Suicide trends in the US, 1900 - 2019

[hamstergang]

For some time, I have been trying to track down an Excel sheet of the suicide rate in the US over the past many decades so I could see for myself how it was really changing (people say it's going up recently, but is that meaningful when looked at more broadly than just the past 1-2 decades?). Unfortunately, I couldn't find this anywhere. So I went through the CDC's website where you can find the old published "Vital Statistics of the United States" and entered the data in Excel myself. I entered nearly 2800 data points -- I'm not going to let this work go to waste so I'm sharing the Excel file with the world (and if someone tells me this already exists out there, I'll be a little sad).

Here's what's inside:

• Suicide rate (suicides per 100,000 people) in the US from 1900 - 2019, in total and separated for male and for female
• From 1940 - 2017, this is further stratified by age (so for male, female, and both combined I have it separated into 5-14 y.o., 15-24 y.o., ..., 75-84 y.o., and 85 y.o. +). There was data starting at some year that broke it down into 5 years age brackets instead of 10, and while that would have been nice it would also have doubled the work at that point and prevented me from going back as far as I did.
• From 1900 - 1938, the method of suicide is included. I was going to do this for the entire time, but it was a lot of work and not my primary focus. Also, they changed the terminology at times which made it hard to keep the comparisons going through the years. As indicated in the file, from 1921 on there were some different categories which I assumed were similar to the old categorizations.
• I have a sheet in the file with all my sources as well as page numbers.
• I have a sheet in the file with some graphs made from the data. One is included below. I'm not exactly sure what conclusions to draw from this in terms of how to view the current increases in the suicide rate relative to the historical context. Please provide your thoughts.

Please note that there is a lot more data there that can be looked at. I just didn't want to type it all into Excel right now. Also, I did NOT double check my work and so I may have made errors. However, the graphs made it clear when I made a huge error so those were corrected. Enjoy.

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[wolfvgang22]

Very nice!
Gee, I wonder what happened in 1929...that one seems easy to figure out.

Since the turn of this century suicide rates are climbing. I wonder why.

 

[calvnandhobbs68]

Very nice!
Gee, I wonder what happened in 1929...that one seems easy to figure out.

Since the turn of this century suicide rates are climbing. I wonder why.

Seriously apparently we’re at Great Depression rates of suicide right now.

Although I do wonder sometimes if there was underreporting of suicides since it’s been such a taboo thing in the past (even now at some level).

 

[WisNeuro]

The most worrying thing would be why our rates are still climbing pretty steadily, while rates from comparable countries continues to decline. Heck, even Japan is continuing a decline after a runup in the late 90's, and they theoretically should be rising or at least holding steady if we only consider demographics.

Not that I think it would change the overall trend, but I wonder what proportion of datasets include drug overdoses/accidental drug overdoses within the statistic?

 

[hallowmann]

The most worrying thing would be why our rates are still climbing pretty steadily, while rates from comparable countries continues to decline. Heck, even Japan is continuing a decline after a runup in the late 90's, and they theoretically should be rising or at least holding steady if we only consider demographics.

Not that I think it would change the overall trend, but I wonder what proportion of datasets include drug overdoses/accidental drug overdoses within the statistic?

The few ME offices I'm familiar with do not use drug OD (with recreational/illicit drugs only) as a default suicide as opposed to accidental unless there was other evidence (e.g. swallowed a ton of other meds, left a note, had talked about suicide recently, etc.).

That said, it is not uncommon for people to commit suicide in the context of other drugs, usually first alcohol, but more recently narcotics.

 

[wolfvgang22]

There must be large social and cultural issues at play. Formal mental health care, while still limited, has historically never been as good as it is now. The trend should be concerning. Unless as a society suicide prevention is not as important to people as they say.
Can we do more as a profession?

 

[FlowRate]

As other people are mentioning, there may be a disconnect between the data and what the data is intended to represent. How do you know whether a death was a suicide? Who reports it to the data collecting agency? Understanding the methods used to collect the data--and when those methods changed--is necessary to deriving useful information from such a chart.

 

[WisNeuro]

There must be large social and cultural issues at play. Formal mental health care, while still limited, has historically never been as good as it is now. The trend should be concerning. Unless as a society suicide prevention is not as important to people as they say.
Can we do more as a profession?

Thomas Joiner gave a talk here last year at our state psych conference meeting. He actually went a little into cultural issues possibly at play. Particularly our glorification of violence, especially when we see it as necessary or justified. Not sure if I still have his slides, but I'll look around.

 

[hamstergang]

As other people are mentioning, there may be a disconnect between the data and what the data is intended to represent. How do you know whether a death was a suicide? Who reports it to the data collecting agency? Understanding the methods used to collect the data--and when those methods changed--is necessary to deriving useful information from such a chart.

Yeah, the data is certainly not perfect, though I'd like to think that the CDC's data is the best we have over this time period. If I remember correctly, this issue of determining cause of death is discussed in some of the Vital Statistics documents I cite (though I read a lot of things so maybe it came from elsewhere). I guess the question is if this error in the data is systematic and therefore influencing the observed trend, or if it's random or at least consistent over decades?

 

[WisNeuro]

Yeah, the data is certainly not perfect, though I'd like to think that the CDC's data is the best we have over this time period. If I remember correctly, this issue of determining cause of death is discussed in some of the Vital Statistics documents I cite (though I read a lot of things so maybe it came from elsewhere). I guess the question is if this error in the data is systematic and therefore influencing the observed trend, or if it's random or at least consistent over decades?

I'd tend to agree, the errors that are present are likely systematic, and would wash out, especially for stats in modern times. Additionally, the trend matches smaller sets of data with tighter data points (e.g., VHA), so, there's no reason to think that the increase is solely due to error.

 

[LadyHalcyon]

I blame technology. Increased work expectations combined with real and/or perceived isolation. As a population we are much more disconnected from one another. However, it would be interesting to exmaine how our culture compares to other cultures in terms of mental health treatment, prevalence of mental health issues, and psychopharm interventions for these issues. Our "quick fix" society, and subsequent expectations, may be slowly killing us. As with most things, I'm sure it's complicated.

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[birchswing]

There must be large social and cultural issues at play. Formal mental health care, while still limited, has historically never been as good as it is now. The trend should be concerning. Unless as a society suicide prevention is not as important to people as they say.
Can we do more as a profession?

I've heard from mental health professionals who think things have gotten worse, whether it's from deinstitutionalization, increased prescribing, fewer visits for therapy. In my state the waiting list to get a bed in a public residential facility is years long.

 

[FlowRate]

I'd tend to agree, the errors that are present are likely systematic, and would wash out, especially for stats in modern times. Additionally, the trend matches smaller sets of data with tighter data points (e.g., VHA), so, there's no reason to think that the increase is solely due to error.

This isn't considered true in crime reporting, so why would it be true of suicide reporting? It's typically the same folks making the reports. Are drug overdoses potential murders, suicides, or other?

 

[cara susanna]

There's a good amount of research that suggests access to firearms in the US is a big factor in our suicide rate. For instance, one study by Michael Anestis found that state gun control laws were related to suicide rates.

 

[FlowRate]

That points out the other issue of completed suicide vs attempts. Attempts seem much harder to study reliably. If the causative factor in an increased rate of completed suicide is availability of means, I'd wonder if it was fentanyl, given firearms are, if anything, less easy to get now. (That's not intended to discount that firearms are a huge contributor to completed suicides.)

 

[WisNeuro]

That points out the other issue of completed suicide vs attempts. Attempts seem much harder to study reliably. If the causative factor in an increased rate of completed suicide is availability of means, I'd wonder if it was fentanyl, given firearms are, if anything, less easy to get now. (That's not intended to discount that firearms are a huge contributor to completed suicides.)

Very state dependent. Incredibly easy to obtain where I am. Heck, took me far less time and hassle to recently buy a gun than it was to get a new ID.

 

[FlowRate]

Very state dependent. Incredibly easy to obtain where I am. Heck, took me far less time and hassle to recently buy a gun than it was to get a new ID.

Less easy to get on an averaged national level... Yes, there's a difference in how easy depending on state and city.

 

[WisNeuro]

Less easy to get on an averaged national level... Yes, there's a difference in how easy depending on state and city.

I'd say it's about the same, some states got tougher, some states got more lax. I've personally never lived anywhere that enacted tougher gun laws (2 red states, 2 solid blue, 1 purple).

 

[calvnandhobbs68]

Less easy to get on an averaged national level... Yes, there's a difference in how easy depending on state and city.

What additional restrictions have been enacted since 2000 that make it harder to buy guns on a national level?

The thing people forget about the US is that it's extremely easy to transport guns across state lines as well or go to a gun show in another state and buy a gun. That's why gun control doesn't work in Chicago...you can right across the border go to Indiana to a gun show and buy whatever you want.

 

[FlowRate]

I'd say it's about the same, some states got tougher, some states got more lax. I've personally never lived anywhere that enacted tougher gun laws (2 red states, 2 solid blue, 1 purple).

What additional restrictions have been enacted since 2000 that make it harder to buy guns on a national level?

The thing people forget about the US is that it's extremely easy to transport guns across state lines as well or go to a gun show in another state and buy a gun. That's why gun control doesn't work in Chicago...you can right across the border go to Indiana to a gun show and buy whatever you want.

I'm not arguing that it's hard to get guns. Or that gun control laws work or don't work. Most meaningful gun legislation is state-level, not national.

State Gun Control Laws in America: A State Gun Law Guide

When it comes to gun control, there’s much variance among the states. Read on to discover the history of state gun control laws from CCW permits to gun bans.

ammo.com

Politically biased source but clearly lists a history of major gun laws. I haven't read the entire article but of the bunch I have read, I've yet to run across a state that managed to make it easier to buy guns. Many instituted universal background checks. More recently, Red Flag states.

So to link this back to the post that spawned all this:

Completed Suicides = Attempted Suicides * Completion Rate

So why the spike in completed suicides? Is it attempts or completion rate or both?

Completion rate is related to means. Guns are a huge contributor to lethal means of suicide. But gun ownership hasn't increased nationally and it hasn't, as best I can tell, become easier to purchase guns (again, if anything, more difficult, YET STILL REALLY EASY FOR THE MOST PART.) So it's probably not guns themselves causing the increase in completed suicides (although still a major contributor as a lethal means.) But it could be fentanyl/heroin/Rxopioid+benzos (means) or it could be loss of industry / poverty / loneliness / desperation (attempts.)

 

[Merovinge]

So to link this back to the post that spawned all this:

Completed Suicides = Attempted Suicides * Completion Rate

So why the spike in completed suicides? Is it attempts or completion rate or both?

Completion rate is related to means. Guns are a huge contributor to lethal means of suicide. But gun ownership hasn't increased nationally and it hasn't, as best I can tell, become easier to purchase guns (again, if anything, more difficult, YET STILL REALLY EASY FOR THE MOST PART.) So it's probably not guns themselves causing the increase in completed suicides (although still a major contributor as a lethal means.) But it could be fentanyl/heroin/Rxopioid+benzos (means) or it could be loss of industry / poverty / loneliness / desperation (attempts.)

While I certainly think both means and attempts are increasing, I see a lot of adult psychiatrists who are not aware of how much the pediatric population is impacting these numbers. This past AACAP they presented on the 2013-2018/9ish suicide data that is being heavily linked to smart phone/social media access and the numbers are staggering. We are similar to or maybe even exceeding the worst stretch of time to ever be a child in terms of suicide. This data set doesn't have the last few years and, the spoiler alert, is that it's getting even worse. Parent's don't know what to do, schools don't know what to do, and largely CAP does not know how to change the situation as it's such a new phenomenon.

 

[LadyHalcyon]

While I certainly think both means and attempts are increasing, I see a lot of adult psychiatrists who are not aware of how much the pediatric population is impacting these numbers. This past AACAP they presented on the 2013-2018/9ish suicide data that is being heavily linked to smart phone/social media access and the numbers are staggering. We are similar to or maybe even exceeding the worst stretch of time to ever be a child in terms of suicide. This data set doesn't have the last few years and, the spoiler alert, is that it's getting even worse. Parent's don't know what to do, schools don't know what to do, and largely CAP does not know how to change the situation as it's such a new phenomenon.

Like I said, I blame technology. On a closely related aside, the teens I treat fall asleep on the phone/tablet with their significant other. They feel isolated and need to be in constant "communication" with one another. I've heard of teens spending 18 hours with their partner via facetime. I can't even fathom

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[foreverbull]

Interesting thoughts, many good points. I’m sure there are several factors involved, but speaking from my anthropology background I wonder about reduced connection to nature and reduced socializing. Time exercising or spending time outside for the younger generations is on the decline, and there is now an unprecedented level of detachment from all of the activities our ancestors engaged in (food gathering, hunting, production, etc. and group socializing).

On a small scale, cognitive psychology research suggests spending time in a natural environment with no signs of civilization (cars, people, signs, etc.) replenishes attentional resources and how urban environments have an overwhelming and depleting effect to our attentional resources. I wonder about this in relationship to depression as well, in addition to the effect of social comparison on social media and seeing how “happy” everyone else is (and the time we spend on phones and in front of the tv is on the rise).

For those interested in the anthropological side, Savages and Civilization (Weatherford) is a great read on the topic of how we have shifted drastically from the path of our ancestors and some of the effects of this shift.

I just wonder if some Americans are reaching new levels of detachment from the activities and experiences that help us feel more balanced, connected, and give meaning to our lives.

 

[LadyHalcyon]

Also, probably has something to do with this

America's Wealth Inequality Is At Roaring Twenties Levels

What is the common denominator between U.S. wealth inequality during the Roaring Twenties and now? A massive stock market bubble.

www.google.com

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[Candidate2017]

The thing people forget about the US is that it's extremely easy to transport guns across state lines as well or go to a gun show in another state and buy a gun. That's why gun control doesn't work in Chicago...you can right across the border go to Indiana to a gun show and buy whatever you want.

I'll take a shot in the dark and guess people crossing state lines to bring guns back to Chicago aren't interested in committing suicide or putting their guns to any other legal use.

 

[calvnandhobbs68]

While I certainly think both means and attempts are increasing, I see a lot of adult psychiatrists who are not aware of how much the pediatric population is impacting these numbers. This past AACAP they presented on the 2013-2018/9ish suicide data that is being heavily linked to smart phone/social media access and the numbers are staggering. We are similar to or maybe even exceeding the worst stretch of time to ever be a child in terms of suicide. This data set doesn't have the last few years and, the spoiler alert, is that it's getting even worse. Parent's don't know what to do, schools don't know what to do, and largely CAP does not know how to change the situation as it's such a new phenomenon.

The pediatric population is not impacting those numbers much on an absolute scale. On a population level there are way less 5-18yo (the population that is measured for suicide) than 18+. Yes, the suicide rate for <18 has increased but it isn’t the primary driver for those numbers. It’s a leading cause of death for that age range because the mortality rate for kids overall is relatively low compared to middle age and older adults.

 

[hamstergang]

I wanted to overlay a graph of the use of antidepressants on the graph of suicide rate (maybe separated by antidepressant type, definitely stratified by age). My interest in this was really to try to answer the question about the potential risk of suicide with antidepressants in youth. The studies that led to that black box warning didn't find any suicides but just suicidal thoughts and self-harm. Also, there's another current thread here in which someone claimed that there's a relationship between the use of SSRIs over TCAs and the suicide rate in the country overall.

NHANES (NHANES - National Health and Nutrition Examination Survey Homepage ) has this data. However, I can't figure out how to actually see the numbers, even after installing an SAS viewer. Anyone know how to do this or already have the numbers?

 

[wolfvgang22]

Have you considered emailing the authors?