Suicide Rates Rose in Nearly Every State, 1999–2016 — and Most Who Died Had No Known Mental Health Condition

In 2016, nearly 45,000 people aged 10 and older died by suicide in the United States — 15.6 per 100,000. Suicide was the tenth leading cause of death, one of only three leading causes still rising. From 1999, rates rose nearly 30% — across both sexes, every racial and ethnic group, every level of urbanization, and every age group under 75. Adults 45–64 saw the largest rise (13.2 per 100,000 in 1999 to 19.2 in 2016). Emergency visits for nonfatal self-harm, a key risk factor, rose 42% from 2001 to 2016, and suicide and self-harm together cost about $70 billion a year in medical and work-loss costs.

State by state

CDC analyzed state death records in six three-year periods from 1999 to 2016.

• For 2014–2016, state rates ranged fourfold, from 6.9 per 100,000 in DC to 29.2 in Montana.
• Rates rose in every state but Nevada, where they were high throughout. Increases ranged from 5.9% (Delaware) to 57.6% (North Dakota) — and topped 30% in 25 states.
• Modeled trends showed significant increases in 44 states — among men in 34 and women in 43 — and nationally, averaging 1.5% a year (1.1% for men, 2.6% for women).

Percentage change in suicide rates by state, 1999–2001 to 2014–2016. CDC

Beyond mental illness

Using the National Violent Death Reporting System (NVDRS) in 27 states in 2015, CDC compared people who died by suicide with and without a known mental health condition. 54% had none known.

Firearms were the most common method overall (48.5%). People without a known condition were less often tested for toxicology; when tested, they were less likely to test positive for substances overall, including opioids, but more likely for alcohol. They were less likely to have recently left an institution — but those who had were more often released from prison or jail, a hospital, or a substance use treatment facility. Among those with known conditions who had recently left an institution, 46.7% came from psychiatric facilities.

Of people with a known condition, two-thirds had been treated for mental health or substance use problems, and about half were in treatment when they died.

What it means

Suicide is rarely caused by a single factor, yet prevention often focuses on mental health alone. With about half of those who died having no known condition, efforts need to reach further upstream, addressing relationship problems and other stressors — while also better supporting people who do have mental health conditions, through affordable, effective care such as collaborative care and cognitive behavioral therapy, more behavioral health providers in underserved areas, and systems that integrate physical and behavioral health, especially at care transitions.

CDC's Preventing Suicide: A Technical Package of Policy, Programs, and Practices sets out a comprehensive approach:

• strengthen economic supports, such as housing stabilization and household financial help;
• teach coping and problem-solving skills, especially early in life;
• promote connectedness;
• identify and support people at risk, such as veterans and people with physical or mental health conditions;
• create protective environments — including reducing access to lethal means for people at risk, and workplace policies that encourage help-seeking;
• strengthen access to and delivery of care;
• support family and friends after a suicide, and encourage safe media reporting.

Some states, such as Colorado, plan to adopt this kind of approach. The national goal — set by the National Action Alliance for Suicide Prevention and the American Foundation for Suicide Prevention — is to cut the annual suicide rate 20% by 2025.

Limits

In Maryland, Massachusetts, Rhode Island and Utah, many injury deaths of undetermined intent may have affected state rankings or trends. The 27 NVDRS states cover 49.6% of the population, not the whole country. And NVDRS relies on investigators' reports: some people recorded without a known condition likely had undiagnosed or unreported mental health problems.

If you or someone you know is struggling or in crisis, call or text 988, or chat at 988lifeline.org, to reach the 988 Suicide & Crisis Lifeline.

Sources

Based on Stone DM, Simon TR, Fowler KA, et al., "Vital Signs: Trends in State Suicide Rates — United States, 1999–2016 and Circumstances Contributing to Suicide — 27 States, 2015," MMWR volume 67, number 22, Centers for Disease Control and Prevention; a work of the United States government in the public domain.