Why are suicide rates still on the rise?

Deborah M Stone, ScD, MSW, MPH

Suicide rates increased in nearly every state between 1999 and 2016, according to a new report on suicide from the Centers for Disease Control and Prevention (CDC).¹ While the report doesn’t identify a cause for the upward trend in suicide, experts have revealed a number of contributing factors that should alert pediatricians.

According to its newest Vital Signs report, the CDC reveals that 45,000 Americans-2553 teenagers aged 10 to 19 years-lost their lives to suicide in 2016 alone, and more than half of them did not have a known diagnosed mental health condition at the time of their death. Suicide rates rose more than 30% in half the states across the country since 1999, according to the report, with rates increasing by 38% to 58% in some states including Idaho, Kansas, Minnesota, Montana, New Hampshire, North Dakota, Oklahoma, South Carolina, South Dakota, Utah, Wyoming, and Vermont. The only state that saw a decrease in suicide rates was Nevada, the report notes, although Nevada also consistently had one of the highest suicide rates across the study period.

Relationship problems were listed as a top factor in suicides, followed by acute crisis events, substance misuse, and physical health problems. Firearms were the method most often used by victims of suicide, followed by suffocation and then poisoning, according to the study data.

Deborah M. Stone, ScD, MSW, MPH, a behavioral scientist with the CDC, says vital statistics data alone don’t reveal causative factors in the uptick in suicide rates. Experts do know, however, that there is not just one factor involved in an individual’s decision to take his or her life. “It is typically caused by a combination of individual, relationship, community, and societal factors,” Stone says.

There are a number of factors that may have been tied to increasing suicide risks over the last several years, Stone notes. One of these is economic conditions.

“The role of the great recession in the late 2000s and subsequent financial challenges and concerns about economic instability could have contributed to increases in suicide risk,” she says. “Past research on the association between business cycles and US suicide rates indicates that the overall suicide rate rises and falls in connection with the economy, with increases during economic recessions. We know that suicides increase in times of economic turmoil, and financial stress experienced by parents may trickle down resulting in vulnerable youth.”

Finances aside, the opioid epidemic in the United States also is taking its toll on even the youngest in the population.

“Substance misuse itself is an established risk factor for suicide and, therefore, opioid misuse associated with the opioid overdose epidemic could be driving the suicide rate higher,” Stone says. “When we look at who is dying from suicide and who is dying from unintentional overdoses involving opioids, we see that there is overlap in the demographics of the populations most highly affected by suicide and unintended opioid overdose deaths.”

The opioid epidemic hit rural areas especially hard in the early days of the epidemic, and Stone says rural areas have historically experienced high suicide rates.

“While there have been increases and decreases in rates over time, research shows that rates across cities and towns in the United States have been rising, with rural areas experiencing the most increases,” Stone explains. “The increased rates may be associated with suicide risk factors that are more common in less urban areas, such as limited access to mental healthcare, as well as greater social isolation.”

Whereas social isolation plays a role in suicide, social media saturation may contribute, as well, Stone adds. “More research is needed on the impact of social media use on suicide rates. However, changes in social media content or use patterns could potentially be contributing to risk,” she says.

“Social media can exacerbate bullying, romanticize suicide, and provide harmful content on suicide methods,” she continues. “Alternatively, social media can be used to enhance connections between people, correct myths about suicide, and facilitate access to help. Research is needed to determine how to reduce risk and enhance the protective factors associated with social media.”

With so many contributors to suicide and suicide risk, Stone says pediatricians must be aware of all these factors and assess for impact in their patients. The Vital Signs report from the CDC is meant to highlight these risks and bring attention to this problem, she adds.

“It is our hope that the findings from the Vital Signs report will raise awareness and spur a public health approach to suicide prevention, one that incorporates preventing risk before it starts, helping people who are at increased risk so they don’t attempt suicide, and supporting and caring for people who have already made an attempt or who have lost a loved one to suicide,” Stone says.

“The CDC’s technical package [“Preventing suicide: A technical package of policy, programs, and Practices”]² provides a select group of strategies with the best available evidence,” Stone notes. “Several of these strategies are directly relevant to clinical practice, including strengthening access and delivery of care, teaching coping and problem-solving skills to youth and parents, recognition of people at risk, providing crisis intervention, and providing clinical support for people at risk including preventing reattempts.”

Pediatricians and primary care providers are critical to efforts in suicide prevention, Stone adds. This includes efforts in upstream prevention-preventing adverse childhood experiences and promoting positive parenting practices-to prevent risk in the first place, as well as downstream activities to respond to those who faced increased suicide risk. This can include those with previous suicide attempts, LGBT youths, and more.

Pediatricians can help by providing high-quality, ongoing care focused on patient safety and suicide prevention, Stone advises, as well as providing affordable and effective mental and physical healthcare. This includes utilizing evidence-based treatment strategies and collaborative care models for patients at a high risk for suicide attempts, she says.

There are a number of guidelines available to pediatricians for screening suicide risks, including assessments focused on older teenagers and adults, and in younger children.