High and Rising Mortality Rates Among Working-Age Adults (2021) / Chapter Skim
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8 Suicide
8 Suicide
Pages 283-310
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From page 283... ...
and Hispanics, and this was the case among working-age adults during the study period. During this period, moreover, suicide mortality increased substantially mainly for Whites, with the largest absolute increases occurring among White males across the 25–64 age range.1 Suicide is clearly a prominent preventable cause of death, particularly among working-age Whites, and an important public health concern.
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. Although at lower levels, suicide rates began to rise among White women after 2000 (Figure 8-1)
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. Suicide rates for males are shown in the lefthand panels, while those for females are shown in the righthand panels.
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At the beginning of the study period, there was little difference in suicide rates by metropolitan status among White adults. Over time, however, suicide rates increased more slowly in large central metropolitan areas (hereafter referred to as "large central metros")
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Hispanic Males Age 45-64 14 20 12 18 16 10 14 8 12 10 6 8 4 6 4 2 2 0 0 1990-1993 2000-2002 2009-2011 2015-2017 1990-1993 2000-2002 2009-2011 2015-2017 Large Central Metro Large Fringe Metro Large Central Metro Large Fringe Metro Small/Medium Metro Nonmetro Small/Medium Metro Nonmetro FIGURE 8-2 Suicide rates per 100,000 population among U.S. working-age males and females (ages 25–64)
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From page 288... ...
They were lowest in large fringe metropolitan areas (hereafter referred to as "large fringe metros") in 1990– 1993 but increased in these areas during the 2000s, surpassing suicide rates in large central metros and small/medium metropolitan areas (hereafter referred to as "small/medium metros")
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. Suicide rates for males are shown in panel a above, while those for females are shown in panel b on the next page.
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Deaths per 100,000 Population 10 15 20 0 5 New Hampshire Vermont Pennsylvania Maine Connecticut FIGURE 8-3 Continued Rhode Island Northeast NORTHEAST Massachusetts New York New Jersey North Dakota South Dakota Kansas Missouri Indiana Wisconsin Ohio Midwest MIDWEST Minnesota Michigan Iowa Nebraska Illinois District of Columbia Oklahoma 1990-1992 West Virginia Arkansas South Carolina Kentucky Alabama b. Females ages 25-64 2015-2017 Tennessee Louisiana South Mississippi Florida SOUTH Georgia North Carolina Texas Virginia Delaware Maryland Montana Alaska Wyoming Idaho Utah Colorado New Mexico West Oregon Arizona Nevada Washington WEST Hawaii California 290
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From page 291... ...
found that, although baby boom cohorts did not have higher suicide rates than previous birth cohorts, male and to a lesser extent female suicide rates began to rise and continued to do so for subsequent birth cohorts. Thus, the baby boom cohorts appear to have ushered in new cohort patterns of suicide rates over the life course.
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From page 292... ...
The review that follows includes research that has considered various factors that may have played a role: economic factors; social engagement, religious participation, and social support; access to lethal means; and mental, emotional, and physical health. Economic Factors The available evidence suggests that suicide mortality can be responsive to economic conditions.
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From page 293... ...
These authors measured educational attainment in quartiles to help account for increasing educational attainment across time and showed that working-age Whites with lower levels of education experienced slightly higher increases in suicide rates relative to those with more education. Indeed, some of the strongest evidence for a link between economic conditions and suicide mortality has been found among those with lower levels of schooling.
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, and they continued to decline following the Great Recession despite historically low unemployment rates in recent years. Between 2009 and 2016, the labor force participation rate among Whites ages 25–64 with less than a high school education declined from 58 percent to 53 percent; the decline for those with a high school education was from 76 percent to 72 percent.
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examined associations between various dimensions of social capital and suicide rates at the state level during 1999–2002, controlling for other state-level characteristics that had been associated with suicide mortality in prior studies, including state-level Gini coefficient, gun ownership, alcohol and drug use, serious mental illness, poverty and unemployment rates, suicide belt state,6 urbanization, and population instability. They found that suicide rates for White men and women were lower in states with higher levels of social capital, controlling for other state-level characteristics, but not for Black men, the only other group that had sufficient numbers of suicides to be included in the analysis.
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, participation in religious activities predicted lower suicide rates in multivariate analysis of the 1993 National Mortality Followback Survey (Nisbet et al., 2000)
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Research examining links between these patterns and suicide rates, however, has been mainly descriptive. To what extent these changes can explain the increase in suicide mortality among White men and women and whether such changes interact with the growing economic stratification and individual-level risk factors requires further investigation.
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studied trends in suicide by firearms between 1999 and 2015 and found that at the state level, the absence of laws requiring universal background checks and imposing a mandatory waiting period for the purchase of firearms were associated with a more steeply rising trajectory of statewide suicide rates. Furthermore, where firearm suicide rates were declining, this decline was not offset by increases in suicide by other means.
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The increased contribution of hanging, suffocation, and strangulation to rising suicide rates suggests that changes in gun availability cannot be the primary reason for rising suicide mortality among White men and women. Mental, Emotional, and Physical Health An individual's risk of suicide is related to a family history of suicide; prior suicide attempts; psychiatric disorders, including depression and substance use; pain and other health problems; social adversity and deprivation during childhood and adolescence; and impulsivity (Conejero et al., 2016; Denney et al., 2009; Fazel and Runeson, 2020; Ilgen, 2018; Petrosky et
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Several national surveys include nondiagnostic indicators of mental health, such as self-reports of depressive symptoms, anxiety, depression, panic attacks, and psychological distress, but none include the array of commonly diagnosed mental illnesses thought to be most associated with suicide risk, such as anxiety disorders, bipolar disorder, phobias, personality disorders, eating and gambling disorders, schizophrenia and other psychoses, and panic disorders. These mental conditions predict different levels of suicidal behavior (Fazel and Runeson, 2020)
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found that states receiving more federal mental health aid had lower suicide rates, and aid was a stronger correlate of suicide rates than was the proportion of uninsured individuals in the state, density of psychiatrists or physicians, or sociodemographic variables.
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. A recent study attempted to address the minority mental health paradox by examining a common argument that Whites compared with non-Whites have more access to and receive better health care, including for mental illness.
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found racial/ethnic differences in optimism for the period 2010–2015 using data from the Gallup Healthways Survey, which showed that lower-income Blacks and Hispanics had higher levels of optimism about their future life satisfaction8 compared with lower-income Whites, especially Whites living in rural areas. The role of lower and declining psychological well-being among Whites of low socioeconomic status may be important given that greater psychological well-being has been associated with significantly lower overall mortality (Alimujiang et al., 2019; Keyes and Simoes, 2012; O'Connor and Graham, 2019)
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working-age adults over the study period (1990–2017) indicate that suicide rates increased substantially mainly among Whites, especially White males.
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Extensive research documents the Durkheimian premise that social integration within institutions, communities, and friendship and family networks is protective against suicidal behavior and death, and descriptive evidence suggests that such social capital resources are associated with lower suicide rates among Whites. Whether levels of social engagement have changed in recent decades to bring about the rise in suicide mortality, however, is more difficult to determine.
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Comorbidities related to physical illnesses, disabilities, and drug and alcohol use also contribute to levels of mental illness and pain, all of which represent important predisposing factors to suicide. While the research literature provides some compelling evidence for links between changes in economic conditions, social integration, and psychological and physical well-being and the rise in suicide mortality among Whites, most of this evidence is suggestive and obscures the fact that these factors are interrelated and operate across the societal, community, and individual levels.
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From page 307... ...
Although evidence indicates that recent trends in religious involvement, marriage rates, experience with pain, and psychological well-being coincided with rising rates of suicide among working-age Whites, especially those of low socioeconomic status, research has yet to forge explicit links between macro-, community-, family-, and individual-level trends and changes in suicide rates by sex, race and ethnicity, socioeconomic status, or geography. For example, the continued rise in suicide rates over the past several years among White Americans despite low unemployment and the prolonged economic expansion following the Great Recession points to the need to consider differential impacts of economic restructuring on population subgroups and geographic regions of the United States.
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From page 308... ...
Given that the recent rise in suicide mortality has been driven mainly by Whites in nonmetro areas, understanding why the same economic, social, and geographic factors associated with rising suicide rates among Whites are not related to rising rates among other groups could provide insights into how to reduce suicide among Whites. Moreover, recent trends showing a slight rise in suicide deaths among Black and Hispanic young adults (ages 25–45)
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RECOMMENDATION 8-1: Federal agencies, in partnership with pri vate foundations and other funding entities, should support research on lethal means of suicide aimed at better understanding the increase in use of different suicide modalities, how modalities differ by sex, and what factors might precipitate the choices made. Research on the role of gun control laws and gun availability is particularly warranted, with attention paid to the causal effect of changes in gun control laws and gun availability on trends in suicide mortality.
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RECOMMENDATION 8-2: Directors and funders of longitudinal studies should routinely link these survey data to the National Death Index to support a life-course approach to the study of mental health and suicide mortality.
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