Examining trends and factors in U.S. suicide rates

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient, with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.

The rate of suicide in the United States has been concerning in recent years, and today I'm speaking with a researcher who recently completed a review of this topic and published a lengthy paper about health equity in suicide. Dr. Seth Perry is an associate professor of neuroscience and physiology at Upstate.

Welcome to "The Informed Patient," Dr. Perry.

Seth Perry, PhD: Thank you, Amber. It's good to be here.

Host Amber Smith: Let me start by asking you about suicide rates. Overall, they peaked in 2018, before declining in 2019 and 2020. How have things been since then?

Seth Perry, PhD: Let me first say that we don't yet have the full data from 2021 or '22, because it takes a bit of time until that data comes out. But in general, it -- from the data we do have -- it seems as if the overall population trends are continuing, with a decline in suicide rates during the first part of COVID.

But by this same token, we're also seeing a continued trend toward greater suicide rates in some populations, particularly young people. And so of course, that is concerning to us. Young people in general tend to have lower suicide rates than older people, but they're also climbing at a faster rate, and so that means there is a narrowing gap between older and younger people's suicides.

Host Amber Smith: I understand that you and your colleagues focused on the disparities in suicide rates and sought to understand what drives the disparities. What kinds of disparities did you look for and what did you find?

Seth Perry, PhD: We wanted to take as comprehensive an approach as possible, so we were looking for disparities across sex, racial and ethnic backgrounds and demographics. So, urban versus rural, and also in populations like gender identity and veteran status.

And we've found in general that -- and this is well known -- that females have a lower suicide rate than males have, though it is climbing faster. So, there is a narrowing gap there, too.

And we also found that suicide rates tend to increase, generally, with the age of a person, though usually there's a peak in the 20s and then maybe a plateau through middle age and then again a rise later in life. We also found that there tends to be more gaps with regard to suicide deaths by firearm as well, where the availability of firearms seems to increase both the numbers of suicides as well as the percent of suicides by firearm.

Host Amber Smith: So you did find a connection between gun ownership, access to firearms and suicide rates or suicide attempts?

Seth Perry, PhD: It has been fairly well established through the literature, and of course that's a very tricky topic because it's so charged, but my own approach is to try to take the politics aside as much as possible, to approach it from, really, a public health perspective. Just present the data and then see what it's telling us, and then think about how we can do better at preventing self harm through firearms.

Host Amber Smith: Do I understand correctly, you said, or you found, that the suicide rate among men is higher than it is among women, but the rate among women is rising?

Seth Perry, PhD: Yes. Well, let me backtrack a little bit here. Data from about 2000 to 2018 or so, if I recall, it was both men and women had rising rates, al though women were rising more during that period. So the gender gap narrowed a bit. The last couple of years for the total population, both groups are coming down a little bit. Suicides have been rising in younger people, so teens and 20s, and even in some cases preteens. I actually read a couple days ago that for the first time, that firearms were the leading means of suicides for females. Now that is a new, but unfortunate, development. Firearms have long been the leading means of suicide for men, which is thought to be one of the reasons that men have, I think, it's more than or at least twice the suicide rat e of women, despite having only half as many attempts, because they typically employ more deadly means, frequently guns, whereas in the past, females have not used them as much for suicide attempts. But like I mentioned, in 2020, guns were the most used means for females, too, for the first time on record, to my knowledge anyway.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith. I'm talking with an associate professor of neuroscience and physiology Dr. Seth Perry. He and colleagues thoroughly researched and published a paper about suicide in the United States.

One of the alarming trends with suicide, which you've already mentioned, is that of younger adults and even children committing suicide. Did your analysis shed any light on why that's happening or what can be done to help?

Seth Perry, PhD: That's a tough question. The paper we did didn't really seek to determine the cause. We wanted to present the data and use that for a launching pad to try to then look at possible causes. But I think there are people who are doing research, though, and I think some of the theories are that the increased pressures young people are feeling through social factors, maybe home and family factors. There is a lot of mention of the social media pressures and changes. Bullying is a big issue. It's, I think, a complex causation, but it needs to be addressed, of course.

Host Amber Smith: You explored two modifiable targets for general suicide prevention -- untreated or undertreated depression, and access to firearms. How much might our nation's suicide rate improve if depression was more reliably diagnosed and treated, and if we had more rules about gun access?

Seth Perry, PhD: I think it's probably difficult to put numbers there, but I think that with mental health, the access to care can be an issue. think we are doing better there. And I think that there is some traction recently toward paying attention to the things that we can do to prevent people at risk from gaining access to firearms to do harm to themselves, to others and so forth. And we are seeing in the past couple of years a general downward trend in suicides, which is great, and we hope it continues. But the biggest battle now, I think, is to try to improve the numbers with the younger people and try to bring those numbers back down, to determine why the suicide rate is climbing in the younger populations to now better address that problem also.

Host Amber Smith: What have England and Finland and Denmark done to reduce the rate of suicide in their countries?

Seth Perry, PhD: What I understand there is that they've taken a very comprehensive and multipronged approach that tries to begin to identify risk factors long before people become or are known to become suicidal. Of course, they have a very different culture with firearms as well, which is one of many means restrictions that they have employed, as well as, I think, several types of drugs and chemicals. Like, pesticides can be a common means of suicide in some countries where they are more available and common the than firearms, perhaps.

Host Amber Smith: What are the health-related drivers of suicide deaths?

Seth Perry, PhD: Well, we know any mental health diagnosis or serious psychiatric disease can contribute to suicide risk. One of the biggest, of course, being depression, and others are bipolar and schizophrenia. But it's very important to mention here that most people with mental health challenges -- and none of us are perfect; we all have something that is our own personal challenge -- but most people who have mental health challenges will not be suicidal, of course.

Host Amber Smith: Well, Dr. Perry, I appreciate you making time for this interview. Thank you.

Seth Perry, PhD: Thank you. It's been a pleasure, Amber.

Host Amber Smith: My guest has been Dr. Seth Perry. He's an associate professor of neuroscience and physiology at Upstate. "The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe. Find our archive of previous episodes at upstate.edu/informed. This is your host, Amber Smith, thanking you for listening.