Rising Suicide Among Adults Aged 40–64 Years

The Role of Job and Financial Circumstances
Published:February 26, 2015DOI:https://doi.org/10.1016/j.amepre.2014.11.006

      Introduction

      Suicide rates among middle-aged men and women in the U.S. have been increasing since 1999, with a sharp escalation since 2007.

      Purpose

      To examine whether suicides with circumstances related to economic crises increased disproportionately among the middle-aged between 2005 and 2010.

      Methods

      This study used the National Violent Death Reporting System (NVDRS) in 2014 to explore trends and patterns in circumstance and method among adults aged 40–64 years.

      Results

      Suicide circumstances varied considerably by age, with those related to job, financial, and legal problems most common among individuals aged 40–64 years. Between 2005 and 2010, the proportion of suicides where these circumstances were present increased among this age group, from 32.9% to 37.5% of completed suicides (p<0.05). Further, suffocation is a method more likely to be used in suicides related to job, economic, or legal factors, and its use increased disproportionately among the middle-aged. The number of suicides using suffocation increased 59.5% among those aged 40–64 years between 2005 and 2010, compared with 18.0% for those aged 15–39 years and 27.2% for those aged >65 years (p<0.05).

      Conclusions

      The growth in the importance of external circumstances and increased use of suffocation jointly pose a challenge for prevention efforts designed for middle-aged adults. Suffocation is a suicide method that is highly lethal, requires relatively little planning, and is readily available. Efforts that target employers and workplaces as important stakeholders in the prevention of suicide and link the unemployed to mental health resources are warranted.
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      References

        • CDC
        Suicide among adults aged 35–64 years United States, 1999–2010.
        MMWR Morb Mortal Wkly Rep. 2013; 62: 321-325
        • Berk M.
        • Dodd S.
        • Henry M.
        Itʼs the economy: the effect of macroeconomic variables of the rate of suicide.
        Psychol Med. 2006; 36: 181-189https://doi.org/10.1017/S0033291705006665
      1. Hu G, Wilcox HC, Wissow L, Baker SP. Mid-life suicide: an increasing problem in U.S. whites, 1999-2005. Am J Prev Med. 2008;35(6):589-593. 10.1016/j.amepre.2008.07.005.

        • Phillips J.A.
        • Robin A.V.
        • Nugent C.
        • Idler E.
        Understanding recent changes in suicide rates among the middle-aged: period or cohort effects?.
        Public Health Rep. 2010; 125: 680-688
      2. Pew Research Center. How the Great Recession has changed life in America. Pew Research Center Social and Demographic Trends Project. 2010. http://www.pewsocialtrends.org/2010/06/30/how-the-great-recession-has-changed-life-in-america/8/.

        • Thorne D.
        • Warren E.
        • Sullivan T.
        The increasing vulnerability of older Americans: evidence from the bankruptcy courts.
        Harvard Law Policy Rev. 2009; 3: 87-101
        • Anglemyer A.
        • Horvath T.
        • Rutherford G.
        The accessibility of firearms and risk for suicide and homicide victimization among household members: a systematic review and meta-analysis.
        Ann Intern Med. 2014; 40: 101-121
        • Miller M.
        • Lippmann S.J.
        • Azrael D.
        • Hemenway D.
        Household firearm ownership and rates of suicide across the 50 United States.
        J Trauma. 2007; 62: 1029-1035https://doi.org/10.1097/01.ta.0000198214.24056.40
        • Durkheim E.
        Suicide, a study in sociology.
        Free Press, Glencoe, IL1951
        • Luo F.
        • Florence C.S.
        • Quispe-Agnoli M.
        • Ouyang L.
        • Crosby A.
        Impact of business cycles on U.S. suicide rates, 1928-2007.
        Am J Public Health. 2011; 101: 1139-1146https://doi.org/10.2105/AJPH.2010.300010
        • Chang S.
        • Stuckler D.
        • Yip P.
        • Gunnell D.
        Impact of 2008 global economic crisis on suicide: time trend study in 54 countries. BMJ. 2013; 347: f5239https://doi.org/10.1136/bmj.f5239
        • Lopez Bernal J.A.
        • Gasparrini A.
        • Artundo C.M.
        • McKee M.
        The effect of the late 2000s financial crisis on suicides in Spain: an interrupted time-series analysis.
        Eur J Public Health. 2013; 23: 732-736https://doi.org/10.1093/eurpub/ckt083
        • Reeves A.
        • Stuckler D.
        • McKee M.
        • Gunnell D.
        • Chang S.
        • Basu S.
        Increase in state suicide rates in the USA during economic recession.
        Lancet. 2012; 380: 1813-1814https://doi.org/10.1016/S0140-6736(12)61910-2
        • Saurina C.
        • Bragulat B.
        • Saez M.
        • López-Casasnovas G.
        A conditional model for estimating the increase in suicides associated with the 2008–2010 economic recession in England.
        J Epidemiol Community Health. 2013; 67: 779-787https://doi.org/10.1136/jech-2013-202645
        • Stuckler D.
        • Basu S.
        • Suhrcke M.
        • Coutts A.
        • McKee M.
        The public health effect of economic crises and alternative policy responses in Europe: An empirical analysis.
        Lancet. 2009; 374: 315-323https://doi.org/10.1016/S0140-6736(09)61124-7
        • McInerney M.
        • Mellor J.M.
        • Nicholas L.H.
        Recession depression: mental health effects of the 2008 stock market crash.
        J Health Econ. 2013; 32: 1090-1104https://doi.org/10.1016/j.jhealeco.2013.09.002
        • Paulozzi L.J.
        • Mercy J.
        • Frazier L.
        • Annest J.L.
        CDC’s National Violent Death Reporting System: background and methodology.
        Inj Prev. 2004; 10: 47-52https://doi.org/10.1136/ip.2003.003434
        • Karch D.
        Surveillance of sex differences in completed suicide among older adults: data from the National Violent Death Reporting System—17 U.S. States, 2007-2009.
        Int J Environ Res Public Health. 2011; 8: 3479-3495https://doi.org/10.3390/ijerph8083479
        • Logan J.
        • Karch D.
        • Crosby A.
        Reducing ‘unknown’ data in violent death surveillance: a study of death certificates, coroner/medical examiner and police reports from the National Violent Death Reporting System, 2003–2005.
        Homicide Stud. 2009; 13: 385-397https://doi.org/10.1177/1088767909348323
        • Logan J.
        • Hall J.
        • Karch D.
        Suicide categories by patterns of known risk factors: a latent class analysis.
        Arch Gen Psychiatry. 2011; 68: 935-941https://doi.org/10.1001/archgenpsychiatry.2011.85
        • Hempstead K.
        • Nguyen T.
        • David-Rus R.
        • Jacquemin B.
        Health problems and male firearm suicide.
        Suicide Life Threat Behav. 2013; 43: 1-16https://doi.org/10.1111/j.1943-278X.2012.00123.x
        • Okoro C.A.
        • Nelson D.E.
        • Mercy J.A.
        • Balluz L.S.
        • Crosby A.E.
        • Mokdad A.H.
        Prevalence of household firearms and firearm-storage practices in the 50 states and the District of Columbia: findings from the Behavior Risk Factor Surveillance System.
        Pediatrics. 2002; 116: e370-e376https://doi.org/10.1542/peds.2005-0300
        • Maris R.W.
        • Berman A.L.
        • Silverman M.M.
        • Bongar B.M.
        Comprehensive Textbook of Suicidology.
        Guilford Press, New York2000
        • Gunnell D.O.
        • Bennewith K.
        • Hawton S.
        • Simkin S.
        • Kapur N.
        The epidemiology and prevention of suicide by hanging: a systematic review.
        Int J Epidemiol. 2005; 34: 433-442https://doi.org/10.1093/ije/dyh398
      3. Violence Policy Center. A shrinking minority: the continuing decline of gun ownership in America. 2011. http://www.vpc.org/studies/ownership.pdf.

      4. Saad L. self-reported gun ownership in U.S. is highest since 1993. 2011; http://www.gallup.com/poll/150353/self-reported-gun-ownership-highest-1993.aspx.

        • Easterlin R.A.
        Birth and Fortune: The Impact of Numbers on Personal Welfare.
        Basic Books, New York1980
        • Paez K.A.
        • Zhao L.
        • Hwang W.
        Rising out-of-pocket spending for chronic conditions: a ten-year trend.
        Health Aff. 2009; 28: 15-25https://doi.org/10.1377/hlthaff.28.1.15