Violent Deaths in 27 U.S. States, 2015: Suicides, Homicides and Their Circumstances

If you or someone you know is thinking about suicide, call or text 988, the Suicide & Crisis Lifeline.

Summary

• About 62,000 people died from violence-related injuries in the United States in 2015.
• CDC's National Violent Death Reporting System (NVDRS) recorded 31,415 deaths in 30,628 incidents in 27 states — home to about 46.9% of the U.S. population.
• Suicides were 65.1% of these deaths, homicides 23.5%, deaths of undetermined intent 9.5%, legal intervention deaths 1.3% and unintentional firearm deaths under 1.0%.
• Mental health problems, intimate partner problems, interpersonal conflicts and life stressors preceded many kinds of violent death.

The system

NVDRS draws on death certificates, coroner and medical examiner reports and law enforcement reports, plus other sources in some states. It collects about 600 variables per death and links related deaths — several homicides, or a homicide followed by a suicide — into one incident. It was the first system to record the circumstances leading to violent deaths in this detail.

Legal intervention means a death caused by law enforcement or others with legal authority to use deadly force, excluding legal executions. The term comes from the International Classification of Diseases and says nothing about whether the death was lawful.

States in NVDRS by the year they began collecting data. Figure from the CDC report.

Suicide

• Who: the rate for males (21.2) was nearly three and a half times that for females (6.2). Non-Hispanic American Indian/Alaska Native people had the highest rate (22.2), and non-Hispanic whites were 83.6% of suicides. Adults aged 45–54 (20.2) and 55–64 (18.3) had the highest rates by age; 10–19-year-olds the lowest.
• Men: highest at 85 and older (38.0), then 75–84 (33.3) and 45–54 (30.0). Women: highest at 45–54 (10.7).
• How: firearms in 48.5%, hanging, strangulation or suffocation in 28.9% and poisoning in 14.7%. Men most often used a firearm (54.5%); among women, poisoning (32.9%), firearms (28.6%) and hanging (28.6%) were about equal. Most died at home (74.1%).
• Toxicology: of those tested, 40.6% were positive for alcohol (66.3% of them at 0.08 g/dL or above), 40.8% for antidepressants, 30.3% for benzodiazepines, 26.6% for opioids and 22.4% for marijuana.

What came before (circumstances known for 91.8%):

• Mental health: 50.1% had a diagnosed mental health problem — most often depression (75.3%), anxiety (16.8%) or bipolar disorder (15.2%) — and 37.5% were described as depressed at the time, yet only 27.4% were in treatment.
• Warning signs: 34.5% left a note, 31.9% had a history of suicidal thoughts or plans, 19.9% had attempted before, and 23.5% had told someone they intended to die — most often an intimate partner (37.4%) or another family member (29.6%).
• Stressors: a crisis in the past or coming 2 weeks (29.4%), intimate partner problems (27.2%), physical health problems (22.3%), alcohol (17.4%) or other substance (16.4%) problems, an argument (15.5%), and job, financial, family or legal problems.
• Women were likelier than men to have a diagnosed mental health problem (66.2% vs 45.1%) and to be in treatment (41.1% vs 23.2%).

Homicide

• Who: the rate for males (7.9) was nearly four times that for females (2.0). Non-Hispanic Black people were 54.2% of victims, with the highest rate (19.1). Non-Hispanic Black males had a rate of 35.0, compared with 2.8 for non-Hispanic white males, 14.6 for American Indian/Alaska Native males and 7.4 for Hispanic males. Rates peaked at ages 20–24 (12.1) and 25–29 (11.1), and infants under 1 (7.7) had a much higher rate than children aged 1–4 (2.6).
• How: firearms in 70.3%, sharp instruments in 12.0%. 49.0% happened at home — 70.3% for women, 43.3% for men — and 22.3% on a street or highway.
• The suspect: unknown in 52.3%. When known, an acquaintance or friend for male victims (35.2%), and a current or former intimate partner for female victims (51.4%).
• What came before (known for 80.4%): another crime (34.7%) — mostly assault or robbery — an argument (34.9%), a physical fight (14.1%) and drug involvement (11.5%). Intimate partner violence was a factor in 45.4% of homicides of women but 8.4% of men.

Legal intervention deaths

• Who: 96.6% were male, with the highest rate at ages 30–34 (1.2). Non-Hispanic white males were 55.3% of these deaths, but non-Hispanic Black males had the highest rate — 1.0, against 0.4 for white males.
• How: firearms in 92.6%; 42.2% at a house or apartment.
• What came before: about 86.0% followed another crime, most often assault or homicide. The person reportedly used a weapon in 70.7%; 21.8% had a substance problem other than alcohol and 18.4% a diagnosed mental health problem.

Unintentional firearm deaths

204 deaths: 50.5% self-inflicted and 41.7% inflicted by someone else. 81.4% were male, and more than half (51.5%) were aged 24 or younger. Most happened at home (80.4%) and involved a handgun (61.8%). The most common context was playing with a gun (39.1%), then hunting, cleaning and showing it to others; the most common circumstances were unintentionally pulling the trigger (21.3%) and thinking the gun was unloaded (15.2%).

Deaths of undetermined intent

The rate was higher for males (2.5) than females (1.4), and highest among American Indian/Alaska Native people (3.6). 70.9% were aged 30–64. Poisoning was the method in 68.3%. Where circumstances were known, substance problems other than alcohol (63.6%) and alcohol problems (28.3%) were most common. Opioids were the substances most often found — whether these deaths were overdoses or suicides is unknown.

Suicides among service members and veterans

3,429 current or former military personnel died by suicide — 96.4% male, 89.6% non-Hispanic white, and 52.0% aged 45–74. 69.4% used a firearm. 43.1% had a diagnosed mental health problem — most often depression (71.2%), then posttraumatic stress disorder (18.6%) — but only 21.0% were in treatment. Physical health problems (37.2%), a recent crisis (29.7%) and intimate partner problems (23.4%) were common.

What can be done

• Suicide: CDC's suicide prevention package sets out seven strategies — economic supports, better access to suicide care, protective environments, connectedness, coping and problem-solving skills, identifying and supporting people at risk, and lessening harms and preventing future risk. Fewer than a third of those who died were known to be in treatment, despite frequent mental health problems and disclosed intent.
• Homicide: community-level strategies — improving neighborhoods and economic conditions — can reduce violence and narrow racial and ethnic gaps. For intimate partner violence: screening women of childbearing age and referring them to services, supporting survivors, engaging bystanders, men and boys, and teaching youths about healthy relationships before they date.
• Shared roots: suicides and homicides are often preceded by relationship problems, so programs that build problem-solving, conflict resolution and coping skills can prevent several kinds of violence at once. Alcohol use is a strong predictor of both suicidal behavior and victimization.
• Firearms: most unintentional deaths happened while playing with a gun or believing it unloaded, underlining safe storage and safe handling.
• States at work: Virginia found suicide rates in 2003–2010 higher among active duty members than civilians or veterans; Oregon found veterans' suicide rates rising in 2001–2012 and coordinates prevention across agencies; Arizona found high rates among adults 65 and older — 48.7 among veterans vs 12.7 for nonveterans — and recommended that primary care providers screen older patients for suicidal thoughts and limit access to lethal means.

Limits: the 27 states aren't nationally representative; data depend on partnerships between agencies; toxicology testing varies; abstractors see only what the reports contain; different documents may classify a death differently; coding varies with experience; mental health information comes from coroners, family and friends rather than medical records; and protective factors aren't collected.

Sources

Based on Shane P.D. Jack, Emiko Petrosky, Bridget H. Lyons and others, "Surveillance for Violent Deaths — National Violent Death Reporting System, 27 States, 2015," MMWR Surveillance Summaries, Centers for Disease Control and Prevention; a work of the United States government in the public domain. The report's abstract gives about 3,000 suicides among military personnel and its results 3,429; this page follows the results.