The tragic death of Robin William by suicide highlights a tragic trend that is tantamount to a silent epidemic in this country. The Center for Disease Control reports that from 1999 to 2010, the suicide rate among Americans 35 to 64 rose by almost 30 percent. Williams was 63 years old.
This finding is consistent with a previous study that showed a notable increase in the overall suicide rate among middle-aged adults relative to a small increase in suicide rates among younger persons and a small decline in older persons during a similar period (2). The increases were geographically widespread and occurred in states with high, as well as average and low suicide rates. By race/ethnicity, the increases were highest and statistically significant only among whites and American Indian/Alaska Natives, widening the racial/ethnic gap in suicide rates (3).
Prevalence of mechanisms of suicide changed from 1999 to 2010. Whereas firearm and poisoning suicide rates increased significantly, suffocation (predominantly hanging) suicide rates increased the most among men and women aged 35–64 years. This increasing trend is particularly troubling because a large proportion of suicide attempts by suffocation result in death, suggesting a need for increased public awareness of suicide risk factors and research of potential suicide prevention strategies to reduce suffocation deaths (2).
Possible contributing factors for the rise in suicide rates among middle-aged adults include the recent economic downturn (historically, suicide rates tend to correlate with business cycles, with higher rates observed during times of economic hardship) (6,7); a cohort effect, based on evidence that the “baby boomer” generation had unusually high suicide rates during their adolescent years (8); and a rise in intentional overdoses associated with the increase in availability of prescription opioids (1,2). Additional research is needed to understand the cause of the increase in age-adjusted suicide rates and why the extent of the increase varies across racial/ethnic populations.
The findings in this report are subject to at least four limitations. First, the findings are subject to variation among state coroners/medical examiners regarding determination of manner of death, especially for poisoning, as recorded on the death certificate (9). Second, suicide rates likely are an underestimate of the actual prevalence because suicides might be undercounted in NVSS (9). Third, NVSS lacks information about factors such as physical and mental health history at the time of suicide and recent stressors that might have contributed to risk for suicide.
The National Violent Death Reporting System collects more comprehensive information on suicide circumstances but the system currently is limited to 18 states.§ Finally, suicide rates might be affected by death certificate race/ethnicity misclassification, particularly for AI/ANs.
Most suicide research and prevention efforts have focused on youths and older adults. Although the analysis in this report does not explain why suicide rates are increasing so substantially among middle-aged adults, the results underscore the importance of prevention strategies that address the needs of persons aged 35–64 years, which includes the baby boomer cohort. Prevention efforts are particularly important for this cohort because of its size, history of elevated suicide rates, and movement toward older adulthood, the period of life that has traditionally been associated with the highest suicide rates (3,8).
The 2012 Surgeon General’s National Strategy for Suicide Prevention describes salient risk factors, prevention opportunities, and existing resources to help those at increased risk for suicide (10). Suicide prevention strategies such as those that enhance social support, community connectedness, and access to mental health and preventive services, as well as efforts to reduce stigma and barriers associated with seeking help, are important for addressing suicide risk across the lifespan. Other strategies are likely to be particularly critical for addressing the needs of middle-aged adults, such as those that help persons overcome risk factors, which include economic challenges, job loss, intimate partner problems or violence, the stress of caregiver responsibilities (often for children and aging parents), substance abuse, and declining health or chronic health problems (7,8,10).
Nimesh Patel, MS, Scott Kegler, PhD, Div of Analysis, Research, and Practice Integration, National Center for Injury Prevention and Control, CDC.
- Rockett IR, Regier MD, Kapusta ND, et al. Leading causes of unintentional and intentional injury mortality: United States, 2000–2009. Am J Public Health 2012;102:e84–92.
- Baker SP, Hu G, Wilcox HC, Baker TD. Increase in suicide by hanging/suffocation in the U.S., 2000–2010. Am J Prev Med 2013;44:146–9.
- CDC. Web-based Injury Statistics Query and Reporting System (WISQARS). Available at http://www.cdc.gov/injury/wisqars/index.html.
- Hu G, Wilcox HC, Wissow L, Baker SP. Mid-life suicide: an increasing problem in U.S. whites, 1999–2005. Am J Prev Med 2008;35:589–93.
- National Cancer Institute. Joinpoint regression program, 3.5.4 ed. Bethesda, MD: Statistical Research and Applications Branch, National Cancer Institute; 2012.
6. Reeves A, Stuckler D, McKee M, Gunnell D, Chang S, Basu S. Increase in state suicide rates in the USA during economic recession. Lancet 2012;380:1813–4.
- Luo F, Florence C, Quispe-Agnoli M, Ouyang L, Crosby AE. Impact of business cycles on US suicide rates, 1928–2007. Am J Pub Health 2011;101:1139–46.
- Phillips JA, Robin AV, Nugent CN, Idler EL. Understanding recent changes in suicide rates among the middle-aged: period or cohort effects? Public Health Rep 2010;125:680–8.
- Breiding MJ, Wiersema B. Variability of undetermined manner of death classification in the US. Inj Prev 2006;12(Suppl 2):ii49-ii54.
- US Department of Health and Human Services, Office of the Surgeon General and the National Action Alliance for Suicide Prevention. National strategy for suicide prevention: goals and objectives for action. Washington, DC: US Department of Health and Human Services, Public Health Service; 2012.