Suicide in the United States

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Suicide is a major national public health issue in the United States. The country has one of the highest suicide rates among wealthy nations. [1] In 2020, there were 45,799 recorded suicides, [2] up from 42,773 in 2014, according to the CDC's National Center for Health Statistics (NCHS). [3] [4] [5] On average, adjusted for age, the annual U.S. suicide rate increased 30% between 2000 and 2020, from 10.4 to 13.5 suicides per 100,000 people. [6] In 2018, 14.2 people per 100,000 died by suicide, the highest rate recorded in more than 30 years. [7] [8] Due to the stigma surrounding suicide, it is suspected that suicide is generally underreported. [9] In April 2016, the CDC released data showing that the suicide rate in the United States had hit a 30-year high, [10] [11] and later in June 2018, released further data showing that the rate has continued to increase and has increased in every U.S. state except Nevada since 1999. [12] [13] From 2000 to 2020, more than 800,000 people died by suicide in the United States, with males representing 78.7% of all suicides that happened between 2000 and 2020. [2] In 2022, a record high 49,500 people died by suicide, [14] while the suicide rate in 2022 reached its highest level since 1941 at 14.3 per 100,000 persons. [15] Surging death rates from suicide, drug overdoses and alcoholism, what researchers refer to as "deaths of despair", are largely responsible for a consecutive three year decline of life expectancy in the U.S. [16] [17] [18] [19] This constitutes the first three-year drop in life expectancy in the U.S. since the years 1915–1918. [18]

Contents

In 2015, suicide was the seventh leading cause of death for males and the 14th leading cause of death for females. [20] Additionally, it was the second leading cause of death for young people aged 10 to 34. [21] From 1999 to 2010, the suicide rate among Americans aged 35 to 64 increased nearly 30 percent. The largest increases were among women aged 60 to 64, with rates rising 60 percent, then men in their fifties, with rates rising nearly 50 percent. [8] In 2008, it was observed that U.S. suicide rates, particularly among middle-aged white women, had increased, although the causes were unclear. [22] As of 2018, about 1.7 percent of all deaths were suicides. [2]

The U.S. government seeks to prevent suicides through its National Strategy for Suicide Prevention, a collaborative effort of the Substance Abuse and Mental Health Services Administration, Centers for Disease Control and Prevention, National Institutes of Health, Health Resources and Services Administration, and the Indian Health Service. [23] Their plan consists of eleven goals aimed at preventing suicides. [24] Older adults are disproportionately likely to die by suicide. [25] Some U.S. jurisdictions have laws against suicide or against assisting suicide. In recent years, there has been increased interest in rethinking these laws. [26]

Suicide has been associated with tough economic conditions, including unemployment rate. [27]

There are significant variations in the suicide rates of the different states, [28] ranging from 28.89 per 100,000 people in Montana to 8.11 per 100,000 people in New York. [9]

A firearm is used in approximately half of suicides, accounting for two-thirds of all firearm deaths. [29] Firearms were used in 56.9% of suicides among males in 2016, making it the most commonly used method by them. [20]

On July 16, 2022, the United States transitioned the National Suicide Hotline from the former 10-digit number into the 988 Suicide & Crisis Lifeline, linking both the National Suicide Hotline, the Veterans Crisis Line, and a network of more than 200 state and local call centers run through SAMHSA, the Substance Abuse and Mental Health Services Administration. [30]

Crude suicide rate in the United States, 1981-2016 Crude U.S. suicide rate 1981 2016.png
Crude suicide rate in the United States, 1981–2016

The spike in suicide rates in the United States during the 21st century has gained public and clinical attention. Studies have found that despite efforts to minimize suicide rates, rates have steadily increased by approximately 2% per year from 2006 to 2014. [32] A national epidemiologic survey of 69,341 US adults found the percentage of adults attempting suicide increased from 0.62% in 2004 through 2005 to 0.79% in 2012 through 2013. [33] Because of this, clinicians aim to determine whether this is a coincident national increase in suicide attempts. In order to achieve this, trends in suicide attempts are characterized among sociodemographic and clinical groups. It was found that suicide attempts impact "younger adults with less formal education and those with antisocial personality disorder, anxiety disorders, depressive disorders, and a history of violence" at disproportional rates. [33] It is important for trends in suicide attempts to be investigated and researched for they help to determine the cause of the increase in suicide rates. Knowing the trends in suicide also allow preventive measures to be taken. Suicide prevention is possible through early identification and treatment of individuals deemed high risk. [34] Nearly 50,000 persons died by suicide in 2022, up roughly 2.6% from the previous year. [35]

Suicide as a public health issue

Age-adjusted suicide rate in the United States, 1981-2016 Age adjusted U.S. suicide rate 1981 2016.png
Age-adjusted suicide rate in the United States, 1981–2016

Suicide prevention has been thought of as the responsibility of mental health professionals within clinical settings between 2000 and 2010. [36] As of 2019, suicide prevention is being recognized as a public health responsibility rather than within clinical settings due to the trend in increasing suicide rates. [37] In 1960–2010, population-based risk reduction approaches have been used for other diseases such as myocardial infarction. However, as of 2019, the urgency of development of effective suicide prevention has been recognized by the CDC. While suicide is often thought of as an individual problem, suicides may impact families, communities, and society in general. The responsibility of public health would be to develop policies to reduce people's risk of suicidal behavior through addressing factors at the individual to societal levels. [37] "Public health emphasizes efforts to prevent violence (in this case, toward oneself) before it happens. This approach requires addressing factors that put people at risk for, or protect them from, engaging in suicidal behavior." [37]

The CDC has created a National Suicide Prevention Lifeline where they provide free and confidential support for people in distress, prevention and crisis resources for people who are in need of such help, and best practices for professionals. [38] In May 2019, Bloomberg reported that in spite of the recent mental health crisis, insurance companies, including UnitedHealth Group, are doing what they can to limit coverage and deny claims for mental health related issues. [39]

A 2019 study by the National Bureau of Economic Research found a direct causal link between worker's wages and suicide rates, and that raising the minimum wage would result in a quick drop in the suicide rate. [17] [40]

Total Suicides in the United States, 1981-2016 Total suicides in the United States 1981 2016.png
Total Suicides in the United States, 1981–2016

In August 2020, during the COVID-19 pandemic, a survey conducted by the CDC found that 25.5 percent of people aged between 18 and 24 have seriously contemplated suicide within the last 30 days. For the age group 25 to 44, it was 16 percent. Glenn Greenwald of The Intercept said of the findings: [41]

In a remotely healthy society, one that provides basic emotional needs to its population, suicide and serious suicidal ideation are rare events. It is anathema to the most basic human instinct: the will to live. A society in which such a vast swath of the population is seriously considering it as an option is one which is anything but healthy, one which is plainly failing to provide its citizens the basic necessities for a fulfilling life.

Subgroups

Age and sex

CDC data on suicides by age group in 2015 US Suicide Rate by Age.svg
CDC data on suicides by age group in 2015
CDC data on suicide rate by race and gender in 2015 US Suicide Rate by Demographic.svg
CDC data on suicide rate by race and gender in 2015

The National Violent Death Reporting System (NVDRS) keeps data on U.S. suicides.

Number of suicides by age group and sex in 2016 [42]
Age (years)10 – 1415 – 2425 – 3435 – 4445 – 5455 – 6465 – 7475+UnknownAll
Males2654575588752946198574534633291234727
Females17111481479173622392014940510110238
Male/female ratio1.54.04.03.02.82.93.76.52.03.4
Total4365723736670308437775944033801344965

Based on the NVDRS 2016 data, the New York Times acknowledged that, among men, those over 65—who make up a smaller proportion of the population—are at greatest risk of death by suicide. [43] The NVDRS 2015 data showed that, among men of all races, men over 65 were the most likely to die of suicides (27.67 suicides per 100,000), closely followed by men 40–64 (27.10 suicides per 100,000). Men 20–39 (23.41 per 100,000) and 15–19 (13.81 per 100,000) were less likely to die of suicides. [44]

The American Foundation for Suicide Prevention reported that in 2016 suicide was the tenth leading cause of death in the U.S., imposing a cost of $69 billion to the US annually. [9] [20] In 2016, middle aged white males were considerably more likely to die than other demographic groups, however Native Americans had the highest age-adjusted suicide rate. [9] The suicide rate increased considerably among middle aged white women from 1999-2017. [45]

Race

Native Americans and White Americans have the highest suicide rate in the United States. [46] [47] However, more recently, the CDC reported that suicides have sharply increased among people of color, while the white American suicide rate has decreased. The suicide rate increased by nearly 20% for African Americans, while the Native American rate increased by 26%. White Americans were the only group in America to experience a decline in suicide rate. The age-adjusted non-Hispanic white suicide rate declined by nearly 4%. [48] Suicide rates are higher for older white men. [49] Suicide rates have increased for black children. [50]

By state

There are significant variations in the suicide rates of the different states. [28] A number of theories for these differences have been suggested, ranging from socioeconomics (rural poverty) to access to firearms and social isolation (low population densities), [51] and a study in 2011 found a correlation between altitude above sea level and suicide. [52]

College students

Crude suicide rate in the United States by age, 1981-2016 Crude US suicide rate by age 1981-2016.png
Crude suicide rate in the United States by age, 1981–2016

For college students, suicide is the second highest cause of death. [54] The risk tends to be underestimated, as many falsely believe that young people do not have thoughts about suicide. [55] The suicide rate for male students is about three times higher than that of female students. [56] The study of suicide rates and trends was not common in the past, but it has gained more attention in 2019. From 1990 to 2004, about 1,404 college students died by suicide. This is about 6.5 percent of those who died by suicide nationwide. In 2014, the adjusted age rate was higher for male than female: the suicide rate for males was 20.7 per 100,000 while the rate for females was 5.8 per 100,000. [56]

While counseling services can help prevent suicide, resource availability may be insufficient. [54] Students who do not go to counseling services are at 18 times more at risk of suicide compared to those who do. If a college student has any suicidal thoughts, it is always critical to let others, such as members of the school, family, or friends know. [56]

Occupation

Military veterans

A United States Army suicide prevention poster United States Army Suicide Prevention Poster.jpg
A United States Army suicide prevention poster

A 2009 U.S. Army report indicates military veterans have double the suicide rate of non-veterans, and more active-duty soldiers have died from suicide than in combat in the Iraq War (2003–2011) and War in Afghanistan (2001–2021). [57] Colonel Carl Castro, director of military operational medical research for the Army noted "there needs to be a cultural shift in the military to get people to focus more on mental health and fitness." [58] In 2012, the US Army reported 185 suicides among active-duty troops, exceeding the number of combat deaths in that year (176). This figure has significantly increased since 2001, when the number of suicides was 52. [59]

According to a June 2021 study published by Brown University's Cost of War Project, deaths from suicide among active U.S. military personnel and veterans of the post-9/11 conflicts outnumber combat deaths for those same conflicts by four times, with the numbers being 30,177 and 7,057 respectively. [60]

Healthcare workers

The yearly suicide rate per 100,000 person-years varied between 21.4 for health care support workers, 16 for registered nurses, 15.6 for health technicians, and 13.1 for physicians, according to Columbia University researchers, compared to 12.6 for non-health care professionals. [61]

Suicide rates among veterinarians are a growing problem: suicide rates among male veterinarians are twice the national average, and among female veterinarians the suicide rate is 3.5 times the national average. [62]

LGBTQ

Attempted suicide rates for lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth and adults in the U.S. are higher than national rates. [63] According to the Centers for Disease Control and Prevention report, nearly half of LGBTQ students said they had seriously considered suicide. [64]

Health or disability

Patients with chronic pain are twice as likely to attempt suicide compared with those without chronic pain. [65]

Studies have found very high rates of suicide in people with autism spectrum disorders, including high functioning autism and what was formerly known as Asperger syndrome. Autism and particularly Asperger syndrome are highly associated with clinical depression and as many as 30 percent or more of people with Asperger syndrome also suffer from depression. [66]

Those with ADHD are 3–5 times more likely to die by suicide. A comorbidity of depression with ADHD is the best predictor of suicidal thoughts in adolescence. [67] [68]

Murder–suicide

There have been many high-profile incidents in the United States in the 1990s, 2000s and 2010s of individuals killing others before killing themselves or expecting to be killed by law enforcement ("suicide by cop"). Examples include the 1999 Columbine High School massacre, the 2007 Virginia Tech massacre, the 2010 Austin plane crash, the 2012 Sandy Hook Elementary School shooting, the 2014 Isla Vista killings, and the 2017 Las Vegas shooting.

Comparison between countries

See also

Related Research Articles

<span class="mw-page-title-main">Drug overdose</span> Use of an excessive amount of a drug

A drug overdose is the ingestion or application of a drug or other substance in quantities much greater than are recommended. Typically it is used for cases when a risk to health will potentially result. An overdose may result in a toxic state or death.

Suicide is the second leading cause of death for people in the United States from the ages of 9 to 56.

<span class="mw-page-title-main">Suicide prevention</span> Collective efforts to reduce the incidence of suicide

Suicide prevention is a collection of efforts to reduce the risk of suicide. Suicide is often preventable, and the efforts to prevent it may occur at the individual, relationship, community, and society level. Suicide is a serious public health problem that can have long-lasting effects on individuals, families, and communities. Preventing suicide requires strategies at all levels of society. This includes prevention and protective strategies for individuals, families, and communities. Suicide can be prevented by learning the warning signs, promoting prevention and resilience, and committing to social change.

There are more than 700,000 estimated suicide deaths every year. Suicide affects every demographic, yet there are some populations that are more impacted than others. For example, among 15–29 year olds, suicide is much more prominent; this being the fourth leading cause of death within this age group.

<span class="mw-page-title-main">Gun violence</span> Method of violence

Gun-related violence is violence committed with the use of a firearm. Gun-related violence may or may not be considered criminal. Criminal violence includes homicide, assault with a deadly weapon, and suicide, or attempted suicide, depending on jurisdiction. Non-criminal violence includes accidental or unintentional injury and death. Also generally included in gun violence statistics are military or para-military activities.

<span class="mw-page-title-main">Health in the United States</span> Overall health of the population of the United States

Health may refer to "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity.", according to the World Health Organization (WHO). 78.7 was the average life expectancy for individuals at birth in 2017. The highest cause of death for United States citizens is heart disease. Sexually transmitted infections impact the health of approximately 19 million yearly. The two most commonly reported infections include chlamydia and gonorrhea. The United States is currently challenged by the COVID-19 pandemic, and is 19th in the world in COVID-19 vaccination rates. All 50 states in the U.S. require immunizations for children in order to enroll in public school, but various exemptions are available by state. Immunizations are often compulsory for military enlistment in the United States.

Youth suicide is when a young person, generally categorized as someone below the legal age of majority, deliberately ends their own life. Rates of youth suicide and attempted youth suicide in Western societies and other countries are high. Youth suicide attempts are more common among girls, but adolescent males are the ones who usually carry out suicide. Suicide rates in youths have nearly tripled between the 1960s and 1980s. For example, in Australia suicide is second only to motor vehicle accidents as its leading cause of death for people aged 15 to 25.

<span class="mw-page-title-main">Demographics of Massachusetts</span> Demographics of the U.S. state

Massachusetts has an estimated population of 6.981 million as of 2022 according to the U.S. Census Bureau. This represents a −0.7% decrease in population from the 2020 census, when the population was 7.029 million. Currently, Massachusetts is the sixteenth most populous U.S. state.

<span class="mw-page-title-main">Suicide</span> Intentional act of causing ones own death

Suicide is the act of intentionally causing one's own death. Mental disorders, physical disorders, and substance abuse are risk factors. Some suicides are impulsive acts due to stress, relationship problems, or harassment and bullying. Those who have previously attempted suicide are at a higher risk for future attempts. Effective suicide prevention efforts include limiting access to methods of suicide such as firearms, drugs, and poisons; treating mental disorders and substance abuse; careful media reporting about suicide; improving economic conditions; and dialectical behaviour therapy (DBT). Although crisis hotlines are common resources, their effectiveness has not been well studied.

<span class="mw-page-title-main">Obesity in the United States</span> Overview of obesity in the United States of America

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<span class="mw-page-title-main">Suicide in South Korea</span> Statistics and causes of suicide

Suicide in South Korea occurs at the 12th highest rate in the world. South Korea has the highest recorded suicide rate in the OECD. In South Korea, it is estimated to affect 0.02 percent of the population by the WHO. In 2012, suicide was the fourth-highest cause of death. The suicide rate has consistently declined between 2012 and 2019, the year when the latest data are available.

<span class="mw-page-title-main">Gender differences in suicide</span>

Gender differences in suicide rates have been shown to be significant. There are different rates of suicides and suicidal behavior between males and females. While females more often have suicidal thoughts, males die by suicide more frequently. This discrepancy is also known as the gender paradox in suicide.

World Suicide Prevention Day (WSPD) is an awareness day always observed on 10 September every year, in order to provide worldwide commitment and action to prevent suicides, with various activities around the world since 2003. The International Association for Suicide Prevention (IASP) collaborates with the World Health Organization (WHO) and the World Federation for Mental Health (WFMH) to host World Suicide Prevention Day. In 2011 an estimated 40 countries held awareness events to mark the occasion. According to WHO's Mental Health Atlas released in 2014, no low-income country reported having a national suicide prevention strategy, while less than 10% of lower-middle income countries, and almost a third of upper-middle and high-income countries had.

<span class="mw-page-title-main">Suicide in the United Kingdom</span> Statistics and causes of suicide in the UK (England and Wales figures only)

Suicide is a significant national social issue in the United Kingdom. In 2019 there were 5,691 registered deaths by suicide in England and Wales, equating to an average of 18 suicides per day. Suicide is the single biggest killer of men under the age of 45 in the country.

<span class="mw-page-title-main">United States military veteran suicide</span> Suicide among veterans of the United States armed forces

United States military veteran suicide is an ongoing phenomenon regarding the high rate of suicide among U.S. military veterans in comparison to the general civilian public. A focus on preventing veteran suicide began in 1958 with the opening of the first suicide prevention center in the United States. During the mid-1990s, a paradigm shift in addressing veteran suicide occurred with the development of a national strategy which included several Congressional Resolutions. More advancements were made in 2007, when the Joshua Omvig Veterans Suicide Prevention Act created a comprehensive program including outreach at each Veterans Affairs Office (VA) and the implementation of a 24-hour crisis hotline. PTSD, depression, and combat-related guilt in veterans are often related to suicide as it can be difficult for veterans to transition to civilian life.

<span class="mw-page-title-main">Maternal mortality in the United States</span> Overview of maternal mortality in the United States

Maternal mortality refers to the death of a woman during her pregnancy or up to a year after her pregnancy has terminated; this metric only includes causes related to the pregnancy, and does not include accidental causes. Some sources will define maternal mortality as the death of a woman up to 42 days after the pregnancy has ended, instead of one year. In 1986, the CDC began tracking pregnancy-related deaths to gather information and determine what was causing these deaths by creating the Pregnancy-Related Mortality Surveillance System. According to a 2010-2011 report although the United States was spending more on healthcare than any other country in the world, more than two women died during childbirth every day, making maternal mortality in the United States the highest when compared to 49 other countries in the developed world.

Suicide among Native Americans in the United States, both attempted and completed, is more prevalent than in any other racial or ethnic group in the United States. Among American youths specifically, Native American youths also show higher rates of suicide than American youths of other races. Despite making up only 0.9% of the total United States population, American Indians and Alaska Natives (AIANs) are a significantly heterogeneous group, with 560 federally recognized tribes, more than 200 non-federally recognized tribes, more than 300 languages spoken, and one half or more of them living in urban areas. Suicide rates are likewise variable within AIAN communities. Reported rates range from 0 to 150 per 100,000 members of the population for different groups. Native American men are more likely to commit suicide than Native American women, but Native American women show a higher prevalence of suicidal behaviors. Interpersonal relationships, community environment, spirituality, mental healthcare, and alcohol abuse interventions are among subjects of studies about the effectiveness of suicide prevention efforts. David Lester calls attention to the existence and importance of theories of suicide developed by indigenous peoples themselves, and notes that they "can challenge traditional Western theories of suicide." Studies by Olson and Wahab as well as Doll and Brady report that the Indian Health Service has lacked the resources needed to sufficiently address mental health problems in Native American communities. The most complete records of suicide among Native Americans in the United States are reported by the Indian Health Service.

<span class="mw-page-title-main">United States drug overdose death rates and totals over time</span> US public health issue

The United States Centers for Disease Control and Prevention has data on drug overdose death rates and totals. Around 1,106,900 US residents died from drug overdoses from 1968 to 2020, around 932,400 from 1999 through 2020 and around 91,800 in 2020. Of every 100,000 people in 2020 in the US, drugs killed 28. Opioids were involved in around 80,400 of the around 106,700 deaths in 2021. Synthetic opioids other than methadone were involved with 70,601 deaths in 2021.

Native Americans are affected by noncommunicable illnesses related to social changes and contemporary eating habits. Increasing rates of obesity, poor nutrition, sedentary lifestyle, and social isolation affect many Americans. While subject to the same illnesses, Native Americans have higher morbidity and mortality to diabetes and cardiovascular disease as well as certain forms of cancer. Social and historical factors tend to promote unhealthy behaviors including suicide and alcohol dependence. Reduced access to health care in Native American communities means that these diseases as well as infections affect more people for longer periods of time.

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