For the second year in a row after decades of rising in the U.S., overall suicide death rates dipped in 2020 (PDF), though they increased among certain groups.
Males ages 25 to 34 saw an increase in suicide death rates. And, while the rates decreased among white and Asian males, they rose among Black, American Indian/Alaskan Native and Hispanic males. However, rates of suicide deaths decreased among all females.
There is no solid disposition plan for ER doctors or nurses to follow for people admitted with suicide risk, Christine Moutier, M.D., chief medical officer of the American Foundation for Suicide Prevention (AFSP), told Fierce Healthcare.
Pediatricians also lack the necessary training and support like behavioral health colleagues. These gaps in knowledge contribute to physician burnout and turnover, Moutier noted, adding that a consensus on recommended standard care (PDF) for people with suicide risk did not exist until 2018. The AFSP partners with SafeSide Prevention to provide training for primary care providers and is expected to release a suicide prevention blueprint with an equity lens this coming January in partnership with the American Academy of Pediatrics and the National Institute of Mental Health.
“We’re at the early stages of the implementation,” she said.
The reason there has been a lag in adoption of standardized training and screening practices, Moutier suspects, is that in general, the rapid dissemination and acceptance of health information is rare. “Only when really concerted efforts happen do we really implement what we know,” she said, noting that the COVID-19 pandemic and the race for vaccines were the exceptions, not the rule.
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The increase in suicides among certain groups demonstrates the importance of individualized suicide prevention efforts, Moutier said.
“We need to do far better in paying attention to certain populations,” she said, especially those hit harder by the pandemic due to preexisting conditions and disparities. Moutier also stressed the need for more equity-oriented research focused on examining how race or ethnicity impacts suicide risk.
That’s not a simple task, Moutier cautioned. There is a big difference between completing a study and then breaking down the findings by demographic group and tailoring the entire study’s hypothesis around a particular group. The latter requires mindful methodology with a specific population and its characteristics in mind.
For instance, Moutier said, youth risk behavior surveys of children do not indicate any rising rates of suicidal ideation among Black youth, even though their suicides are rising. That begs questions that require a deeper examination of that particular demographic and why there is a disconnect between the surveys and reality. While there is a lot of research on the thought-to-action continuum of suicidal behavior, very little focuses on race, Moutier noted.
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“Youth and young adults need more support and we need to actually figure out ways that are culturally relevant for each population so that they can feel connected, supported, of value,” she said, especially marginalized groups like LGBTQ+ youth. Evidence-based strategies that exist but have been slow to be adopted—like educating parents and school teachers—can help improve outcomes for these populations, not only when it comes to suicide but also with social determinants like housing security. Building a community safety net is also critical, experts say.
Mental health emergency visits to the ER, including suspected suicide attempt visits, did increase among teens in 2020, but no statistically significant increase was reflected in the suicide death data. That might suggest parents are more aware of and involved in their children’s mental health, Moutier said, which is a positive sign.
The overall decrease in suicides is hopeful and could be explained by society’s instinctive response to global catastrophes like a pandemic, Moutier said. Historically, in the immediate aftermath of tragedies, communities band together and support each other.
“Interpersonal connectedness is a very protective factor,” Moutier said of those at risk of suicide. But only time, and this year’s data, will tell how well our current approaches to treatment and prevention work outside of cultural response.