop 22, an organization that raises funds toward suicide awareness, with an emphasis on veterans.

The name of the foundation refers to a slogan adopted by many suicide prevention advocacy groups stating an average of 22 veterans a day in the United States die by suicide.

Last year, 35 people died by suicide in Butler County, according to the Butler County Suicide Coalition. The number has almost doubled from 19 people in 2022, when the count dropped from the previous year by nearly 30%.

“The numbers have been all over the place, and that’s what makes suicide prevention so hard,” said Amy Cirelli, mental health specialist with Butler County Human Services and co-chairwoman of the suicide coalition. “There’s no way of knowing if there was one thing that was the cause. Everyone is so different and reacts so differently … it’s hard to try to prevent something that doesn’t have specific causes.”

“Any number is way too many,” she said.

Out of the numbers that change year to year, Cirelli said one thing about suicide demographics in the U.S. and Butler County tend to stay the same: it’s men who die by suicide at higher rates than women.

Findings from the U.S. Centers for Disease Control and Prevention reflect this. The most recent findings, from 2021, state that men make up nearly 80% of suicides.

In Butler County, the Butler County Suicide Coalition tries to spread the word about suicide prevention through training and programming.

Crisis intervention services are offered by the Center for Community Resources, which also operates a 24/7 crisis support hotline. People in crisis can call 988 or text 63288.

Putkowski said broadening access to the 988 crisis number — once 11 digits long — has been instrumental in spreading the word about mental health help.

“There has been an increase in people seeking services after the pandemic, and that’s a good thing,” Putkowski said. “With the new 988 number implemented, it is easier to access the national lifeline … we know that with implementing that number, calls went up for 40% and texts went over 1,000%.”

While the numbers “may seem alarming,” Putkowski said, they indicate that a larger percentage of people that need those resources are able to access them now than before.

“A lot more people have easier access now with telehealth, and more people are getting that help and talking about mental health and having those conversations,” Putkowski said.

Keeping the conversation around mental health going can help people build coping skills through stressful life, and show them help is out there.

“It’s important for us as community members and as friends and family to let our loved ones know that we are safe places and that people are aware of resources,” Putkowski said.

In 2010, Putkowski lost her father to suicide. The grieving process — how quickly someone may choose to get help, how they reach out, who they speak about their experience with — differs for everybody, she said.

“I first started my journey by finding a mental health professional and navigating that loss by speaking about my experiences and then connecting with other loss survivors,” Putkowski said.

Since her son’s death, Deb Smith said she discovered suicide touches more people than she imagined.

“I was just amazed — people that I worked with on a daily basis for years, they came up to me and told me they had a lost a child by suicide and I never knew it,” she said. “I worked with these people for years, and they were never comfortable enough to tell me that they had lost somebody to suicide until after we lost A.J.”

“You would be surprised how many people have lost somebody by suicide until you lose somebody by suicide,” she said. “Now, people will open up to me and say, ‘I lost a brother,’ ‘I lost a sister,’ or ‘My dad died by suicide.’”

Within Deb Smith’s support group in Zelienople, listening is key.

“Some people come to group, and if they want to sit there for two hours and cry, that’s OK,” she said. “You know, some people want to share their story. Other people aren’t ready to share their story.”

The group has an “open-door policy,” she said. Some attend with their families. Others bring a friend and some come alone.

“You know, there’s a lot of grief groups around,” Deb Smith said. “But we found it’s much better to have a group that just deals with suicide because it’s so different.”

“A person who hasn’t gone through a suicide, they just — they don’t understand your grief,” she said. “They feel bad, they want to help, but they don’t get it.”

One of the most common — and the most harrowing — feelings that resurfaces among survivors of suicide loss is guilt, Deb Smith said.

“You think, why didn’t I see it?” she said. “Why couldn’t I have stopped it? Why didn’t they call me?”

“I know now that when somebody takes their life, they’re not thinking about you or anything,” she said. “They have tunnel vision. They’re thinking that’s the only answer to their problem — that their life is so bad they can think of no other way to end their pain.”

“Still, as a mom, there’s still times that I, you know, get that ‘if only’ feeling,” she said. “If he’d only called, or if only he’d reached out. But not as much anymore. I’m a Christian. I know I’ll see him again. And then we’ll have a talk. But you never get over missing them. Ever.”

Talking about mental health and talking about suicide is critical to spreading awareness and connecting to people in crisis, Deb Smith said.

“If the thoughts are there, they’re going to do it,” she said. “By not talking about (suicide), that’s worse. If you have any inkling at all that something is thinking about it, ask them. It’s better they say no or if they get offended. A lot of times they’ll say, ‘Yeah, I have.’

“Bring it up, talk about it,” she said. “Don’t push it aside. Don’t think it couldn’t happen to your family, because it could. I never imagined our son would take his life. We were blindsided by it.”

Jim Smith said stigma around suicide exists because nobody wants to face it.

“We need to talk about (suicide) and we need to talk about it in the same way if (A.J.) had died from cancer,” Deb Smith said. “You need to talk about it and get it out there.”

“If you stop and think, wow — that many people took their lives?” she said. “We need to do something about it.

In the aftermath of a suicide, sometimes people don’t know how to broach the subject, Deb Smith said.

“Once somebody does lose somebody by suicide, people don’t know how to approach you,” Deb Smith said. “They’re afraid of hurting your feelings. Don’t be afraid to say the person’s name.”

She said she and her husband love hearing old stories about A.J.

“Last week, somebody brought a picture they found of him from 20 years ago that they found and that just made my day,” she said.

Through the grief, the couple said the death of their son has brought their family closer.

“Nobody leaves without a hug and a kiss,” Deb Smith said. “You don’t know when it could be your last one.”

“The last time I saw A.J. we were on vacation together in Florida and when he got there, I was crying because I hadn’t seen him,” she said. “ … he says, ‘Mom, you cry when I get here and you cry when I leave.’ But thank goodness I gave that last hug and hugged him so tight.”

The couple remembers A.J. as a “jokester.” They recalled his trip to New York City when he was 16, when he talked a guard into taking him to the top of the Empire State Building, and the time when he put a kayak in a swimming pool.

Each February, on the anniversary of his death, Deb and Jim Smith, and their daughter Heather go to out to lunch in A.J.’s memory. Heather orders the most expensive item on the menu — something her brother used to do. The three of them sit at a table for four with a photograph of A.J. and reminisce.

“The first year we did it we cried,” Deb Smith said. “And now — we can laugh about him now. That’s what he would have done.”

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If you are in crisis, call the Suicide and Crisis Lifeline at 988 to speak with a trained listener or text 63288.

To reach the Veterans Crisis Line, dial 988 and press 1 or visit veterancrisisline.net for crisis chat services and more information.