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Suicide Distribution and Trends Among Male Older Adults in the U.S., 1999–2018

  • Sanae El Ibrahimi
    Correspondence
    Address correspondence to: Sanae El Ibrahimi, PhD, Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, 4505 S Maryland Pkwy, Las Vegas, NV 89154.
    Affiliations
    Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada

    Research and Evaluation Division, Comagine Health, Portland, Oregon
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  • Yunyu Xiao
    Affiliations
    School of Social Work, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana

    School of Social Work, Indiana University Bloomington, Bloomington, Indiana
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  • Caroline D. Bergeron
    Affiliations
    Division of Aging and Seniors, Centre for Health Promotion, Public Health Agency of Canada, Ottawa, Ontario, Canada

    Center for Population Health and Aging, Texas A&M University, College Station, Texas
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  • Niema Y. Beckford
    Affiliations
    Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada
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  • Eddy M. Virgen
    Affiliations
    Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada
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  • Matthew L. Smith
    Affiliations
    Center for Population Health and Aging, Texas A&M University, College Station, Texas

    Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, Texas
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Published:February 27, 2021DOI:https://doi.org/10.1016/j.amepre.2020.12.021

      Introduction

      This study examines the distribution and trends in suicide death rates among male adults aged ≥65 years in the U.S. from 1999 to 2018.

      Methods

      Suicide mortality data were derived from Multiple Cause of Death from the Center for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research database. Suicides were identified from the underlying causes of death. Joinpoint regression examined the distribution and shift in suicide age-adjusted death rates overall and by age groups, race/ethnicity, method of suicide, and urbanicity. Analyses were conducted in 2020.

      Results

      Between 1999 and 2018, a total of 106,861 male adults aged ≥65 years died of suicide (age-adjusted rate=31.4 per 100,000 population, 95% CI=31.2, 31.6). Suicide rates showed a V-shaped trend. They were declining annually by 1.8% (95% CI= −2.4, −1.2); however, starting in 2007, there was a shift upward, increasing significantly by 1.7% per year for the next decade (95% CI=1.0, 1.6). Suicide rates were highest among those aged ≥85 years (48.8 per 100,000 population with an upward shift in 2008), Whites (35.3 per 100,000 population with an upward shift in trend in 2007), and the most rural communities (39.0 per 100,000 population). Most suicides were due to firearms (78.3% at a rate of 24.7 per 100,000 population), especially in rural areas, and shifted upward after 2007.

      Conclusions

      Increases in suicide rates among male older adults in the U.S., particularly after the 2007–2008 economic recession, are concerning. Tailored suicide prevention intervention strategies are needed to address suicide-related risk factors.
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      REFERENCES

      1. Suicide. NIH, National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/suicide.shtml. Updated 2021. Accessed May 1, 2020.

        • Nuzzo JL
        Men's health in the United States: a national health paradox.
        Aging Male. 2020; 23: 42-52https://doi.org/10.1080/13685538.2019.1645109
        • Tsirigotis K
        • Gruszczynski W
        • Tsirigotis M
        Gender differentiation in methods of suicide attempts.
        Med Sci Monit. 2011; 17: PH65-PH70https://doi.org/10.12659/msm.881887
        • Mergl R
        • Koburger N
        • Heinrichs K
        • et al.
        What are reasons for the large gender differences in the lethality of suicidal acts? An epidemiological analysis in four European countries.
        PLoS One. 2015; 10e0129062https://doi.org/10.1371/journal.pone.0129062
        • Burns SM
        • Mahalik JR
        Suicide and dominant masculinity norms among current and former United States military servicemen.
        Prof Psychol Res Pract. 2011; 42: 347-353https://doi.org/10.1037/a0025163
        • Pirkis J
        • Spittal MJ
        • Keogh L
        • Mousaferiadis T
        • Currier D
        Masculinity and suicidal thinking [published correction appears in Soc Psychiatry Psychiatr Epidemiol. 2017;52(11):1447–1449].
        Soc Psychiatry Psychiatr Epidemiol. 2017; 52: 319-327https://doi.org/10.1007/s00127-016-1324-2
        • Ritchie H
        • Roser M
        • Ortiz-Ospina E
        Suicide. 2015.
        https://ourworldindata.org/suicide
        Date accessed: October 30, 2020
        • Cui R
        • Fiske A
        New research on older adult suicide: a reason for hope.
        Clin Gerontol. 2020; 43: 1-3https://doi.org/10.1080/07317115.2020.1690299
        • Increase in suicide mortality in the United States, 1999-2018
        National Center for Health Statistics, Centers for Disease Control and Prevention.
        2020. (https://www.cdc.gov/nchs/products/databriefs/db362.htm. Updated April 2020. Accessed July 31, 2020)
      2. CDC WONDER: About multiple cause of death, 1999-2019. HHS, Centers for Disease Control and Prevention, National Center for Health Statistics. http://wonder.cdc.gov/mcd-icd10.html. Updated December 22, 2020. Accessed July 31, 2020.

      3. Suicide. Organization for Economic Cooperation and Development. https://www.oecd-ilibrary.org/sites/0ef32604-en/index.html?itemId=/content/component/0ef32604-en. Updated 2019. Accessed August 8, 2020.

        • Rich R
        The Great recession: December 2007-June 2009.
        Federal Reserve History. 2013; (November 22)
        • Coope C
        • Donovan J
        • Wilson C
        • et al.
        Characteristics of people dying by suicide after job loss, financial difficulties and other economic stressors during a period of recession (2010-2011): a review of coroners’ records.
        J Affect Disord. 2015; 183: 98-105https://doi.org/10.1016/j.jad.2015.04.045
        • Oyesanya M
        • Lopez-Morinigo J
        • Dutta R
        Systematic review of suicide in economic recession.
        World J Psychiatry. 2015; 5: 243-254https://doi.org/10.5498/wjp.v5.i2.243
        • Wilkinson LR
        Financial strain and mental health among older adults during the Great Recession.
        J Gerontol B Psychol Sci Soc Sci. 2016; 71: 745-754https://doi.org/10.1093/geronb/gbw001
        • Noelke C
        • Beckfield J
        Recessions, job loss, and mortality among older U.S. adults.
        Am J Public Health. 2014; 104: e126-e134https://doi.org/10.2105/AJPH.2014.302210
        • Fowler KA
        • Gladden RM
        • Vagi KJ
        • Barnes J
        • Frazier L
        Increase in suicides associated with home eviction and foreclosure during the U.S. housing crisis: findings from 16 National Violent Death Reporting System states, 2005-2010.
        Am J Public Health. 2015; 105: 311-316https://doi.org/10.2105/AJPH.2014.301945
        • Apesoa-Varano EC
        • Barker JC
        • Hinton L
        “If you were like me, you would consider it too”: suicide, older men, and masculinity.
        Soc Ment Health. 2018; 8: 157-173https://doi.org/10.1177/2156869317725890
        • Norström T
        • Grönqvist H
        The Great Recession, unemployment and suicide.
        J Epidemiol Community Health. 2015; 69: 110-116https://doi.org/10.1136/jech-2014-204602
        • Phillips JA
        • Nugent CN
        Suicide and the Great Recession of 2007-2009: the role of economic factors in the 50 U.S. states.
        Soc Sci Med. 2014; 116: 22-31https://doi.org/10.1016/j.socscimed.2014.06.015
        • Reeves A
        • Stuckler D
        • McKee M
        • Gunnell D
        • Chang SS
        • 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
        • National Academies of Sciences, Engineering, and Medicine
        Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System.
        The National Academies Press, Washington, DC2020https://doi.org/10.17226/25663
        • Smith JA
        • Braunack-Mayer A
        • Wittert G
        • Warin M
        I've been independent for so damn long!”: independence, masculinity and aging in a help seeking context.
        J Aging Stud. 2007; 21: 325-335https://doi.org/10.1016/j.jaging.2007.05.004
        • Gregorčič M
        Bottom-up strategies for community engagement and informal learning: targeting men aged 60 years or more.
        Andragoška Spoznanja. 2019; 25: 19-35https://doi.org/10.4312/as.25.2.19-35
        • Neibergall NC
        • Sánchez FJ
        Men's transitions in late life: exploring the influence of male norms.
        in: Altmaier EM Navigating Life Transitions for Meaning. Academic Press, Cambridge, MA2020: 31-48https://doi.org/10.1016/b978-0-12-818849-1.00003-5
        • Coleman D
        Traditional masculinity as a risk factor for suicidal ideation: cross-sectional and prospective evidence from a study of young adults.
        Arch Suicide Res. 2015; 19: 366-384https://doi.org/10.1080/13811118.2014.957453
        • Coleman D
        • Feigelman W
        • Rosen Z
        Association of high traditional masculinity and risk of suicide death: secondary analysis of the Add Health Study.
        JAMA Psychiatry. 2020; 77: 435-437https://doi.org/10.1001/jamapsychiatry.2019.4702
        • Cox AA
        Aiming for manhood: the transformation of guns into objects of American masculinity.
        in: Fruehling Springwood C Open Fire: Understanding Global Gun Cultures. Bloomsbury Academic, London, United Kingdom2007: 141-152https://doi.org/10.5040/9781474215336.ch-011
        • Cassino D
        • Besen-Cassino Y
        Sometimes (but not this time), a gun is just a gun: masculinity threat and guns in the United States, 1999-2018.
        Sociol Forum. 2020; 35: 5-23https://doi.org/10.1111/socf.12565
        • Steele IH
        • Thrower N
        • Noroian P
        • Saleh FM
        Understanding suicide across the lifespan: a United States perspective of suicide risk factors, assessment & management.
        J Forensic Sci. 2018; 63: 162-171https://doi.org/10.1111/1556-4029.13519
        • Conejero I
        • Olié E
        • Courtet P
        • Calati R
        Suicide in older adults: current perspectives.
        Clin Interv Aging. 2018; 13: 691-699https://doi.org/10.2147/CIA.S130670
        • Siflinger B
        The effect of widowhood on mental health - an analysis of anticipation patterns surrounding the death of a spouse.
        Health Econ. 2017; 26: 1505-1523https://doi.org/10.1002/hec.3443
        • Fong JH
        Disability incidence and functional decline among older adults with major chronic diseases.
        BMC Geriatr. 2019; 19: 323https://doi.org/10.1186/s12877-019-1348-z
        • Boyd CM
        • Ritchie C
        • et al.
        Addressing multimorbidity in older adults.
        in: Williams BA Chang A Ahalt C Current Diagnosis & Treatment: Geriatrics. 2nd ed. McGrawHill, New York, NY2014: 59
        • Jaul E
        • Barron J
        Age-related diseases and clinical and public health implications for the 85 years old and over population.
        Front Public Health. 2017; 5: 335https://doi.org/10.3389/fpubh.2017.00335
        • Lee SJ
        • Go AS
        • Lindquist K
        • Bertenthal D
        • Covinsky KE
        Chronic conditions and mortality among the oldest old.
        Am J Public Health. 2008; 98: 1209-1214https://doi.org/10.2105/AJPH.2007.130955
        • Gallagher-Thompson D
        • Osgood NJ
        Suicide in later life.
        Behav Ther. 1997; 28: 23-41https://doi.org/10.1016/S0005-7894(97)80032-9
        • Conwell Y
        Suicide in later life: a review and recommendations for prevention.
        Suicide Life Threat Behav. 2001; 31: 32-47https://doi.org/10.1521/suli.31.1.5.32.24221
        • David DS
        • Brannon R
        The Forty-Nine Percent Majority: The Male Sex Role.
        AddisonWesley Publishing Company, Boston, MA1976
        • Williams DR
        The health of men: structured inequalities and opportunities.
        Am J Public Health. 2008; 98: S150-S157https://doi.org/10.2105/ajph.98.supplement_1.s150
        • Ferraro KF
        • Thorpe RJ
        • McCabe GP
        • Kelley-Moore JA
        • Jiang Z
        The color of hospitalization over the adult life course: cumulative disadvantage in Black and White?.
        J Gerontol B Psychol Sci Soc Sci. 2006; 61: S299-S306https://doi.org/10.1093/geronb/61.6.s299
        • Canetto SS
        Suicide: why are older men so vulnerable?.
        Men Masc. 2017; 20: 49-70https://doi.org/10.1177/1097184X15613832
        • McLaughlin SJ
        • Connell CM
        • Heeringa SG
        • Li LW
        • Roberts JS
        Successful aging in the United States: prevalence estimates from a national sample of older adults.
        J Gerontol B Psychol Sci Soc Sci. 2010; 65B: 216-226https://doi.org/10.1093/geronb/gbp101
        • Smith ML
        • Bergeron CD
        • McCord CE
        • Hochhalter AK
        • Ory MG
        Successful aging and resilience: applications for public health, health care, and policy.
        in: Resnick B Gwyther LP Roberto KA Resilience in Aging. Springer International Publishing, Cham, Switzerland2018: 17-33https://doi.org/10.1007/978-3-030-04555-5_2
        • Oquendo MA
        • Ellis SP
        • Greenwald S
        • Malone KM
        • Weissman MM
        • Mann JJ
        Ethnic and sex differences in suicide rates relative to major depression in the United States.
        Am J Psychiatry. 2001; 158: 1652-1658https://doi.org/10.1176/appi.ajp.158.10.1652
        • Ahmed S
        A phenomenology of whiteness.
        Fem Theory. 2007; 8: 149-168https://doi.org/10.1177/1464700107078139
        • Chandler A
        Boys don't cry? Critical phenomenology, self-harm and suicide.
        Sociol Rev. 2019; 67: 1350-1366https://doi.org/10.1177/0038026119854863
        • Purcell B
        • Heisel MJ
        • Speice J
        • Franus N
        • Conwell Y
        • Duberstein PR
        Family connectedness moderates the association between living alone and suicide ideation in a clinical sample of adults 50 years and older.
        Am J Geriatr Psychiatry. 2012; 20: 717-723https://doi.org/10.1097/JGP.0b013e31822ccd79
        • Range LM
        • Leach MM
        • McIntyre D
        • et al.
        Multicultural perspectives on suicide.
        Aggress Violent Behav. 1999; 4: 413-430https://doi.org/10.1016/S1359-1789(98)00022-6
        • Early KE
        • Akers RL
        It's a white thing”: an exploration of beliefs about suicide in the African-American community.
        Deviant Behav. 1993; 14: 277-296https://doi.org/10.1080/01639625.1993.9967947
        • Lawrence RE
        • Oquendo MA
        • Stanley B
        Religion and suicide risk: a systematic review.
        Arch Suicide Res. 2016; 20: 1-21https://doi.org/10.1080/13811118.2015.1004494
        • Kalesan B
        • Villarreal MD
        • Keyes KM
        • Galea S
        Gun ownership and social gun culture.
        Inj Prev. 2016; 22: 216-220https://doi.org/10.1136/injuryprev-2015-041586
        • Parker K
        • Horowitz J
        • Igielnik R
        • Oliphant B
        • Brown A
        America's complex relationship with guns: an in-depth look at the attitudes and experiences of U.S. adults.
        Pew Research Center, Washington, DC2017 (Published June 22)
        • Hirsch JK
        • Cukrowicz KC
        Suicide in rural areas: an updated review of the literature.
        J Rural Ment Health. 2014; 38: 65-78https://doi.org/10.1037/rmh0000018
        • Barry R
        • Rehm J
        • de Oliveira C
        • Gozdyra P
        • Kurdyak P
        Rurality and risk of suicide attempts and death by suicide among people living in four English-speaking high-income countries: a systematic review and meta-analysis.
        Can J Psychiatry. 2020; 65: 441-447https://doi.org/10.1177/0706743720902655
        • Singh GK
        • Azuine RE
        • Siahpush M
        • Kogan MD
        All-cause and cause-specific mortality among U.S. youth: socioeconomic and rural-urban disparities and international patterns.
        J Urban Health. 2013; 90: 388-405https://doi.org/10.1007/s11524-012-9744-0
        • Searles VB
        • Valley MA
        • Hedegaard H
        • Betz ME
        Suicides in urban and rural counties in the United States, 2006-2008.
        Crisis. 2014; 35: 18-26https://doi.org/10.1027/0227-5910/a000224
        • Kegler SR
        • Stone DM
        • Holland KM
        Trends in suicide by level of urbanization—United States, 1999-2015.
        MMWR Morb Mortal Wkly Rep. 2017; 66: 270-273https://doi.org/10.15585/mmwr.mm6610a2
        • Garnham B
        • Bryant L
        Problematising the suicides of older male farmers: subjective, social and cultural considerations: problematising the suicides of older male farmers.
        Sociol Ruralis. 2014; 54: 227-240https://doi.org/10.1111/soru.12029
        • Kaplan MS
        • Huguet N
        • McFarland BH
        • Mandle JA
        Factors associated with suicide by firearm among U.S. older adult men.
        Psychol Men Masc. 2012; 13: 65-74https://doi.org/10.1037/a0023173
        • Nestadt PS
        • Triplett P
        • Fowler DR
        • Mojtabai R
        Urban–rural differences in suicide in the state of Maryland: the role of firearms.
        Am J Public Health. 2017; 107: 1548-1553https://doi.org/10.2105/AJPH.2017.303865
        • Thorne KL
        • Price E
        • Fiske A
        • Scotti JR
        Traumatic stress and suicide risk: the role of rural origin.
        J Rural Ment Health. 2017; 41: 42-53https://doi.org/10.1037/rmh0000062
        • Han B
        • Kott PS
        • Hughes A
        • McKeon R
        • Blanco C
        • Compton WM
        Estimating the rates of deaths by suicide among adults who attempt suicide in the United States.
        J Psychiatr Res. 2016; 77: 125-133https://doi.org/10.1016/j.jpsychires.2016.03.002
        • Douglas M
        • Katikireddi SV
        • Taulbut M
        • McKee M
        • McCartney G
        Mitigating the wider health effects of COVID-19 pandemic response.
        BMJ. 2020; 369: m1557https://doi.org/10.1136/bmj.m1557
        • Twenge J
        • Joiner TE
        Mental distress among U.S. adults during the COVID-19 pandemic.
        J Clin Psychol. 2020; 76: 2170-2182https://doi.org/10.1002/jclp.23064
        • Morrow-Howell N
        • Galucia N
        • Swinford E
        Recovering from the COVID-19 pandemic: a focus on older adults.
        J Aging Soc Policy. 2020; 32: 526-535https://doi.org/10.1080/08959420.2020.1759758
        • Brooke J
        • Jackson D
        Older people and COVID-19: isolation, risk and ageism.
        J Clin Nurs. 2020; 29: 2044-2046https://doi.org/10.1111/jocn.15274
        • Sparks H
        Morbid ‘boomer remover’ coronavirus meme only makes millennials seem more awful.
        New York Post, 2020 (March 19)
        • Fraser S
        • Lagacé M
        • Bongué B
        • et al.
        Ageism and COVID-19: what does our society's response say about us?.
        Age Ageing. 2020; 49: 692-695https://doi.org/10.1093/ageing/afaa097
      4. Firearm suicide in the United States. Everytown Research & Policy.https://everytownresearch.org/report/firearm-suicide-in-the-united-states/. Updated January 8, 2021. Accessed August 8, 2020.

        • Pyne JM
        • Fortney JC
        • Tripathi SP
        • Maciejewski ML
        • Edlund MJ
        • Williams DK
        Cost-effectiveness analysis of a rural telemedicine collaborative care intervention for depression.
        Arch Gen Psychiatry. 2010; 67: 812-821https://doi.org/10.1001/archgenpsychiatry.2010.82
        • Goldstein EV
        • Prater LC
        • Wickizer TM
        Behavioral health care and firearm suicide: do states with greater treatment capacity have lower suicide rates?.
        Health Aff (Millwood). 2019; 38: 1711-1718https://doi.org/10.1377/hlthaff.2019.00753
        • Emanuel EJ
        • Onwuteaka-Philipsen BD
        • Urwin JW
        • Cohen J
        Attitudes and practices of euthanasia and physician-assisted suicide in the United States, Canada, and Europe [published correction appears in JAMA. 2016;316(12):1319].
        JAMA. 2016; 316: 79-90https://doi.org/10.1001/jama.2016.8499
        • Jones RM
        • Simpson AIF
        Medical assistance in dying: challenges for psychiatry.
        Front Psychiatry. 2018; 9: 678https://doi.org/10.3389/fpsyt.2018.00678
        • Dierickx S
        • Onwuteaka-Philipsen B
        • Penders Y
        • et al.
        Commonalities and differences in legal euthanasia and physician-assisted suicide in three countries: a population-level comparison.
        Int J Public Health. 2020; 65: 65-73https://doi.org/10.1007/s00038-019-01281-6
        • Al Rabadi L
        • LeBlanc M
        • Bucy T
        • et al.
        Trends in medical aid in dying in Oregon and Washington.
        JAMA Netw Open. 2019; 2e198648https://doi.org/10.1001/jamanetworkopen.2019.8648