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Rates of suicide rose by about 25% in the U.S. from 1999 to 2016, according to a new report from the CDC.

Additionally, over half of states saw an increase of over 30% over the past two decades -- accounting for around 45,000 deaths in 2016 alone -- according to a ".

The extent of this increase , with suicide rates rising across the country in all states except Nevada. North Dakota and and Vermont saw increases approaching or topping 50%. Not counting Nevada, Delaware saw the smallest increase at 5.9%.

"We don't know for sure why the rates of suicide are increasing essentially across the board -- across virtually all states and for both females and males," Nadine Kaslow, PhD, of Emory University School of Medicine in Atlanta, explained to 番茄社区.

"Some reasons that people have concerned include the lack of adequate and accessible mental health services for everyone who is experiencing mental health problems and the limited social services for people with financial and employment challenges," said Kaslow, who was not involved with the study.

"The CDC correctly points out that the suicide is multifactorial in its cause," commented John Walkup, MD, of Ann and Robert H. Lurie Children's Hospital of Chicago.

Although a public health approach to solving this is warranted, he explained to 番茄社区 how tackling this issue is particularly difficult.

"Do you target suicide specifically or target the larger issues that contribute to suicide risk," he questioned, suggesting how the greatest benefit will probably be seen by targeting those with risk factors for suicide in order to reduce suicide risk and morbidity on a larger scale due to reduction in risk factors. "For example, educating the public and screening teens for depression and engaging them in treatment will lower suicide risk and may be more universally beneficial than only referring for treatment those with positive suicide screens."

CDC's Findings

In their analysis, led by Deborah M. Stone, ScD, of the Division of Violence Prevention at the National Center for Injury Prevention and Control, and colleagues assessed suicide trends in all 50 states and Washington, D.C., from 1999 to 2016 among individuals 10 years and older.

Firearms were used in about half of suicides, making it by far the most common method. But increases were seen across all methods.

Notably, the report also found that 54% of people who died from suicide had no known mental condition, making it even more important for people to recognize the warning signs.

"What was striking to me as an anxiety disorder expert is the very low rate of reported anxiety disorders in the population of the deceased," commented Walkup.

"This is especially important as untreated anxiety disorders are associated with suicidal behavior, poor educational outcome and problems transitioning to adulthood and substance use disorders. I think we are just beginning to understand the pathway from anxiety to suicide and much can be done to raise awareness that anxiety and depression contribute to suicide risk."

Circumstances surrounding suicides were generally common among decedents with and without mental health conditions, the researchers found. The most common contributing factor being relationship problems, followed by life stressors, recent or impending crises, physical health problems, and substance abuse.

"While the CDC is correct to focus on known triggering events for a specific suicide it is important to note that those triggering events are ubiquitous in the US and not everyone who experiences economic duress, or relationship problems etc. is at risk for suicide," Walkup warned. "Addressing those factors is important as it is directly relevant to the person in distress and the right thing to do."

He continued, adding: "The flip side is the observation that is common in the suicide prevention literature. When common everyday events are linked to suicide in a causative way there are individuals who perceive such a link as "support or permission" for them to consider suicide. One of the problems with media portrayals of suicide is that it can support a person's belief that suicide is logical outcome of economic distress or relationship problems. It is the reason people are concerned about media portrayals of suicide."

Although methods of suicide were also generally similar between those with and without mental health conditions, those without any known mental health conditions were slightly more likely to die by a firearm (55% versus 41%). Among both groups, suffocation was the second most likely cause of death, followed by poisoning.

What Healthcare Providers Can Do

From a healthcare providers perspective, Daniel Dickstein, MD, of Bradley Hospital in Rhode Island, told 番茄社区 it's key that providers not be afraid to ask patients about suicide.

"It is really important for healthcare workers to try to encourage families to consider being part of a research study -- because just as with cancer -- such partnerships are the only way that the future will be brighter," he encouraged. Dickstein also added when dealing with pediatric patients, it's important to include parents in on the conversation, highlighting how suicide is the second leading killer of kids starting at age 10, all the way through young adulthood.

Men in particular may fall under the radar, warned Eric Caine, MD, of the University of Rochester Medical Center in New York, who said it's men who typically don't seek help, are less likely to share thoughts and feelings with others, and are also less prone to visits healthcare providers routinely.

"There is a substantial amount of work within healthcare systems, but it is most important to remember that most suicides occur in communities and most deaths happen with the first attempt," he told 番茄社区.

Kaslow also suggested several steps to clinicians should bear in mind when talking with patients.

"First and foremost, [providers] should routinely ask people if they are feeling depressed, anxious, and or like hurting themselves. They also need to ask about substance use," she explained. If patients respond affirmatively, providers should dive deeper and connect the patient with appropriate services.

She also recommended more integrated primary and specialty care, achieved by integrating behavioral health professions into various medical services. Providers should also readily have resources available for their patients who report mental health problem, such as crisis hotlines, mental health facilities and providers, apps and websites.

Dickstein agreed with this point, expressing that "more than ever, our healthcare system is fragmented," adding that we all must work to improve access to mental healthcare, including tackling barriers such as lack of providers and lack of insurance coverage.

"All health professionals need to be trained in suicide assessment and prevention. This will enable them to be more comfortable talking to their patients about suicide and related topics," Kaslow recommended.

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