<i>Notes from the Field:</i> Recent Changes in Suicide Rates, by Race and Ethnicity and Age Group — United States, 2021

Stone, Deborah M.; Mack, Karin A.; Qualters, Judith R.

doi:10.15585/mmwr.mm7206a4

Cited by 69 publications

(41 citation statements)

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“…White Californians experienced substantial declines in suicide and firearm suicide during the pandemic, a trend aligned with national findings (Stone et al 2023 ). Given the size of the white population and the magnitude of suicide burden among this group, this decrease drove the overall decline observed in the aggregated data.…”

Section: Discussionsupporting

confidence: 72%

Changes in suicide in California from 2017 to 2021: a population-based study

et al. 2023

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Background Suicide is a major public health problem with immediate and long-term effects on individuals, families, and communities. In 2020 and 2021, stressors wrought by the COVID-19 pandemic, stay-at-home mandates, economic turmoil, social unrest, and growing inequality likely modified risk for self-harm. The coinciding surge in firearm purchasing may have increased risk for firearm suicide. In this study, we examined changes in counts and rates of suicide in California across sociodemographic groups during the first two years of the COVID-19 pandemic relative to prior years. Methods We used California-wide death data to summarize suicide and firearm suicide across race/ethnicity, age, education, gender, and urbanicity. We compared case counts and rates in 2020 and 2021 with 2017–2019 averages. Results Suicide decreased overall in 2020 (4123 deaths; 10.5 per 100,000) and 2021 (4104; 10.4 per 100,000), compared to pre-pandemic (4484; 11.4 per 100,000). The decrease in counts was driven largely by males, white, and middle-aged Californians. Conversely, Black Californians and young people (age 10 to 19) experienced increased burden and rates of suicide. Firearm suicide also decreased following the onset of the pandemic, but relatively less than overall suicide; as a result, the proportion of suicides that involved a firearm increased (from 36.1% pre-pandemic to 37.6% in 2020 and 38.1% in 2021). Females, people aged 20 to 29, and Black Californians had the largest increase in the likelihood of using a firearm in suicide following the onset of the pandemic. The proportion of suicides that involved a firearm in 2020 and 2021 decreased in rural areas compared to prior years, while there were modest increases in urban areas. Conclusions The COVID-19 pandemic and co-occurring stressors coincided with heterogeneous changes in risk of suicide across the California population. Marginalized racial groups and younger people experienced increased risk for suicide, particularly involving a firearm. Public health intervention and policy action are necessary to prevent fatal self-harm injuries and reduce related inequities.

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Section: Discussionsupporting

confidence: 72%

Changes in suicide in California from 2017 to 2021: a population-based study

et al. 2023

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“…Sexual minority populations are 3 to 6 times more likely than heterosexual populations to experience STBs . American Indian and Alaska Native individuals have the highest STB prevalence of all racial and ethnic groups, although STB prevalence is increasing for Black and Hispanic young adults …”

Section: Introductionmentioning

confidence: 99%

“…4,5 American Indian and Alaska Native individuals have the highest STB prevalence of all racial and ethnic groups, although STB prevalence is increasing for Black and Hispanic young adults. 6 When viewing STB inequities for women, sexual minority populations, and racial and ethnic minority groups through the lens of Black feminist scholarship's intersectionality theory, 7 these inequities arise not due to the identities themselves but due to mutually constitutive forms of structural discrimination based on these identities. 8 Structural discrimination is a fundamental cause of health inequities and occurs when interlocking systems of power, privilege, and oppression are embedded into policies, cultural norms and practices, and beliefs.…”

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confidence: 99%

Intersectional Prevalence of Suicide Ideation, Plan, and Attempt Based on Gender, Sexual Orientation, Race and Ethnicity, and Rurality

et al. 2023

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ImportanceSuicidal thoughts and behaviors (STBs) are major public health problems, and some social groups experience disproportionate STB burden. Studies assessing STB inequities for single identities (eg, gender or sexual orientation) cannot evaluate intersectional differences and do not reflect that the causes of inequities are due to structural-level (vs individual-level) processes.ObjectiveTo examine differences in STB prevalence at the intersection of gender, sexual orientation, race and ethnicity, and rurality.Design, Setting, and ParticipantsThis cross-sectional study used adult data from the 2015-2019 National Survey on Drug Use and Health (NSDUH), a population-based sample of noninstitutionalized US civilians. Data were analyzed from July 2022 to March 2023.Main Outcomes and MeasuresOutcomes included past-year suicide ideation, plan, and attempt, each assessed with a single question developed for the NSDUH. Intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) models were estimated, in which participants were nested within social strata defined by all combinations of gender, sexual orientation, race and ethnicity, and rurality; outcome prevalence estimates were obtained for each social stratum. Social strata were conceptualized as proxies for exposure to structural forms of discrimination that contribute to health advantages or disadvantages (eg, sexism, racism).ResultsThe analytic sample included 189 800 adults, of whom 46.5% were men; 53.5%, women; 4.8%, bisexual; 93.0%, heterosexual; 2.2%, lesbian or gay; 18.8%, Hispanic; 13.9%, non-Hispanic Black; and 67.2%, non-Hispanic White. A total of 44.6% were from large metropolitan counties; 35.5%, small metropolitan counties; and 19.9%, nonmetropolitan counties. There was a complex social patterning of STB prevalence that varied across social strata and was indicative of a disproportionate STB burden among multiply marginalized participants. Specifically, the highest estimated STB prevalence was observed among Hispanic (suicide ideation: 18.1%; 95% credible interval [CrI], 13.5%-24.3%) and non-Hispanic Black (suicide plan: 7.9% [95% CrI, 4.5%-12.1%]; suicide attempt: 3.3% [95% CrI, 1.4%-6.2%]) bisexual women in nonmetropolitan counties.Conclusions and RelevanceIn this cross-sectional study, intersectional exploratory analyses revealed that STB prevalence was highest among social strata including multiply marginalized individuals (eg, Hispanic and non-Hispanic Black bisexual women) residing in more rural counties. The findings suggest that considering and intervening in both individual-level (eg, psychiatric disorders) and structural-level (eg, structural discrimination) processes may enhance suicide prevention and equity efforts.

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“…Black, Indigenous and people of color (BIPOC) have historically been underrepresented in the healthcare workforce [ 19 ] (Children of underserved and historically marginalized groups often experience poor mental health outcomes that result from socioeconomic status, adverse childhood experiences and access to community resources [ 20 , 21 , 22 ]. In a recent report from the Center for Disease Control and Prevention, “suicide rates among persons aged 10–24 years increased significantly during 2018–2021 among individuals who identified as Black” [ 23 ]. Among high school aged youth, female students, LGBTQ+ students and students who had any same-sex partners were more likely than their peers to experience poor mental health, suicidal thoughts and suicidal behaviors [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

Interdisciplinary Children’s Behavioral Health Workforce Development for Social Work and Nursing

Palley

White

Newransky

et al. 2023

IJERPH

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This paper will begin with a review of child health inequities globally, in the United States and in the State of New York. It will then describe a model training program that was designed to educate social workers and nurse practitioners to create a workforce able to address child behavioral health inequities in the United States (US), specifically New York State. Behavioral health care refers to prevention, care and treatment for mental health and substance abuse conditions as well as physical conditions caused by stress and life crises. This project uses an interdisciplinary training program for nurse practitioner and Master of Social Work students to address workforce shortages in underserved communities in New York State. It will present process evaluation findings to highlight the program’s initial success and will conclude with a discussion of the data that are still needed and the challenges of obtaining this data.

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Notes from the Field: Recent Changes in Suicide Rates, by Race and Ethnicity and Age Group — United States, 2021

Cited by 69 publications

References 2 publications

Changes in suicide in California from 2017 to 2021: a population-based study

Changes in suicide in California from 2017 to 2021: a population-based study

Intersectional Prevalence of Suicide Ideation, Plan, and Attempt Based on Gender, Sexual Orientation, Race and Ethnicity, and Rurality

Interdisciplinary Children’s Behavioral Health Workforce Development for Social Work and Nursing

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