Differences in U.S. Suicide Rates by Educational Attainment, 2000–2014

doi:10.1016/j.amepre.2017.04.010

American Journal of Preventive Medicine

Volume 53, Issue 4, October 2017, Pages e123-e130

https://doi.org/10.1016/j.amepre.2017.04.010 Get rights and content

Introduction

The purpose of this study was to document the association between education and suicide risk, in light of rising suicide rates and socioeconomic differentials in mortality in the U.S.

Methods

Differentials and trends in U.S. suicide rates by education were examined from 2000 to 2014 using death certificate data on 442,135 suicides from the National Center for Health Statistics and Census data. Differences in the circumstances and characteristics of suicide deaths by education were investigated using 2013 data from the National Violent Death Reporting System for nine states. Analyses were conducted in 2016.

Results

Between 2000 and 2014, men and women aged ≥25 years with at least a college degree exhibited the lowest suicide rates; those with a high school degree displayed the highest rates. Men with a high school education were twice as likely to die by suicide compared with those with a college degree in 2014. The education gradient in suicide mortality generally remained constant over the study period. Interpersonal/relationship problems and substance abuse were more common circumstances for less educated decedents. Mental health issues and job problems were more prevalent among college-educated decedents.

Conclusions

The findings highlight the importance of social determinants in suicide risk, with important prevention implications.

Introduction

Age-adjusted suicide rates rose by 24% between 2000 and 2014 in the U.S., with the increase especially pronounced among those aged 45–64 years. For middle-aged men, rates rose by 43% over this period and by 63% for women, although death by suicide remains far more common among men.¹ This substantial increase in suicide, alongside rising death rates from drug and alcohol poisonings, has been large enough to produce a marked upturn in all-cause mortality among white middle-aged Americans.²

The current epidemic of rising suicide and drug abuse has affected some groups more than others—namely, those who are less educated. The increases in suicide rates for those aged 40–60 years between 2000 and 2005 were confined to those who lacked a college degree.³ By 2013, suicide rates for those aged 45–54 years had risen for all educational groups, but the increases were substantially larger for the less educated. In 1999, suicide rates for those aged 45–54 years with a high school degree or less were 1.7 times greater than those with a college degree, but that differential increased to 2.4 by 2013.² These trends have contributed to widening socioeconomic disparities in mortality.⁴

Following the famous Whitehall study of British civil servants,⁵ a flurry of research investigated the relationship between SES and morbidity and mortality, revealing the importance of education in shaping health status, health-related behaviors, and psychosocial factors. These studies document the recent widening of the educational gradient in mortality in Western countries, emphasizing not only differences in the prevalence of risk behaviors such as tobacco and alcohol use but also differential returns to risk factors, suggesting there may be important differences in access and ability to benefit from health care and medical information.6, 7, 8

The nature of educational differences in suicide, however, is poorly understood. Durkheim⁹ observed a positive association between educational attainment and suicide rates in 19th-century Europe, although his theory of suicide focused more on the role of religion and secularization than education. More recent studies report mixed findings on the education–suicide link, with variation by cohort and race.¹⁰ Most document a higher suicide risk among those with less education,11, 12, 13 yet others report the opposite.14, 15 In light of this limited information, the goal of this study is to (1) examine the differential and annual trends in suicide rates by educational attainment between 2000 and 2014, a period when U.S. suicide rates rose significantly and that encompasses the Great Recession; and (2) describe the ways in which the circumstances and other characteristics of suicide differ by educational attainment.

Section snippets

Methods

To investigate trends in suicide by educational attainment, annual age-adjusted suicide rates by educational attainment were constructed for all people aged ≥25 years from 2000 to 2014. Suicide rates were age adjusted using 5-year age groups and the U.S. 2000 standard population.¹⁶ Suicide rates among individuals aged <25 years were not examined because many have not completed their formal education by that age. Information on the number of suicide deaths by education was obtained from death

Results

Over the study period, 442,135 suicides occurred among individuals aged ≥25 years and with information on their educational attainment (Appendix, available online). Men and women aged ≥25 years who possess a college degree or higher consistently exhibited the lowest rates of suicide whereas those with a high school degree displayed the highest rates. The differential was substantial for men; a college degree halved the risk of death by suicide relative to those who had a high school degree only

Discussion

This study is the first to examine the relationship between education and suicide over an extended period that encompassed the Great Recession of 2007–2009 and how circumstances surrounding suicide vary by education. The findings reveal an important differential—both men and women with a college degree exhibit the lowest rates of suicide, a pattern that held constant between 2000 and 2014. To the extent that education engenders self-efficacy, strengthens various forms of human, social, and

Conclusions

The study findings offer insight into the important connection between education and suicide, during a period when levels of suicide and economic inequality have been rising. The differences in circumstances surrounding suicide deaths by education level highlight the greater volatility and fragility in the daily lives of those experiencing socioeconomic disadvantage, with important implications for prevention. Health and social policies may provide important opportunities to address some of

Acknowledgments

Julie Phillips acknowledges the support of the American Foundation for Suicide Prevention.

No financial disclosures were reported by the authors of this paper.

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Citation Excerpt :
There is then much discussion to be had about what ‘factors’ about a certain country or place would make education correlate positively or negatively with suicide. Phillips and Hempstead (2017) propose a salient answer to this, claiming that the relationship is determined by the extent to which achieving high education contributes to “self efficacy, strengthen(ing) various forms of human, social, and cultural capital, and is linked to greater access to and use of mental health services” (128, emphasis added). Evidently, not every context of high education results in the sure acquirement of capital in this sense.
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Research ArticleDifferences in U.S. Suicide Rates by Educational Attainment, 2000–2014

Introduction

Methods

Results

Conclusions

Introduction

Section snippets

Methods

Results

Discussion

Conclusions

Acknowledgments

J Aff Disord

Am J Prev Med

Biol Psychiatry

Am J Prev Med

Increase in suicide in the United States, 1999-2014

NCHS Data Brief

Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century

Proc Natl Acad Sci USA

Understanding recent changes in suicide rates among the middle-aged: period or cohort effects?

Public Health Rep

Differences in life expectancy due to race and educational differences are widening, and many may not catch up

Health Aff (Millwood)

Do socioeconomic differences in mortality persist after retirement? 25 year follow up of civil servants from the first Whitehall study

BMJ

The relationship between education and adult mortality in the United States

Rev Econ Stud

The gap gets bigger: changes in mortality and life expectancy by education, 1981-2000

Health Aff (Millwood)

Explaining the rise in educational gradients in mortality

Suicide, A Study in Sociology

The relationship between general population suicide rates and educational attainment: a cross-national study

Suicide Life Threat Behav

Research Article
Differences in U.S. Suicide Rates by Educational Attainment, 2000–2014