Mid-Life Suicide

Background

The overall suicide rate in the U.S. increased by 6% between 1981 and 1986 and declined by 18% between 1986 and 1999. Detailed descriptions of recent trends in suicide are lacking, especially with regard to the method of suicide. Information is needed on the major changes in rates of suicide in specific population groups in recent years (1999–2005).

Methods

Mortality data came from the Web-based Injury Statistics Query and Reporting System. Suicide trends during 1981–2005 were analyzed by age, race, gender, and method, with an emphasis on increases between 1999 and 2005. Linear regression was used to examine the significance of trends in suicide mortality. The annual percentage change in rates was employed to measure the linear trend in suicide mortality.

Results

The suicide rate increased after 1999, due primarily to an increase in suicide among whites aged 40–64 years, whose rate of completed suicide between 1999 and 2005 rose by 2.7% annually for men and by 3.9% annually for women, with increases of 6.3% and 2.3% for hanging/suffocation, 2.8% and 19.3% for poisoning, and 1.5% and 1.9% for firearms for men and women, respectively. Rates did not increase for other age or racial groups.

Conclusions

The differential increases by age, race, gender, and method underscore a change in the epidemiology of suicide. Whites aged 40–64 years have recently emerged as a new high-risk group for suicide. Although firearms remain the most common method of suicide, the notable increases in suicide by hanging/suffocation in men and by poisoning in women deserve preventive attention.

Introduction

Suicide is defined as fatal, intentional, self-inflicted injury with the intent to end life.1, 2 In 2005, based on the most recent data available, the rate of suicide in the U.S. was 11 per 100,000.³ In 2005, suicide claimed 32,637 lives in the U.S. and was the fourth-leading cause of death for people aged 10–64 years.⁴ Between 1999 and 2005, the overall suicide rate increased by 0.7% annually.⁵

One of the most comprehensive reviews of the epidemiology of suicide that included all age groups was published in 2001 and was based on pre-2000 data.⁶ Risk factors for suicide can be classified as distal: such as a previous suicide attempt, mental or physical illness, a history of sexual assault or abuse, a family history of suicide or mental illness, access to lethal methods (e.g., firearms, poison); or as proximal: such as stressful life events, hopelessness, intoxication, violence perpetration/victimization, media presentations of suicide, or a firearm in the home.⁶ Protective factors discussed in the literature include coping/problem-solving skills or personal resilience; cultural and religious beliefs that discourage suicide; good physical and mental health; access to effective treatments for mental, physical, and substance-use disorders; restricted access to highly lethal means of suicide (e.g., firearms, motor vehicle exhaust); and strong connections to family and community support. In the U.S., rates are highest in men (80% of suicides); non-Hispanic whites (84% of suicides); and people aged >80 years. The most common method used is firearms (52% of suicides), followed by hanging/suffocation (22%) and poisoning (18%).³

Detailed descriptions of recent trends in suicide are lacking, especially with regard to the method of suicide.7, 8 The recent CDC report on injury trends⁵ calls attention to the increase in suicide by hanging/suffocation, but does not include information on racial and gender differences and thereby may miss important increases in specific population groups. This study emphasizes recent (1999–2005) changes in suicide mortality by age, race, gender, and method in the U.S., uncovering important increases in specific population groups that can help to prioritize and guide prevention efforts.