Author:
Perry Seth W.,Rainey Jacob C.,Allison Stephen,Bastiampillai Tarun,Wong Ma-Li,Licinio Julio,Sharfstein Steven S.,Wilcox Holly C.
Abstract
AbstractSuicide rates in the United States (US) reached a peak in 2018 and declined in 2019 and 2020, with substantial and often growing disparities by age, sex, race/ethnicity, geography, veteran status, sexual minority status, socioeconomic status, and method employed (means disparity). In this narrative review and commentary, we highlight these many disparities in US suicide deaths, then examine the possible causes and potential solutions, with the overarching goal of reducing suicide death disparities to achieve health equity.The data implicate untreated, undertreated, or unidentified depression or other mental illness, and access to firearms, as two modifiable risk factors for suicide across all groups. The data also reveal firearm suicides increasing sharply and linearly with increasing county rurality, while suicide rates by falls (e.g., from tall structures) decrease linearly by increasing rurality, and suicide rates by other means remain fairly constant regardless of relative county urbanization. In addition, for all geographies, gun suicides are significantly higher in males than females, and highest in ages 51–85 + years old for both sexes. Of all US suicides from 1999–2019, 55% of male suicides and 29% of female suicides were by gun in metropolitan (metro) areas, versus 65% (Male) and 42% (Female) suicides by gun in non-metro areas. Guns accounted for 89% of suicides in non-metro males aged 71–85 + years old. Guns (i.e., employment of more lethal means) are also thought to be a major reason why males have, on average, 2–4 times higher suicide rates than women, despite having only 1/4—1/2 as many suicide attempts as women. Overall the literature and data strongly implicate firearm access as a risk factor for suicide across all populations, and even more so for male, rural, and older populations.To achieve the most significant results in suicide prevention across all groups, we need 1) more emphasis on policies and universal programs to reduce suicidal behaviors, and 2) enhanced population-based strategies for ameliorating the two most prominent modifiable targets for suicide prevention: depression and firearms.
Funder
national institute of mental health
Publisher
Springer Science and Business Media LLC
Subject
Public Health, Environmental and Occupational Health
Reference195 articles.
1. Jorm AF, Patten SB, Brugha TS, Mojtabai R. Has increased provision of treatment reduced the prevalence of common mental disorders? Review of the evidence from four countries. World Psychiatry. 2017;16(1):90–9.
2. Perry SW, Allison S, Bastiampillai T, Wong M-L, Licinio J, Sharfstein SS, Wilcox HC: Rising US Suicides: Achieving Health Equity. OSF Preprints, November 22, 2019 1031219/osfio/m5q64
3. National Center for Health Statistics, Mortality Data on CDC WONDER [https://www.wonder.cdc.gov/ucd-icd10.html]
4. National Stakeholder Strategy for Achieving Health Equity. Rockville, MD: By: National Partnership for Action to End Health Disparities, US Department of Health and Human Services, Office of Minority Health; 2011 (https://www.minorityhealth.hhs.gov/npa/files/Plans/NSS/CompleteNSS.pdf).
5. Hedegaard H, Curtin SC, Warner M. Suicide Mortality in the United States, 1999–2017. NCHS Data Brief. 2018;330:1–8.