There are significant differences in U.S. suicide death rates and methods across age, race and sex — and younger generations of people of color, particularly Black people, are becoming more likely to die by nonfirearm suicide, a finding that researchers say has implications for mental health interventions and emergency counseling.
"We believe that the increased suicide risk we found among very young cohorts of nonwhite individuals is partially explained by their experience of marginalization — anti-racist policies would hence be theoretically helpful here," said Gonzalo Martínez-Alés, a psychiatrist and epidemiologist from Columbia University and the lead author of the study, published April 7 in Molecular Psychiatry. The risk profiles drawn in the paper could help health care providers and public policymakers tailor interventions, particularly since much of U.S. emergency counseling focuses on access to firearms.
Looking at the birth year, age, race, sex and cause of death on all death certificates in the U.S. between 1999 and 2018, the researchers saw that suicide rates went up across all groups, with peaks in young adulthood and, notably, peaks for older men using guns and younger people of color using methods other than guns. Men, in general, were more likely to die by suicide than women, and men, but not women, had a spike in suicide rates after turning 60, with the exception of Asian and Pacific Islander men.
Young Black men and Asian and Pacific Islander men born between 1990 and 2010 were at elevated risk for nonfirearm suicide; for young Black men, the risk was higher than any preceding groups of Black men the study examined. Young American Indian/Alaska Native men were particularly vulnerable, with a peak rate of over 20 suicides per 100,000 deaths at age 20. Young American Indian/Alaska Native women were at the greatest risk of nonfirearm suicide among all women; at age 20, they had nine deaths per 100,000.
"People from minoritized groups face economic, cultural and social barriers in access to care, which can be very important during a suicidal crisis," Martínez-Alés told The Academic Times. "We also suggest that programs [reducing] such barriers and [making] sure that access to care during suicidal crises is easy — e.g., reducing or eliminating costs, ensuring treatment centers are culturally and structurally competent, etc. — would help."
Older men, especially older white men, were more likely to die by self-inflicted gunshot wounds. Although white people born more recently did not seem to have the same increase in nonfirearm suicides as younger people of color, the researchers speculated that some suicide deaths due to opioids might have been misclassified as accidental — white people have the highest risk of opioid overdose death in the U.S.
White women in their 50s had the highest firearm suicide rate for women by age, with 3.3 deaths per 100,000 annually.
Previous studies have broken down age-period-cohort effects of suicide along Black and white racial lines, but this is the first to include other races.
"Cohort effects are very important because they identify the specific risk of groups of individuals born into a specific historical context, in comparison to other birth cohorts, and help identify potential causes of the outcome — in this case, suicide risk — shared by members of that specific birth cohort, over their life course," Martínez-Alés said.
However, despite the unusual level of detail in this study, Hispanic and Latino people were not accurately represented. "This is because of the way [the National Center for Health Statistics'] data is organized, and their use of bridged race categories," Martínez-Alés said. "Yes, I think it should change, especially since other research indicates that the suicide rate among Hispanics, which has traditionally been low, has increased over the last few years."
The authors wrote in the paper that their findings show the need to address not only suicidal crises but also the root causes that lead to suicidality: "the social, economic and political drivers of minoritized population's adverse early-life experiences and … racial/ethnic differences in access to and quality of mental health systems." As Martínez-Alés put it, "We hope to generate debate and draw some attention to these facts so that these and other potential solutions are deployed."
The study, "Age, period, and cohort effects on suicide death in the United States from 1999 to 2018: moderation by sex, race, and firearm involvement," published April 7 in Molecular Psychiatry, was authored by Gonzalo Martínez-Alés, Caroline Rutherford, Catherine Gimbrone, Sasikiran Kandula, Mark Olfson, Madelyn S. Gould, Jeffrey Shaman and Katherine M. Keyes, Columbia University; and John R. Pamplin II, Center for Urban Science and Progress, New York University