America’s rising suicide rate

By C.K. | WASHINGTON, DC

THIS month, the Centres for Disease Control (CDC) released a report suggesting that America’s suicide rate increased by 25% between 1999 and 2016. The climb is from a historic low at the turn of the millennium and American suicide rates overall are still not significantly above those of other high-income countries. Nonetheless, World Health Organisation estimates suggest that out of its 183 member countries the United States had the seventh largest percentage increase in suicide rates between 2000 and 2016. Every suicide can have multiple causes, and the CDC does not offer a simple explanation for the rise. But other research suggests that one factor behind the rising suicide rate is an erosion of the privileged status of white men.

Nearly 45,000 Americans took their own lives in 2016, and suicide is an important part of the rising number of “deaths of despair” (also including drug overdoses and liver disease) described by Anne Case and Angus Deaton, economists. These causes of death have increased the overall mortality rate amongst white men without a college degree. Both absolute levels of suicide per 100,000 people and recent increases are particularly high amongst those aged between 45 and 64. The male suicide rate remains almost four times that for women, and suicide rates for whites are higher and have been climbing faster than those for other racial and ethnic groups.

Relative status over time appears to play a role in suicide trends. The relationship between average income and reported suicide rates across countries is weak, but inequality, recessions and unemployment are all associated with higher rates. Rising unemployment during the financial crisis was associated with increased suicide rates across Europe, for example, even while it was associated with reduced overall mortality. In America, work by Mary C. Daly and her colleagues at the Federal Reserve Bank of San Francisco suggested suicide risk rises for individuals when they see their income decline relative to the average in their county. Ms Daly has also found that richer countries in which citizens report higher average subjective wellbeing or happiness see higher suicide rates and the same is true across America's states. Discontented people in a happy place may feel particularly harshly treated by life, they suggest.

The link between erosion of relative status and suicide may also involve gender and race. A 35-country study by Allison Milner of Griffith University and colleagues suggested rising female labour force participation is associated with increased male suicide rates. Carol Graham and colleagues at the Brookings Institute find that controlling for factors including income, gender, marital status, education and employment, whites are considerably less optimistic, report lower life satisfaction and more worry and stress than Latinos and blacks. They also find an association between deaths of despair and these subjective wellbeing measures. The researchers argue that one factor behind their results may be that poor whites have fallen in status in relative terms, so that they are doing worse or no better than their parents while poor minorities have still seen some progress even if they remain disadvantaged. “The combination of fear of downward mobility, weak safety nets, and eroding social cohesion likely contributes to the high levels of desperation,” they suggest.

What can be done? The CDC suggests that a range of interventions can lower the suicide rate. These include better coverage of mental health conditions in health insurance and treatment for people at risk alongside reduced access to lethal means amongst that population—not least, guns, used in 49% of suicides. But given that more than half of suicides involve people not diagnosed with a mental health condition, the CDC suggests the need for a greater focus on “non-mental health factors further upstream” including causes of financial distress. That suggests that a strengthened safety net alongside improved insurance coverage might help both the old poor and the new hopeless cope better.