CDC: Geographic, socioeconomic factors linked to suicidal behaviors in adults
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Suicidal thoughts and behaviors in the U.S. adult population arise due to several factors, including geography, demographics, socioeconomic status and cultural setting, according to study findings published in MMWR.
“Self-directed violence is a major public health issue in the United States. It includes a range of behaviors, from nonsuicidal intentional self-harm (ie, behavior in which the intention is not to kill oneself, as in self-mutilation) to acts of fatal and nonfatal suicidal behavior,” Asha Ivey-Stephenson, PhD, of the division of injury prevention, National Center for Injury Prevention and Control at the CDC, and colleagues wrote.
In 2019, the authors wrote, suicide was the 10th-leading cause of death among persons aged 18 or older, with 45,861 deaths recorded as a result of suicide. An estimated 381,295 adults required emergency care for nonfatal, self-inflicted injuries.
For the new study, Ivey-Stephenson and colleagues collected data from 2015 to 2019 through the National Survey on Drug Use and Health (NSDUH), a yearly questionnaire that gathers information on alcohol, drug and tobacco usage as well as substance use disorders, health care and mental health status from a representative sample of the civilian, noninstitutionalized U.S. population for those aged 12 years and older.
Ivey-Stephenson and colleagues culled data from 254,767 responses on the mental health section of the NSDUH from residents 18 and older from all 50 states and the District of Columbia. Participants answered whether they had suicidal thoughts, ideation, made plans to commit suicide or attempted suicide over the previous 12 months, as well as subsequent questions about the level of hospitalization or emergency care required based on initial answers.
The researchers calculated national, regional and state-level average prevalence estimates for adults who reported suicidal thoughts, plans or suicide attempts in that 12-month window, and they conducted analyses by sex, age group (18 to 39 years, 40 to 55 years, and 56 years or older), race and ethnicity (non-Hispanic white, Black, Asian, American Indian or Alaska Native), Native Hawaiian or other Pacific Islander, two or more races, and Hispanic).
Weighted estimates were also generated at the national level for adults who had received medical attention or required hospitalization for a suicide attempt by sex, age group, race and ethnicity, educational level, county type, marital status, poverty level, type of health insurance or lack thereof, as well as geographic region.
Results showed that 4.3 percent of the adult population surveyed reported instances of suicidal thoughts during the previous 12 months, with the highest percentage in the West (4.8 percent), and lowest in both the Northeast and South (4.0%). The largest percentage in any single state was 6.9% in Utah, and lowest in New Jersey (3.3%). While approximately 3.1 million adults reported making a suicide plan in the past year, the highest prevalence occurred in the Midwest and West (1.4%), with the highest frequency per state occurred in Alaska (2.4%) Prevalence of reported suicide attempts was relatively low across the board, ranging from 0.5% in the Northeast to 0.6% in the Midwest, South and West.
The researchers also found that suicidal planning, ideation and attempts were higher among women than men overall, elevated with adults aged 18 to 39 years compared with those 40 and older, higher among those who didn’t graduate college than college graduates, and higher among adults who had never been married compared with respondents who were married, separated, divorced or widowed. Suicidal planning, ideation and attempts were also higher among participants living below the federal poverty threshold and those insured by either Medicaid or the Children’s Health Insurance Program as opposed to respondents with other health insurance or none at all.
“Understanding the patterns of and risk factors for suicide is essential for designing, implementing, and evaluating public health programs for suicide prevention and policies that reduce morbidity and mortality related to suicidal thoughts and behaviors,” Ivey-Stephenson and colleagues wrote. “State health departments and federal agencies can use the results from this report to assess progress toward achieving national and state health objectives in suicide prevention. Strategies might include identifying and supporting persons at risk, promoting connectedness, and creating protective environments.”