By Cori McMahon, Psy.D, NCCE, Vice President for Clinical Services
Suicide is a significant public health issue in the U.S. It was the 10th leading cause of death overall in our country, claiming the lives of almost 48,000 people in 2019. Taking a closer look at various subsets of the population, we can see, based on the data, that vulnerabilities exist.
Death by suicide, for example, is the second leading cause of death in those aged 10-34; males are 3.5 times more likely to die by suicide, with those over 75 years old being the most vulnerable; LGBTQ youth are four to six times more likely to attempt suicide than their peers; an alarming percentage of trans individuals (18-45 percent) have attempted suicide; and since 9/11, four times as many U.S. service members and veterans have died by suicide than have been killed in combat.
Adding to these disturbing statistics, according to SAMHSA, 22 percent of deaths by suicide in the U.S. involve alcohol intoxication. Further, opiates, including heroin and prescription painkillers, are present in 20 percent of deaths.
Suicide: Where to intervene
In order to determine where to intervene so that we can improve upon suicide prevention efforts, it is first necessary to understand the myriad factors that might make certain groups more vulnerable than others. Across groups, there are a number of life experiences, or situations, that can help us pinpoint those who might be at greater risk for dying by suicide.
Situations that increase suicide risk include:
- History of suicide attempt or suicide in the family
- Substance use
- Mental health diagnosis
- Major life transition (job loss, divorce) or financial hardship
- Multiple health comorbidities and/or chronic pain
- Trauma history
- History of non-suicidal self-injury
- Interpersonal conflict
When considering various subsets of our population who might be more vulnerable to death by suicide, it is not uncommon to find one or more of these risk factors present. Looking at risk across the lifespan, for example, younger individuals who have experienced recent conflict with friends, family, or a romantic partner or who are experiencing insomnia might be at-risk.
Adults who are at greater risk are male, may be using substances, and have had a recent marital or job loss. Older individuals are at risk for death by suicide if they are experiencing multiple health comorbidities, are isolated, or are feeling hopeless.
Those who are transgender are at higher risk for suicide than their non-trans peers. While the high rate of suicide attempts in this population has been established, estimates on death by suicide are challenging to find, likely resulting from the dearth of research on this marginalized population.
However, a study conducted in Sweden showed that trans individuals who are undergoing gender-affirming surgery are at 19 times greater risk than the general population. Factors involved in understanding risk for this population are biopsychosocial in nature. That is, they include a variety of things like internalized homophobia or transphobia, being assigned female sex at birth, multiracial identity, or being HIV+. The biopsychosocial risks further include being low income as well as psychological factors like depression, substance use, or body dissatisfaction.
In addition, a number of factors are associated with suicide attempt for the transgender population, including victimization experiences like childhood maltreatment, bullying, harassment, and sexual or physical violence. There are challenges in accessing these individuals to better research suicide risk, and it is a worthy cause given the particular vulnerabilities the trans population experiences.
Trauma increases risk
Considering the impact that trauma can have on suicide risk, the Costs of War Project at Brown University found an estimated 30,177 active duty personnel and veterans who have served in the military since 9/11 have died by suicide. This is in comparison to the 7,057 who have died in military operations during this time. The majority (over 22,000) of suicides in this group were attributed to veterans.
Factors that impact suicide risk include increasingly traumatic injuries from improvised explosive devices like roadside bombs, posttraumatic stress resulting from high exposure to trauma, and, unfortunately, the subjective experience in which soldiers encounter a lack of care and care services for their situations upon re-entry into U.S. civilian life. Additional mental health factors may also have a causal link to suicide in this population.
A 2012 surveillance report of all active duty U.S. Armed Forces personnel found annual counts and rates of mental health diagnoses among active duty service members increased by 65 percent from 2000 to 2011. Suicide rates nearly doubled in that time and the mental health concerns for active duty personnel became more of a focus as a result.
The main issues noted included:
- Adjustment disorders (26 percent)
- Depressive disorders (17 percent)
- Alcohol abuse and dependence (13 percent)
- Anxiety disorders (10 percent)
- PTSD (6 percent)
Each of these mental health issues has an association with suicide risk. For example, approximately 15-20 percent of those with depression die by suicide.
Understanding the factors that create vulnerabilities for subsets of our population is crucial to improving upon our ability to make a difference when it comes to screening and early intervention efforts. Knowing that there are commonalities across the population as well as factors that are specific to various groups, we can focus efforts accordingly.
While there remains a myth that asking about or talking about suicidal thoughts can trigger someone who is already at risk, on the contrary, routine screening and discussion about suicide risk actually serves to decrease stigma around the topic, instead making it a routine part of the healthcare experience. If providers demonstrate a willingness and level of comfort asking about mood functioning and suicide risk, then patients come to see the topic as both acceptable and important, resulting in an increased likelihood they will seek help when it’s needed.
As calls to suicide hotlines are up between 47 percent and 300 percent nationally during the past year of the pandemic, and a new suicide hotline is on its way (988), this national public health crisis is both worthy of this month dedicated to suicide awareness while also remaining priority all year long.
- National Suicide Prevention Lifeline: 1-800-273-8255 (TALK)
- NIH Suicide Prevention information & Resources
- Crisis Text Line: Text HOME to 741741
- Veterans Crisis Line: 1-800-273-8255 and press 1
- Veterans Text Line: 838255