Clinical Pearls & Morning Reports
Published October 10, 2018
Only a minority of patients who die by suicide have a known diagnosis of a mental illness. Data from 27 states suggest that 54% of people in the United States who died from suicide in 2015 had no known history of a mental illness. Read the latest NEJM Case Records of the Massachusetts General Hospital here.
Q: Are rates of suicide in the United States increasing?
A: The Centers for Disease Control and Prevention recently reported that suicide rates across the United States increased substantially between 1999 and 2016, with an increase of 30% or more in half the states. In 2016, suicide was the 10th leading cause of death in the United States, accounting for nearly 45,000 deaths.
Q: Is there a particular age range associated with either the highest risk or lowest risk of suicide?
A: Although late adolescent boys and elderly men are classically considered to have the highest risk of suicide, the demographic characteristics associated with suicide seem to be changing over time. Between 1999 and 2016, the rate of death by suicide increased in all age groups between 10 and 75 years of age. The most recent epidemiologic data suggest that no age group should be considered to be at low risk.
A: Whether a suicide attempt results in death is directly related to the means used to commit the act. In the United States, suicide is inextricably linked with gun violence and accounts for nearly two thirds of all firearm-related deaths; approximately half of suicides are completed with guns. Access to a firearm is a risk factor for suicide; the odds of death from suicide among those who have access to a gun are more than 3 times as high as the odds among those who do not. People who attempt suicide with a firearm rarely get a second chance, with a fatality rate of approximately 85%, as compared with a rate of approximately 2% among those who attempt suicide by poisoning or overdose.
A: Evidence suggests that suicide may sometimes be an impulsive act rather than a long-reasoned decision. For example, in one study involving patients who survived a suicide attempt, nearly half reported that the time between the first thought of suicide and the attempt was 10 minutes or less. Therefore, the presence of factors that increase impulsivity may be an important element in the complex act of attempting suicide. Are there ways to prevent people from dying by suicide that was attempted at an impulsive moment? Changing their access to guns during periods of crisis has the potential to save their lives. Methods of achieving this include efforts to identify patients who are at a potentially elevated risk of suicide and to counsel them about safe storage of firearms or voluntary removal of guns from the home, as well as legal interventions, such as Extreme Risk Protection Orders (so-called Red Flag laws), which have now been enacted in 13 states.