psychiatric disorders
Suicidal Behavior
Epidemiology of Suicidal Behavior
Statistics on suicidal behavior are based mainly on death certificates and inquest reports and underestimate the true incidence. To provide more reliable information in the United States, the Centers for Disease Control and Prevention (CDC) established a state-based system called the National Violent Death Reporting System (NVDRS), which collects facts about each violent incident from various sources to provide a clearer understanding of the causes of violent deaths (homicides and suicides). The NVDRS is now in place in all 50 states, the District of Columbia, and Puerto Rico. In the United States, suicide had been the 10th leading cause of death for several decades until 2020, when COVID-19 became the third leading cause of death and displaced suicide from the top 10 ( Epidemiology references ). The US suicide rate increased from 1999 through 2018 by an overall 36% (from 10.2 to 14.2/100,000 people per year), followed by 2 consecutive years of decreasing rates in 2019 and 2020. US 2021 suicide data, unfortunately, showed a 4% increase from 2020 to 2021 ( In 2021, the age groups with higher suicide rates were adults ages 25 to 34 and 75 to 84, but rates were highest for adults older than 85. The highest suicide rate across racial and ethnic groups by age is found among American Indian youth ( Epidemiology references ). However, in terms of overall burden of suicide, White males, who make up approximately one third of the US population, account for 7 in every 10 suicides in the United States. Emerging data also indicate increasing suicide rates among Black, Hispanic, and Asian American populations ( In the 1990s, Suicidal Behavior in Children and Adolescents rates decreased after more than a decade of steady increase, only to start climbing again in the early 2000s due to an alarming increase in suicide deaths by gun. Numerous influences are likely related to the increasing trends in suicide rates among children and adolescents, including the following ( Unaddressed mental health conditions (including Depressive Disorders , Health conditions such as Traumatic Brain Injury (TBI) or Adverse childhood events (including abuse, neglect, loss) Experiences of trauma or loss (including unstable home environment; growing up with a parent with mental illness; exposure to peer suicide and/or a relative who died by suicide; experience of bullying or discrimination based on race, gender, or sexual orientation) Research on the role of social media is evolving and so far reveals a complex and variable influence of social media use, ranging from detrimental effects on mood, sleep, and suicidal ideation to positive interpersonal connectedness for some people, which can actually be protective ( Epidemiology references ). (See also Male deaths by suicide outnumber female deaths approximately 2.5:1 to 4:1 globally and nearly 4:1 in the United States. The reasons are unclear, but possible explanations include Males are less likely to seek help when they are distressed. Males have a higher prevalence of Alcohol Use Disorder and Rehabilitation and Males tend to be more aggressive and use more lethal means when attempting suicide. The number of suicides in males includes suicides among military personnel and veterans, where there is a higher proportion of males to females. In terms of the spectrum of suicide-related experiences, an estimated 14 million Americans experience suicidal ideation, 1.4 million American adults have made a suicide attempt, and just under 50,000 die by suicide each year. Suicidal ideation is a fairly common experience in the general population and more common in clinical samples. Of those who consider suicide, far fewer act on suicidal thoughts or impulses. Among people who survive even medically serious suicide attempts, more than 90% do not go on to die by suicide. From a life span perspective, adolescents and young adults have the highest incidence of suicidal ideation; females attempt suicide more than males, but males die by suicide at 3 to 4 times the rate of females. Among older adults, while suicidal ideation is less common, 1 in 4 suicide attempts end in death. A suicide note is left by about 1 in 6 people who complete suicide. The content may indicate clues regarding the factors that led to the suicide (eg, psychiatric illness, hopelessness, cognitive constriction and narrowing of perceived options for coping, sense of being a burden to others, and sense of isolation). The intersection of these and other life stressors or losses may precipitate suicide. Suicide contagionrefers to a phenomenon in which one suicide seems to beget others in a community, school, or workplace. Highly publicized suicides may have a very wide effect. Affected people are usually those already vulnerable. Humans are social creatures prone to imitation of one another, and adolescents are more likely to engage in imitation than adults because of their stage of psychological and neurological development. It is estimated that contagion is a factor in 1 to 5% of all adolescent suicides. Contagion can occur by exposure to a peer who attempts or dies by suicide, by widespread media coverage of a celebrity’s suicide, or by graphic and/or sensationalized portrayal of suicide in popular media. Conversely, media coverage with positive messaging about a suicide death can mitigate the risk and/or impact of suicide contagion for vulnerable youth. Positive-themed suicide prevention messaging typically involves portraying mental health struggles as part of life and human health experience with no stigma related to seeking help and treatment. After a suicide has occurred, positive messages in a school or workplace should communicate clearly about the tragic loss of a community member, express support for the grieving community, and provide resources for support. The language a leader uses to discuss suicide, whether in writing or at in-person meetings, for debriefing the loss is important. For more detailed information on communication and templates for written communication, see the After A Suicide Toolkits freely available from the American Foundation for Suicide Prevention (afsp.org). Suicide contagion can also spread in schools and workplaces, which are important settings for implementing and following postvention guidelines to prevent future suicides. Other categories of suicideare rare. These include Group suicides Murder/suicides "Suicide by cop" (situations in which people act in a way, for example, brandishing a weapon, that prompts law enforcement officers to act with deadly force) 1.Ahmad FB, Anderson RN: The leading causes of death in the US for 2020.JAMA325(18):1829-1830, 2021. 10.1001/jama.2021.5469 2.Stone DM, Mack KA, Qualters J: Notes from the field: Recent changes in suicide rates, by race and ethnicity and age group — United States, 2021.MMWR Morb Mortal Wkly Rep72:160–162, 2023.doi: 10.15585/mmwr.mm7206a4 3. Moutier C, Pisani A, Stahl S: Stahl’s Handbooks: Suicide Prevention. 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