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Suicide rates increasing across the US
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Suicide rates rose significantly in 44 states, with 25 states experiencing increases of more than 30%, between 1999 and 2016 in the United States, CDC data revealed.
Mental illness was not the only circumstance that contributed to this increase, according to findings published in a Morbidity and Mortality Weekly Report. The report showed that more than half of those who died by suicide did not have a known diagnosed mental health condition.
“Suicide is preventable and multiple factors contribute to suicide beyond mental health conditions alone,” Deborah M. Stone, ScD, division of violence prevention, National Center for Injury Prevention and Control, CDC, told Healio Psychiatry. “It’s important to conduct research on the topic of suicide, because rates have been on the rise between 1999 and 2016. Understanding the trends, as well as the contributing factors to suicide can help inform a public health response to suicide in states and communities.”
In addition to mental health issues, contributors to suicide include social and economic problems, access to lethal means among at-risk people and poor coping skills. The researchers analyzed state-level trends in suicide rates and examined the multiple factors that contribute to suicide to inform evidence-based comprehensive suicide prevention efforts.
Using data from the National Vital Statistics System, Stone and colleagues evaluated trends in age-adjusted suicide rates among individuals aged 10 years and older by state and sex across six 3-year periods between 1999 and 2016. They also used data from the National Violent Death Reporting System — which covers 27 states in 2015 — to assess contributing circumstances among decedents with and without known mental illnesses.
In the 17-year period, suicide rates in the U.S. showed significant increases in 44 states, with 25 states seeing increased rates of 30% or more. When examining the suicide rates by sex, the investigators found that the rates rose significantly among males in 34 states and among females in 43 states.
Importantly, National Violent Death Reporting System data revealed that 54% of decedents did not have a known diagnosis of any mental health condition, according to the results.
“For clinicians it’s important to know that the people without mental health conditions in this study may have had a diagnosable mental health condition that had not been diagnosed, or it’s possible that their mental health condition was unknown to informants and, therefore, not reported to law enforcement or medical examiners/coroners,” Stone said. “It’s also possible that some diagnosed cases were unreported, and finally some people truly may not have had a diagnosable mental health condition.”
Decedents without known mental health conditions were significantly more likely to die by suicide than those with mental health conditions when they reported relationship problems/loss (45.1% vs. 39.6%), life stressors (50.5% vs. 47.2%) and recent/impending crises (32.9% vs. 26%). Firearms were the most common method of suicide overall (48.5%), the CDC data showed. Decedents who did not have any known mental health conditions were more likely to die by firearm than were those with mental health issues (55.3% vs. 40.6%).
“Clinicians can be part of the solution by taking up and championing widespread implementation of evidence-based treatments (eg dialectical behavior therapy, collaborative care approaches), by supporting ongoing care of patients, especially through care transitions (eg inpatient to outpatient care), and by working with other health care providers to assure that high quality care focused on patient safety is instituted,” Stone told Healio Psychiatry.
Following the publication of this report, the American Psychiatric Association released a statement calling for better access to mental health care.
The report “reinforces the need to fund and enforce laws ensuring access to mental health services,” Saul Levin, MD, MPA, CEO and medical director of APA, said in the statement.
“Congress has recently passed laws aimed at expanding the psychiatric workforce in the United States and requiring that insurance companies provide equal coverage for mental health as physical health, such as diabetes and heart disease, but implementation and enforcement of these laws are needed,” Levin continued. “Early identification of mental illness is essential, and we are ready to work with Congress and other stakeholders to ensure that Americans can receive treatment when needed.” – by Savannah Demko
Disclosure: The authors report no relevant financial disclosures. Levin is an employee at APA.
Perspective
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Igor Galynker, MD, PhD
Over the last 18 years, the suicide rates in the United States have increased by 30%, and in 2016 nearly 45,000 Americans willingly ended their lives. Suicide rates increased among both sexes, all racial and ethnic groups and all age groups younger than 75 years. Adult women aged 45 to 64 years had the largest absolute rate increase. Startlingly, more children ages 10 to 14 years die of suicide than in traffic accidents. The research by Stone and colleagues is rich with implications for suicide prevention.
Although the authors discuss multiple suicide-related factors, its analysis of the National Vital Statistics System coded death certificate records has identified two notable new directions for the prevention efforts. First, in stark contrast to the prevalent view that over 90% of those who die by suicide have been diagnosed with mental illness, 54% of all suicide decedents did not have a known mental health condition. Thus, the suicide prevention efforts directed at those within the mental health care system will miss more than half of those at risk for suicide. Second, only 23% of decedents without known mental health conditions had a history of suicidal ideation and only 10.3% had prior suicide attempts. Moreover, only 22.4% of persons without known mental health conditions and 24.5% of those with mental health conditions disclosed suicide intent. This supports the common experiences that suicidal individuals may know or may hide their suicide intent, and that our current reliance on self-reported suicidal ideation as the staple of the suicide risk assessment is misdirected.
Over the last 10 years, we obtained encouraging results defining suicide-specific mental syndromes and creating new methods of suicide risk assessment not reliant on self-disclosed suicidal ideation and intent. The data analyses reported by Deborah Stone and colleagues lend new support to this approach.
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