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Original Investigation
September 13, 2017

National Trends in Suicide Attempts Among Adults in the United States

Author Affiliations
  • 1Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
  • 2The New York State Psychiatric Institute, Columbia University, New York, New York
  • 3Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Rockville, Maryland
  • 4Division of Biometry and Epidemiology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
JAMA Psychiatry. Published online September 13, 2017. doi:10.1001/jamapsychiatry.2017.2582
Key Points

Questions  Has a national increase in suicide attempts occurred in the United States in the decade since wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions?

Finding  In this national epidemiologic survey of 69 341 US adults, the percentage making a recent suicide attempt increased from 0.62% in 2004 through 2005 to 0.79% in 2012 through 2013. The adjusted risk differences for suicide attempts were significantly larger among adults aged 21 to 34 years than among adults aged 65 years or older; adults with no more than a high school education than among college graduates; and adults with antisocial personality disorder, a history of violent behavior, anxiety disorders, or depressive disorders than among adults without these conditions.

Meaning  A recent overall increase in suicide attempts among US adults has disproportionately affected younger adults with less formal education and those with antisocial personality disorder, anxiety disorders, depressive disorders, and a history of violence.

Abstract

Importance  A recent increase in suicide in the United States has raised public and clinical interest in determining whether a coincident national increase in suicide attempts has occurred and in characterizing trends in suicide attempts among sociodemographic and clinical groups.

Objective  To describe trends in recent suicide attempts in the United States.

Design, Setting, and Participants  Data came from the 2004-2005 wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and the 2012-2013 NESARC-III. These nationally representative surveys asked identical questions to 69 341 adults, 21 years and older, concerning the occurrence and timing of suicide attempts. Risk differences adjusted for age, sex, and race/ethnicity (ARDs) assessed trends from the 2004-2005 to 2012-2013 surveys in suicide attempts across sociodemographic and psychiatric disorder strata. Additive interactions tests compared the magnitude of trends in prevalence of suicide attempts across levels of sociodemographic and psychiatric disorder groups. The analyses were performed from February 8, 2017, through May 31, 2017.

Main Outcomes and Measures  Self-reported attempted suicide in the 3 years before the interview.

Results  With use of data from the 69 341 participants (42.8% men and 57.2% women; mean [SD] age, 48.1 [17.2] years), the weighted percentage of US adults making a recent suicide attempt increased from 0.62% in 2004-2005 (221 of 34 629) to 0.79% in 2012-2013 (305 of 34 712; ARD, 0.17%; 95% CI, 0.01%-0.33%; P = .04). In both surveys, most adults with recent suicide attempts were female (2004-2005, 60.17%; 2012-2013, 60.94%) and younger than 50 years (2004-2005, 84.75%; 2012-2013, 80.38%). The ARD for suicide attempts was significantly larger among adults aged 21 to 34 years (0.48%; 95% CI, 0.09% to 0.87%) than among adults 65 years and older (0.06%; 95% CI, −0.02% to 0.14%; interaction P = .04). The ARD for suicide attempts was also significantly larger among adults with no more than a high school education (0.49%; 95% CI, 0.18% to 0.80%) than among college graduates (0.03%; 95% CI, −0.17% to 0.23%; interaction P = .003); the ARD was also significantly larger among adults with antisocial personality disorder (2.16% [95% CI, 0.61% to 3.71%] vs 0.07% [95% CI, −0.09% to 0.23%]; interaction P = .01), a history of violent behavior (1.04% [95% CI, 0.35% to 1.73%] vs 0.00% [95% CI, −0.12% to 0.12%]; interaction P = .003), or a history of anxiety (1.43% [95% CI, 0.47% to 2.39%] vs 0.18% [95% CI, 0.04% to 0.32%]; interaction P = .01) or depressive (0.99% [95% CI, −0.09% to 2.07%] vs −0.08% [95% CI, −0.20% to 0.04%]; interaction P = .05) disorders than among adults without these conditions.

Conclusions and Relevance  A recent overall increase in suicide attempts among adults in the United States has disproportionately affected younger adults with less formal education and those with antisocial personality disorder, anxiety disorders, depressive disorders, and a history of violence.

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