June 12, 2018, 08:43 am Chris Crawford – In 2016, nearly 45,000 Americans age 10 or older took their own lives -- a figure that reflects the unfortunate fact that suicide rates in the country have risen nearly 30 percent since 1999.
That's the word from a pair of reports the CDC released June 7; that timing, unhappily, coincided with the high-profile suicides of Kate Spade on June 5 and Anthony Bourdain on June 8.
Additionally, data from the National Violent Death Reporting System, which covered 27 states in 2015, allowed investigators to research the contributing circumstances among decedents with and without known mental health conditions.
"Suicide is a leading cause of death for Americans -- and it's a tragedy for families and communities across the country," said CDC Principal Deputy Director Anne Schuchat, M.D., in a news release. "From individuals and communities to employers and health care professionals, everyone can play a role in efforts to help save lives and reverse this troubling rise in suicide."
From 1999-2016, overall suicide rates increased significantly in 44 states, with 25 states experiencing increases greater than 30 percent; modeled suicide rate trends indicated significant increases among males in 34 states and among females in 43 states.
Also of note, 54 percent of decedents in the 27 states that reported complete information in 2015 did not have a known mental health condition.
Among decedents who did have mental health information available, circumstances that were more likely to be seen among those without known mental health conditions than among those with mental health conditions included relationship problems/loss (45.1 percent versus 39.6 percent), life stressors (50.5 percent versus 47.2 percent) and recent/impending crises (32.9 percent versus 26.0 percent) -- but these circumstances were common across groups.
Suicide rates increased among those in all age groups younger than 75, with adults 45-64 having the largest absolute rate increase (from 13.2 per 100,000 people to 19.2 per 100,000) and the greatest number of suicides (232,108) during the same period.
In addition, rates of emergency department visits for nonfatal self-harm, a primary risk factor for suicide, increased 42 percent between 2001 and 2016.
Suicide rates from 2014-2016 varied from 6.9 (District of Columbia) to 29.2 (Montana) per 100,000 people per year.
Across the full study period, suicide rates increased in all states except Nevada (where the rate was high throughout the study period), with absolute increases ranging from 0.8 per 100,000 (Delaware) to 8.1 per 100,000 (Wyoming).
Percentage increases in rates ranged from 5.9 percent (Delaware) to 57.6 percent (North Dakota), as seen in a supplementary table.
Firearms were the most common method used (48.5 percent), with decedents without known mental health conditions more likely to die by firearm (55.3 percent) and less likely to die by hanging/strangulation/suffocation (26.9 percent) or poisoning (10.4 percent) than were those with known mental health conditions (40.6 percent, 31.3 percent and 19.8 percent, respectively).
The report recommended comprehensive statewide suicide prevention activities to address the full range of factors that contribute to suicide.
Such prevention strategies include
Additional strategies include creating protective environments (e.g., reducing access to lethal means among people at risk for suicide, creating organizational and workplace policies to promote help-seeking, easing transitions into and out of work for people with mental health conditions and other life challenges), strengthening access to and delivery of care, supporting family and friends after a suicide, and encouraging the media to follow safe reporting recommendations.
Some states, such as Colorado, are already planning to implement such comprehensive approaches to suicide prevention, said the CDC.
To support these state-level efforts, the agency released a technical package on suicide prevention last year that describes strategies and approaches based on the best available evidence.
"This can help inform states and communities as they make decisions about prevention activities and priorities," the agency noted.
Jennifer Frost, M.D., medical director for the AAFP's Health of the Public and Science Division, told AAFP News the increase in suicide rates in the United States is a concerning trend.
"While it is a complex issue, family physicians have a role in preventing suicide," she said. "Family physicians should screen all adults for depression, and those who screen positive should receive further evaluation and appropriate treatment."
That advice pertains, in particular, to the more than half of suicide victims who don't have a known mental health condition. "One wonders how many of those individuals had been screened for depression," Frost said.
There are several validated depression screening tools that are easy to administer, she explained, including the commonly used Patient Health Questionnaire (PHQ), and the Edinburgh Postnatal Depression Scale (EPDS) for pregnant and postpartum women.
"Any positive screen should lead to further assessment to confirm the diagnosis of depression, determine severity and evaluate for other mental health conditions," Frost emphasized.
Of course, screening patients for depression can't have an impact if people don't have access to primary care, affordable medications and mental health services, she said.
"Lack of comprehensive health care coverage and qualified professionals also contribute to access issues," Frost added.
Another key factor in the upward trend of suicide rates is access to guns.
"Firearms are the most common method of suicide in this country," Frost said. "The AAFP has called for more research on the prevention of gun violence, including its role in suicide."
This is addressed in the Academy's position paper on preventing gun violence.
Finally, the CDC offered tips to help prevent suicide that family physicians can pass along to patients, such as