Contextual Factors Associated With County-Level Suicide Rates in the United States, 1999 to 2016

Steelesmith, Danielle L.; Fontanella, Cynthia A.; Campo, John V.; Bridge, Jeffrey A.; Warren, Keith; Root, Elisabeth Dowling

doi:10.1001/jamanetworkopen.2019.10936

Cited by 133 publications

(140 citation statements)

References 57 publications

(84 reference statements)

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“…One plausible explanation for the widening gap in mortality comes from individuals' health and health-related behaviors. In particular, the opioid crisis (Gomes et al 2018;Kolodny et al 2015), obesity (Flegal et al 2012;Frederick, Snellman, and Putnam 2014), suicide rates (Rossen et al 2018, Steelesmith et al 2019, and smoking (Pernenkil, Wyatt, and Akinyemiju 2017) may each contribute to growing inequality in mortality. While previous research has documented trends in mortality inequality by using mortality data and some education and income measures of SES, it often has not looked at health status directly, partly because the data analyzed (e.g., Census data, Current Population Survey data, Social Security Administration death records) had no or limited information about individuals' health.…”

Section: Introductionmentioning

confidence: 99%

Trends in Health and Mortality Inequalities in the United States

2019

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Recent literature has documented a widening gap in mortality in the United States between individuals with high socioeconomic status (SES) and low SES. An important question is whether this trend will continue. In this paper we document trends and inequalities in the health status at ages 54 to 60 of individuals born between 1934 and 1959. We do so by using detailed subjective and objective measures of health in the Health and Retirement Study to examine contributors to mortality inequality and to forecast life expectancy. We found that the health of individuals 54 to 60 years old has generally declined in recent years. In particular, we found large increases in obesity rates, notable increases in diabetes and reported levels of pain, and lower self-reported health and subjective survival probabilities. We also found strong evidence for increasing health inequalities, as the health of individuals in these cohorts with high SES remained largely stable while that for individuals with low SES declined. When we forecast life expectancies using these predictor variables, as well as gender-and SES-specific time trends, we predict overall life expectancy to increase further. However, the increase is concentrated among high SES individuals, suggesting growing mortality inequality. Results are similar among men and women.

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Section: Introductionmentioning

confidence: 99%

Trends in Health and Mortality Inequalities in the United States

2019

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“…A detailed and more recent analysis found associations between higher suicide rates and higher: deprivation (especially in rural areas); social fragmentation; percent uninsured; and percent veterans [48]. Lower suicide rates, in contrast, were associated with higher social capital [48]. Others have presented similar or complementary data and analyses, with similar conclusions and useful discussions [49,50].…”

Section: Driving Forcesmentioning

confidence: 90%

“…drug/alcohol related deaths and suicides, or "deaths of despair"). A detailed and more recent analysis found associations between higher suicide rates and higher: deprivation (especially in rural areas); social fragmentation; percent uninsured; and percent veterans [48]. Lower suicide rates, in contrast, were associated with higher social capital [48].…”

Section: Driving Forcesmentioning

confidence: 96%

“…Indeed, estimates suggest that 20% of US children have a diagnosable mental health condition, and "[m]ore than half of mental illness emerges before age 14" [81], yet 85% of those needing treatment do not receive it [60,81]. Suicide is the second leading cause of death for 10-34 year olds, fourth leading cause of death for [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] year olds, and 8th leading for ages 55-64 [82].…”

Section: Driving Forcesmentioning

confidence: 99%

“…Increased presence of gun shops is associated with higher suicide rates, underscoring the need for more lethal means safety programs of this nature [48]. These are all very positive steps in the right direction with demonstrated efficacy in reducing suicide deaths [114,125,130], and thus the importance of these measures for improving public health cannot be overstated.…”

Section: Identifying the Most Effective Firearm Safety Measuresmentioning

confidence: 99%

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Rising US Suicides: Achieving Health Equity

Perry¹,

Allison²,

Bastiampillai³

et al. 2019

Preprint

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Evidence suggests that increased availability of mental health treatment has not significantly reduced depression prevalence and suicide in the US, and that significant personal (i.e., stigma) or practical/logistical barriers to effective mental health care remain. Mental health treatment has increased in the US since the early 1990s with greater use of antidepressant medications, especially SSRIs, however suicide rates continue to climb, with significant gender, ethnic, geographic, socioeconomic, and other health disparities. Depression rates are at best stable, but are increasing in certain subpopulations such as youths ages 12-17. Combating these distressing trends to achieve health equity will require more attention to promising and evidence-based, sustainable, proactive, practical solutions that address the varied causes, demographics, and differential risk factors and mechanisms of suicide deaths. Herein we explore sociodemographic disparities that exist in suicide deaths, with emphasis on two of the largest modifiable targets for suicide prevention: untreated or undertreated depression, and access to the lethal means (firearms) that cause more suicide deaths than all other means combined, and thus pose the greatest threat to individual and public health. Furthermore, we newly define increased or unsafe (i.e. disparate) access to firearms as a suicide health disparity that promotes health inequities. To achieve the greatest results in suicide prevention across all groups, we need 1) more emphasis on policies and universal programs shown to reduce suicidal behaviors, and 2) enhanced focus on the two largest modifiable targets for suicide prevention: depression and firearms.

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