an opioid-prescribing guideline to encourage safer prescribing practices aimed at reducing the likelihood of patient abuse and overdose. In addition, considering that, compared to decedents without, more decedents with a history of substance abuse have Precipitating circumstances surrounding suicide When Fowler et al. (2018) examined the NVDRS data to identify key precipitating factors and circumstances surrounding suicide, they found that these factors accounted for 90.1% of suicides. Overall, mental health problems were the most common: 36.6% of decedents were described as experiencing a depressed mood at the time of their death; 47.7% as having a current diagnosed mental health problem; and 28.3% as receiving mental health treatment. Among the 6,375 decedents with a current diagnosed mental health problem, depression/dysthymia (73.3%), anxiety disorder (15.9%) and bipolar disorder (15%) were the most common diagnoses for both males and females. The study reported that equivalent percentages of both male (36.6%) and female (36.5%) decedents had a depressed mood at the time of their suicide. It reported greater percentages of females having a current diagnosed mental health problem (62.3% of females versus 43.2% of males) and/or receiving current mental health treatment (40.8% of females versus 24.5% of males). Among 13,368 suicides with known circumstances, 33.7% left a suicide note, 31.6% had a history of suicidal thoughts or plans, 19.8% had a history of previous suicide attempts, and 24.6% had disclosed suicidal intent to another person. The majority who disclosed intent did so to a previous or current intimate partner Suicide in California California’s suicide rate is one of the lowest among U.S. states (California Mental Health Services Overview and Accountability Commission [MHSOAC], n.d.). Even so, the rate has risen dramatically in recent years, up 52% from 2001 to 2017 (Wiener, 2019). Therefore, following the 2018 passage of Assembly Bill 1436, Chapter 527 (effective on January 1, 2021), California’s Board of Behavioral Sciences (BBS) requires that applicants both for initial licensure and for license renewal complete the one-time requirement of “a minimum of six hours coursework or applied experience under supervision in suicide risk assessment and intervention” (BBS, n.d.). One reason for California’s relatively low suicide rate may be the state’s gun regulations. In the United States, rates of gun ownership are generally positively associated with suicide rates. A large study focusing on California gun ownership and suicide (Studdert et al., 2020) confirmed what numerous smaller studies had reported about gun ownership: “Handgun owners had … substantially higher rates of suicide.” Rural counties in California tend to have higher suicide rates than the rest of the state, possibly because of higher rates of gun ownership as well as less access to mental health services (MHSOAC, n.d.). Although suicide rates tend to be higher in rural northern and eastern counties (California Department of Public Health [DPH], 2019b), the actual number of suicides is higher in densely populated southern counties. In 2017, 21% of California suicides occurred in Los Angeles County (MHSOAC, n.d.). Sexual minority youth and adults (LGBTQIA) Individuals who identify as sexual minorities (e.g., individuals identifying as lesbian, gay, bisexual, transgender, queer, intersex, asexual or those questioning their orientation; LGBTQIA) face a number of unique challenges and stressors, and these stressors have often translated into elevated rates of suicidal behavior for both adults (Chang, Fehling, & Selby, 2020) and youth (Chang, Kellerman, Feinstein, Selby, & Goldbach, 2020). The CDC 2020 National Youth Risk Behavior Survey found high rates of suicidal ideation among students who identified as LGBTQIA or members of a sexual minority group. The survey revealed that approximately 46% of high school students who
drugs in their system at the time of death, these findings suggest that comprehensive violence prevention efforts can benefit from strategies that address ongoing substance abuse problems.
(38.5%) or to some other family member (29.7%). Alcohol and other substance abuse problems were indicated for 17.9% and 15.9% of suicide decedents, respectively. A higher percentage of males (18.6% of males versus 15.6% of females) reportedly had alcohol problems, and a higher percentage of females than males also indicated another substance problem (19.3% of females versus 14.9% of males). Other common circumstances were a crisis in the preceding or upcoming two weeks (34.3%) and intimate partner problems (28.3%). Physical health problems (22%), an argument or conflict (15.3%), job or financial problems (11.1% and 9.8%, respectively), family relationship problems (10%), and recent criminal legal problems (9.1%) were also reported to have preceded suicides. Job problems were noted as a precipitating circumstance in a higher percentage of males than females (12.3% and 7.3%, respectively), as were financial problems (10.5% versus 7.7%) and recent criminal legal problems (10.7% and 4.1%). In contrast, family (non-intimate partner) relationship problems were a precipitating circumstance in a higher percentage of deaths by suicide for females than males (12.5% and 9.2%, respectively). Although indicated in a small percentage of suicides, males were more often a perpetrator of interpersonal violence in the month before death (3.1%) than were females (<1%). From the end of the 20th century to 2016, suicide rates increased in California and every other U.S. state except Nevada (Reese, 2018). In 2016, almost 4,300 Californians died by suicide, representing 10.9 suicides per 100,000 people (Reese, 2018). Older men (especially those aged 85 and older) are the most likely to die by suicide in California. Caucasians and Native Americans are more likely to die by suicide than Californians belonging to other races; suicide rates are lowest among Californians of Hispanic descent (Reese, 2018). Even though men aged 85 and older are the most likely to die by suicide, an earlier peak occurs for men between the ages of 25 and 29 (DPH, 2019b). In California, 37% of suicides involve firearms, 32% involve hanging or suffocation, and 16% involve poisoning. Although hanging or suffocation are the methods more often used by younger people who die by suicide, firearms become the most- favored method as the age at time of suicide goes up (DPH, 2019b). California’s MHSOAC estimates that for every completed suicide, 25 people have attempted to take their own lives. Using the 2017 number of California suicides, therefore, MHSOAC calculates that 4,323 suicides represent approximately 108,075 attempts. Thus, although California has a lower suicide rate relative to much of the country, much work remains to further reduce suicide attempts and outcomes.
AT-RISK GROUPS
identified as LGBTQIA were seriously considering suicide (CDC, 2020). The survey reviewed 15,624 high school students in grades nine through 12 between the ages 14 and 18 who were representative of the national population. For LGBTQIA adolescents, results in 2019 indicated that 46% seriously considered suicide, 40.2% were planning suicide; and 23.4% had attempted suicide in the previous year. Compared with heterosexual teens, those numbers are exceptionally high; of the non-LGBTQIA teens in the study,
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