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Abstract
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Suicide is the second leading cause of death among people aged 10-34 and the 10th leading cause of death overall in the United States. In 2018, more than 48 000 people in the United States died of suicide, a 34% increase since 1999.1 That same year, 1.4 million US adults attempted suicide.1 An estimated 1 in 14 US adults knows someone who has died of suicide in the past 12 months.2,3 In addition to its emotional toll, suicide has a substantial economic burden in the United States. In 2018, the Centers for Disease Control and Prevention (CDC) estimated that together, suicides and self-harm injuries cost the nation approximately $70 billion per year in direct medical and work loss costs.4 This loss has been further exacerbated by the current coronavirus disease 2019 (COVID-19) pandemic. A 2020 study by the Meadows Mental Health Policy Institute quantified the risk of COVID-19-related unemployment on suicide, estimating that for every 5 percentage-point increase in unemployment in Texas during the COVID-19 recession across a year, an additional 300 Texans could die each year of suicide.5
One in 5 people in the United States has a mental health condition.6 Conditions such as depression, posttraumatic stress disorder, psychosis, and substance use are associated with increased suicide risk. For example, each year, as many as 50% of people with bipolar disorder will attempt suicide, and 11% will die of suicide.7 However, death by suicide is usually a result of a complex interaction of factors.8 Data from CDC show that in 2015, 54% of people in the United States who died of suicide did not have a known mental health condition at the time of their death.8 Most of these deaths were precipitated by economic losses, relationship issues, substance use, physical health problems, or housing stress.8 Even among people with known mental health conditions, relationship problems, other life stressors, substance use, and recent acute crises were prevalent.8 Although mental illness and suicide are often conflated and people with mental illness are certainly at an elevated risk of suicide, there is no single cause of suicide, and suicide risk extends beyond mental health conditions.8 Longitudinal studies show that only a small minority of people diagnosed with a mental illness die by suicide; most die of other causes.9
Veterans are one population that is disproportionately at risk for suicide. Every day, about 20 veterans--including 2 or 3 guardsmen and reservists--take their lives, totaling more than 6000 per year.10 After leaving the military, most service members transition to civilian life and lead healthy, productive lives. However, some veterans have substantial mental health conditions, including posttraumatic stress, substance use disorders, depression, and anxiety.11 In addition to health problems, veterans can face other life stressors that can contribute to suicide risk. In 2017, the US Department of Housing and Urban Development estimated that 40 000 veterans had experienced homelessness and more than 15 300 veterans were living on the street on any given night.12 Veterans die of suicide at a rate 1.3 times that of the general population after adjusting for age and sex, and female veterans die of suicide at a rate of 2.2 times that of the general population after adjusting for age.11 In 2017, the highest suicide rate (44.5 vs 14.0 per 100 000 population in the United States overall) was among veterans aged 18-34, and 38% of suicide deaths among veterans were among older adults aged 55-74...
Language: en |