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Suicidality: Demographic Risk and Protective Factors

Each year since 2001, over 30,000 people have died by suicide in the United States. At least 650,000 persons each year receive emergency treatment after attempting suicide. Over a million die by suicide worldwide. Suicide, the taking of one's own life, is the 13th leading cause of death worldwide and 11th in the United States.

In the United States, suicide kills nearly twice as many people each year as homicide. Although suicide is an individual act that occurs in what can appear to be unique circumstances, examining patterns of suicide deaths indicates many risk and protective factors at different levels-demographic, community, familial, and individual. Demographically, suicide completion and attempt patterns vary by age, gender, race-ethnicity, occupation, geography, income, and other factors.

Age, Gender, Ethnicity

Suicide is the third leading cause of death among 10- to 24-year-olds in the United States, despite a decline among 15- to 19-year-olds from 10.71/ 100,000 in 1992 to 7.26/100,000 in 2003. Youth suicide in the United States is more common among Whites than among African Americans or Latinos. Suicide is the 8th leading cause of death for all U.S. males, but 17th among females. Suicide rates are highest among White males and second highest among American Indian or Alaska Native males. The high rate among White males (20.97/100,000 in 2003) is largely driven by the rate of deaths of those aged 65+ years (33.13/100,000). The highest rates among American Indian or Alaska Native males are between the ages of 24 and 34 (31.71/100,000) and 15 and 24 (27.22/100,000) years. Suicide rates decline substantially in American Indian or Alaskan Native males after age 55 years. Among females, suicide rates increase to age 45 years, then decline. Suicide rates among females across ethnic groups are more similar than are male suicide rate patterns in those same groups. The lowest suicide rates, all ages, are among Asian or Pacific Islanders. The difference in suicide rates between Whites and African Americans, all ages, has decreased in the past 15 years due to an increase among African American males starting in 1986.

Fatal and nonfatal suicidal behavior patterns differ markedly by age, gender, and ethnicity. Males are 4 times more likely to die from suicide than females, while females attempt suicide about 3 times more often than males. A previous suicide attempt has occurred in 25%-30% of completed suicides among youth and is considered a major risk factor, particularly among males. Hispanic youth report high rates of suicide attempts, but have lower suicide completion rates than non-Hispanics.

Marital Status, Household Composition, Sexual Orientation, Incarceration

In general, suicide rates are lower among married persons than among those who are single, divorced, or widowed. However, intimate partner violence, regardless of marital status, raises suicidal risk. Being married is more protective for males than for females, while the presence of children, particularly young children, is especially protective for females. Sexual orientation appears to be a suicide risk factor for males only. Evidence indicates that gay or bisexual males ages 18-40 are 5-14 times more likely to report a suicide attempt than heterosexual males. Same-sex attraction is associated with suicide attempts among male adolescents; however, the vast majority of youth reporting same-sex sexual orientation report no suicidality at all. Suicide rates for jail inmates are 9 times greater than that of the general population and 15 times higher for incarcerated males. Incarcerated adolescents and adolescents with legal problems exhibit significant risk for suicidal behaviors. Most completed suicides are young White males arrested for nonviolent offenses who are intoxicated when arrested.

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