Chartbook on Effective Treatment

Mental Health and Substance Abuse: Suicide Deaths

Suicide may be prevented when its warning signs are detected and treated.
- The growing use of standardized screening instruments and electronic medical records will likely increase clinicians' ability to identify suicidal ideas and plans among individuals being treated for depression.
- A recent study found that about half of people who died by suicide made a health care visit within 4 weeks of death. Only 24% had a mental health diagnosis (Ahmedani, et al., 2014).

Probability of Suicide

Risk factors for suicide include:
- Psychotic experiences:
  - Individuals with psychotic experiences are about 5 times more likely to report suicidal ideation and nearly 10 times more likely to report a suicide attempt (DeVylder, et al., 2015). Assessing psychotic experiences among individuals with suicidal ideation could reduce suicide attempts.
- Suicidal ideation:
  - Progression from ideation to suicide attempt varies by suicide plan and major depression status.
  - Research needs to explore factors that affect suicide attempts and death by suicide among high-risk individuals with suicidal ideation (Han, et al., 2015).
  - About 13% of suicidal ideators in a given year attempt suicide during that year. Suicidal ideation is the strongest known clinical predictor for death by suicide (Han, et al., 2015).
  - Positive responses to the item "Thoughts that you would be better off dead, or of hurting yourself in some way" on the Patient Health Questionnaire for depression (Simon, et al., 2013).

Suicide Prevention

Suicide prevention is multifaceted, including:
- Educating physicians and keeping lethal weapons away from suicidal people (Mann, et al., 2005).
- Using cognitive-behavioral therapy (Tarrier, et al., 2008).
- Implementing various strategies depending on risk:
  - Universal strategies that target entire populations (e.g., public education and awareness programs).
  - Selective strategies that address at-risk populations (e.g., peer "natural helpers" and accessible crisis services).
  - Indicated strategies that address specific high-risk individuals (e.g., case management and parent support programs) (Nordentoft, 2011).
Ongoing research shows promising results for Internet-based cognitive-behavioral therapy and psychoeducation in treating individuals with conditions such as mood, eating, and sleep disorders (Thorndike, et al., 2013).
As "mobile health" interventions become more sophisticated, they can be adapted to be culturally specific and sensitive (Burns, et al., 2013).

Suicide Death Rate

Suicide deaths per 100,000 population age 12 and over, by race/ethnicity and sex, 2008-2011

Charts show suicide deaths per 100,000 population age 12 and over, by race/ethnicity and sex. Go to tables below for details.

Left Chart:

Race / Ethnicity	2008	2009	2010	2011
Total	14.0	14.2	14.6	14.9
White	15.7	15.9	16.4	16.8
Black	6.3	6.2	6.2	6.4
API	6.7	7.1	7.6	7.2
AI/AN	12.2	12.1	13.1	12.8

2008 Achievable Benchmark: 9 per 100,000 Population.

Right Chart:

Sex	2008	2009	2010	2011
Male	23.0	23.2	23.9	24.2
Female	5.7	5.9	6.0	6.3

2008 Achievable Benchmark: 9 per 100,000 Population.

Key: API =Asian and Pacific Islander; AI/AN = American Indian or Alaska Native.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System—Mortality, 2008-2011.
Note: For this measure, lower rates are better. Estimates are age adjusted to the 2000 U.S. standard population.White and Black are non-Hispanic. Hispanic includes all races.

Overall Rate: In 2011, the overall suicide death rate was 14.9 per 100,000 population age 12 and over.
Trends: From 2008 to 2011, the suicide death rates worsened for the total population, Whites, and both sexes.
Groups With Disparities:
- From 2008 to 2011, Blacks, Asians and Pacific Islanders, and American Indians and Alaska Natives had lower suicide death rates than Whites.
- In all years, males had higher suicide death rates compared with females.
- In all years, people living in medium metropolitan, small metropolitan, micropolitan, and noncore areas had higher suicide death rates compared with people living in large fringe metropolitan areas (data not shown). For more information on suicide death rates by geographic location, refer to the Rural Health Reform Policy Research Center 2014 Update of the Rural-Urban Chartbook, available athttps://ruralhealth.und.edu/projects/health-reform-policy-research-center/pdf/2014-rural-urban-chartbook-update.pdf (3.572 MB)
Achievable Benchmark:
- The 2008 top 5 State achievable benchmark was 9 suicide deaths per 100,000 population. The top 5 States that contributed to the achievable benchmark are Connecticut, District of Columbia, Massachusetts, New Jersey, and New York.
- APIs, Blacks, and females have achieved the benchmark.
- The total population, AI/ANs, Whites, and males are moving away from the benchmark.

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Page last reviewed July 2015
Page originally created September 2015

Internet Citation: Mental Health and Substance Abuse: Suicide Deaths. Content last reviewed July 2015. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/2014chartbooks/effectivetx/eff-mhsa2.html