Suicide Attempts Rising in America

Megan Brooks

September 13, 2017

There has been an increase in suicide attempts among adults in the United States in recent years, especially among younger adults with less formal education and those with common personality, mood, and anxiety disorders, new research suggests.

"Because attempted suicide is the greatest known risk factor for completed suicide, reducing suicide attempts is an important public health and clinical goal," write the researchers, led by Mark Olfson, MD, MPH, of Columbia University, New York City.

"The pattern of suicide attempts supports a clinical and public health focus on younger, socioeconomically disadvantaged adults, especially those with a history of suicide attempts and common personality, mood, and anxiety disorders," they add.

The study was published online September 13 in JAMA Psychiatry.

Vulnerable Groups

Data for the analysis were drawn from 34,629 participants in the National Institute on Alcohol Abuse and Alcoholism's 2004-2005 wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and 34,712 participants in the 2012-2013 NESARC-III. Both surveys asked questions about the occurrence and timing of suicide attempts.

The percentage of adults aged 21 years and older who attempted suicide increased significantly, from 0.62% in 2004-2005 to 0.79% in 2012-2013. In both surveys, most adults who attempted suicide were women (60% in 2004-2005 and 61% in 2012-2013) and were younger than age 50 (85% and 80%).

The adjusted risk differences (ARDs) for suicide attempts were significantly larger for adults aged 21 to 34 than for adults aged 65 and older (0.48% vs 0.06%; interaction P = .04) and for adults with no more than a high school education than among those with a college degree (0.49% vs 0.03%; interaction P = .003).

Young adults and those with less formal education ― the two groups who experienced disproportionately large increases in suicide attempt risk during the study period ― may have been particularly vulnerable to economic stress and psychological distress associated with deterioration in the US economy, the researchers note.

The ARD for suicide attempt was also significantly larger for adults with these conditions than for those without: antisocial personality disorder (2.16% vs 0.07%; P = .01); history of violent behavior (1.04% vs 0.00%; P = .003); history of anxiety (1.43% vs 0.18%; P = .01); and history of depressive disorders (0.99% vs -0.08% P = .05).

"These findings highlight an increasing prevalence of suicide attempts and underscore the prominent role of mental disorders, including personality disorders, in risks for suicide attempts at the population level," Dr Olfson and colleagues say.

Beyond the Clinic Walls

"Despite the efforts of many, suicides and attempted suicides continue to increase in the United States," Eric Caine, MD, of the Injury Control Research Center for Suicide Prevention, Department of Psychiatry, University of Rochester Medical Center, New York, writes in a linked editorial.

"It is essential now to build public health approaches to preventing suicide, attempted suicides, risk-related premature deaths, and their antecedent adversities under an umbrella of public health and preventive psychiatry. Many people who have attempted suicide never come to attention of medical personnel until they arrive at the local morgue," Dr Caine says.

"Given the cumulative frequency of family, legal, and financial problems," he adds, "it behooves us to look beyond the walls of our clinics and offices to engage vulnerable individuals and families in diverse settings such as courts and jails, social service agencies, and perhaps the streets long before they have be come 'suicidal.' If we wait until many are considering their options to kill themselves, much like waiting to intervene until someone is in the middle of an occlusion of the anterior descending branch of his left coronary artery (aka, the widow-maker), it likely will be too late."

The study was supported by grants from the National Institutes of Health and the New York State Psychiatric Institute. The authors and Dr Caine have disclosed no relevant financial relationships.

JAMA Psychiatry. Published online September 13, 2017. Full text, Editorial

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