Why is it increasing?
The past year has definitely been a challenging one. For some, it became too much to bear. Unfortunately, the number of people who have committed suicide has been on the rise for a long time. Experts are concerned that this will rise more sharply in light of recent events and the impacts they’re having, and will continue to have, on many individuals. Why have suicides been on the rise? What can be done to reduce risk?
Recent reports show that the number of individuals committing suicide in the United States has increased significantly over the past couple of decades. The data comes from the Centers for Disease Control and Prevention’s (CDC) National Vital Statistics System. According to an analysis of the 2016 data, the rate increased about 1% per year from 2000 – 2006 and about 2% per year from 2006 – 2016. So, the rate rose from 10.4 to 13.5 per 100,000 people during the 16 years. This change resulted in it becoming the 10th leading cause of death among all ages in 2016. It’s important to note that it was the second-leading cause of death among people ages 10 to 34 and the fourth-leading cause among people ages 35 to 54 that year. A new report was released in September 2020 and compared the three-year averages of suicide rates for 2007–2009 and 2016–2018. The rate rose from 6.8 per 100,000 in 2007 to 10.7 in 2018. The study also indicated that in 2017, 14 out of every 100,000 Americans died by suicide, which is a 33% increase since 1999, making it the highest age-adjusted suicide rate recorded in the US since 1942.
Historically, men die by suicide more frequently than women. The male suicide rate is over three times higher than the female rate. However, female suicide rates are rising more quickly. It’s gone up by 53% since 1999, while men’s rate grew by 26%. The 2016 CDC statistics show that the rate rose from 4 to 6 per 100,000 among girls and women and from 17.7 to 21.4 per 100,000 among boys and men between 2000 and 2016. For either gender, suicide rates are highest among American Indians and Alaska natives. The data shows the pace of increase has been more significant in rural areas, rising 48% from 2000 through 2018 compared urban increase of 34% in the same period. The CDC conducted a web-based survey between June 24 and June 30 in 2020. There were over 5,400 adults (18-years-old and older) who participated. Of those who said they had seriously considered suicide, there was disproportionate representation among unpaid caregivers for adults, people 18 to 24, essential workers, Hispanic people, and Black people. Most suicide deaths are reported among people ages 45 to 64.
Unfortunately, suicide has become increasingly common among young people, especially boys and girls ages 10 to 14. Per the 2020 CDC report, the rate of suicide among those aged 10 to 24 increased nearly 60% between 2007 and 2018. A separate research study published June 2019 in JAMA found that youth suicide rates are at their highest point since 2000. Per the statistics, it’s the 2nd leading cause of death among 10 – 24-year-olds and the 3rd among 12-year-olds. It’s relatively common for kids to have thoughts of suicide during adolescence because they’re vulnerable as they develop their sense of self and experience all of the changes of puberty. About one in eight children between the ages 6 and 12 has suicidal thoughts. The CDC figures confirm that white youth die by suicide at a higher rate, but the rate of Black youth suicide is increasing faster than any other racial or ethnic group. Black youth under 13 were twice as likely to die by suicide than their white peers. The rate of suicides for Black children jumped from 2.55 suicides per 100,000 in 2007 to 4.82 per 100,000 in 2017.
When it comes to suicide, many people don’t think of it in relation to the elderly. However, while older adults make up 12% of the population, they account for 18% of all suicide deaths. Information from 2002 shows that the annual suicide rate for persons over 65 was above 15 per 100,000 individuals. For those 75 to 84, that increases to over 17 per every 100,000 and goes even higher for those over 85. Experts say that this is concerning because elder suicide may be under-reported by over 40%. Most likely as the deaths from overdoses, self-starvation, dehydration, or “accidents” aren’t counted as suicides. Another consideration is double suicides involving spouses or partners, which occurs most frequently among this demographic. Public perception plays a role in why this isn’t talked about more. Many people believe depression and suicide are normal aspects of aging when they aren’t.
Health experts are trying to figure out the possible causes for the increase. They know for sure that it isn’t just one thing, but a combination of factors that push people to that point. The circumstances that trigger suicide is unique between different populations. Relationship issues, economic stressors, isolation, and political strife tend to be top factors. Research published in the American Public Health Association’s (APHA) American Journal of Public Health (AJPH) indicates diseases of despair, such as suicide, accidental poisonings, liver disease deaths, and chronic behavioral health disease, combined with family dysfunction, poor social support, or addiction are on the rise. This is predominantly true among white individuals. Economic disadvantages, especially unemployment, have been shown to elevate the risk of suicide. For many men, their self-esteem and self-worth are tied to jobs and being providers. So, when this disappears, they have a hard time. Many rural states are still recovering from the economic downturn of 2008. On top of that, these states have been hit hard by the opioid epidemic. Opioid use is known to precipitate suicidal behavior not only in drug users but their children and families. Poor access to mental health services and stigma could be obstacles as well. Several research studies point to the “contagion” effect after high-profile suicides. The Wall Street Journal reported that following Kate Spade’s death, the US suicide prevention hotline saw a 25% spike in calls. All of these factors affect children, too. During the economic recession, they saw their parents lose homes and jobs, which meant they had to change schools and lost friends. Fear of school shootings and the cost of college might be influences for them as well. Social media may also contribute to rising suicide rates among young people because it’s used by them more intensively. Furthermore, some new apps allow more anonymity, which makes bullying easier, and more kids are talking about suicide without their parents knowing. Parents need to talk openly about emotions. When they don’t, teens are more likely to internalize their feelings.
In addition to external factors, health experts say internal factors can increase the risk of suicide. These include having a mental illness, a family history of suicide or mental illness, enduring physical/sexual abuse, experiencing losses, demonstrating aggressive behavior/impulsivity, having poor coping skills, difficulty dealing with sexual orientation, suffering a physical illness, dealing with family disruptions (ex. divorce or problems with the law), and living through a traumatic event. Another issue is access to ways of harming oneself, such as guns, knives, or pills.
A recent development concerning health officials and lawmakers is the COVID-19 pandemic. It has many elements that can precipitate suicidal ideation, like economic stress, social isolation, reduced access to religious services, overall national anxiety, increased firearm sales, and increases in healthcare provider suicides. The rise in firearms is especially problematic since two-thirds of gun-related deaths every year are suicides per the CDC. Since the nation’s suicide rate was extraordinarily high before the pandemic, experts feel that it’s only going to get worse. According to a study published in the Journal of the American Medical Association (JAMA) in April 2020, the upsurge of suicides over the past two decades combined with the pandemic creates the “perfect storm” for an even larger spike to occur. The National Alliance on Mental Illness HelpLine has seen a 65% increase in calls and emails since March 2020, even though it is not a crisis hotline.
The CDC survey from June 2020 indicated that almost 31% of the respondents said they “had symptoms of anxiety or depression,” and about 26% described trauma and stress-related disorders. More than 13% said they had used alcohol and prescription or illegal drugs to deal with their stress and anxiety. The number of people with anxiety symptoms was triple the number of at the same time the previous year. Of those surveyed, 11% had seriously considered suicide in the 30 days before the study. The age range that had the highest prevalence (25%) of this was 18 – 24-year-olds. This isn’t too surprising because people are developing increasingly secure and intimate connections with peers during this time of their lives. It’s also a time during which young adults begin to identify and pursue life goals. In many cases, the pandemic has hindered their ability to proceed with their life plans.
The pandemic’s short-term effects on the suicide rate seem to be clear, but the long-term ones aren’t. It’s still early to know the extent of the impact, but some experts point to similar rises in suicide deaths during other health crises and economic recessions. During the influenza pandemic in 1918-19 (US) and the SARS epidemic in 2003 (Hong Kong), suicides increased. A 2019 study printed in the International Journal of Social Psychiatry looked at the 2008 economic crisis. It found that financial catastrophes can lead to more suicides. Considering all the recent business closures and lost jobs, the fear of a new economic recession or even a depression matching that of the 1930s, the likelihood of seeing an uptick of suicides is very real.
Unfortunately, the mental health consequences aren’t likely to be seen until after the pandemic itself. A major research study supported by the United Nations and WHO concludes, “Mental health consequences are likely to be present for longer and peak later than the actual pandemic. Suicide is likely to become a more pressing concern, as the pandemic spreads and has longer-term effects on the general population, the economy and vulnerable groups.” Experts say the mental strain of the pandemic is particularly trying for people in marginalized groups. The earliest signs of whether suicides are increasing because of the pandemic will come from those who have a history of dealing with self-destructive behaviors in the past.
Congress has started taking action to address the growing rate of suicides present before the pandemic but should help with those who need it after. In July 2020, the House Energy and Commerce Committee put forth a bipartisan mental health package that included four bills focused on suicide prevention and education. One measure would require the Federal Communications Commission (FCC) to designate 9–8–8 as a universal telephone number for a national suicide prevention and mental health crisis hotline. While the FCC passed this, it won’t fully take effect until 2022. Another proposition would establish grants for training healthcare professionals to deal with mental health challenges and identify/provide best-practice strategies. The bill is named after New York-Presbyterian Hospital emergency room director, Dr. Lorna Breen, who died by suicide in April after struggling with the challenges affecting many healthcare workers, especially due to the pandemic. This is important since a study in the AJPH found only 20% of states have laws mandating healthcare professionals complete suicide prevention training. Current suicide prevention efforts focus on identifying and providing treatment for people with mental health conditions. While useful, there’s some concern that this won’t be as helpful as it could because the CDC study showed that 54% of Americans who died by suicide had no known mental health illness. However, research published in the Journal of General Internal Medicine in 2014 disclosed that over 80% of people who die by suicide see a healthcare professional in the year before their death. So, the training should be used to screen everyone because this would be a more efficient way to reduce suicides.
No question, the legislation will be valuable, but people need help now. This is where public health workers could be the key. The National Violent Death Reporting System is a surveillance system that provides data to researchers so they can better understand the context surrounding a suicide death. By using this information, public health leaders can create better prevention efforts. Officials can take action to limit access to the most lethal means of suicide through comprehensive preventive care, such as techniques that could curb behavioral health risks, which could be used in healthcare settings, schools, and community organizations. To accomplish this goal, the data needs to be updated and available in real-time. Currently, most research is at least a few years old by the time it’s reported.
Often, people contemplating suicide feel like they have nowhere to turn. This is especially true during the pandemic because mental health services haven’t been given the same priority as hospitals and other primary care facilities. As a result, people dealing with mental health crises have little choice but to wait in emergency departments, exposing them to the coronavirus. Yet, if they don’t go, they have to deal with their symptoms without relief. Treatments that offer flexibility in delivery (ex. telehealth appointments) and cost minimally are crucial to assisting those seeking ways to cope with these excruciating circumstances. One option is Certified Community Behavioral Health Clinics (CCBHCs). They must have 24-hour crisis response services, offer same-day services, and serve people regardless of their ability to pay. Currently, there are more than 200 CCBHCs are in 33 states. The funding from the COVID-19 relief law will expand it to two more states.
We all know that social distancing is key to stopping the spread of COVID-19, but that directly contradicts mental health advice during crisis times. Typically, when someone is experiencing depression or anxiety, the last thing they should do is socially isolate. That’s why many mental health professionals prefer the term “physical distancing.” While it’s necessary to stay away from one another physically, we can still connect with others via video calls or from a safe physical distance with appropriate safety precautions. This can help take back control that many feel has been lost.
Experts agree that teaching people how to process loss and cope with difficult emotions is essential in suicide prevention, but this takes time. So, in the meantime, it’s vital to follow some self-care tips recommended by mental health professionals. Ensure you have a daily routine and set aside time each day to engage in a healthy, stress-relieving activity. Each week, challenge yourself to find examples of positive, uplifting moments that have happened. With the constant exposure to information via social media or television, it’s easy to become overwhelmed. Therefore, limit your exposure to it to a set amount each day. Also, remember the level of pain and distress you’re feeling at this moment is temporary. It’s a good idea to have a “safety plan,” so if things aren’t going well, you’ll know what to do. Find something that can distract you in the moment. Try deep breathing exercises, going for a walk, listening to music, taking pictures of your kids, or watching funny cat videos. These can help you calm down to the point that you can then use other coping strategies. You can also reach out to a friend or talk to a trained counselor.
Suicide is something that we need to be prepared to talk about openly and honestly with others, especially if we’re concerned about their wellbeing. The first step is to recognize the warning signs indicating someone is at increased risk of suicide. These include loss of interest in things/activities that were once enjoyable, reducing social interaction, not taking care of one’s appearance/hygiene, not following medical regimens, experiencing a significant personal loss, feeling hopeless/worthless, putting affairs in order, giving things away, or stock-piling medication/other lethal means. It might also include preoccupation with death, substance abuse, sleep disturbance, risky behavior, lack of energy, inability to think clearly/concentration problems, declining performance/increased absences from school/work, increased irritability, and changes in appetite. The most significant indicator is an expression of suicidal intent.
The National Institute of Mental Health has a guide, the Five Action Steps for Helping Someone in Emotional Pain, to help individuals intervene to prevent the suicide of someone they care about. The first step is asking, “Are you thinking about killing yourself?” Research shows that doing this doesn’t increase suicides or suicidal thoughts. It’s essential to do this because it’s rare that someone will say that they are considering suicide without prompting. The next significant thing is listening carefully before making sure the person is connected to resources that can help them. It’s also vital to stay in touch with the person after a crisis. A 2001 study published in Psychiatric Services illustrated that the number of suicide deaths decreases when someone follows up with an at-risk person. Having a conversation like this can be challenging, so the Mental Health First Aid USA, a nonprofit organization, has an eight-hour course called “The Awkward Conversation,” which gives individuals tools to safely and helpfully respond to someone having a mental health crisis. It’s vital to use direct, non-judgmental questions. Regardless of their response, if you suspect that the person is suicidal, get them help immediately.
If you or someone you know is struggling with suicidal thoughts, call the US National Suicide Prevention Lifeline at 1-800-273-TALK (8255) any time day or night, or chat online. Crisis Text Line (741741) also provides free, 24/7, confidential support via text message. For LGBTQ individuals, you can also contact The Trevor Project’s Trevor Lifeline 24/7/365 at 1-866-488-7386. Remember, you’re never alone; there’s always someone willing to listen!