Suicide

Suicide in United States

United States

Suicide is the 12th-leading cause of death in the United States. It is the fourth-leading cause of death for adolescents ages 15-19 globally. In 2020, an estimated 3.2 million people planned a suicide, 1.2 million attempted suicide and there were 45,979 deaths by suicide. More than half of all suicides involved firearms and there were almost twice as many deaths by suicide than by homicide.

When someone dies by suicide, as with any cause of death, the loss is felt by many people. The ripples of loss spread from close family and friends to community members, acquaintances and even people the deceased did not know. All of those exposed to the loss may experience different levels of grief and trauma. 

Societal costs associated with suicide and suicide attempts are estimated at $93.5 billion. These costs include lifetime medical fees and lost work. 

Mental health and substance use disorders are the most significant risk factors for suicidal behaviors. In addition, environmental factors such as stressful life events and access to lethal means such as firearms or drugs may increase the risk of suicide. Previous suicide attempts and a family history of suicide are also important risk factors.

The rate of suicide is higher among: 

• Males, who have a rate 4 times higher than females.
• The American Indian/Alaska Native population, who have a rate more than 3 times higher than the Asian population.
• Adults ages 85 and older than individuals ages 15-24.
• Veterans compared with non-veteran adults.
• Those living in rural areas compared with those living in urban areas.
• LGBTQ adults and youth compared with heterosexual adults and youth.

Strategies to reduce suicide include:

• Universal screening at emergency rooms to identify patients at higher risk of suicide.
• Safety planning at emergency rooms to assist patients with suicidal behaviors by providing them with a prioritized list of evidence-based coping strategies and sources of support.
• Cognitive behavioral therapy to identify and manage suicidal thoughts. 
• Reducing access to lethal means such as firearms, lethal doses of medications and alcohol. Studies over the past two decades show a strong association between the presence of a firearm in the home and an increased risk of suicide for the gun owner and the gun owner’s spouse and children. At the community level, the Gun Shop Project builds partnerships between firearms businesses and public health experts to provide firearm suicide prevention educational materials to firearms retailers, instructors and customers. 
• Devoting resources to the ten public health domains of suicide prevention outlined in The State of State, Tribal and Territorial Suicide Prevention report.

The Suicide Prevention Resource Center has detailed resources for implementing effective suicide prevention in schools and universities, emergency departments, American Indian/Alaska Native communities and other organizations that serve populations at risk for suicide. In 2022 the 988 Suicide & Crisis Lifeline was launched to provide an easy-to-remember number and 24/7 confidential support for people in distress, as well as prevention and crisis resources, by call, text or online chat. The previous National Suicide Prevention Lifeline number (1-800-273-TALK(8255)) is also active and can still be used.

Reducing the suicide rate to 12.8 suicides per 100,000 population is a Healthy People 2030 objective.

Allchin, Adelyn, Vicka Chaplin, and Joshua Horwitz. “Limiting Access to Lethal Means: Applying the Social Ecological Model for Firearm Suicide Prevention.” Injury Prevention 25, no. Suppl 1 (September 1, 2019): i44–48. https://doi.org/10.1136/injuryprev-2018-042809.

Conner, Kenneth R., Jeffrey A. Bridge, Dustin J. Davidson, Carly Pilcher, and David A. Brent. “Metaanalysis of Mood and Substance Use Disorders in Proximal Risk for Suicide Deaths.” Suicide and Life-Threatening Behavior 49, no. 1 (2019): 278–92. https://doi.org/10.1111/sltb.12422.

Dunlap, Laura J., Stephen Orme, Gary A. Zarkin, Sarah A. Arias, Ivan W. Miller, Carlos A. Camargo, Ashley F. Sullivan, et al. “Screening and Intervention for Suicide Prevention: A Cost-Effectiveness Analysis of the ED-SAFE Interventions.” Psychiatric Services 70, no. 12 (August 27, 2019): 1082–87. https://doi.org/10.1176/appi.ps.201800445.

National LGBT Health Education Center. “Suicide Risk and Prevention for LGBTQ People.” Boston, MA: The Fenway Institute, September 2018. https://www.lgbtqiahealtheducation.org/wp-content/uploads/2018/10/Suicide-Risk-and-Prevention-for-LGBTQ-Patients-Brief.pdf.

Office of Mental Health and Suicide Prevention. “2021 National Veteran Suicide Prevention Annual Report.” Washington, D.C.: U.S. Department of Veterans Affairs, September 2021. https://www.mentalhealth.va.gov/docs/data-sheets/2021/2021-National-Veteran-Suicide-Prevention-Annual-Report-FINAL-9-8-21.pdf.

Opoliner, April, Deborah Azrael, Catherine Barber, Garrett Fitzmaurice, and Matthew Miller. “Explaining Geographic Patterns of Suicide in the US: The Role of Firearms and Antidepressants.” Injury Epidemiology 1, no. 1 (March 20, 2014): 6. https://doi.org/10.1186/2197-1714-1-6.

Shepard, Donald S., Deborah Gurewich, Aung K. Lwin, Gerald A. Reed, and Morton M. Silverman. “Suicide and Suicidal Attempts in the United States: Costs and Policy Implications.” Suicide and Life-Threatening Behavior 46, no. 3 (June 2016): 352–62. https://doi.org/10.1111/sltb.12225.

Stanley, Barbara, Gregory K. Brown, Lisa A. Brenner, Hanga C. Galfalvy, Glenn W. Currier, Kerry L. Knox, Sadia R. Chaudhury, Ashley L. Bush, and Kelly L. Green. “Comparison of the Safety Planning Intervention With Follow-up vs Usual Care of Suicidal Patients Treated in the Emergency Department.” JAMA Psychiatry 75, no. 9 (September 1, 2018): 894–900. https://doi.org/10.1001/jamapsychiatry.2018.1776.

Steelesmith, Danielle L., Cynthia A. Fontanella, John V. Campo, Jeffrey A. Bridge, Keith L. Warren, and Elisabeth D. Root. “Contextual Factors Associated With County-Level Suicide Rates in the United States, 1999 to 2016.” JAMA Network Open 2, no. 9 (September 4, 2019): e1910936–e1910936. https://doi.org/10.1001/jamanetworkopen.2019.10936.