CDC: Suicidal Thoughts, Behaviors in US Adults Vary by Sociodemographic and Geographic Factors

The prevalence of suicidal thoughts and behaviors among US adults vary by sociodemographic factors (eg, sex, age, education level) and across states and regions, according to a new Morbidity and Mortality Weekly Report surveillance summary.

“Geographic differences in suicidal thoughts and behavior varied by sociodemographic characteristics and might be attributable to sociodemographic composition of the population, selective migration, or the local cultural milieu. These findings underscore the importance of ongoing surveillance to collect locally relevant data on which to base prevention and intervention strategies,” wrote authors led by Asha Ivey-Stephenson, PhD, of the division of injury prevention, National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention.

In 2019, Ivey-Stephenson and colleagues wrote, suicide was the 10th leading cause of death for persons aged ≥18 years, with 45 861 adults who died as a result of suicide and 381 295 adults who required emergency care for nonfatal, self-inflicted injuries.

For the new report, researchers collected data from 2015 to 2019 through the National Survey on Drug Use and Health (NSDUH). The NSDUH is a yearly questionnaire that gathers data on alcohol, drug, and tobacco usage as well as substance use, substance use disorders, health care, and mental health status from a representative sample of the civilian, noninstitutionalized US population aged ≥12 years.

Investigators analyzed 254 767 responses from the mental health section of the NSDUH from adults aged ≥18 years from all 50 states and the District of Columbia. All participants were asked whether they had serious thoughts of suicide at any point during the preceding 12 months. Respondents who answered “yes” were then asked if they had made a plan to commit suicide in the past year and whether they had attempted suicide in the past 12 months.

In addition, adults who reported making a suicide attempt in the past year were asked if they had received medical attention. If so, respondents were then asked if they had stayed in a hospital overnight or longer after their suicide attempt, according to the report.

Researchers calculated national, regional and state-level average prevalence estimates for adults who reported suicidal thoughts, plans, or suicide attempts in the previous 12 months, and conducted analyses by sex, age group (18-39 years, 40-55 years, and ≥56 years), race and ethnicity (non-Hispanic White, Black, Asian, American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, 2 or more races, and Hispanic), region, state, education, marital status, poverty level, and health insurance status.

During 2015 to 2019, 4.3% (10.6 million) of adults reported instances of suicidal thoughts during the previous year, with the highest percentage in the West (4.8%) and the lowest in the Northeast and South (4.0%), wrote Ivey-Stephenson and colleagues. The largest percentage in any state was 6.9% in Utah, and the lowest was 3.3% in New Jersey.

Approximately 1.3% (3.1million) of adults said they had made a suicide plan in the past year, according to the report. The prevalence of having made suicide plans ranged from 1.0% in the Northeast to 1.4% in the Midwest and West, and from 0.8% in Connecticut and New Jersey to 2.4% in Alaska.

An estimated 1.4 million (0.6%) adults had made a suicide attempt in the past 12 months. The prevalence ranged from 0.5% in the Northeast to 0.6% in the Midwest, South, and West and from 0.3% in Connecticut to 0.9% in West Virginia, reported authors.

The researchers also found that past-year prevalence of suicidal thoughts, suicide planning, and suicide attempts was higher among:

  • Women than men,
  • Adults aged 18 to 39 years than those aged ≥40 years,
  • Noncollege graduates than college graduates, and
  • Adults who had never been married than those who were married, separated, divorced, or widowed.

Past-year prevalence of suicidal thoughts, planning, and attempts were also higher among participants living in poverty than those with a family income at or above the federal poverty threshold and among those covered by Medicaid or the Children’s Health Insurance Program as opposed to those with other health insurance or none at all.

“Understanding the patterns of and risk factors for suicide is essential for designing, implementing, and evaluating public health programs for suicide prevention and policies that reduce morbidity and mortality related to suicidal thoughts and behaviors,” wrote researchers. “State health departments and federal agencies can use the results from this report to assess progress toward achieving national and state health objectives in suicide prevention. Strategies might include identifying and supporting persons at risk, promoting connectedness, and creating protective environments.”