Suicide attempts in the United States continue to climb, particularly among young, economically disadvantaged adults and people with mental health disorders, according to a troubling study published this week in JAMA Psychiatry.
Suicide prevention efforts need to focus more on people in those groups, particularly on individuals with a history of suicide attempts, the authors of the study stress.
“Attempted suicide is the strongest risk factor for suicide, so it’s important that clinicians know just who faces the highest risk so that we can do a better job of preventing suicides from happening,” said Dr. Mark Olfson, the study’s lead author and a professor of psychiatry and epidemiology at Columbia University, in a released statement.
Finding those at greatest risk
The suicide rate in the U.S. has been steadily rising during the past two decades. In 2015, more than 44,000 American adults took their own lives. That’s a rate of 13.26 per 100,000 people — up from 10.4 per 100,000 in 2000.
Olfson and his colleagues wanted to see if a corresponding increase in suicide attempts has occurred in recent years and, if so, which groups are at highest risk.
Some research has shown that the rate of suicide among individuals who attempt suicide is 100 times higher during the first year after those attempts than the rate in the general population.
The researchers collected and compared data from two National Institutes of Health (NIH) surveys — one conducted in 2004-2005, the other in 2012-2013 — in which almost 70,000 adults answered questions about suicide attempts. Those years covered the Great Recession, which began in 2007 and has been linked with a spike in suicides.
An analysis of the data revealed that suicide attempts among adults aged 21 years and older increased from 0.62 percent in 2004-2005 to 0.79 percent in 2012-2013. The increase in attempts was greatest among younger adults (those under age 35), especially individuals with no more than a high school education and a low income. Individuals with depression, anxiety and other mental disorders, as well as those with a history of substance abuse or violent behavior, also drove much of the increase.
“The patterns seen in this study suggest that clinical and public health efforts to reduce suicide would be strengthened by focusing on younger patients who are socioeconomically disadvantaged and psychiatrically distressed,” said Olfson.
The study also found a couple of important differences in risk factors between the rate of attempted suicides and that of completed suicides. Although the increase in suicide attempts was greatest among young adults during, suicide completions were more likely among middle-aged adults (ages 45 to 64).
In addition, women were more likely to attempt suicide, but men were more likely to complete the act.
Underreporting is likely
As an editorial that accompanies the study points out, the increase in the U.S. suicide rate since 2000 is probably much greater than reported due to an underreporting of opioid-related suicides. Because of the ambiguous circumstances that can surround such deaths, it’s possible that many medical examiners and coroners are misclassifying opioid-related suicides as “unintentional” or “undetermined.”
No matter what the actual numbers are, suicide — attempted and completed — is one of the country’s major public health issues. It is now the 10th leading cause of death in the U.S.
That’s a tragedy, because, for all its complexity and challenges, suicide is often preventable — if, as a society, we are willing to identify at-risk people early and get them the services they need.
“It is essential now to build public health approaches to preventing suicide, attempted suicides, risk-related premature deaths, and their antecedent adversities under an umbrella of public health and preventive psychiatry,” writes the author of the editorial, Dr. Eric Caine, co-director of the Injury Control Research Center for Suicide Prevention at the University of Rochester. “Many people who have attempted suicide never come to attention of medical personnel until they arrive at the local morgue.”
“Given the cumulative frequency of family, legal, and financial problems, it behooves us to look beyond the walls of our clinics and offices to engage vulnerable individuals and families in diverse settings such as courts and jails, social service agencies, and perhaps the streets long before they have become ‘suicidal,’” he adds. “If we wait until many are considering their options to kill themselves, much like waiting to intervene until someone is in the middle of an occlusion of the anterior descending branch of his left coronary artery (aka, the widow-maker), it likely will be too late.”
For more information: You’ll find abstracts of the study and the editorial on the JAMA Psychiatry website, but the full articles are behind a paywall. If you know someone in crisis, call the toll-free National Suicide Prevention Lifeline (NSPL) at 1-800-273-TALK (8255), 24 hours a day, 7 days a week. The deaf and hard of hearing can reach the lifeline via TTY at 1-800-799-4889. If it’s an emergency, dial 911.