A University of Florida study provides new insights on patterns of age and suicide methods that may help health providers and policymakers develop targeted interventions to support people when they may be at greater risk for suicide.
Suicide rates have steadily climbed in the U.S. over the past decades with more than 48,000 people committing suicide in 2018, according to the Centers for Disease Control and Prevention. White Americans are particularly at risk; they account for more than 70% of suicides.
In a study published in the journal Epidemiology and Psychiatric Sciences, Bin Yu, Ph.D., a recent graduate of UF’s doctoral program in epidemiology, and Xinguang “Jim” Chen, M.D., Ph.D., a professor of epidemiology in the College of Public Health and Health Professions and College of Medicine, use a powerful epidemiological method called age-period-cohort analysis to adjust both age and birth year from the year in which the suicides occurred.
“Age-period-cohort is a way to disentangle data to look at truer trends, either by age or over time,” Chen said.
Yu and Chen analyzed suicide mortality data among whites ages 15-84 during the period 1999-2017. The data were derived from the Wide-Ranging Online Data for Epidemiological Research, prepared by the Centers for Disease Control and Prevention.
Among white males, they found three age ranges at greater risk of suicide: ages 15-20, 30-50 and 65 and over. Among white females, the risk of suicide steadily increased from age 15 to 50 before declining.
The researchers also examined suicide methods and found that among males, suicide by firearms was most prevalent among adolescents and older adults. Among women, poisoning, often by overdose from opioids, was the most common method of suicide across the lifespan.
“The study findings suggest that health care providers and policymakers may consider the different age patterns of suicide by different methods when devising interventions,” said Yu, a postdoctoral associate at Duke University’s School of Medicine.
Beyond targeting specific age groups, these interventions may include controlling access to firearms among young and older men, and preventing and treating opioid misuse in middle-aged women.
The study did not examine suicide causes, but based on previous work by other researchers, the authors suggest that the age patterns of suicide risk may correspond with major phases of the lifespan. Bin and Chen theorize that during the first phase of increased risk among males (ages 15-20), young men may be experiencing physical and cognitive imbalances caused by puberty along with new independence that comes from leaving their parents’ homes. The midlife period of increased risk (ages 30-50) may correspond to stresses related to career, marriage and family. The final high-risk period of 65 and over coincides with many men entering retirement.
“This may indicate that for men, a lot of their self-esteem may be connected to their careers,” Chen said. “We may need to develop interventions to help men still feel connected to society as they enter the retirement phase.”
The authors speculate that women’s increasing risk of suicide up to age 50 may indicate that the stresses of daily life, such as education, family, marriage and work, continue to build until middle age. After 50, the authors suggest, women may be able to shift attention away from children and family to themselves. And, unlike males, women are more likely to maintain and build new social ties after retirement, which may provide additional buffers against strains and stress.
Findings from the UF study are consistent with previous studies that demonstrate that women have a much lower risk of suicide across all ages than men. This may be due to the fact that men are more likely to attempt suicide with more lethal methods.
With many Americans impacted by COVID-19 related-stress, including isolation and job losses, suicide prevention strategies are as important as ever. Yu and Chen plan to continue their efforts to increase understanding of suicide causes so that health providers know better how and when to intervene.
“For the next steps, we will further investigate the underlying causes of the age pattern with more individual level studies, and devise effective interventions or bring current interventions to the specific age groups to facilitate precision public health and precision medicine,” Yu said.