Simrat Kaur Sarai, M.D., Steven Lippmann, M.D. 

Suicide is one of the 10 leading causes of death, within all groups 10-64 years of age (1). Despite consistent declines from 1986-1999, the United States experienced a 24% increase in suicide rates between 1999-2014, rising to 10-13 per 100,000 people; such fatalities included males and females for all ages 10-74 years (2). Suicide among adolescents, young adults, and middle-age persons are rising (3,4).  Adults aged 45-64 evidenced some of the largest escalations, in women up to nearly 10 and among men almost 30 per 100,000 (2).  The average annual increase in the age-adjusted suicide frequency was about 1% each year during 1999-2006 and 2% annually from 2006-2014 (3).  The male incidence in 2014 was over three times higher than that of females.From 1999-2014, the percent increase in the age-adjusted rate was greater for women than in men, and represented a 45% versus the 16% gain for males, narrowing the gender gap (3).

For all age groups under 75 years of age, self-induced deaths among females were more frequent in 2014 than in 1999. The rates in them were highest for those aged 45–64, and they had the second-largest percent increase, with a 63% rise (3).  Suicides rates for females aged 10-14 were documented at a 200% increase during this time period, tripling to 1.5 per 100,000.  The increases in suicide for those aged 15-44 and 65-74 ranged between 31%-53% (3). In contrast to other age groups, the rates for women aged over 74 decreased by 11%.

Males aged 45-64 had their second-highest frequency of taking their own life in 2014 at a 43% increase to nearly 30 per 100,000. Those aged 10-14 had the lowest suicide rate of all age groups, but the second-largest percent increase between 1999-2014 (3).  Suicide was most common among men over age 74, yet the frequency decreased by 8% (3).

Poisoning was the most common method of self-induced deaths among females in 2014, accounting for one-third of cases. This was a change from 1999, when firearms were the most frequent method; yet, jumping from heights and drowning on purpose were also common. Over half of the suicides among men in 2014 were firearm-related, despite being less than in 1999; for them, the most frequent other means were jumping and self-laceration (3). In both genders, about one out of four fatalities were attributable to suffocation (3). People over 74 evidenced modest decreases, with a decline respectively of 8% in men and 11% among women.

Improvements in the health care system and advancement in medicine might have aided these trends. Laws like the Mental Health Parity, Addiction Equity Act, and the Medicare Improvements for Patients and Providers Act made psychiatric care more accessible and reduced costs for Medicare beneficiaries with mental illness. Social media might have helped older persons feel more connected to friends and family. Physicians are able to address factors that influence suicide in older adults; however, access to firearms is a major concern and substance abuse induces additional danger (2). Nationally over 60% of all self-induced fatalities are by gun shots.5 Improved reporting, economic distress, availability of opiates or guns, substance abuse, and limited access to care are potential contributing factors. There was a rise in suicide among boys at 37% and at 200% among girls, aged 10 to 14; perhaps the advent of social media might be responsible, especially for children exposed to cyberbullying (2).

Although it is good that suicide diminished among elderly people, many of them are still taking their own lives. Physicians should remain vigilant for suicide risks, such as in cases of depression, anxiety, and substance use disorders. Appropriate intervention and prevention includes, psychotherapeutic approaches, prescribing medication, and providing for social supports, as indicated. Safety planning is also important to help identify triggers for suicidal ideation and establish a management plan (2). Three important interventions are limiting firearm access, involving family support, and providing substance abuse treatment for appropriate individuals. 

REFERENCES

1. Heron M. Deaths: Leading Causes for 2013. National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System. 201; 65(2):1-14.
2. Zagorski N. Psychiatric News. U.S. Experiences Uptick In Rates of Suicide. 2016. Available at http://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2016.6a3   Last accessed August 27, 2016.
3. Curtin SC, Warner M, Hedegaard H. Increase in Suicide in the United States, 1999-2014. National Center for Health Statistics-data brief. 2016; 241:1-8.
4. Hempstead KA, Phillips JA. Rising suicide among adults aged 40–64 years: The role of job and financial circumstances. American Journal of Preventive Medicine. 2015; 48(5):491-500.
5. Statistics on Gun Deaths & Injuries. 2016. Available at http://smartgunlaws.org/gun-deaths-and-injuries-statistics/   Last accessed September 8, 2016.