Vital Signs:Trends in State Suicide Rates — United States, 1999–2016 and Circumstances Contributing to Suicide — 27 States, 2015

Abstract

IntroductionSuicide rates in the United States have risen nearly 30% since 1999, and mental health conditions are one of several factors contributing to suicide. Examining state-level trends in suicide and the multiple circumstances contributing to it can inform comprehensive state suicide prevention planning.MethodsTrends in age-adjusted suicide rates among persons aged ≥10 years, by state and sex, across six consecutive 3-year periods (1999–2016), were assessed using data from the National Vital Statistics System for 50 states and the District of Columbia. Data from the National Violent Death Reporting System, covering 27 states in 2015, were used to examine contributing circumstances among decedents with and without known mental health conditions.ResultsDuring 1999–2016, suicide rates increased significantly in 44 states, with 25 states experiencing increases >30%. Rates increased significantly among males and females in 34 and 43 states, respectively. Fifty-four percent of decedents in 27 states in 2015 did not have a known mental health condition. Among decedents with available information, several circumstances were significantly more likely among those without known mental health conditions than among those with mental health conditions, including relationship problems/loss (45.1% versus 39.6%), life stressors (50.5% versus 47.2%), and recent/impending crises (32.9% versus 26.0%), but these circumstances were common across groups.ConclusionsSuicide rates increased significantly across most states during 1999–2016. Various circumstances contributed to suicides among persons with and without known mental health conditions.Implications for Public Health PracticeStates can use a comprehensive evidence-based public health approach to prevent suicide risk before it occurs, identify and support persons at risk, prevent reattempts, and help friends and family members in the aftermath of a suicide.

Surveillance for Violent Deaths — National Violent Death Reporting System, 32 States, 2016

“…Although treatment for mental health problems is an essential component of suicide prevention, previous research with NVDRS data has documented that more than half of suicide decedents did not have a known mental health condition ( 21 ). That study indicated that multiple factors contribute to suicide among those with and without known mental health conditions.…”

“…Alcohol use is a robust predictor of suicidal behavior ( 32 ), victimization ( 33 ), and interpersonal violence perpetration ( 17 , 27 ). Intoxication can lead to disinhibition, enhance feelings of hopelessness and depression, and impair judgment that can lead to impulsive behaviors ( 21 ). Alcohol use can also reduce awareness and perception of surrounding risks, thus increasing one’s vulnerability to being victimized ( 34 ).…”

Suicide Crisis Syndrome: A review of supporting evidence for a new suicide‐specific diagnosis

“…Suicide is a leading cause of death worldwide, and the 10th leading cause of death in the USA (Centers for Disease Control and Prevention, ). Despite increased public attention and ongoing research efforts in suicide prevention, in the USA suicide rates increased by 30% between 1999 and 2016 (Stone et al, ), with nearly 45,000 deaths by suicide in 2016 (Centers for Disease Control and Prevention, ).…”

“…Second, while conscious suicidal ideation may or may not precede suicide, only a minority of suicide decedents reveal it through self‐report. A recent Centers for Disease Control and Prevention (CDC) report underscored that self‐reported suicidal ideation was present only in a fraction of suicide decedents (Stone et al, ). Of those who died by suicide and had a diagnosed mental health condition, 24.5% expressed suicidal intent.…”

Inequalities in elevated depressive symptoms in middle‐aged and older adults by rural childhood residence: The important role of education

“…For example, three US‐based studies included in a recent meta‐analysis suggested lower prevalence of depression among rural versus urban older adults . However, other recent US studies have revealed increasing rates of suicide and alcohol‐related and drug‐related deaths in rural and sparsely populated regions, suggesting that mental health outcomes may disproportionately burden these areas. Our results add to this growing literature on geographic health disparities by suggesting that the prevalence of elevated depressive symptoms may be higher among participants who lived in the rural United States during childhood.…”