Suicidal acts increase among women, adolescents, older adults

Jing Wang

Suicidal acts have increased among women, adolescents and older adults, according to findings of a cross-sectional study published in JAMA Psychiatry.

"It is well documented that suicide rates have been increasing in the United States in the past two decades, but the underlying reasons for the rise remain unclear,” Jing Wang, MD, MPH, of CDC’s National Center for Injury Prevention and Control, told Healio Psychiatry. "An important question is whether there were more suicidal acts, whether suicidal acts became more lethal or if both occurred during this time. This knowledge can help inform suicide prevention efforts.”

Prior studies revealed greater incidence of suicide attempts among particular adult subgroups and youth, and other research showed changing patterns in suicide methods over time. Specifically, between 2000 and 2010, the rate of suicide by suffocation increased 52% compared with a 19% increase in suicide by poisoning and a 3% increase in suicides related to firearms in the United States. The lethality of suicidal acts, which depends largely on the method used, may be affected, according to the investigators; however, no studies have examined the trends in both lethality and incidence of suicidal acts to understand the association between these factors and suicide rates.

Wang and colleagues sought to examine these trends from 2006 to 2015 among individuals aged 10 to 74 years. They identified medically treated nonfatal suicide attempts using Nationwide Inpatient Sample and Nationwide Emergency Department Sample databases, and they identified suicides using mortality files of the National Vital Statistics System. They calculated the incidence rate of suicidal acts by dividing the number of total suicidal acts by the U.S. population and measured lethality through the case fatality rates (CFR) of suicidal acts by dividing the number of suicides by the total number of suicidal acts.

Wang and colleagues identified 1,222,419 suicidal acts, including both suicides and nonfatal suicide attempts, from 2006 to 2015. Incidence rates of total suicidal acts increased 10% during this period, for an annual percentage change (APC) of 0.8% (95% CI, 0.3-1.3). The CFRs of suicidal acts increased 13% (APC = 2.3%; 95% CI, 1.3-3.3). Subgroup analyses showed incidence rates increased by 1.1% (95% CI, 0.6-1.6) per year for women but remained stable for men. The CFRs increased for women and men, with APCs of 5% (95% CI, 3.1-6.9) since 2010 for women and 1.6% (95% CI, 0.6-2.5) since 2009 for men. The researchers also observed an increase in incidence rates among adults aged 65 to 74 years throughout the 2006 to 2015 period and among adolescents from 2011 to 2015. The CFRs increased since 2009 among those aged 20 to 44 years (APC = 3.7%; 95% CI, 2.5-5) and since 2012 for those aged 45 to 64 years (APC = 2.7%; 95% CI, 0-5.4). Adolescents and adults aged 65 to 74 years showed increased incidence by all means, whereas those aged 20 to 44 years and 45 to 64 years experienced increases in suicidal acts by more lethal means.

"Our findings call attention to the evolving patterns in the use of more lethal means (ie, suffocation and firearms) in suicidal acts among the working-age population," Wang told Healio Psychiatry. "Suicide by firearms accounted for half of all suicides. Health care professionals may play a role in promoting safe storage of firearms, medications and other potentially dangerous household products to reduce access to lethal means among individuals at risk for suicide. Also, given the increases observed in suicidal acts among adolescents and older adults, states and communities can strengthen access and delivery of care for suicide risk, including training in assessing and treating patients with suicide risk, assuring patient safety during transitions in and out of the health care system and within levels of care (ie, inpatient to outpatient care) and preventing suicide re-attempts.” – by Joe Gramigna

Disclosures: The authors report no relevant financial disclosures.