More than a decade of steadily rising rates have made suicide the nation's 10th leading cause of death and one of only three causes of death — including Alzheimer's disease and drug overdoses — that are increasing in the U.S., according to the Centers for Disease Control and Prevention.
In a report that examines trends in suicide at the state level from 1999 to 2016, the CDC says suicide rates have increased in nearly every state. In half the states, the agency found the rate rose more than 30 percent.
In releasing the report — the same week fashion designer Kate Spade was found dead by suicide — CDC officials noted that more than half of those who died by suicide — 54 percent — did not have a known diagnosed mental health condition.
A new study on suicide trends in 27 states found that many victims acted after relationship problems or loss; substance misuse; physical health problems; or job, money, legal or housing stress.
"Our data suggests suicide is more than a mental health issue," said Deborah M. Stone, lead author of that study. Noting that suicide is "very rare" among those with chronic depression, Stone said friends, families and co-workers should not overlook the risk of self-harm among people who have never been diagnosed with mental illness.
On Thursday, public health officials urged people with suicidal thoughts to call the National Suicide Prevention Lifeline at (800) 273-8255. They also said Americans should learn the warning signs of suicide so they can recognize those at risk.
Among the agency's recommendations: Reduce a high-risk person's access to lethal items such as medications and firearms.
"Everyone can play a role in efforts to help save lives and reverse this troubling rise in suicide," said Dr. Anne Schuchat, the CDC's principal deputy director.
In 2016, nearly 45,000 Americans 10 or older died by suicide. The increases were particularly stark in the intermountain West, including Idaho, Montana, Wyoming, Utah, North and South Dakota, Kansas, Minnesota and Oklahoma. Between 1999 and 2016, suicide rates in these states, along with Vermont, New Hampshire and South Carolina, rose 38 percent to 58 percent.
Guns were used in roughly half the suicides in 2016. Suffocation, including hanging, was the next most-common method, followed by poisoning.
Opioids were present in 31 percent of those who died by suicide. While Stone acknowledged that a person's intentions are not always clear when drugs are present, these were deemed to be suicides by self-inflicted poisoning.
In a 2016 report, the CDC found that U.S. suicide rates jumped 24 percent from 1999 to 2014. That rise was driven by stark increases in suicides by white women and Native Americans.
In the age group of greatest vulnerability to suicide — 45 to 64 — that report found rates among women in 2014 vaulted 80 percent over 1999's rates. The trend has begun to close a longstanding gender gap in suicide, in which men were far more likely to take their own lives.
Dr. Steven H. Woolf, a Virginia Commonwealth University physician who has studied suicide in the U.S., says the trend of rising self-harm is now well established.
"We really have to focus on what's going on in people's lives that's driving so many to such desperate acts," said Woolf, who chronicled what has become known as America's "epidemic of despair" — rising death rates due to drug overdoses, suicide and diseases related to substance abuse — in a recent essay in the journal BMJ.
Woolf said scant access to mental health care has driven down diagnoses even as it allows despair to fester.
"But our research shows something more alarming — these increases are occurring in places that have been struggling for many years: places where incomes have been stagnant and poverty rates have been high. The pressures on middle-class and low-income families are considerable ... and it's taking its toll."
To address these problems, he said, "the answer is not suicide hotlines. We need to focus on things that reduce stress on American families, and that includes economic assistance, jobs and access to education."
First among the strategies the CDC recommended to states in 2017 is to "strengthen economic supports," including bolstering financial security, adopting policies to stabilize housing, improving access to mental health care, and creating programs on problem-solving and coping skills.
© 2018 Los Angeles Times. Visit the Los Angeles Times at www.latimes.com, Distributed by Tribune Content Agency, LLC.
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