In recent years, the topic of suicide has gained traction in the media due to the high number of veterans who die by suicide. It has been estimated that 22 veterans die by suicide each day or 30.0 per 100,000. This is more shocking when compared to that of their civilian counterparts—14.0 per 100,000. The Action Alliance for Suicide Prevention has estimated that 100 Americans die by suicide a day (see background slide set 1).

Also surprising is the increase in the number of middle age Americans who die by suicide. In 2013, the CDC reported that the rate of suicide in Americans ages 35 to 64 was reported to be 17.6 per 100,000 in 2010. The table below illustrates the high number of male deaths by suicide in the age range of 45 to 59 in the NC in 2010. What is also troubling is the high number of suicides for men age 70 and above.

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In general, men tend to die by suicide more frequently than women (19.2 vs. 5.5 per 100,000), and the chart above shows that this national trend is true in NC. Similar to national statistics, women in NC attempt suicide more frequently, with more self injury (NC Division of Public Health, 2013). While suicide is the tenth leading cause of death of all suicides (12.0 per 100,000), it is the third leading cause of death among young people between the ages of 15 and 24 (8.5 per 100,000). In NC, young men between the ages of 20-24 had a rate of 22.58 per 100,000.

Researchers have been studying the role of adverse childhood experiences (ACEs) (i.e., physical, sexual, or psychological abuse; neglect; inadequate supervision; domestic violence; parental separation or divorce; parental substance use; parental mental illness; and parental incarceration before the age of 19) in various physical diseases and mental disorders for nearly 20 years. In 2001, Dube and associates looked specifically at the role of ACES in suicidal behaviors and found that the presence of one or more ACEs significantly increased the risk of death by suicide. Brodsky and Stanley (2008) reviewed the literature and found that early experiences of physical and sexual abuse and parental neglect are risk factors for suicidal behavior in adolescence and adulthood.

In 2007, Belik and co-investigators reported on a national survey, which found that interpersonal traumas and exposure to three or more types of traumatic events were particularly associated with suicidal behaviors. Age of onset analyses indicated that the age of traumatic exposure was earlier than the age at which suicidal behaviors began in the majority of respondents. The results implied that exposure to traumatic events was associated with the incidence of suicidal behaviors above and beyond the effect of sociodemographics, mental disorders, and physical disorders assessed in the survey.

In response to the increase in suicides, the federal government has developed a National Strategy for Suicide Prevention (2012), a collaborative effort of the Substance Abuse and Mental Health Services Administration (SAMHSA), the Centers for Disease Control and Prevention, the National Institutes of Health, the Health Resources and Services Administration, and the Indian Health Service (A copy of the National Strategy may be obtained by clicking here). In addition, SAMHSA has developed suicide prevention toolkits for both seniors and high school students. For middle age Americans, the CDC recommends enhancing social support and community connectedness, improving access to health, mental health and preventive services, and reducing the stigma and barriers associated with seeking help. Other prevention strategies include programs to help those at increased risk of suicide, such as those struggling with financial challenges, job loss, intimate partner problems or violence, stress of caregiving for children and aging parents, substance abuse, major depressive disorders, and serious or chronic health problems.

There is no single cause of suicide. To increase awareness of suicide and suicide prevention, SAMHSA established the Suicide Prevention Resource Center (SPRC). The SPRC hosts a Best Practices Registry, which lists 23 practices. In North Carolina and nationally, a suicide prevention lifeline is also available on a 24/7/365 basis (800-273-8255) for both civilians and veterans (Veterans know it as the Veterans or Military Crisis Line; it is the same telephone number but veterans are routed differently).

In addition to the SAMHSA initiatives, the US Department of Veterans Affairs (VA) and the US Department of Defense collaborated to release a clinical practice guideline, Assessment and Management of Patients at Risk for Suicide in 2013. The Army has developed the ACE (Ask, Care, and Escort) Suicide Intervention Program, which the VA also promotes. For family members, the VA has developed a resource guide, which includes branch-specific websites and resources.

References:
Belik SL, Cox BJ, Stein MB, Asmundson GJ, Sareen J. Traumatic events and suicidal behavior: results from a national mental health survey. Journal of Nervous and Mental Disease, 2007;195(4):342-9.

Brodsky BS, Stanley B. Adverse childhood experiences and suicidal behavior. Psychiatric Clinics of North America, 2008;31(2):223-35.

Dube SR, Anda RF, Felitti VJ, Chapman DP, Williamson DF, Giles WH. Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study. Journal of the American Medical Association, 2001;286(24):3089-96.

Injury Epidemiology and Surveillance Unit, Injury and Violence Prevention, NC Division of Public Health. The burden of suicide in North Carolina. Raleigh, NC: Division of Public Health, NC Department of Health and Human Services, December 2013