New research shows case fatality rates are increasing for individuals between 20-44 years old.
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Suicide rates are becoming more lethal for both males and females, according to new research.
A team, led by Jing Wang, MD, MPH, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, examined whether increases in suicide rates are associated with more suicidal acts becoming more lethal, or a combination of both.
In the cross-sectional study, the investigators examined 1.2 million suicidal acts of individuals between 10-74 years old including both suicides and nonfatal suicide attempts. Medically treated nonfatal suicide attempts were identified from the 2006-2015 Nationwide Inpatient Sample and Nationwide Emergency Department Sample databases.
Suicides were identified from the 2006-2015 mortality files of the National Vital Statistics System.
The investigators calculated the incidence rate of suicidal acts by dividing the number of total suicidal acts by the US population. They measured lethality through the case fatality rates of suicidal acts by dividing the number of suicides by the total number of suicidal acts.
Overall, increased suicide rates were linked to an increase in both incidence rates and lethality of suicidal acts between 2006-2015. In a subgroup analysis, the team found the incidence of suicidal acts increased most among females, adolescents, and older adults between 65-74 years old.
However, suicidal acts became more lethal among both sexes and individuals between 20-64 years old.
The incidence rates of total suicidal acts increased 10% between 2006-2015 (annual percentage change [APC], 0.8%; 95% CI, 0.3-1.3%).
The case fatality rates of suicidal acts also increased by 13% during the study time period (APC, 2.3%; 95% CI, 1.3-3.3%).
In subgroup analyses, the incidence rates increased by 1.1% (95% CI, 0.6-1.6%) per year for female individuals but remained stable for males. The case fatality rates increased for both sexes (APC, 5.0% [95% CI, 3.1-6.9%] since 2010 for female individuals; 1.6% [95% CI, 0.6%-2.5%] since 2009 for male individuals).
For adolescents, incidence rates increased from 2011-2015, as well as for older adults throughout the study period.
The case fatality rates increased since 2009 for individuals between 20-44 years old (APC, 2.7%; 95% CI, 0.0-5.4%), while persons aged 20-44 years and 45-64 years experienced increases in suicidal acts by more lethal means and adolescents and older adults aged 65-74 years showed increased incidence by all means.
By understanding the changes in the incidence rates and lethality of suicidal acts, policymakers may better explain increasing suicide rates,.
“This study found increased suicidal acts among female persons, adolescents, and older adults aged 65-74 years, implying the need to address emerging or exacerbating suicide risk factors for these populations,” the authors wrote. “The findings on the increased lethality particularly among persons aged 20-64 years highlighted the need to reduce access to materials that could be used as lethal means among persons at risk of suicide. These findings on population-level epidemiologic patterns can be used to guide the development of comprehensive suicide prevention strategies.”
Suicide is currently the 10th leading cause of death in the US, claiming more than 47,000 lives in 2017. The age-adjusted suicide rates increased 33% between 1999-2017 for both sexes between 10-74 years old.
The study, “Trends in the Incidence and Lethality of Suicidal Acts in the United States, 2006 to 2015,” was published online in JAMA Psychiatry.