It shows the growing severity of the issue

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Middle-aged adults - ages 45 to 64 - had the largest rate increase, rising to 19.2 per 100,000 in 2016 from 13.2 per 100,000 in 1999.

In a conference call with reporters on Thursday, Dr. Schuchat and Deborah Stone, the lead author of the C.D.C. analysis, stressed that other factors were critical to preventing suicide. Among people ages 15 to 34, suicide is the second-leading cause of death.

Firearms were the most common method of suicide for those with and without a diagnosed mental health condition. However, the fact that so many other factors appeared to contribute to suicide is an important finding. "It points to the need for a comprehensive approach to prevention". Variation in suicide rates within the USA supports this conclusion. And because suicide is, more often than not, impulsive - and the time between ideation and action is short - firearm access is uniquely deadly if someone thinks to kill themselves at all.

The rise in suicide rates was highest in the central, northern region of the USA, with North Dakota, for example, seeing a 57.6 percent increase since 1999. The biggest increases have been in states like Oklahoma, Montana and Wyoming where gun ownership, drug use and economic hardship are common.

Since 1999, suicide has become almost 30 percent more common in the U.S. - and more than half of those who killed themselves in 2016 had not been diagnosed with a mental health disorder, underscoring the need for better understanding of the signs that precede suicide and access to mental health care, experts say. "Those who died by suicide were somewhat more likely to struggle with relationship problems or loss, other life stresses, or deal with impending crises", Schuchat says.


"Our data show that suicide is more than a mental health issue", Schuchat said.

"None of this is surprising information, which is not to trivialize its importance".

"Research for many years and across social and health science fields has demonstrated a strong relationship between economic downturns and an increase in deaths due to suicide", Sarah Burgard an associate professor of sociology at the University of MI, explained in an email on Thursday.

The CDC report comes at a time of heightened attention to the issue with the suicide this week of designer Kate Spade.

Prevention has been elusive, in part because doctors have not had programs that reliably reduce suicide rates. Follow up to see how they're doing.


Effective strategies, she said, included teaching coping and problem-solving skills to those at risk, establishing more social "connectedness", and safe storage of pills and guns.

Additionally, the report looked at the rates of emergency department visits for nonfatal self-harm, a major risk factor for suicide, which rose by 42 percent from 2001 to 2016. Rates have risen steadily in most age and ethnic groups, even as rates of psychiatric treatment and diagnosis have also greatly increased.

Every day, 123 Americans commit suicide.

Among decedents aged 18 years or older, 20.1% of those without known mental health conditions and 15.3% of those with had served in the U.S. military. "Every step feels like it's an uphill stretch, but you just keep going and keep going and eventually you get to that summit, and the view when you get there is just spectacular", he said.


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