A National Suicide Epidemic
America faces an unprecedented suicide epidemic. According to a study conducted by the Center for Disease Control (CDC), the national suicide rate increased by more than 25% between 1999 and 2016, and has increased by more than 30% in more than half of U.S. states. In 2016 alone, nearly 45,000 people took their own lives. With the recent suicides of high-profile celebrities Kate Spade and Anthony Bourdain, the U.S. suicide epidemic is once again front and center in the public eye.
Long thought to be primarily a mental health issue, the CDC study reveals that may not be the case. While there is certainly a difficulty in determining whether a suicide was caused by mental health issues, the study reveals that more than 54% of Americans who died by suicide had no previously known mental health issues. With relational issues, financial troubles, and substance use disorders all contributing to the epidemic, numbers indicate suicide is an issue that needs to be addressed by those in both public and private spheres, from the government to healthcare officials to the private home. But what exactly needs to be done?
We take a comprehensive look at the American suicide epidemic––who’s at risk, the major factors contributing to the issue, and what America can do moving forward.
Data indicates that over the past 20 years, suicide rates have increased across gender, age and ethnic lines in every state except for Nevada. As it stands, suicide is the second highest cause of death in persons ages 10 to 34, and the fourth leading cause of death in persons ages 35 to 64. In 2016, there were twice as many suicides as homicides.
While the rates have generally increased for every demographic, suicide rates vary by gender. For starters, men are nearly 4 times more likely to die by suicide than females. Of the 121 Americans who die from suicide each day, 93 of those are men. However, females are more likely than males to have suicidal thoughts and actually make a suicide attempt.
There are a number of theories as to why this may be the case, including theories around men having a higher intent in suicide and being more likely to drink alcohol before an attempt. But this disparity is most likely due to the means by which men and women attempt suicide. 56.6 percent of men attempt suicide by firearm, whereas the most common method for women is poisoning––i.e. overdosing on painkillers.
Julie Cerel, president of the American Association of Suicidology and a professor at the University of Kentucky School of Social Work, told an NBC News reporter in 2017 that another reason for the higher suicide rate among men is that, “Men notoriously don’t seek help. And as people are aging and at a place in their lives where the world isn’t looking the way they want, men especially don’t know how to reach out and get help or express that they’re feeling pain."
Studies have also found that there is a high disparity with suicide rates when it comes to race and ethnicity. According to the Suicide Prevention Resource Center, the rate of suicide among American Indians/Alaska Natives was 21.39 per 100,000 and the rate of suicide among non-Hispanic whites was 18.15. From there, there is a dramatic drop off. The suicide rate is 7.00 among Asian/Pacific Islanders, while the rate for Hispanics is 6.38 and the rate for African Americans is the lowest at 6.35.
In the conversation about suicide, it is important to note that the group of people most at risk are middle aged white men between the ages of 45 and 54. In fact, 70% of suicides happen among white middle aged men, and 90% of these men are from a lower socioeconomic class. Experts theorize that there are a number of factors at play that contribute to this, but many reference an idea called “hegemonic masculinity.” In the book, “Explaining suicide: Patterns, Motivations and What Notes Revealed” the authors claim that white middle aged men have a social stereotype and standard they feel obligated to live up to. These expectations are unrealistic and the world around them is changing and making it less feasible. For example, many of these men feel they have to be providers for themselves and their families. However, due to the mechanization of the economy, many of these men in lower socioeconomic situations are losing jobs and watching job prospects dwindle. Therefore, they are facing increased levels of poverty and hopelessness. This is troubling for any individual, but given that it strikes at a man’s identity as independent and a provider––it is even more devastating for people in this demographic. Relationally, there is in increased rate of divorce among men in this age range. As stated earlier, men are less likely to open up about their struggles to anyone except for a partner. Without a partner, there is no outlet to deal with the emotions.
While suicide rates have increased in every state except for Nevada, statistics show that there is a higher rate of suicide in western states. And the numbers in the west are so drastic that in 2011 sociologist Matt Wray of UNLV deemed the region the “suicide belt.” Montana, Alaska, Wyoming, New Mexico, Utah, Idaho, Nevada, Oklahoma, Colorado and South Dakota made up the top 10 states for suicide rates respectively. According to Wray in a Freakonomics Radio interview, "The Intermountain West is a place that is disproportionately populated by middle-aged and aging white men, single, unattached, often unemployed, with access to guns."
Mental Health in America, a leading community-based non-profit, ranks states based on access to treatment, access to insurance, quality and cost of insurance, workforce availability and access to special education when assessing a state’s ability to provide access to mental health care. It is worthy to note that many of the states who have the lowest suicide rates––New York, Massachusetts, Maryland, Connecticut, Rhode Island and Delaware, to name a few––also rank highest when it comes to access to care. Likewise, many of the western states rank among the lowest in the nation when it comes to access to care.
Looking at other countries where suicide rates are decreasing further strengthens the idea that there is a strong correlation between access to care and suicide rates. Much of western Europe except for the Netherlands saw a decrease in suicide rates between 2000 and 2012. Compared to these western European countries such as France, Finland and Belgium, the U.S. spends a much smaller percentage of its GDP on social welfare programs. Whereas France spends 31.5 percent of its GDP on social welfare programs, the U.S. spends 18.5 percent on these programs.
Suicide is complicated at every level, so it’s important to frame any conversation about it in terms of factors that contribute to an individual’s suicide, rather than cause that person to take their life. It is clear that there is a suicide epidemic, but what are the factors contributing to the rising numbers?
For a long time, suicide was often pegged as a depression or mental health issue. That’s part of the story. Depression is the most common condition associated with suicide. Depression leaves individuals with feelings of isolation, helplessness and hopelessness, disinterest in daily activities, and anger or irritability. And while depression and other mood disorders are major contributing factors, 54 percent of people who took their lives didn’t have a previously known mental health disorder, according to the CDC study. That is not to say that more people who took their lives did not suffer from a mental health condition. There may have been mental health issues but circumstances prevented them from being diagnosed, known or reported. However, focusing merely on mental health would not give a full picture of risk factors.
The CDC study also revealed other contributing situational factors including relationship problems, substance use disorders, a recent or impending crises, physical health issues, and financial issues that contributed to a majority of the suicides. With that being said, there are a few societal trends that are worth looking at in order to understand why rates may be rising.
Substance Use Disorders and Suicide
According to the CDC study, substance use disorders were a factor in 28 percent of suicides. Those with a substance use disorder are six times more likely to commit suicide than those without substance use disorders. Numbers are much higher when considering suicide attempts. Prior research even suggests that alcoholism is the strongest predictor of suicide, not a psychiatric diagnosis. Opioid, heroin, and alcohol abuse are all rising in the U.S. Lead researcher Dr. Deborah Stone of the CDC suicide study also posits that the opioid crisis that has hit the western states particularly hard could be an additional contributing factor to why suicide rates are higher in that region.
But what is it about substance use disorders that make them a risk factor for suicide? To start, those under the influence tend to lose their inhibitions and take risks they may not normally take. Additionally, depressants such as alcohol repress the chemical in the body responsible for regulating anxiety and reducing depression, so heavy use can trigger depression. Substance use disorders can also negatively affect the other major suicide risk factors, which makes them an extremely dangerous risk factor. Those with substance use disorders often experience relationship hardship, financial hardship and other factors that contribute to suicide. As substance use disorders continue to rise, trends indicate that suicide rates will also rise.
As stated earlier, one of the leading factors of suicide according to the CDC is relationship problems. This could include, but is not limited to, abuse, emotional conflict or loss. According to attachment theory in a romantic relationship, the type of attachment adults form to a romantic partner is similar to the type of attachment a child forms to his or her parents. With these relationships comes a sense of identity, security and comfort. Studies suggest that the loss of an important romantic relationship, and the subsequent loss of identity, security and comfort can lead to emotional vulnerability and depression.
When considering relationships in general, not just romantic relationships, the same thought process applies. In an article for Thrive Global, Dr. Robin Stern says, “We know that feeling connected to family and friends — a sense of belonging — reduces suicide risk dramatically.” These relationships also teach important coping mechanisms and how to deal with negative emotions. It is then not difficult to look at the way society is developing and see a weakening of these relationships as an ever-growing concern in the suicide epidemic. Divorce rates are at an all-time high and social media is rising affecting intimacy and impairing important social skills.
When looking at the rise in social media and smart usage in comparison with the rise of suicide, it is difficult to ignore the connection, especially among teenagers. According to CDC statistics, suicide is the second leading cause of death among teenagers. Factors such as cyber bullying, and the presentation of perfection in other people’s lives has been noted as having harmful effects on mental health. In a study published in Clinical Psychological Science, teenagers who spent at least five hours daily on an electronic device, including a smartphone, were 70% more likely to have suicidal thoughts than those who reported one hour of daily use. Interviews with teenagers suggest that social media use increases their feelings of feeling left out when they see friends hanging out without them, as well as feelings of despair when their lives don’t look anything like the perfect moments they see on Facebook or Instagram.
Theories suggest that while social media has one effect of connecting people across the world, it may also have the effect of making individuals feel more isolated and alone than ever before. As American society gets used to interacting through smart phones and social media, we stop learning how to make the healthy human connections that are essential for healthy human development. It’s through face-to-face interactions that, among other things, we learn how to manage conflict, cope with negative emotions, express and receive love. Depression, isolation, and critical relational issues can open the door for suicidal thoughts.
Over the past decade, there have been a number of high profile celebrities who died of suicide––notably, Robin Williams in 2014, and Kate Spade and Anthony Bourdain in 2018. Statistics paint a clear picture that while these deaths were tragic in their own right, they may have also contributed to an increase in the number of suicides immediately following. In the five months immediately following Robin Williams death, the number of suicides rose 10 percent. Not only that, but the number of suffocation suicides, which is how Williams died, rose by the 32.3 percent. In a similar vein, the National Suicide Prevention Lifeline says calls have spiked by 25 percent following the death of Spade and Bourdain. Experts have long called this phenomenon “suicide contagion” or “copycat suicide.”
Experts don’t know for sure why a suicide like Williams’ would spark an increase in other people immediately following. However, theories suggest that when headlines and storylines of the deceased don’t use discretion and don’t follow media guidelines regarding the communication of suicide, there can be a glamorization of suicide that makes it seem more attractive as an option to those who may be considering it.
“Maybe it is a 'just do it' phenomenon” said one psychologist we spoke with. “I don't think we can change it. Although it is common that press articles will talk about a person 'fighting demons' rather than suffering from a mental illness.”
It is not difficult then to see how the rise of 24/7 media coverage, where journalists might not adhere to media guidelines for the sake of reporting the story quickly, might contribute to copycat suicides.
Suicide is an intricate, complicated web of factors that all push and pull one another. And while the outlook at this moment in history appears grim, the good news is that we as a society are now coming to understand just how complex it is.
“First and foremost, we should stop equating school and other mass shootings with mental illness. This adds to the stigma toward the mentally ill and makes people less likely to discuss their needs for help,” said one psychologist and clinical writer. “Only a very small percentage of shootings are committed by someone with mental illness. Improve health coverage so that all individuals can access high quality care. Dedicate more federal funds to mental health research.”
It is no longer seen as a single faceted issue, which means everyone––from the federal government to the healthcare system to the individual family unit––is beginning to realize they all have a role in fixing the issue.
Online Suicide Prevention Courses, offered by Relias Academy
As a provider of online training for the healthcare industry, Relias Academy offers a number of online courses that cover suicide prevention and related topics. Browse our selection of suicide prevention courses to learn more about this important topic and what you can do.