Module 3 > Populations at elevated risk

Some populations experience elevated risk of suicide because of historical and current-day policies, laws, practices, and procedures that shape the determinants of health.  One of the seven strategies included in the CDC’s Preventing Suicide: A Technical Package of Policy, Programs, and Practices is to identify and support people at risk. Who are the populations at elevated risk for suicide? The CDC regularly tracks and reports national-level data on suicide and leading causes of death for different groups in the U.S.  These data indicate that people in certain age groups, from marginalized identities or geographical areas, with certain life experiences, and who work in certain industries are at elevated risk of suicide.

Suicide is a problem throughout the life span.  Suicide risk is elevated as people navigate key developmental transitions. These risks are particularly pronounced for young people as they move from childhood to adolescence, and for older individuals as they face retirement, health challenges, and in some cases, increased social isolation.

 

Between 2016 and 2018, young women's rates of non-fatal self-harm increased more than 7%.

  • Elderly: According to the Suicide Prevention Resource Center, suicide is also a risk for older adults. Suicide rates are particularly high among older men, with men ages 85 and older having the highest rate of any group in the country. Suicide attempts by older adults are much more likely to result in death than among younger persons.

In the United States, certain groups of people experience marginalization because of historic and ongoing discrimination and oppression.  For these groups, systems of power, including racism, sexism, and homophobia shape their daily lives and systematically exclude group members from full political, social, and economic participation.  This historic and ongoing marginalization contributes to elevated suicide risk for these groups.  For example:

  • Indigenous people: American Indians and Alaska Native (AI/AN) populations have some of the highest rates of deaths by suicide, substance misuse, and overdose. AI/AN have the highest rates of death by suicide among all other population segments.

  • Age, Race, and Gender Intersections

    • ​Black and Latino young men: The Center for Law and Social Policy reported increasing rates of suicide for Black and Hispanic young men ages 18-25 from 2016-2018.
    • AANHPI (Asian American, Native Hawaiian, and Pacific Islander) Youth: In a 2015 report, both Native Hawaiian and Pacific Islander youth (11.8%)  and Asian American Youth (9.5%) reported higher rates of suicide attempts than white youth (8.0%).  Suicidal thoughts, plans, and attempts have been increasing for AANHPI young adults between 2009 and 2019.


 

  • Latina girls: In their 2017 report co-authored with Latina girls in Philadelphia, the National Women’s Law Center highlighted an ongoing suicide crisis amongst Latina girls.

  • LGBTQ+: Among youth who identify as lesbian, gay, bisexual, trans, queer, or questioning, the likelihood of death by suicide has been estimated to be two to seven times greater than the likelihood of death by suicide among heterosexual youth. According to the 2019 Youth Risk Behavior Survey, lesbian, gay, and bisexual U.S. high school students were more likely to report a suicide attempt during the last year.

  • Rural: According to the CDC, from 2000 through 2018, rural suicide rates were higher than urban suicide rates, a gap that widened over the period.

Certain transition periods are associated with higher rates of suicide. These life changes often represent significant stressors that can increase suicide risk. For example:

  • Pregnant/postpartum: According to a JAMA article, suicide is the second leading cause of death among postpartum women.  According to the Well Being Trust, 10–20% of new mothers experience maternal depression - a risk factor for suicide - and the likelihood of postpartum depression increases if the mother has previously experienced depression or financial hardship. One in four mothers of infants below poverty threshold experience moderate-to-severe depressive symptoms and only 15% receive care.

  • Experiencing homelessness: According to a fact sheet from the National Healthcare for the Homeless Council, a 2012 study found suicide rates to be 10 times higher for a homeless cohort compared to the general population, and other research has indicated a higher suicide rate among people experiencing homelessness than the general population. In fact, more than half of people experiencing homelessness have had thoughts of suicide or have attempted suicide.

  • Unemployment: According to the CDC technical package, studies from the U.S. examining historical trends indicate that suicide rates increase during economic recessions marked by high unemployment rates, job losses, and economic instability and decrease during economic expansions and periods marked by low unemployment rates, particularly for working-age individuals 25 to 64 years old. Economic and financial strain, such as job loss, long periods of unemployment, reduced income, difficulty covering medical, food, and housing expenses, and even anticipation of financial stress may increase an individual’s risk for suicide or may indirectly increase risk by exacerbating related physical and mental health problems.

Reflection Questions 

Read this article about suicide amongst immigrants or this article about postpartum suicide.

  • What are some examples of common life stressors in your community that might increase suicide risk?

  • What can we learn across these life stressors about suicide risk?

According to the CDC, suicide rates are significantly higher in five major industry groups:

  • Mining, Quarrying, and Oil and Gas Extraction (males)

  • Construction (males)

  • Other Services (e.g., automotive repair) (males)

  • Agriculture, Forestry, Fishing, and Hunting (males)

  • Transportation and Warehousing (males and females).

Active-duty military and veterans also experience elevated risk. Data shows that veterans often experience greater mental health needs at a higher incidence than the general population. One in five veterans of Iraq or Afghanistan conflict have major depression or Post-Traumatic Stress Disorder (PTSD), and one in four show signs of substance-use disorders, all of which are risk factors for suicide. From 2008 to 2018, there were over 6,000 veterans that died by suicide per year.

Reflection Questions

Read this article about suicide deaths amongst farmers or watch this video about suicide in the military.

  • What do you think are some of the factors that contribute to higher suicide rates in these industries? 

  • What might be the role of organizational culture in these industries’ increased suicide risk?

To skip ahead and learn about examples of equitable solutions for populations at elevated risk, click here.

National Data Sources

This tool from the Suicide Prevention Resource Center includes a number of common sources of national suicide data. 

Spotlight

In late August of 2020, the CDC’s weekly Morbidity and Mortality Report focused on Mental Health, Substance Abuse, and Suicidal Ideation during the COVID-19 Pandemic.  The report highlighted that during the last week of June 2020, U.S. adults reported considerably elevated adverse mental health conditions associated with COVID-19.  Younger adults, people of color, essential workers, and adults with caregiving responsibilities reported having experienced disproportionately worse mental health outcomes, increased substance use, and elevated suicidal ideation.  

In A Guide for Health Systems to Save Lives from “Deaths of Despair” and Improve Community Well-Being, the Institute for Healthcare Improvement identifies two populations potentially experiencing elevated risk during the COVID-19 pandemic:

  • Healthcare Workers Magnified during the COVID-19 pandemic, the healthcare workforce has experienced significant trauma. The workforce includes providers, food-service staff, environmental-services staff, community health workers, and all who contribute their skills to ensure a functioning health system. Physicians, nurses, and other healthcare workers face extremely high rates of burnout — emotional exhaustion, depersonalization, and feelings of inefficacy resulting from chronic work related stress — though they rarely seek treatment, which may result in worsening illness or even death by suicide.

  • Essential Workers Certain aspects of the “essential” workforce have experienced disproportionate burdens of exposure to the virus, fear, and stresses that threaten wellbeing. These include grocery store workers, workers in the hospitality industry, transportation workers, food and agriculture workers, and other jobs that support critical infrastructure and can only be done in person. Unfortunately, much of this burden falls on people in low-paying jobs who are already struggling with economic and other challenges. This, too, has played out as a disproportionate burden on people of color.

Reflection Questions

  • How is your community supporting the mental health and wellbeing of healthcare workers and essential workers during the pandemic?

  • Read this article about mental health challenges in the Asian-American community in the context of xenophobia and anti-Asian violence during the coronavirus pandemic. What are some ways that infrastructure disruptions can marginalize communities further?

  • What lessons from the coronavirus pandemic can be applied to future infrastructure disruptions?

 

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Photo credits: CC by sdttds, CC by the Nevada National Guard, and IG by Soni López-Chávez