_______________________________________________________________________ Depression and Suicide
static, non-acute factor with low predictive power [369]. While nearly half of suicides made previous attempts, only 5% to 15% of attempters ultimately die by suicide [370; 371]. This seems a robust predictor, but with distribution of risk across the lifespan, even this risk factor does little to inform of acute patient risk level in any given contact [369]. EPIDEMIOLOGY Suicide rates declined 24% between 1977 and 2000, but then increased 28% between 2000 and 2015. From 1999 to 2015, approximately 600,000 Americans died by suicide [372; 373]. In 2021 alone, 48,183 Americans died of suicide, an average of 132 suicides every day, or one person every 10.9 minutes. Among persons younger than 15 years of age, one suicide occurs every 1.4 hours [374]. Suicide is the 11th leading cause of death in the United States, and the third leading cause for youth 14 to 18 years of age. The annual cost of suicide in the United States is $70 billion [373; 374; 375]. White boys and men accounted for 70% of all suicides in the United States in 2021; the suicide rate in this population is two times greater than that for non-White boys/men. White men 45 to 64 years of age had the highest suicide rate and number of any demographic in 2021 [374]. White girls and women also have markedly higher suicide rates than their non-White counterparts [374].
In 2021, suicide rates by race/ethnicity were highest in Ameri- can Indians/Alaska Natives, followed by White Americans, Native Hawaiian/Pacific Islander, Black Americans, Hispanic Americans, and Asian Americans [373]. Overall, suicide rates were highest in persons 25 to 34 years of age and 85 years of age or older and lowest in persons 15 to 24 years of age, despite suicide being the third leading cause of death in this age group [373]. The NSDUH found few racial and ethnic differences for suicidality [15]. Suicide rates in urban and rural areas diverged during 1999–2015, especially after 2008. This could reflect more prevalent social isolation, financial hardship, access to lethal means (guns), and limited access to mental health care [372]. Aside from measures of suicide-related deaths, various levels of suicidality among adults have been studied, with suicidal thoughts, plans, and attempts quantified ( Table 6 ). Among adults with past-year suicidal ideation, around 1 in 4 plan suicide and 1 in 7 attempt suicide. There are 25 attempts for every suicide, increasing to 100 to 200 attempts per suicide in individuals 15 to 24 years of age and decreasing to 4 attempts per suicide among the elderly. For each male attempt are three female attempts, and there are 3.9 male suicides for each female suicide [374].
SUICIDALITY IN ADULTS IN THE UNITED STATES, 2021
Demographic Group
Past-Year Suicidal Thoughts 12.3 million (4.8%)
Past-Year Suicide Plans 3.5 million (1.4%)
Past-Year Suicide Attempts 1.7 million (0.7%)
All adults
18 to 25 years of age
13.0%
4.9% 0.9% 0.3% 1.3% 1.5% 1.7% 3.5% 7.4% 8.7% 6.4% 3.4%
0.7% 0.4% 0.1% 0.6% 0.8% 0.8% 2.0% 5.3% 5.0% 4.2% 1.8% 4.4% 5.4%
26 years of age and older 50 years of age and older
3.6% 2.0% 4.5% 5.2% 5.7%
Males
Females
Past-year use of alcohol or illicit drugs
Past-year use of any illicit drug
11.0% 15.0% 19.4% 16.7% 10.9% 21.8% 31.8%
Methamphetamine use Tranquilizer misuse
Cocaine use Cannabis use
Past-year substance use disorder Past-year major depressive episode Treated for suicide attempt(s) Population
8.46.0%
11.2%
Any Medical Attention
Hospitalization 87,000 (4.1%)
All adults
106,000 (4.3%)
18 to 25 years of age 26 to 49 years of age
4.46%
3.89%
Not available Not available
Not available Not available
50 years of age and older
Source: [15]
Table 6
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