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CHAPTER 11 ■ Suicide Prevention
rates for some demographic groups increased. For example, the rate of suicide for those over 85 years of age increased by 5.2%. It cannot be overstated, how- ever, that although statistics reveal degrees of risk in certain age-groups, screening for risk of suicide should be conducted for all individuals regardless of demographic characteristics. Religion Assessing religion’s role in risk for suicide is compli- cated by variables such as degree of affiliation, par- ticipation, religious doctrine, and others. Further, some studies have found it to be protective while others have found it to be a risk factor (Lawrence et al., 2016). A systematic review of the research on religion and suicide risk (Lawrence et al., 2016) found that although religious affiliation is not protective against suicide ideation , it is protective against suicide attempts, and that religious service attendance is possibly protective against suicide. The authors of another study (Rasic et al., 2009) found that religious affiliation is associated with a decreased risk of suicide attempts in both the gen- eral population and in those with a mental illness, independent of the availability of social support systems. Socioeconomic Influences Financial strain and unemployment have often been identified as risk factors for suicide. To what extent these factors act alone (as opposed to a complex interaction of several variables) requires further study. The CDC (2019b) discusses loss (including loss of employment) as one risk factor for suicide. Suicide rates are higher in rural areas and with a twofold greater use of firearms as the means (Ivey-Stephenson et al., 2017). Kim and associates (2016) studied the factors influencing a move from suicide ideation to suicide attempts and found that low education and unemployment significantly increased the prevalence of attempts among young adult men and women with suicide ideation. Because previous attempts are a leading risk factor for even- tual suicide, assessing for suicide ideation and previ- ous attempts along with demographic risk factors are important aspects of risk assessment. Ethnicity In 2019 the highest U.S. age-adjusted suicide rate (per 100,000 individuals) was among white popula- tions (15.67), and the second-highest rate was among American Indians and Alaska Natives (13.64). Much
lower rates were found among black populations (7.04) and Asians and Pacific Islanders (7.04) (AFSP, 2021). In 2019, although the overall suicide rate was lower, there were increases in rates for black men (1.7% increase) and Asian/Pacific Islanders (2.8% increase). It is difficult to pinpoint the associated vari- ables and whether these changes will become trends, but the statistics focus attention on the changing face of suicide in the United States and can contribute to early identification of problems. Research has highlighted two trends that illumi- nate issues of concern within specific ethnic groups. First, although national suicide rates among white populations are higher in adults and the elderly, within the American Indian community, young adults are the highest-risk age-group, and the rate of suicide is 2.5 times higher than the national average (National Indian Council on Aging, 2019). Almen- drala (2015) relays the story of a psychiatrist called to a reservation where there had been 17 suicides in the previous 8 months, and the community members described themselves as “grieved out.” The second trend of concern, as Almendrala reports, is that the rates of suicide may be underestimated in this popu- lation because death certificates do not always report accurately regarding ethnicity. Another study examined suicide trends among school-age children younger than age 12 (Bridge et al., 2015) and found that suicide rates for black children 5 to 11 years of age nearly doubled over the period from 1993 to 2012, while the overall sui- cide rate in this age-group remained relatively stable during the same period. As of 2018, suicide became the second-leading cause of death in black children ages 10 to 14, and the third-leading cause of death in black adolescents ages 15 to 19 (Gordon, 2020). It is hard to imagine what causes children so young to take their own lives. The contributing factors to these recent trends are not well understood and will require further research, including a review of the impact of health-care disparities for select communi- ties or populations. Other Risk Factors The majority of people who die by suicide have a diagnosable mental illness, most commonly depres- sion, bipolar disorder, or substance use disorder. Studies support that individuals who have been hospitalized for a psychiatric illness have a higher risk of suicide than those with psychiatric illness in the general population and particularly in the first week and first month following hospitalization
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