Suicide rates among middle-aged Americans rose a striking 28% over the last decade, a possible reflection of the stressful economic times.
The annual, age-adjusted suicide rate among adults, aged 35-64 years, was 13.7/100,000 persons in 1999 vs. 17.6/100,000 in 2010, according to a study by the Centers for Disease Control and Prevention. The greatest increases were observed among American Indian/Alaska Natives (65%) and whites (40%).
The investigators are calling for additional research but suggest that the recent economic downturn might have contributed to the rise in middle-age suicides, observing that suicide rates traditionally cycle up during times of economic hardship.
Other contributing factors include a cohort effect based on evidence that baby boomers had unusually high suicide rates during their adolescent years, and a rise in intentional overdoses associated with the increased availability of prescription opioids.
The report also highlights a disturbing increase in suicide by suffocation, predominantly hanging, jumping 81.3% from 2.3/100,000 persons in 1999 to 4.1/100,000 in 2010. This was followed by increases of 24.4% for poisoning, predominantly overdose; and 14.4% for firearms. Women were more likely to use poison and firearms to commit suicide, and men were most likely to use firearms and suffocation.
"This increasing trend is particularly troubling, because a large proportion of suicide attempts by suffocation result in death, suggesting a need for increased public awareness of suicide risk factors and research of potential suicide prevention strategies to reduce suffocation deaths," wrote lead author Joseph L. Annest, Ph.D., and his colleagues at the CDC (MMWR 2013;62:321-5).
The statistics are shocking but have a ring of veracity, Dr. Michael F. Myers, professor of clinical psychiatry at State University of New York, Brooklyn, said in an interview.
"All of us in the field of suicidology are so involved in the world of guns and reducing suicides by firearms, but it’s true," he said, recalling the case of a young man who aborted his plans for suicide only after spotting an emergency room across from a Home Depot where he was preparing to buy a rope – because he didn’t want to wait to buy a gun.
In the report, Dr. Annest suggests that the overall suicide rates are likely an underestimation of the actual prevalence, because suicides might be undercounted in the National Vital Statistics System, which was used for the analysis.
The findings are consistent, however, with a study reported earlier this year by Johns Hopkins University, Baltimore, citing a 16% increase in the suicide rate between 2000 and 2010, driven largely by an increase in suicides by hanging/suffocation (52%) and poisoning (19%). Subgroup analyses showed that hanging/suffocation suicides skyrocketed by a startling 104% among those aged 45-59 years (Am. J. Prev. Med. 2013;44:146-9).
According to Susan P. Baker, lead author of the Hopkins study, when looking at the CDC’s findings, it is important not to lose sight of trends found among other age and gender groups. For example, although the largest increases were found in the 55-59 group, rates also rose among women in their 20s and girls aged 10-14
“For the latter group, the numbers are fairly small (87 deaths in 2010), and the rates are only about half the rate for boys,” said Ms. Baker, a professor in the Johns Hopkins Bloomberg School of Public Health, Baltimore. “But [they] increased so much in 2009 and 2010 that they might deserve special attention. This is especially true because suicide is the third-leading cause of death in the 10- 14-year age group.”
Dr. Michael F. Myers
Both studies underscore the need for a shift in prevention strategies, which traditionally have focused on youths and older adults. Prevention efforts targeting the needs of adults aged 35-64 years are particularly important for this cohort because of its size, history of elevated suicide rates, and their movement toward older adulthood when suicide rates are traditionally the highest, the CDC report contends.
Some 76 million people were born in the United States during the baby boom years of 1946 to 1964.
The 2012 Surgeon General’s "National Strategy for Suicide Prevention" highlights the need for prevention strategies such as enhanced social support and access to mental health and preventive services, but notes that other strategies are likely to be "particularly critical" for addressing the needs of middle-age Americans. Those efforts will need to help overcome risk factors such as economic challenges, job loss, intimate partner problems or violence, caregiver responsibilities for children and aging parents, and declining health or chronic health problems.