Each year since 2001, over 30,000 people have died by suicide in the United States. At least 650,000 persons each year receive emergency treatment after attempting suicide. Over a million die by suicide worldwide. Suicide, the taking of one’s own life, is the 13th leading cause of death worldwide and 11th in the United States.
In the United States, suicide kills nearly twice as many people each year as homicide. Although suicide is an individual act that occurs in what can appear to be unique circumstances, examining patterns of suicide deaths indicates many risk and protective factors at different levels—demographic, community, familial, and individual. Demographically, suicide completion and attempt patterns vary by age, gender, race-ethnicity, occupation, geography, income, and other factors.
Age, Gender, Ethnicity
Suicide is the third leading cause of death among 10- to 24-year-olds in the United States, despite a decline among 15- to 19-year-olds from 10.71/ 100,000 in 1992 to 7.26/100,000 in 2003. Youth suicide in the United States is more common among Whites than among African Americans or Latinos. Suicide is the 8th leading cause of death for all U.S. males, but 17th among females. Suicide rates are highest among White males and second highest among American Indian or Alaska Native males. The high rate among White males (20.97/100,000 in 2003) is largely driven by the rate of deaths of those aged 65+ years (33.13/100,000). The highest rates among American Indian or Alaska Native males are between the ages of 24 and 34 (31.71/100,000) and 15 and 24 (27.22/100,000) years. Suicide rates decline substantially in American Indian or Alaskan Native males after age 55 years. Among females, suicide rates increase to age 45 years, then decline. Suicide rates among females across ethnic groups are more similar than are male suicide rate patterns in those same groups. The lowest suicide rates, all ages, are among Asian or Pacific Islanders. The difference in suicide rates between Whites and African Americans, all ages, has decreased in the past 15 years due to an increase among African American males starting in 1986.
Fatal and nonfatal suicidal behavior patterns differ markedly by age, gender, and ethnicity. Males are 4 times more likely to die from suicide than females, while females attempt suicide about 3 times more often than males. A previous suicide attempt has occurred in 25%-30% of completed suicides among youth and is considered a major risk factor, particularly among males. Hispanic youth report high rates of suicide attempts, but have lower suicide completion rates than non-Hispanics.
Marital Status, Household Composition, Sexual Orientation, Incarceration
In general, suicide rates are lower among married persons than among those who are single, divorced, or widowed. However, intimate partner violence, regardless of marital status, raises suicidal risk. Being married is more protective for males than for females, while the presence of children, particularly young children, is especially protective for females. Sexual orientation appears to be a suicide risk factor for males only. Evidence indicates that gay or bisexual males ages 18-40 are 5-14 times more likely to report a suicide attempt than heterosexual males. Same-sex attraction is associated with suicide attempts among male adolescents; however, the vast majority of youth reporting same-sex sexual orientation report no suicidality at all. Suicide rates for jail inmates are 9 times greater than that of the general population and 15 times higher for incarcerated males. Incarcerated adolescents and adolescents with legal problems exhibit significant risk for suicidal behaviors. Most completed suicides are young White males arrested for nonviolent offenses who are intoxicated when arrested.
Occupation, Education, Unemployment, Income, Religion
Persons employed in certain occupations, such as police, doctors, dentists, and military personnel, have higher suicide rates than others. This increase may in part be due to the accessibility in these occupations to lethal means, such as potentially deadly medications and firearms.
Education may be an independent risk factor for suicide, or it may be associated with suicide because of its correlation with income and employment status. Some studies indicate higher rates of suicide at both ends of the educational spectrum.
Unemployment, especially prolonged unemployment, correlates with suicide risk. Unemployment is also associated with poverty, intimate partner violence, and substance use.
Income has consistently been found to correlate negatively with suicide rates, both at individual and population levels.
Religious involvement, defined as attending church, has been shown to be protective for suicidal behaviors. It is not clear whether the church social network or the belief system is protective, but it is probably a combination of both.
Geographic Patterns, Urban Versus Rural, Mobility
U.S. suicide geographic patterns have persisted for more than a decade. Most of the contiguous western states and Alaska, with the exception of California and Washington, have consistently had the highest suicide rates. No one variable (e.g., higher rates of household firearm ownership, higher proportions of populations living in rural areas) explains the consistently high rates in western states.
Suicide rates are generally higher in rural locations and lower in urban locales. Some evidence indicates these factors may have to do with access to pesticides and guns, and lack of access to Level 1 trauma centers.
Youth and young adult mobility is a potential risk factor for suicidal behavior. A population-based, case-control study of nearly lethal suicide attempts indicated that moving in the past 12 months was positively associated with a nearly lethal suicide attempt as were specific characteristics of the move such as frequency, recentness of move, distance, and difficulty staying in touch.
Global Patterns
Although suicide completions worldwide are usually higher among males than among females and females attempt suicide more than males, there is some variation. China, for example, has had consistently higher rates of completed suicides for females than for males. However, international comparisons of suicide rates must be considered cautiously because of differential surveillance methods.
Suicide pattern variations demonstrate that social norms, trends over time, environmental influences, and surveillance methods must be considered when interpreting demographic risk and protective factors for suicide.
