Suicide Attempts More Common, More Lethal, New US Data Show

Megan Brooks

April 30, 2020

From 2006 to 2015, suicide attempts in the US became more common and more lethal in certain subgroups of the population, new data from the Centers for Disease Control and Prevention (CDC) show.

Investigators found the incidence of suicidal acts increased in females, adolescents, and older adults aged 65 to 74 years, whereas suicidal acts became more lethal in both sexes and in those between the ages of 20 to 64 years.

"Effective suicide prevention efforts must be informed by an understanding of whether increased suicide rates are associated with more suicidal acts, greater lethality of suicidal acts, or a combination of both," write Jing Wang, MD, MPH, and colleagues with the CDC's National Center for Injury Prevention and Control.

The study was published online April 22 in JAMA Psychiatry.

Prior US studies show a greater incidence of suicide attempts among some adult subgroups and young people, as well as changing patterns in suicide methods over time.

Between 2000 and 2010, for example, the rate of suicide by suffocation jumped 52% compared with a 19% increase in suicide by poisoning and a 3% increase in firearm-related suicides. 

However, until now, there's been no research examining the trends in both incidence and lethality of suicidal acts. 

Wang and colleagues analyzed data on more than 1.2 million suicidal acts (suicides and nonfatal suicide attempts) from 2006 to 2015 among people aged 10 to 74 years.

Medically treated nonfatal suicide attempts were identified using the Nationwide Inpatient Sample and Nationwide Emergency Department Sample databases, and suicide deaths were identified via the National Vital Statistics System.

The incidence rate of total suicidal acts rose 10% during the study period (annual percentage change [APC] 0.8%; 95% confidence interval [CI], 0.3% - 1.3%). The case fatality rate (CFR) increased 13% (APC, 2.3%; 95% CI, 1.3% - 3.3%).

In subgroup analyses, the incidence rate of suicidal acts increased 1.1% (95% CI, 0.6% - 1.6%) per year for women but held stable for men. The CFR increased for women and men, with APCs of 5% (95% CI, 3.1% - 6.9%) since 2010 for women and 1.6% (95% CI, 0.6% - 2.5%) since 2009 for men.

The data show an increase in incidence rate of suicidal acts among adults aged 65 to 74 years throughout the study period, and among adolescents from 2011 to 2015. The CFR increased since 2009 among those aged 20 to 44 years (APC, 3.7%; 95% CI, 2.5% - 5.0%) and since 2012 for individuals 45 to 64 years (APC, 2.7%; 95% CI, 0% to 5.4%).

Among males and females aged 20 to 64 years, suicidal acts involving guns and suffocation (methods of greater lethality) increased, but suicidal acts by poisoning (a method of lesser lethality) decreased or flattened, "which may explain the observed increases in lethality," the CDC researchers say.

"Adolescents and older adults aged 65 to 74 years experienced general increases in suicide attempts by all means, including poisoning, which was associated with stable or declining lethality for these subgroups," they report.

Wang and colleagues say their findings on population-level epidemiologic patterns may help with efforts to develop comprehensive suicide prevention strategies.

In particular, they say reducing access to lethal means of suicide among those at risk, "which include not only firearms but also medications and other potentially dangerous household products, may be a helpful approach for reducing suicide rates."

"Ultimately, upstream prevention approaches, including teaching coping and problem-solving skills early in life, promoting connectedness, and developing and implementing policies that strengthen economic supports, may mitigate the risk of suicidal behavior for all age groups," they conclude.

The study had no specific funding. The authors have disclosed no relevant financial relationships.

JAMA Psychiatry. Published online April 22, 2020. Abstract

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