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US suicide rates rose sharply between 1999 and 2020, with the greatest increase in American Indian/Alaska Native (AIAN) populations and White men, new data from the Centers for Disease Control and Prevention (CDC) show.
Suicide rates increased 65% in AIAN women, 35% in AIAN men, and 29% in White men. Firearms and hanging were the most common methods of suicide among all racial groups, with a nearly 200% increase in hanging among AIAN women.
Investigators note the data suggest suicide prevention strategies should be race-relevant and implemented at the community.
“The findings underscore the need to address underlying mental health issues in AIAN populations and emphasize the importance of implementing community-based suicide prevention strategies tailored to specific racial groups,” lead investigator Bibha Dhungel, DrPH, of Waseda University in Tokyo, Japan, told Medscape Medical News.
The findings were published online on December 18 in the Annals of Internal Medicine.
Ongoing Racism, Inequality
The study included age-specific data on suicide deaths from the CDC’s WONDER database and corresponding US population figures for each year from 1999 to 2020. To compare trends in method-specific mortality by racial groups, researchers estimated age-standardized suicide mortality rates per 100,000 persons among adults by method and race, using the 5-year age- and sex-specific population in 2000 as the standard.
Overall, there were 837,000 suicide deaths in the US between 1999 and 2020. White men had the highest suicide rates overall, beginning in 1999 with a relative rate of 21.5 suicides and ending up with 27.8 in 2020, for a relative increase of 29%.
Suicide rates among AIAN men, although slightly lower overall than those of White men, had a much steeper incline from a relative rate of 19.6 per 100,000 people in 1999 to 26.5 per 100,000 people in 2020, a 35% relative increase. Rates among AIAN women rose from 4.6 per 100,000 in 1999 to 7.6 per 100,000 in 2020, a 65% relative increase.
Among AIAN men, firearms and hanging were the major means of suicide, and these increased at similar rates between 1999 and 2020. Hangings among AIAN women increased nearly 200% during the study period, from a relative rate of 1.4 in 1999 to 4.1 in 2020.
AIAN people have a life expectancy that is about 7 years shorter than that of White persons in the US and high prevalence rates of mental health problems. Historically high rates of suicide among AIAN people may be a long-term consequence of the “well-documented history of genocide, colonialism, associated historical trauma, and ongoing inequality and discrimination” against AIAN people in the United States, the authors write.
Data May ‘Mask’ Reality
In an accompanying editorial, Joseph P. Gone, PhD, a professor in global health and social medicine at Harvard University in Boston, notes that studies by Dhungel and others add to a growing body of research on suicide risk among Indigenous populations.
“There have been consistent findings across decades of epidemiologic inquiry into Indigenous suicide,” Gone writes. “Suicide mortality is alarmingly high.”
Still, Gone argues that statistics such as these can “mask more complicated realities,” citing precedents in which Indigenous suicide rates have been studied as a function of societal functions at the tribe or community level, recasting “Indigenous suicide as a postcolonial disorder in need of not just more and better medical treatment but also of social justice and societal reparation.”
“We need alternative research that will motivate and mobilize new ways of understanding Indigenous suicide and new approaches to prevention,” he adds.
Study limitations include an absence of information on the background of suicide cases and biases or errors in the death recording process.
Financial disclosures can be found in the original article.
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