Suicide Prevention in the United States: Designing Comprehensive Policy Recommendations
Every year, close to 800,000 people worldwide die by suicide. In the United States, where every day approximately 130 Americans take their own lives, suicide is a leading cause of death in the nation. Not only is this a preventable public health issue, but also a tragedy affecting families, communities, and entire countries. With May being Mental Health Awareness Month, it is vital to design comprehensive policy solutions to tackle the dire situation. This will require researchers to understand the risk factors that increase chance of suicide — such as mental health and substance use disorders, environmental factors, and access to lethal means. Moreover, addressing the distressing statistics and the stigma associated with mental health requires collecting data on demographics, frequency, location, and causes of suicide — and ultimately using that information to design policy interventions going forward.
Suicide Rates by State
Analyzing the suicide mortality by state on the US heat map below, it is clear that suicide rates vary dramatically from region to region. While lighter states like New York and California have suicide death rates of 8.3% and 10.7%, respectively, darker states like Alaska (28.5%) and Wyoming (29.3%) have some of the highest rates in the country.
These discrepancies can be explained due to a variety of factors. According to Patrick Sidmore, health planner and research analyst at Alaska Mental Health Board, historical trauma endured by Alaska Natives, as well as adverse childhood experiences (ACEs), put them at a higher risk of suicide. Historical trauma among Alaska Native populations — such as the forced placement of children in boarding schools, destruction of culture, and overt racism — can have a lasting effect on Alaskans for multiple generations. Similarly, much of the Mountain West — states like Wyoming, Montana, Idaho, Colorado, Nevada, and Utah — struggles with the same issue and has been tragically dubbed the “suicide belt”. Researchers cite isolation and low access to mental health care and emergency medical services in rural areas as key reasons for the high rates in this region. This can be further demonstrated through the following US heat map — a summary of Mental Health America’s rankings of the 50 states according to access to mental health care for residents, budget for and existence of suicide prevention initiatives, and extent of access to lethal means:
The results are striking, and correlate strongly with the first map. States that are ranked higher on mental health support, where 1 indicates the best rank and 50 implies the worst, tend to have lower suicide rates. This conclusion is further supported through an analysis of existing suicide prevention initiatives in states. For example, Wyoming, which is ranked 48th for mental health support and has one of the nation’s highest suicide rates, was the last state to develop an in-state suicide prevention hotline. In fact, before August of last year, Wyomingites who called the national number were rerouted to a handful of backup out-of-state call centers. Callers were placed on hold for as long as a half hour, an eternity for a person considering taking their own life.
Recommendation #1: Increase government spending for mental health care, especially in rural areas, and maintain prompt hotlines with trained responders throughout the country to prevent suicides going forward.
Access to Lethal Means
Yet another factor that can describe the above discrepancies in suicide rate between states is the extent to which residents have access to lethal means. For example, the pie chart below shows that nearly half of all suicides are committed through access to a firearm, while 29% occur through suffocation, and 12.9% through poisoning. Specifically, gun availability in the household is linked with violent crime, accidental injury, and death — as firearm ownership expands access to lethal means for those with suicidal thoughts.
While detractors claim that establishing causality between limitations on gun ownership and declines in suicide rate is challenging, as the regression analysis below demonstrates, the risk of suicide is far higher in states with high rates of gun ownership than in those with low ownership rates:
With a strong positive correlation of 0.67, the regression shows that suicide rate is highly correlated with firearm ownership. This could further explain the differences in rates between states from earlier. For example, only 5.2% and 5.8% of households in Rhode Island and Delaware, respectively, own firearms — these states also had some of the lowest suicide rates on the first heat map. On the other hand, Alaska (61.7%), Wyoming (53.8%), and Montana (52.3%) have the nation’s highest rates of gun ownership as well as suicide rates.
Recommendation #2: Despite the strong correlation pictured above as well as empirical evidence that restriction of access to guns reduces suicides, access to firearms in the United States is generally subject to few restrictions. As a result, all states should implement a waiting period for purchasing handguns with a requirement for a permit or license that includes firearm safety training. For a suicidal person who does not already own a handgun, a delay in the purchase of one allows time for suicidal impulses to pass or diminish. Further, safe gun storage for all households delays or prevents access to a gun for a suicidal person living with a gun owner.
Demographic Factors and Suicide Rates
Analyzing what demographic may be more likely to commit suicide can provide valuable insights into how to further allocate mental health resources. For example, on one hand, because of pervasive racism, Black Americans experience substantial stress, fewer opportunities for advancement and more threats to well-being. These negative experiences can degrade mental and physical health, as well as limit education, employment and income — all of which can increase suicide risk. Yet the Black suicide rate is about one-third that of whites.
The figure below shows the rates of suicide split up by ethnicity and gender. Clearly, males make up a much bigger proportion of suicide rates than women in each racial group. Moreover, the crude rates of suicide were highest for Native Americans (45.3 per 100,000), followed by white Americans (38.7 per 100,000). Meanwhile, the suicide rate for Black Americans is much lower — at 14.9%.
Experts say that this is because the deaths of Black Americans are far more likely to be coded as undetermined than those of white Americans, in part because Black Americans dying by suicide are less likely than whites to leave a note and to have a record of mental disorders. (Lower rates of mental health diagnoses reflect at least in part poorer access to health care and treatment that stems from racism.) Other factors that may help protect Black Americans from suicide include religious involvement and close social and family networks, which can build and maintain resilience.
In explaining higher suicide rates among Native American populations, scholars cite greater alcohol and drug use and documented high rates of psychological distress among Indigenous communities — all byproducts of colonization. Finally, middle-aged white men, who are often expected by society to “tough it out” instead of seeking for help, have tended to have the highest suicide rates of any demographic in America. In fact, only about one-third of therapy patients in the nation are men; most therapists — intentionally or unintentionally — market to women.
Recommendation #3: Destigmatize therapy, especially for males, and increase investments in mental health resources for Native American and indigenous communities.
Impact on Youth
Suicide is one of the leading causes of death in late childhood and adolescence worldwide. This visualization below depicts the share of American high school students in grades 9 to 12 who stated they have seriously considered attempting suicide during the 12 months before the survey was given.
Once again, even in the youth context, white Americans have the highest rates of suicide at 52.4%. Moreover, almost half — 46.8% — of LGBTQ+ students have had serious thoughts of suicide. This is attributed to the rejection that LGBTQ+ youth often receive from their families. In fact, those who come from highly rejecting families are 8.4 times as likely to have attempted suicide as LGBTQ+ peers who reported no or low levels of family rejection. Each episode of LGBT victimization, such as physical or verbal harassment or abuse, further increases the likelihood of self-harming behavior by 2.5 times on average.
Recommendation #4: Establish safe spaces for marginalized students, especially those that do not identify as straight, to confide in trusted adults regarding victimizations. Work with schools, where youth spend the majority of their time, to support mental health and implement suicide prevention trainings for students and teachers alike.
Investigating Depressive Sentiments
Using the reddit thread r/depression to scrape posts about depression and suicidal ideation helps to highlight the stories of those struggling with mental health. The visual below shows the most common words and phrases; for example, some of the most common sentiments include “depression,” “can’t feel,” and “nothing,” all words with negative connotations that indicate a sense of hopelessness for the future. The chart illustrate the stories of those who may be having suicidal thoughts while demonstrating the commonality between those experiences.
NLP can also be used to organize these posts into positive sentiments (forgiveness, happiness, peacefulness, hopefulness, love, pride, thankfulness), negative sentiments (guilt, hopelessness, blame, sorrow, anger, fear, abuse), and neutral (objective) classes (such as information and instructions). By introducing an extensive corpus of posts from reddit threads or from real-life suicide notes, data can be trained to further facilitate research and development and design predictive models for suicide prevention strategies going forward.
Analyzing Google Trends: Connecting Community to Battle Suicide Risk
Americans have reported increased depression, anxiety, and substance use during the pandemic, which is evident by the increased searches for “depression” in the Google trends data below. On the other hand, internet searches for suicide, previously found to be associated with population changes in suicidal behavior, decreased during the early stages of the COVID-19 pandemic in the US. Although this cannot independently confirm that changes in search rates were caused by changes in population-level suicide rates, it shows that COVID-19 may have been inversely associated with population suicide trends between February and April 2020.
A possible explanation for this is the following: experts say people tend to rally around each other during times of crisis, such as a pandemic or war. They add that while people may have been more depressed during the initial stages of quarantine, they also tended to be open about their feelings and were more likely to seek mental health services. Community cohesion and sense of belonging are potent protective factors against suicide risk, along with other experiences like connecting to support and mental health service. Moreover, rates of suicide may be impacted by more individuals receiving treatment. With more people being home and telehealth visits with therapists being more accessible, people are better able to access and take advantage of mental health services than in the past.
Recommendation #5: Continue building community cohesion through suicide prevention trainings in schools, churches, and workplaces. Further develop telehealth initiatives to increase access to mental health services.
Ultimately, understanding the extent of suicides according to demographic group, location, and frequency will enable community leaders and policymakers to address high suicide rates in the United States and direct resources accordingly.
Data Sources
Suicide Rates by State
“Suicide Mortality by State” (CDC)
“Adult Ranking 2020” (Mental Health America)
Access to Lethal Means
“Suicide Statistics” (American Foundation for Suicide Prevention)
“Gun Ownership by State 2021” (World Population Review)
Demographic Factors and Suicide Rates
“Suicide” (NIH)
Impact on Youth
“Percentage of U.S. High School Students” (Statista)
Investigating Depressive Sentiments
“r/depression” (Reddit)
Analyzing Google Trends