U.S. Experiences Uptick In Rates of Suicide

This past April, the CDC’s National Center for Health Statistics released updated data on suicide rates in the United States, which revealed an alarming trend.

After experiencing a period of nearly consistent decline in suicide rates from 1986 through 1999, the United States experienced a 24 percent increase in suicide between the years 1999 and 2014—rising from 10.5 to 13.0 per 100,000 people—with increases for both males and females in nearly every age bracket.

“This report reaffirms that psychiatrists and other providers need to identify individuals at risk for suicide, such as people with depression, anxiety, and substance use disorders, and treat them aggressively,” said APA President Maria A. Oquendo, M.D., who has conducted extensive research into suicide prevention.

Such rigorous suicide prevention eincludes treating psychiatric illness, but also specifically targeting suicidal behavior through approaches like dialectical behavior therapy.

Safety planning is another critical tool at a therapist’s disposal, she added. “Safety planning is a straightforward approach to help someone identify triggers for suicidal ideation and make a plan to manage them,” she said. “It may involve listening to music or finding someone to talk to; they may seem like obvious items, but a suicidal patient would not think of them.”

As to why rates have been rising these past two decades, David Fassler, M.D., a clinical professor of psychiatry at the University of Vermont College of Medicine, highlighted several potential contributing factors, including improved reporting, economic distress such as the 2007-2008 financial crisis, the increasing availability of opiates, and continuing challenges with timely access to effective care for people with psychiatric disorders.

The rise of social media may also be a contributing factor, especially for children exposed to cyberbullying and other online stressors. Indeed, the suicide rates for boys and girls 10 to 14 showed some of the greatest increases between 1999 and 2014; there was a 37 percent increase among boys 10 to 14 and a 200 percent increase among girls 10 to 14.

“The report, however, does not speculate on the causes for the observed increase in the suicide rates,” Fassler stressed. “Clearly, further research is needed to fully understand the implications of the current findings.”

While the increase in suicides, particularly among youth, garnered much of the media’s attention after the release of the suicide data and reawakened speculation about the impact of the black-box warnings on antidepressant use and suicide risk in people under 25, there was one overlooked group for whom the trends were going in the right direction.

Positive Data on Older Adults

Adults 75 and older of both sexes showed modest but clear decreases in suicide rates; males had an 8 percent decrease (from 42.4 to 38.8 per 100,000), and females had an 11 percent decline (from 4.5 to 4.0 per 100,000).

Aaron Levin

Yeates Conwell, M.D., professor and vice chair of psychiatry at the University of Rochester Medical Center and co-director of its Center for the Study and Prevention of Suicide, thinks that improvements to the health care system have helped drive these lower rates.

For one, advances in medicine are reducing disability and impairment among seniors, while laws such as the Mental Health Parity and Addiction Equity Act and the Medicare Improvements for Patients and Providers Act have made psychiatric care more accessible and eliminated the discriminatory copay for Medicare beneficiaries with mental illness.

In addition, while social media presents risks for some children, it can help seniors feel more connected to their friends and family.

“Over the past decade, we have been doing well at addressing three of the four D’s that influence suicide in older adults: depression, debility, and disconnectedness,” Conwell told Psychiatric News.

The fourth D—access to “deadly means,” particularly firearms—remains a strong concern.

“That’s why I have mixed feelings about these statistics,” Conwell said. “It is great to see suicide rates diminishing among the elderly, but still too many older adults, particularly men, are taking their own lives.”

A major concern is the looming demographic bubble of middle-aged adults that includes a large portion of the baby-boom generation. In the study period, adults aged 45 to 64 saw some of the largest increases in suicide risk (from 6.0 to 9.8 per 100,000 in women and from 20.8 to 29.7 per 100,000 in men) and also represented the most deaths by suicide in terms of raw numbers.

“Each generation has its own social and cultural traits,” explained Conwell, suggesting that as this cohort ages, they may bring along an elevated suicide risk into the next age bracket. “I’m not sure whether we will keep seeing suicide rates among the elderly decrease,” he said.

To try to keep the suicide rate from increasing among older adults, Conwell suggested that in addition to the efforts of health care professionals, families and communities can help by taking advantage of the skills and life experiences of these individuals, for example by encouraging more volunteerism among seniors.

“I believe that if older adults feel more assured that they have a role in later life, they will feel valued, and that will lead to positive mental health outcomes,” he said. ■