Suicide on the Rise: Understanding an Urgent Public Health Issue – Thought Leadership

Suicide on the Rise: Understanding an Urgent Public Health Issue

Behavioral Health Insights
By Micah Hoffman, MD, DABPN, FAPA, QME, CIME, CHCQM
AllMed Behavioral Health Medical Director

 

One death every 11 minutes—48,183 deaths in 2021 alone.¹ While shocking, these figures only begin to convey the scope of the suicide problem in the United States today. From 2000 to 2021, U.S. suicide rates rose by 36 percent, transforming what once was viewed as an isolated personal tragedy into an alarming public health concern. The tally of deaths by suicide obscures a less well-known but equally troubling fact: millions of Americans struggle with suicidal ideation and behavior. According to the Centers for Disease Control (CDC), in 2021, an estimated 12.3 million adults seriously thought about suicide, 3.5 million planned an attempt, and 1.7 million carried out an attempt (with nonfatal results).²

High rates of suicide and suicide attempts cause incalculable emotional and physical harm to communities. They also take an enormous financial toll on the nation. In 2020, suicide and nonfatal self-harm cost the U.S. over $500 billion in medical, work loss, value of statistical life, and quality of life costs.³

Providing optimal care to members at risk of suicide calls for an in-depth understanding of risk factors and available treatments. In this first article in a three-part series, we look at societal factors contributing to rising rates. Subsequent articles will focus on methods of risk assessment and effective approaches to using levels of care in treatment.

A Complex Personal and Sociological Phenomenon

Identifying why suicide rates rise or fall is challenging because the reasons are complex and often intertwined. Individual risk factors such as depression, substance use, and mental illness play a part, as do historical factors such as a family history of suicide or childhood abuse. Environmental circumstances also play a major role. These may include discrimination, isolation, financial insecurity, stressful life events, and/or access to lethal means such as a firearm.

On a societal level, a variety of cultural factors contribute to suicide risk:

The persistent stigma associated with asking for help and with mental illness deters many people from seeking support when they need it. Individuals fear being perceived as weak or a burden to others and may be reluctant to risk harm to their careers. In certain fields, mental health conditions can disqualify a person from specific career trajectories.

The nationwide shortage and fragmentation of mental health resources exacerbate the situation. Qualified help can be hard to find even for those who actively seek it, especially in rural areas where the shortage is most acute. The recently introduced 988 Suicide & Crisis Lifeline, now active across the U.S., represents an effort by the federal government to close this gap.

The Impact of Living in an Increasingly Violent Society

Mental health experts cite the normalization—and even glorification—of violence and suicide in our society (e.g., the television series 13 Reasons Why) as significant drivers of increased risk, particularly for young people. In 2021, suicide was the second leading cause of death (after unintentional injury) for people ages 10-14 and 20-34.⁴

Easy access to guns adds a lethal component to the problem of suicide in the U.S. Guns are the most common mode of suicide—53 percent of suicides involve a firearm.⁵ A study in the Annals of Internal Medicine that reviewed millions of records from hospitals and emergency departments found that while less than nine percent of all suicide attempts were fatal, nearly 90 percent that involved firearms resulted in death.⁶ Notably, analysis of CDC data indicates that more than twice as many suicides by firearm occur in states with the fewest gun laws, relative to states with  the most laws, while non-firearm suicide rates are relatively stable across states.⁷ These findings support the contention that stricter laws governing gun ownership, maintenance, and storage have the potential to reduce suicide deaths.

COVID’s Surprising Effect

Since the emergence of COVID-19 in 2020, the pandemic has exacerbated many known risk factors for suicide. Beyond its direct effects on those who were infected, COVID-19 brought widespread economic stress, social isolation, separation from religious communities, and new barriers to mental health treatment.⁸ Many expected a spike in suicides, but in fact, the numbers dipped modestly in 2020 (for the second year in a row) before resuming their climb in 2021.⁹ The two-year decline was due to fewer suicides among white people, a trend that masked disparities in suicide mortality among non-White racial/ethnic groups and other vulnerable populations.

Experts theorize that one explanation for the decline in suicidality at the pandemic’s onset may be that collective emergencies at first bring a sense of community and psychological strengthening as people feel that they are working together against a common enemy. Over time, this mitigating effect fades as populations hit hardest by the crisis continue to struggle and the crisis compounds preexisting inequities. In the longer term, suicide rates rebound, particularly among the most severely impacted populations.¹⁰ This reversal is what happened in the U.S. in 2021.¹¹

Soon-to-be-released 2022 data will confirm whether suicide rates have continued to rise. In the meantime, by increasing awareness of risk factors and treatment options, we can work toward reversing the trend.

Informed Clinical Guidance Improves Risk Management

Suicide is a multifaceted phenomenon influenced by a wide range of personal and sociological factors. Understanding those factors and their interplay is a crucial first step in mitigating risk. The board-certified psychiatrists and psychologists at AllMed bring specialized, up-to-date training and extensive experience to reviews of complex behavioral health cases. Rely on our specialists for informed clinical guidance to help your team better manage suicide risk among members.

Check back in this space soon for an update on methods of clinical assessment of suicide risk.

1. Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System, Mortality 2018-2021 on CDC WONDER Online Database, released in 2023. Data are from the Multiple Cause of Death Files, 2018-2021, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/mcd-icd10-expanded.html on Jan 11, 2023
2. Substance Abuse and Mental Health Services Administration (2022). Key substance use and mental health indicators in the United States: Results from the 2021 National Survey on Drug Use and Health (HHS Publication No. PEP22-07-01-005, NSDUH Series H-57). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/report/2021-nsduh-annual-national-report
3. Centers for Disease Control and Prevention, WISQARS Cost of Injury Data. Number of Injuries and Associated Costs, 2020. https://wisqars.cdc.gov/cost/?y=2020&o=MORT&i=2&m=20810&g=00&s=0&u=TOTAL&u=AVG&t=COMBO&t=MED&t=VPSL&a=5Yr&g1=0&g2=199&a1=0&a2=199&r1=MECH&r2=INTENT&r3=NONE&r4=NONE&c1=&c2=. Accessed May 16, 2023.
4. Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System, Mortality 2018-2021 on CDC WONDER Online Database, released in 2023. Data are from the Multiple Cause of Death Files, 2018-2021, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/mcd-icd10-expanded.html on Jan 11, 2023
5. Saunders, Heather. Do States with Easier Access to Guns Have More Suicide Deaths by Firearm? KFF. Jul 18, 2022. https://www.kff.org/other/issue-brief/do-states-with-easier-access-to-guns-have-more-suicide-deaths-by-firearm/. Accessed May 16, 2023.
6. Conner A, Azrael D, et al. Suicide Case-Fatality Rates in the United States, 2007 to 2014. Annals of Internal Medicine. Dec 17, 2019. https://doi.org/10.7326/M19-1324. Accessed May 17, 2023.
7. https://www.kff.org/other/issue-brief/do-states-with-easier-access-to-guns-have-more-suicide-deaths-by-firearm/.
8. Liang A, Nestadt P. Suicide Risk in the COVID-19 Pandemic. Johns Hopkins Medicine. Feb 13, 2021. https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Psychiatry_Guide/787393/all/Suicide_Risk_in_the_COVID_19_Pandemic. Accessed May 17, 2023.
9. Stone DM, Mack KA, Qualters J. Notes from the Field: Recent Changes in Suicide Rates, by Race and Ethnicity and Age Group — United States, 2021. MMWR Morb Mortal Wkly Rep 2023;72:160–162. DOI: http://dx.doi.org/10.15585/mmwr.mm7206a4. Accessed May 17, 2023.
10. Barry, Ellen. Following a Two-Year Decline, Suicide Rates Rose Again in 2021. The New York Times. Feb 11, 2023. https://www.nytimes.com/2023/02/11/health/suicide-rates-cdc.html. Accessed May 15, 2023.
11. Centers for Disease Control and Prevention. Suicide Increases in 2021 After Two Years of Decline. Sep 30, 2022. https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/20220930.htm. Accessed May 17, 2023.

 

 

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