Suicide In The United States Research Articles

50.4 Current Rates and Epidemiological Trends of Suicide in the United States: An Alarming Phenomena

50.4 Current Rates and Epidemiological Trends of Suicide in the United States: An Alarming Phenomena

Research on Youth Suicide and Sexual Orientation is Impacted by High Rates of Missingness in National Surveillance Systems

Objective The sexual orientation of youth who die by suicide in the United States is usually unknown. This study assessed how observed patterns of unknown sexual orientation are likely to affect research findings. Methods We analyzed the National Violent Death Reporting System (NVDRS) Restricted Access Dataset to assess whether sexual orientation among youth suicide decedents is disproportionately known for different demographics. We then assessed the degree to which estimated sexual minority rates would be affected if researchers were to assume either (a) that sexual orientation data is missing completely at random, or (b) that orientation information is missing at random after accounting for observed demographic patterns. Results <10% of the sample had known sexual orientation. Sexual orientation was more frequently known for females, white people, and older people, and missingness varied by geography. The choice between modeling the data as missing completely at random versus at random conditional upon demographics had a > 2-fold impact on estimated sexual minority rates among youth suicide decedents. Conclusion Research on sexual orientation and youth suicide is strongly impacted by how researchers account (or do not account) for missingness.

Characteristics of and Circumstances Associated With Female Intimate Partner Problem-Included Suicides: Analysis of Data From the National Violent Death Reporting System (2003-2019).

Intimate partner problems (IPP)-which include divorce, breakups, arguments, jealousy, conflict, discord, and violence-have been robust precipitating factors associated with an increased risk for suicidal thoughts and behaviors. Although research on suicide related to IPP is growing, efforts to explore the circumstances surrounding suicidality among female victims struggling with IPP remain insufficient. To address this gap, this exploratory study sought to understand the circumstances surrounding female IPP-related suicide in the United States. We conducted a secondary analysis of data from the U.S. National Violent Death Reporting System (NVDRS, 2003-2019) which includes 43 states, the District of Columbia, and Puerto Rico. Of the final analytical sample of 58,545 female suicide cases in the United States, we delineated IPP-included suicide cases (13,496, 23.1%) and non-IPP-included suicide cases (45,049, 76.9%). Two-sided Pearson chi-square tests and standardized difference (SD) tests identified significant differences in the surrounding circumstances between IPP-included suicide and non-IPP-included suicide. IPP-included female suicide was more common among younger women, those involved in an intimate relationship, and women who were pregnant or postpartum (p < .001; SD > .10). IPP-included suicide victims were more likely to have experienced depression, substance abuse, and previous interpersonal trauma than non-IPP-included suicide victims (p < .001; SD > .10). Compared to non-IPP-included suicide, IPP-included suicide was more likely to occur at the victim's house or apartment during evening and nighttime by firearm or hanging (p < .001; SD > .10). Our findings also showed that IPP-included suicide victims had previous suicidal thoughts and were more likely to have disclosed their suicidal ideation with others before committing suicide than non-IPP-included suicide victims (p < .001; SD > .10). Findings identified unique circumstances and characteristics possibly associated with IPP-included female suicide. Our understanding of suicide may be enhanced by exploring the causal pathway behind these relationships.

Gun Violence and Risk to Children and Youth in the United States.

As we write this editorial on March 14, 2023, the Gun Violence Archive (2023) reports 110 mass shootings, 48 children aged 0 to 11 killed (114 injured), and 284 teens aged 12 to 17 killed (710 injured) from gun violence so far in 2023 in the United States. Tragically, school shootings are no longer uncommon. Some politicians, lobbyists, national organizations, and gun advocates strongly oppose any type of gun control legislation including universal background checks and closing gaps in background checks before being allowed to purchase a gun, red flag laws, raising the age to 21 to be able to purchase a gun, and bans on sale to the public of assault-type weapons such as semiautomatic military-style weapons and high-capacity magazines often used in mass shootings. Gun violence is the leading cause of death among children and youth aged 0 to 24 in the United States, surpassing deaths from motor vehicle injuries in 2017 (Lee et al., 2022a). Most homicides (~80%) and suicides (~55%) in the United States involve firearms (Kegler et al., 2022). There has been a significant increase in gun violence during the COVID-19 pandemic (Iantorno et al., 2022; Kegler et al., 2022). Not all injuries from guns result in death. Exponentially more children and youth suffer long-term physical and psychological harm from gun violence. In December 2022, the American Academy of Pediatrics published a policy statement on firearm-related injuries and deaths in children and youth and offered strategies for injury prevention and harm reduction (Lee et al., 2022b). Pediatric nurses have many interactions with children, youth, and their families. Pediatric nurses can encourage gun safety among parents who have guns at home including making sure they are unloaded, storing bullets and guns in separate locations, and maintaining guns in a locked gun safe. Parents should be urged to ask other parents and relatives about the state of gun safety when their children are invited to their home. Children and youth should be educated about firearms including what to do if they come across an unsecured weapon. Nurses can be strong advocates for gun control legislation on the local, state, and national level. Despite the heavily funded misinformation campaign that the wide access to guns is not related to the continued increase in firearm violence, injuries, and death, there are ample data to support the link, and evidence-based strategies to promote gun safety and minimize risk of harm from guns (Lee et al., 2022b). The editors of MCN, The American Journal of Maternal Child Nursing strongly support gun control legislation to increase the legal age to purchase a gun to 21, a ban on the sale of assault-type weapons, and universal background checks. Nurses are well positioned to influence change to keep America's children and youth safe from gun violence.

Social Vulnerability and Risk of Suicide in US Adults, 2016-2020

There were over 45 000 suicides in the US in 2020, making suicide the 12th leading cause of death. If social vulnerability is associated with suicide rates, targeted interventions for at-risk segments of the population may reduce US suicide rates. To determine the association between social vulnerability and suicide in adults. This cohort study analyzed 2 county-level social vulnerability measures (the Social Vulnerability Index [SVI] and the Social Vulnerability Metric [SVM]) and US Centers for Disease Control and Prevention-reported county-level suicides from 2016 to 2020. Data were analyzed November and December 2022. County-level variability in social vulnerability. The primary outcome measure was number of county-level adult suicides from 2016 to 2020, offset by county adult population during those years. The association between social vulnerability (measured using the SVI and the newly created SVM for 2018) and suicide was modeled using a bayesian-censored Poisson regression model to account for the CDC's suppression of county-level suicide counts of less than 10, adjusted for age, racial and ethnic minority, and urban-rural county characteristics. From 2016 to 2020, there were a total of 222 018 suicides in 3141 counties. Comparing the least socially vulnerable (0% to 10%) to the most socially vulnerable (90% to 100%) counties, there was a 56% increase in suicide rate (17.3 per 100 000 persons to 27.0 per 100 000 persons) as measured by the SVI (incidence rate ratio, 1.56; 95% credible interval, 1.51-1.60) and an 82% increase in suicide rate (13.8 per 100 000 persons to 25.1 per 100 000 persons) as measured by the SVM (incidence rate ratio, 1.82; 95% credible interval, 1.72-1.92). This cohort study found that social vulnerability had a direct association with risk for adult suicide. Reducing social vulnerability may lead to life-saving reduction in the rate of suicide.

Socioenvironmental drivers of adolescent suicide in the United States: A scoping review.

Socioenvironmental drivers of adolescent suicide in the United States: A scoping review.

Association Between Acute Alcohol Use and Firearm-Involved Suicide in the United States

Firearms are the method of suicide used most often in the US. Acute alcohol use is associated with an increased risk of suicide by firearm. However, the dose-response association between acute alcohol use and the probability of using a firearm as the method of suicide is unknown. To evaluate the association between the amount of alcohol consumed and the probability of using a firearm as the method of suicide. This cross-sectional study used mortality data from the US National Violent Death Reporting System on suicide decedents aged 18 years or older with a positive blood alcohol concentration (BAC; ie, ≥0.01 g/dL). Statistical analysis was performed from January 2003 to December 2020. Acute alcohol use, ascertained via postmortem toxicologic examination. Probability of using a firearm as the method of suicide compared with all other methods of suicide. The study included 45 959 male suicide decedents (mean [SD] age, 42.6 [14.8] years) and 12 136 female suicide decedents (mean [SD] age, 44.2 [13.8] years) with a positive BAC; of those, 24 720 male decedents (53.8%) and 3599 female decedents (29.7%) used a firearm as the method of suicide. The probability of using a firearm as the method of suicide when alcohol is consumed was higher for male decedents, with the probability starting at just below 0.50 and increasing to approximately 0.75. In contrast, for female decedents, the probability began at just above 0.30 and increased to approximately 0.55. For both male and female decedents, the dose-response curves were an inverted U shape; as BAC increased, the probability of firearm-involved suicide initially increased and then decreased at very high BACs (approximately 0.40 g/dL for male decedents and approximately 0.30 g/dL for female decedents; these BACs were present among only a small percentage of alcohol-involved suicides: male decedents, 589 [1.3%]; female decedents, 754 [6.2%]). This cross-sectional study of suicide decedents who had consumed alcohol prior to their death suggests that, as alcohol consumption increased, the probability of a firearm-involved suicide increased until a certain BAC, at which point the probability started to decrease.

When Laws Collide With Responsible Patient Care

When Laws Collide With Responsible Patient Care

What Is Causing the Ongoing Youth MH Crisis?

What Is Causing the Ongoing Youth MH Crisis?

The United States must improve its data infrastructure to ensure high-quality mental health care.

Use of and spending on mental health services in the United States more than doubled over the past two decades. In 2019, 19.2% of adults received mental health treatment (medications and/or counseling) at a cost of $135 billion. Yet, the United States has no data collection system to determine what proportion of the population benefited from treatment. Experts have for decades called for a learning behavioral health care system: a system that collects data on treatment services and outcomes to generate knowledge to improve practice. As the rates of suicide, depression, and drug overdoses in the United States continue to rise, the need for a learning health care system becomes even more pressing. In this paper, I suggest steps to move toward such a system. First, I describe the availability of data on mental health service use, mortality, symptoms, functioning, and quality of life. In the United States, the best sources of longitudinal information on mental health services received are Medicare, Medicaid, and private insurance claims and enrollment data. Federal and state agencies are starting to link these data to mortality information; however, these efforts need to be substantially expanded and include information on mental health symptoms, functioning, and quality of life. Finally, there must be greater efforts to make the data easier to access such as through standard data use agreements, online analytic tools, and data portals. Federal and state mental health policy leaders should be at the forefront of efforts to create a learning mental health care system.

Increases in ‘deaths of despair’ during the COVID-19 pandemic in the United States and the United Kingdom

ObjectivesThe COVID-19 pandemic significantly impacted mental health, health-related behaviours such as drinking and illicit drug use and the accessibility of health and social care services. How these pandemic shocks affected ‘despair’-related mortality in different countries is less clear. This study uses public data to compare deaths from alcohol, drugs and suicide in the United States and the United Kingdom to identify similarities or differences in the impact of the pandemic on important non-COVID causes of death across countries and to consider the public health implications of these trends. Study design and methodsData were taken from publicly available mortality figures for England and Wales, Northern Ireland, Scotland and the United States of America, 2001–2021, and analysed descriptively through age-standardised and age-specific mortality rates from suicide, alcohol and drug use. ResultsAlcohol-specific deaths increased in all countries between 2019 and 2021, most notably in the United States and, to a lesser extent, England and Wales. Suicide rates did not increase markedly during the pandemic in any of the included nations. Drug-related mortality rates rose dramatically over the same period in the United States but not in other nations. ConclusionsMortality from ‘deaths of despair’ during the pandemic has displayed divergent trends between causes and countries. Concerns about increases in deaths by suicide appear to have been unfounded, whereas deaths due to alcohol have risen across the United Kingdom and in the United States and across almost all age groups. Scotland and the United States had similarly high levels of drug-related deaths pre-pandemic, but the differing trends during the pandemic highlight the different underlying causes of these drug death epidemics and the importance of tailoring policy responses to these specific contexts.

Changes in Pregnancy-Associated Deaths in the US During the COVID-19 Pandemic in 2020

This cross-sectional study assesses changes in pregnancy-associated mortality from drug overdose, homicide, suicide, and other causes in the US from 2018 through 2020.

Leveraging Community Context, Data, and Resources to Inform Suicide Prevention Strategies.

Colorado has consistently had one of the highest rates of suicide in the United States, and El Paso County has the highest number of suicide and firearm-related suicide deaths within the state. Community-based solutions like those of the Suicide Prevention Collaborative of El Paso County may be more effective in preventing suicide as they are specific to local issues, sensitive to local culture, and informed by local data, community members, and stakeholders.

Seasonal suicide trends in adolescents in the US: Did they explain the apparent effect of the Netflix show 13 Reasons Why?

Controversy surrounds the effects of the first season of the Netflix show 13 Reasons Why on adolescent suicide in the United States. This research reexamined the question using more sensitive weekly suicide counts and more sensitive tests for seasonal changes in suicide. Weekly suicide counts for adolescents ages 10-19 and young people ages 20-29 obtained from CDC were analyzed from 2013 to 2018 NVSS Mortality Data using time series methods. Adolescents ages 10-19 exhibited seasonal changes in suicides that increased from March to April and that also paralleled the school year. The same seasonal pattern was evident in males ages 20-24. There was no evidence of an effect of 13 Reasons in male adolescent suicides in 2017 once seasonality, auto-correlation, and longer term trends were removed. Seasonal changes and secular increases can explain why previous studies observed suicide increases in March and April of 2017 in male adolescents. The association between school year and suicide suggests that stressors associated with schooling increase the risk of suicide in some youth. How to reduce these risks is an important focus for future research as is the need to understand the conditions under which fictional depictions of suicide lead to contagion.

Improving maternal mental health: assessing the extent of screening and training about peripartum depression

Objective Peripartum depression (PPD) is a common mental health complication of pregnancy and increases risk for maternal mortality and poorer outcomes for children. Despite its importance, screening rates vary across organizations and care team members. The goal of the current study was to explore the perspectives from care team members in both behavioral health and acute care settings about how they screen and refer pregnant and post pregnant women for PPD, what training around PPD is currently offered by their organization, and if they could benefit from additional PPD training. Methods Data were collected from an online self-report survey of care team members from behavioral health and acute care settings in the US. Questions focused on (1) when/if the care teams had a screening protocol for PPD, (2) beliefs about the efficacy of their organization’s PPD screening, identification, and referral process, and (3) if their organization currently offered or needed training around the topic of PPD. Results A total of 794 care team members in behavioral health and acute care responded to the survey between December 2021 and May 2022. Nearly, all (96.7%) reported having a specific protocol for screening for PPD when they know a patient is pregnant; however, only 69.6% of respondents routinely screen regardless of symptoms being reported by the patient. While 93.3% of the sample believed their organization does a good job screening for and identifying PPD, gaps in the referral processes were described, especially in acute settings. 95.3% of the sample reported their organization currently gives training in screening, identifying, or treating PPD or in the process for establishing outpatient referrals for PPD care for care team members who have direct contact with pregnant patients; however, 96.5% also reported their organization would benefit from additional training in one or more of these areas. Conclusion High rates of self-reported PPD screening and training indicate that care team members in both behavioral health and acute care are aware of the importance of maternal mental health issues. However, other research indicates that high rates of screening may not lead to improved outcomes, and there are still high rates of maternal suicide and suicidal ideation in the US. It is possible that high self-reported screening rates may indicate a false sense of security such that care team members feel the issue is addressed while problems remain. Alternatively, many respondents felt their organizations would benefit from further training, perhaps indicating an awareness of this gap. Care team members in behavioral health and acute care settings should increase collaboration to ensure high rates of screening lead to improved maternal mental health care.

Unemployment and Suicide in the United States: The Import of Addressing Cross-Sectional Dependence

Abstract Recent reviews of the sociological and economic-based ecological studies of suicide find cyclical unemployment to be a key suicide risk factor, though the evidence presented is mixed at best. The ambiguity of the ecological associations appear to stem from faulty statistical methodologies. Panel treatments offer advantages over conventional time-series methods by exploiting cross-section variation. However, if the added cross-section units are cointegrating (dependent) and independence is presumed, incorrect statistical inference and inconsistent coefficient estimation can result. Herein, we fully address the import of cross-sectional dependence on the ecological relationship between U.S. unemployment rates and suicide rates using an 81-year panel of the 48 contiguous states and the District of Columbia. When proper allowances are made for cross-section dependence at each step of the examination, we find no significant statistical association, short-run or long-run, running from unemployment to suicide rates in the U.S. Results of this sequential analysis highlight potential sources of the ambiguity found in the literature. JEL classification number: B55, C31, C49. Keywords: Suicide rates, Cointegration, Cross-section dependence.

Voluntary Firearm Divestment and Suicide Risk: Real-World Importance in the Absence of Causal Identification.

Voluntary Firearm Divestment and Suicide Risk: Real-World Importance in the Absence of Causal Identification.

Deaths of Despair: A Scoping Review on the Social Determinants of Drug Overdose, Alcohol-Related Liver Disease and Suicide.

Background: There is a lack of consensus on the social determinants of Deaths of Despair (DoD), i.e., an increase in mortality attributed to drug overdose, alcohol-related liver disease, and suicide in the United States (USA) during recent years. The objective of this study was to review the scientific literature on DoD with the purpose of identifying relevant social determinants and inequalities related to these mortality trends. Methods: Scoping review focusing on the period 2015–2022 based on PubMed search. Articles were selected according to the following inclusion criteria: published between 1 January 2000 and 31 October 2021; including empirical data; analyzed DoD including the three causes defined by Case and Deaton; analyzed at least one social determinant; written in English; and studied DoD in the USA context only. Studies were excluded if they only analyzed adolescent populations. We synthesized our findings in a narrative report specifically addressing DoD by economic conditions, occupational hazards, educational level, geographical setting, and race/ethnicity. Results: Seventeen studies were included. Overall, findings identify a progressive increase in deaths attributable to suicide, drug overdose, and alcohol-related liver disease in the USA in the last two decades. The literature concerning DoD and social determinants is relatively scarce and some determinants have been barely studied. However different, however, large inequalities have been identified in the manner in which the causes of death embedded in the concept of DoD affect different subpopulations, particularly African American, and Hispanic populations, but blue collar-whites are also significantly impacted. Low socioeconomic position and education levels and working in jobs with high insecurity, unemployment, and living in rural areas were identified as the most relevant social determinants of DoD. Conclusions: There is a need for further research on the structural and intermediate social determinants of DoD and social mechanisms. Intersectional and systemic approaches are needed to better understand and tackle DoD and related inequalities.

Distinct groups of firearm owners with differential risk for suicide in the United States: A latent class analysis

Suicide is a leading cause of mortality and firearm suicide accounts for the majority of fatalities. Firearm owners are a diverse population and firearm-specific suicide prevention programs should be tailored to distinct at-risk firearm-owning groups. This study set out to identify groups of firearm owners with differential suicide risk having unique characteristics that could be used to customize suicide prevention efforts. We conducted a nationally-representative survey of 2646 firearm owners to assess individual suicide risk, suicide risk factors, and demographic characteristics. A Latent Class Analysis identified unique segments of firearm owners at increased risk of suicide with similar underlying suicide risk factors and demographic characteristics. We found almost one in ten (9.6%) of firearm owners were at increased risk of suicide with 25% reporting suicide ideation, 6.6% reporting suicide planning, and 1.8% reporting previous suicide attempts. We identified three unique groups of firearm owners with higher than average suicide risk. Relative to other groups of firearm owners, one at-risk group were more affluent with a history of adverse experiences and mental health challenges, a second group had more male veterans with high levels of alcohol consumption, and third group had more non-heterosexual women who experienced trauma. We conclude that there are three unique groups of firearm owners with higher than average suicide risk with very different characteristics. In addition to broad suicide prevention efforts, customized firearm suicide prevention programs should be developed individually for these different firearm-owning populations, taking into consideration the unique suicide risk factors and demographics of each group.

Saving light, losing lives: How daylight saving time impacts deaths from suicide and substance abuse.

This paper estimates the impact of Daylight Saving Time (DST) on deaths from suicide and substance abuse in the United States. Using Multiple Cause-of-Death Mortality Data from the National Vital Statistics System of the National Center for Health Statistics from 1979 to 1988, the effect is identified in two ways: a regression discontinuity design that exploits discrete time changes in the Spring and Fall; and a fixed effects model that uses a policy change and a switching mechanism that introduces random variation to DST's start and end dates. This is one of the first attempts to estimate the impact of DST on deaths due to suicide and substance abuse and the first to use either identification strategy. The results from both methods suggest that the sleep disruptions during the Spring transition cause the suicide rate to rise by 6.25 percent and the death rate from suicide and substance abuse combined to increase by 6.59 percent directly after the time change. There is no evidence for any change in these outcomes during the Fall transition. The contrasting results from Spring to Fall suggest the entire effect can be attributed to disruptions in sleep patterns rather than changes in ambient light exposure.