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Characteristic Suicidal thought§ Suicide plan Suicide attempt
No. % (95% CI) No. % (95% CI) No. % (95% CI)
Sex
Male 4,860 4.1 (4.0–4.3) 1,356 1.1 (1.1–1.2) 565 0.5 (0.4–0.5)
Female 5,727 4.5 (4.4–4.6) 1,728 1.4 (1.3–1.4) 820 0.6 (0.6–0.7)
Age group (yrs)
18–39 6,515 6.9 (6.8–7.1) 2,004 2.1 (2.1–2.2) 968 1.0 (1.0–1.1)
40–55 2,218 3.4 (3.2–3.6) 655 1.0 (0.9–1.1) 252 0.4 (0.3–0.5)
≥56 1,854 2.2 (2.0–2.3) 425 0.5 (0.4–0.6) 166 0.2 (0.1–0.3)
Race/Ethnicity
White, non-Hispanic 7,169 4.6 (4.4–4.7) 2,014 1.3 (1.2–1.3) 805 0.5 (0.5–0.6)
Black, non-Hispanic 1,081 3.7 (3.5–4.0) 349 1.2 (1.1–1.4) 204 0.7 (0.6–0.8)
Asian, non-Hispanic 400 2.9 (2.5–3.4) 121 0.9 (0.7–1.1) 64 0.5 (0.3–0.6)
AI/AN, non-Hispanic 68 5.0 (4.2–6.0) 26 1.9 (1.4–2.7) 11 0.8 (0.5–1.1)
NH/OPI, non-Hispanic 34 3.8 (2.5–5.8) 11 1.3 (0.5–3.4) 9 0.9 (0.3–3.4)
Two or more races, non-Hispanic 319 7.7 (6.8–8.7) 116 2.8 (2.4–3.3) 51 1.2 (1.0–1.6)
Hispanic 1,514 3.9 (3.6–4.1) 446 1.1 (1.0–1.3) 243 0.6 (0.5–0.7)
Education level
Less than high school 1,299 4.2 (3.9–4.5) 436 1.4 (1.2–1.6) 292 0.9 (0.8–1.1)
High school graduate** 2,689 4.4 (4.2–4.7) 878 1.5 (1.4–1.6) 435 0.7 (0.6–0.8)
Some college 4,148 5.5 (5.3–5.7) 1,200 1.6 (1.5–1.7) 484 0.6 (0.6–0.7)
College graduate or higher 2,450 3.2 (3.0–3.3) 569 0.7 (0.7–0.8) 174 0.2 (0.2–0.3)
County type††
Large metropolitan area§§ 5,617 4.1 (4.0–4.2) 1,575 1.2 (1.1–1.2) 715 0.5 (0.5–0.6)
Small metropolitan area¶¶ 3,438 4.7 (4.5–4.9) 1,005 1.4 (1.3–1.5) 449 0.6 (0.6–0.7)
Nonmetropolitan area*** 1,532 4.4 (4.2–4.7) 504 1.5 (1.3–1.6) 221 0.6 (0.5–0.7)
Marital status†††
Never married 5,440 7.8 (7.6–8.0) 1,662 2.4 (2.3–2.5) 816 1.2 (1.1–1.2)
Married 3,174 2.5 (2.4–2.6) 779 0.6 (0.6–0.7) 271 0.2 (0.2–0.3)
Separated, divorced, or widowed 1,973 4.1 (3.8–4.3) 643 1.3 (1.2–1.5) 298 0.6 (0.5–0.7)
Poverty level§§§
<100% 2244 6.6 (6.2–6.9) 763 2.2 (2.1–2.4) 441 1.3 (1.2–1.4)
100%–199% 2427 5.0 (4.8–5.3) 767 1.6 (1.5–1.7) 360 0.7 (0.7–0.8)
≥200% 5827 3.6 (3.5–3.7) 1,527 0.9 (0.9–1.0) 574 0.4 (0.3–0.4)
Health insurance¶¶¶
Private 5,824 3.6 (3.4–3.7) 1,506 0.9 (0.9–1.0) 603 0.4 (0.3–0.4)
Medicaid or CHIP**** 2,451 7.0 (6.7–7.3) 874 2.5 (2.3–2.7) 487 1.4 (1.2–1.5)
Other†††† 2,172 3.2 (3.0–3.5) 632 0.9 (0.9–1.0) 248 0.4 (0.3–0.4)
No coverage 1,480 6.1 (5.8–6.4) 470 1.9 (1.7–2.1) 234 1.0 (0.8–1.1)
Total§§§§ 10,586 4.3 (4.2–4.4) 3,084 1.3 (1.2–1.3) 1,385 0.6 (0.5–0.6)

Table 1. Annual average estimated number* and percentage of adults aged ≥18 years who had suicidal thoughts, made any suicide plans, or attempted suicide during the previous year, by selected demographic characteristics — National Survey on Drug Use and Health, United States, 2015–2019

Abbreviations: AI/AN = American Indian/Alaska Native; CHIP = Children’s Health Insurance Program; NH/OPI = Native Hawaiian or Other Pacific Islander.

* In thousands.
Estimates are based only on responses to suicide items in the Mental Health module. Respondents with unknown suicide information were excluded. Only respondents who reported suicide ideation were asked about suicide plans and attempts.
§ Respondents who answered “yes” to the question, "At any time in the past 12 months, did you seriously think about trying to kill yourself?" were categorized as having serious thoughts of suicide in the past year.
Persons of Hispanic origin can be of any race.

** Includes persons with a general education diploma.
†† County type estimates are based on the 2013 Rural-Urban Continuum Codes. https://www.ers.usda.gov/data-products/rural-urban-continuum-codes.aspx
§§ Area with a population of ≥1 million persons.
¶¶ Area with a population of <1 million persons.
*** Area that is outside of a metropolitan statistical area.
††† Methodological changes that occurred in 2015 had minimal effects on estimates provided in this report.
§§§ Estimates are based on a definition of the poverty level that incorporates information on family income, size, and composition and is calculated as a percentage of the U.S. Census Bureau's poverty thresholds. Respondents aged 18–22 years who were living in a college dormitory were excluded.
¶¶¶ Respondents could indicate multiple types of health insurance; thus, these response categories are not mutually exclusive.

**** Persons aged ≤19 years are eligible for this plan.
†††† Defined as having Medicare, CHAMPUS, TRICARE, CHAMPVA, Veterans Administration, military health care, or any other type of health insurance.
§§§§ Totals exclude persons with missing or unknown race and ethnicity. Totals might vary due to rounding.

 

Region/State Suicidal thought§ Suicide plan Suicide attempt
No. % (95% CI) p value (national vs state/region) No. % (95% CI) p value (national vs state/region) No. % (95% CI) p value (national vs state/region)
Geographic region
Northeast 1,750 4.0 (3.8–4.3) 0.014** 442 1.0 (0.9–1.1) 0** 220 0.5 (0.4–0.6) 0.143
Midwest 2,340 4.5 (4.3–4.8) 0.019** 741 1.4 (1.3–1.6) 0.001** 317 0.6 (0.5–0.7) 0.125
South 3,704 4.0 (3.9–4.2) 0** 1,084 1.2 (1.1–1.3) 0.013** 521 0.6 (0.5–0.6) 0.977
West 2,792 4.8 (4.6–5.1) 0** 818 1.4 (1.3–1.5) 0.003** 326 0.6 (0.5–0.6) 0.960
State
Alabama 146 4.0 (3.3–4.8) 0.350 41 1.1 (0.8–1.6) 0.470 19 0.5 (0.3–0.8) 0.646
Alaska 32 6.1 (5.4–7.0) 0** 12 2.4 (1.9–2.9) 0** 4 0.8 (0.5–1.2) 0.151
Arizona 239 4.5 (3.9–5.3) 0.541 81 1.5 (1.2–1.9) 0.118 40 0.8 (0.5–1.0) 0.131
Arkansas 106 4.8 (3.9–5.8) 0.352 31 1.4 (1.0–1.9) 0.531 15 0.6 (0.4–1.0) 0.569
California 1,259 4.2 (3.9–4.6) 0.679 358 1.2 (1.0–1.4) 0.544 148 0.5 (0.4–0.6) 0.227
Colorado 259 6.1 (5.1–7.3) 0.002** 72 1.7 (1.3–2.2) 0.074 24 0.6 (0.4–0.9) 0.949
Connecticut 100 3.6 (3.0–4.4) 0.059 22 0.8 (0.5–1.2) 0.005** 7 0.3 (0.2–0.4) 0**
Delaware 39 5.3 (4.4–6.3) 0.047** 10 1.4 (1.0–1.9) 0.611 4 0.6 (0.3–1.0) 0.856
District of Columbia 21 3.7 (3.0–4.6) 0.130 6 1.0 (0.7–1.5) 0.228 3 0.6 (0.4–1.0) 0.762
Florida 588 3.6 (3.2–4.1) 0.001** 153 0.9 (0.8–1.1) 0.001** 74 0.5 (0.4–0.6) 0.069
Georgia 296 3.9 (3.3–4.5) 0.152 93 1.2 (0.9–1.6) 0.805 50 0.7 (0.4–1.0) 0.504
Hawaii 46 4.4 (3.5–5.4) 0.910 13 1.3 (0.9–1.8) 0.974 6 0.6 (0.4–0.9) 0.816
Idaho 70 5.6 (4.8–6.5) 0.007** 25 2.0 (1.6–2.4) 0.001** 7 0.5 (0.3–0.8) 0.748
Illinois 351 3.6 (3.2–4.1) 0.004** 115 1.2 (0.9–1.5) 0.644 51 0.5 (0.4–0.7) 0.694
Indiana 275 5.5 (4.7–6.5) 0.008** 98 2.0 (1.5–2.6) 0.008** 43 0.9 (0.6–1.3) 0.074
Iowa 111 4.7 (3.9–5.7) 0.425 42 1.8 (1.3–2.4) 0.053 20 0.9 (0.6–1.3) 0.105
Kansas 112 5.3 (4.4–6.3) 0.061 35 1.6 (1.2–2.2) 0.135 15 0.7 (0.4–1.1) 0.407
Kentucky 171 5.1 (4.3–6.0) 0.071 56 1.7 (1.2–2.2) 0.108 25 0.8 (0.5–1.1) 0.192
Louisiana 153 4.4 (3.8–5.2) 0.739 55 1.6 (1.2–2.1) 0.160 31 0.9 (0.6–1.3) 0.033**
Maine 48 4.5 (3.9–5.3) 0.587 13 1.2 (0.9–1.7) 0.890 4 0.4 (0.3–0.6) 0.059
Maryland 187 4.1 (3.4–4.8) 0.499 47 1.0 (0.7–1.4) 0.176 19 0.4 (0.3–0.7) 0.151
Massachusetts 241 4.5 (3.6–5.6) 0.741 55 1.0 (0.7–1.4) 0.187 27 0.5 (0.3–0.8) 0.578
Michigan 312 4.1 (3.6–4.6) 0.327 86 1.1 (0.9–1.4) 0.261 42 0.5 (0.4–0.7) 0.813
Minnesota 188 4.5 (3.7–5.3) 0.715 55 1.3 (0.9–1.9) 0.811 17 0.4 (0.3–0.7) 0.127
Mississippi 98 4.5 (3.6–5.5) 0.751 34 1.6 (1.1–2.1) 0.233 15 0.7 (0.5–1.0) 0.339
Missouri 189 4.1 (3.4–5.0) 0.597 57 1.2 (0.9–1.7) 0.935 27 0.6 (0.4–1.0) 0.854
Montana 43 5.3 (4.7–6.1) 0.004** 13 1.6 (1.2–2.1) 0.159 4 0.5 (0.4–0.8) 0.857
Nebraska 62 4.4 (3.7–5.3) 0.774 23 1.6 (1.2–2.1) 0.136 7 0.5 (0.3–0.9) 0.753
Nevada 116 5.2 (4.3–6.2) 0.090 43 1.9 (1.3–2.7) 0.060 17 0.8 (0.5–1.2) 0.255
New Hampshire 56 5.2 (4.5–6.1) 0.028** 17 1.6 (1.1–2.3) 0.231 4 0.4 (0.3–0.5) 0.006**
New Jersey 221 3.3 (2.7–3.9) 0.001** 53 0.8 (0.6–1.1) 0** 28 0.4 (0.3–0.7) 0.117
New Mexico 73 4.7 (3.8–5.7) 0.456 17 1.1 (0.8–1.4) 0.248 7 0.4 (0.3–0.6) 0.159
New York 565 3.7 (3.3–4.2) 0.005** 150 1.0 (0.8–1.2) 0.009** 83 0.5 (0.4–0.7) 0.842
North Carolina 329 4.3 (3.7–4.9) 0.842 101 1.3 (1.0–1.7) 0.752 50 0.6 (0.4–0.9) 0.487
North Dakota 25 4.5 (3.8–5.4) 0.638 8 1.5 (1.0.-2.0) 0.397 3 0.6 (0.4–0.8) 0.995
Ohio 480 5.4 (4.9–6.0) 0** 138 1.6 (1.3–1.9) 0.028** 52 0.6 (0.5–0.7) 0.690
Oklahoma 118 4.1 (3.3–5.0) 0.605 38 1.3 (1.0–1.7) 0.723 17 0.6 (0.4–1.0) 0.841
Oregon 182 5.7 (4.9–6.5) 0.001** 50 1.6 (1.2–2.1) 0.149 18 0.6 (0.4–0.8) 0.990
Pennsylvania 448 4.5 (4.0–5.2) 0.453 111 1.1 (0.9–1.4) 0.308 59 0.6 (0.4–0.8) 0.776
Rhode Island 41 4.9 (4.1–5.8) 0.186 12 1.5 (1.0–2.0) 0.426 5 0.6 (0.4–1.0) 0.662
South Carolina 164 4.3 (3.5–5.3) 0.989 56 1.5 (1.0–2.2) 0.478 20 0.5 (0.3–1.0) 0.786
South Dakota 24 3.8 (3.2–4.7) 0.211 8 1.2 (0.9–1.7) 0.874 4 0.6 (0.4–0.9) 0.727
Tennessee 236 4.6 (4.0–5.5) 0.387 69 1.4 (1.0–1.9) 0.674 35 0.7 (0.5–1.0) 0.355
Texas 726 3.6 (3.2–4.0) 0** 196 1.0 (0.8–1.1) 0** 95 0.5 (0.4–0.6) 0.103
Utah 149 6.9 (5.8–8.3) 0** 44 2.0 (1.5–2.7) 0.013** 17 0.8 (0.6–1.1) 0.096
Vermont 31 6.1 (5.2–7.2) 0.001** 8 1.7 (1.2–2.3) 0.156 3 0.5 (0.3–0.9) 0.685
Virginia 258 4.0 (3.5–4.6) 0.331 72 1.1 (0.9–1.5) 0.387 35 0.6 (0.4–0.8) 0.921
Washington 300 5.3 (4.6–6.2) 0.015** 85 1.5 (1.1–2.0) 0.247 31 0.6 (0.3–1.0) 0.939
West Virginia 70 5.0 (4.3–5.8) 0.100 27 1.9 (1.4–2.5) 0.022** 13 0.9 (0.5–1.6) 0.167
Wisconsin 212 4.8 (4.1–5.6) 0.239 75 1.7 (1.3–2.2) 0.062 35 0.8 (0.5–1.2) 0.185
Wyoming 24 5.4 (4.5–6.4) 0.028** 6 1.4 (1.1–1.8) 0.535 3 0.6 (0.4–0.8) 0.849
Total 10,586 4.3 (4.2–4.4) NA 3,084 1.3 (1.2–1.3) NA 1,385 0.6 (0.5–0.6) NA

Table 2. Annual average estimated number* and percentage of adults aged ≥18 years who had suicidal thoughts, made any suicide plans, or attempted suicide during the previous year, by state and geographic region — National Survey on Drug Use and Health, United States, 2015–2019

Abbreviation: NA = not applicable.
* In thousands.
Estimates are based only on responses to suicide items in the Mental Health module. Respondents with unknown suicide information were excluded. Only respondents who reported suicide ideation were asked about suicide plans and attempts.
§ Respondents who answered “yes” to the question, "At any time in the past 12 months, did you seriously think about trying to kill yourself?" were categorized as having serious thoughts of suicide in the past year.
Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont. Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin. South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia. West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.
** Statistical significance at the p<0.05 level.

 

Geographic region§ Male Female
No. % (95% CI) No. % (95% CI)
Suicidal thought
Northeast 765 3.7 (3.4–4.0) 985 4.3 (4–4.7)
Midwest 1,037 4.2 (3.9–4.5) 1,302 4.9 (4.6–5.2)
South 1,686 3.8 (3.6–4.1) 2,018 4.2 (4.0–4.4)
West 1,371 4.8 (4.5–5.2) 1,421 4.8 (4.5–5.1)
Total 4,860 4.1 (4.0–4.3) 5,727 4.5 (4.4–4.6)
Suicide plan
Northeast 175 0.8 (0.7–1) 267 1.2 (1.0–1.4)
Midwest 331 1.3 (1.2–1.5) 410 1.5 (1.4–1.7)
South 477 1.1 (1.0–1.2) 607 1.3 (1.2–1.4)
West 374 1.3 (1.1–1.5) 444 1.5 (1.3–1.7)
Total 1,356 1.1 (1.1–1.2) 1,728 1.4 (1.3–1.4)
Suicide attempt
Northeast 67 0.3 (0.3–0.4) 153 0.7 (0.5–0.8)
Midwest 138 0.6 (0.5–0.7) 179 0.7 (0.6–0.8)
South 222 0.5 (0.4–0.6) 299 0.6 (0.5–0.7)
West 138 0.5 (0.4–0.6) 188 0.6 (0.5–0.8)
Total 565 0.5 (0.4–0.5) 820 0.6 (0.6–0.7)

Table 3. Annual average estimated numbe* and percentage of adults aged ≥18 years who had suicidal thoughts, plans, and attempts during the previous year, by geographic region and sex — National Survey on Drug Use and Health, United States, 2015-2019

* In thousands.
Estimates based only on responses to suicide items in the Mental Health module. Respondents with unknown suicide information were excluded.
§ Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont. Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin. South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia. West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.

 

Geographic region§

Age group (yrs)

18–39

40–55

≥56

No. % (95% CI) No. % (95% CI) No. % (95% CI)
Suicidal thought
Northeast 1,073 6.7 (6.3–7) 350 3.0 (2.6–3.5) 328 2.1 (1.7–2.5)
Midwest 1,453 7.5 (7.2–7.8) 509 3.8 (3.4–4.2) 378 2.0 (1.7–2.4)
South 2,272 6.5 (6.2–6.8) 782 3.1 (2.8–3.5) 650 2.0 (1.8–2.3)
West 1,717 7.4 (7–7.8) 577 3.8 (3.4–4.2) 499 2.6 (2.0.2–3)
Total 6,515 6.9 (6.8–7.1) 2,218 3.4 (3.2–3.6) 1,854 2.2 (2.0–2.3)
Suicide plan
Northeast 295 1.8 (1.7–2.0) 79 0.7 (0.5–0.9) 68 0.4 (0.3–0.7)
Midwest 478 2.5 (2.3–2.7) 166 1.2 (1.0–1.5) 97 0.5 (0.4–0.7)
South 695 2.0 (1.8–2.1) 246 1.0 (0.8–1.2) 143 0.4 (0.3–0.6)
West 536 2.3 (2.1–2.5) 165 1.1 (0.9–1.3) 117 0.6 (0.4–0.8)
Total 2,004 2.1 (2.1–2.2) 655 1.0 (0.9–1.1) 425 0.5 (0.4–0.6)
Suicide attempt
Northeast 166 1.0 (0.9–1.2) 27 0.2 (0.1–0.5) 27 0.2 (0.1–0.3)
Midwest 216 1.1 (1.0–1.2) 63 0.5 (0.3–0.6) 39 0.2 (0.1–0.4)
South 350 1.0 (0.9–1.1) 111 0.4 (0.3–0.6) 60 0.2 (0.1–0.3)
West 236 1.0 (0.9–1.2) 51 0.3 (0.2–0.5) 40 0.2 (0.1–0.4)
Total 968 1.0 (1.0–1.1) 252 0.4 (0.3–0.5) 166 0.2 (0.1–0.3)

Table 4. Annual average estimated number* and percentage of adults aged ≥18 years who had suicidal thoughts, plans, and attempts during the previous year, by geographic region and age group — National Survey on Drug Use and Health, United States, 2015–2019

* In thousands.
Estimates based only on responses to suicide items in the Mental Health module. Respondents with unknown suicide information were excluded.
§ Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont. Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin. South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia. West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.

 

Geographic region§ Race/Ethnicity
White, non-Hispanic Black, non-Hispanic Asian, non-Hispanic AI/AN, non-Hispanic Hispanic
No. % (95% CI) No. % (95% CI) No. % (95% CI) No. % (95% CI) No. % (95% CI)
Suicidal thought
Northeast 1,228 4.1 (3.8–4.5) 169 3.6 (2.9–4.5) 44 1.6 (1.2–2.0) 2 3.8 (1.9–7.4) 261 4.6 (3.9–5.5)
Midwest 1,846 4.6 (4.3–4.8) 212 4.3 (3.7–5.0) 62 3.8 (2.9–4.9) 18 7.7 (5.7–10.3) 140 4.1 (3.4–4.9)
South 2,428 4.4 (4.1–4.6) 583 3.5 (3.2–3.8) 93 3.0 (2.3–3.9) 21 4.5 (3.0–6.7) 477 3.2 (2.9–3.6)
West 1,667 5.3 (5.0–5.7) 118 4.7 (3.7–5.9) 201 3.3 (2.6–4.1) 27 4.5 (3.4–5.9) 637 4.1 (3.7–4.6)
Total 7,169 4.6 (4.4–4.7) 1,081 3.7 (3.5–4.0) 400 2.9 (2.5–3.4) 68 5.0 (4.2–6.0) 1,514 3.9 (3.6–4.1)
Suicide plan
Northeast 284 1.0 (0.8–1.1) 45 1.0 (0.7–1.3) 21 0.7 (0.5–1.1) 1 1.4 (0.4–4.3) 74 1.3 (0.9–2.0)
Midwest 562 1.4 (1.3–1.5) 68 1.4 (1.0–1.9) 25 1.5 (1.0–2.4) 6 2.6 (0.9–7.0) 55 1.6 (1.2–2.3)
South 713 1.3 (1.2–1.4) 196 1.2 (1.0–1.3) 16 0.5 (0.3–1.0) 10 2.1 (1.2–3.6) 108 0.7 (0.6–0.9)
West 455 1.5 (1.3–1.6) 40 1.6 (1.0–2.5) 59 1.0 (0.6–1.5) 10 1.6 (1.1–2.4) 208 1.3 (1.2–1.6)
Total 2,014 1.3 (1.2–1.3) 349 1.2 (1.1–1.4) 121 0.9 (0.7–1.1) 26 1.9 (1.4–2.7) 446 1.1 (1.0–1.3)
Suicide attempt
Northeast 122 0.4 (0.3–0.5) 28 0.6 (0.4–0.9) 13 0.5 (0.3–0.8) 0 0.6 (0.1–2.7) 47 0.8 (0.5–1.4)
Midwest 233 0.6 (0.5–0.7) 37 0.8 (0.5–1.1) 9 0.5 (0.3–1.1) 2 0.9 (0.5–1.8) 25 0.7 (0.5–1.1)
South 302 0.5 (0.5–0.6) 118 0.7 (0.6–0.8) 14 0.5 (0.2–0.9) 3 0.7 (0.3–1.5) 63 0.4 (0.3–0.6)
West 148 0.5 (0.4–0.6) 21 0.8 (0.5–1.3) 27 0.4 (0.2–0.9) 5 0.8 (0.5–1.4) 107 0.7 (0.6–0.9)
Total 805 0.5 (0.5–0.6) 204 0.7 (0.6–0.8) 64 0.5 (0.3–0.6) 11 0.8 (0.5–1.1) 243 0.6 (0.5–0.7)

Table 5. Annual average estimated number* and percentage of adults aged ≥18 years who had suicidal thoughts, plans, and attempts during the previous year, by geographic region and race/ethnicity — National Survey on Drug Use and Health, United States, 2015–2019

Abbreviation: AI/AN = American Indian or Alaska Native.
* In thousands.
Estimates based only on responses to suicide items in the Mental Health module. Respondents with unknown suicide information were excluded.
§ Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont. Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin. South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia. West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.

 

Characteristic Medical attention Hospitalization
No. % (95% CI) No. % (95% CI)
Sex
Male 299 52.9 (48.0–57.8) 215 38.1 (33.4–43.1)
Female 442 53.9 (50.0–57.8) 301 36.7 (32.8–40.9)
Age group (yrs)
18–39 453 46.8 (43.9–49.8) 299 30.9 (28.3–33.7)
40–55 178 70.6 (62.6–77.4) 133 53.0 (44.7–61.1)
≥56 §
Race/Ethnicity
White, non-Hispanic 458 56.9 (52.9–60.7) 312 38.7 (34.9–42.8)
Black, non-Hispanic 111 54.6 (47.2–61.8) 82 40.2 (33.0–47.9)
Asian, non-Hispanic
AI/AN, non-Hispanic
NH/OPI, non-Hispanic
Two or more races, non-Hispanic
Hispanic 106 43.8 (36.2–51.7) 82 33.8 (26.5–42.1)
Education level
Less than high school 171 58.7 (51.9–65.1) 135 46.1 (39.1–53.3)
High school graduate** 209 48.1 (42.7–53.6) 132 30.5 (25.9–35.5)
Some college 254 52.6 (47.9–57.3) 170 35.2 (30.7–40.0)
College graduate or higher 106 60.9 (50.3–70.5) 79 45.2 (34.9–55.9)
County type††
Large metropolitan§§ 370 51.8 (47.1–56.6) 271 38.0 (33.3–42.9)
Small metropolitan¶¶ 257 57.3 (52.4–62.2) 176 39.3 (34.3–44.6)
Nonmetropolitan*** 113 51.2 (44.0–58.3) 69 31.0 (25.3–37.4)
Marital status†††
Never married 375 46.0 (42.8–49.3) 255 31.3 (28.3–34.4)
Married 171 63.2 (54.9–70.7) 115 42.6 (34.5–51.1)
Separated, divorced, or widowed 195 65.2 (57.0–72.6) 146 49.0 (40.5–57.5)
Poverty level§§§
<100% 247 56.2 (50.6–61.6) 186 42.3 (36.8–48.1)
100%–199% 181 50.2 (44.2–56.2) 104 28.9 (24.1–34.2)
≥200% 309 53.9 (49.0–58.8) 223 38.9 (34.0–44.1)
Health insurance ¶¶¶
Private 329 54.6 (50.0–59.1) 221 36.7 (32.2–41.4)
Medicaid or CHIP**** 289 59.3 (53.6–64.7) 216 44.3 (38.8–50.0)
Other †††† 149 60 (50.8–68.5) 109 44.0 (35.2–53.1)
No coverage 94 40.2 (33.6–47.1) 62 26.4 (20.7–33.0)
Geographic region§§§§
Northeast 118 53.6 (46.3–60.7) 88 40.0 (32.7–47.9)
Midwest 182 57.3 (51.4–62.9) 128 40.4 (34.6–46.5)
South 272 52.2 (47.1–57.3) 183 35.1 (30.3–40.2)
West 169 51.9 (44.9–58.7) 117 36.0 (29.5–43.0)
Total ¶¶¶¶ 741 53.5 (50.3–56.7) 516 37.3 (34.2–40.5)

Table 6. Annual average estimated number* and percentage of adults aged ≥18 years who attempted suicide requiring medical attention or hospitalization during the previous year, by selected demographic characteristics — National Survey on Drug Use and Health, United States, 2015–2019

Abbreviations: AI/AN = American Indian or Alaska Native; CHIP = Children’s Health Insurance Program; NH/OPI = Native Hawaiian or Other Pacific Islander; RSE = relative standard error.
* In thousands.
Estimates based only on responses to suicide items in the Mental Health module. Respondents with unknown suicide information were excluded.
§ Low precision; no estimate reported. According to the suppression criteria, prevalence estimates are suppressed if any of the following occurred: 1) the prevalence estimate is <0.005% or >99.95%, 2) the RSE of the negative natural logarithm of the estimated proportion p (where p is the prevalence divided by 100) is >0.175 if the prevalence is ≤50%, 3) the RSE of the negative of the natural logarithm of (1-p) is >0.175 if the prevalence is >50%, 4) the actual sample size is <100, or 5) the effective sample size (defined as the actual sample size divided by the design effect) is <68.
Persons of Hispanic origin can be of any race.
** Includes persons with a general education diploma.
†† County type estimates are based on the 2013 Rural-Urban Continuum Codes. https://www.ers.usda.gov/data-products/rural-urban-continuum-codes.aspx
§§ Area with a population of ≥1 million persons.
¶¶ Area with a population of <1 million persons.
*** Area that is outside of a metropolitan statistical area.
††† Methodological changes that occurred in 2015 had minimal effects on estimates provided in this report.
§§§ Estimates are based on a definition of the poverty level that incorporates information on family income, size, and composition and is calculated as a percentage of the U.S. Census Bureau's poverty thresholds. Respondents aged 18–22 years who were living in a college dormitory were excluded.
¶¶¶ Respondents could indicate multiple types of health insurance; thus, these response categories are not mutually exclusive.
**** Persons aged ≤19 years are eligible for this plan.
†††† Defined as having Medicare, CHAMPUS, TRICARE, CHAMPVA, Veterans Administration, military health care, or any other type of health insurance.
§§§§ Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont. Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin. South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia. West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.
¶¶¶¶ Totals exclude persons with missing or unknown race and ethnicity. Totals might vary due to rounding.

CME / ABIM MOC / CE

Suicidal Thoughts and Behaviors Among Adults Aged ≥18 Years — United States, 2015–2019

  • Authors: Asha Z. Ivey-Stephenson, PhD; Alex E. Crosby, MD; Jennifer M. Hoenig, PhD; Shiromani Gyawali, MS; Eunice Park-Lee, PhD; Sarra L. Hedden, PhD
  • CME / ABIM MOC / CE Released: 4/12/2022
  • Valid for credit through: 4/12/2023
Start Activity

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Target Audience and Goal Statement

This activity is intended for public health officials, psychiatrists, family medicine clinicians, nurses, pharmacists, and other clinicians caring for patients with or at risk for suicidal thoughts, plans, and/or attempts.

The goal of this activity is to describe suicidal thoughts and behaviors among sampled persons aged ≥ 18 years in all 50 US states and the District of Columbia from 2015 to 2019, according to the National Survey on Drug Use and Health annual survey of 254,767 respondents regarding national-, regional-, and state-level prevalence of suicidal thoughts, planning, and attempts by age group, sex, race and ethnicity, region, state, education, marital status, poverty level, and health insurance status.

Upon completion of this activity, participants will:

  • Describe U.S. prevalence estimates of suicidal thoughts, suicide planning, and suicide attempts during the preceding year among adults aged ≥18 years by region and state, according to the National Survey on Drug Use and Health (NSDUH) annual survey from 2015 to 2019
  • Determine sociodemographic risk factors for suicidal thoughts, suicide planning, and suicide attempts during the preceding year among U.S. adults aged ≥18 years, according to the NSDUH annual survey from 2015 to 2019
  • Identify clinical and public health implications of prevalence of and risk factors for suicidal thoughts, suicide planning, and suicide attempts during the preceding year among U.S. adults aged ≥18 years, according to the NSDUH annual survey from 2015 to 2019


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Faculty

  • Asha Z. Ivey-Stephenson, PhD

    Division of Injury Prevention 
    National Center for Injury Prevention and Control
    Centers for Disease Control and Prevention (CDC)

    Disclosures

    Disclosure: Asha Z. Ivey-Stephenson, PhD, has disclosed no relevant financial relationships.

  • Alex E. Crosby, MD

    Division of Injury Prevention
    National Center for Injury Prevention and Control
    Centers for Disease Control and Prevention (CDC)

    Disclosures

    Disclosure: Alex E. Crosby, MD, has disclosed no relevant financial relationships.

  • Jennifer M. Hoenig, PhD

    Division of Surveillance and Data Collection
    Center for Behavioral Health Statistics and Quality
    Substance Abuse and Mental Health Services Administration

    Disclosures

    Disclosure: Jennifer M. Hoenig, PhD, has disclosed no relevant financial relationships.

  • Shiromani Gyawali, MS

    Division of Surveillance and Data Collection
    Center for Behavioral Health Statistics and Quality
    Substance Abuse and Mental Health Services Administration

    Disclosures

    Disclosure: Shiromani Gyawali, MS, has disclosed no relevant financial relationships.

  • Eunice Park-Lee, PhD

    Division of Surveillance and Data Collection
    Center for Behavioral Health Statistics and Quality
    Substance Abuse and Mental Health Services Administration

    Disclosures

    Disclosure: Eunice Park-Lee, PhD, has disclosed no relevant financial relationships.

  • Sarra L. Hedden, PhD

    Division of Surveillance and Data Collection
    Center for Behavioral Health Statistics and Quality
    Substance Abuse and Mental Health Services Administration

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    Disclosure: Sarra L. Hedden, PhD, has disclosed no relevant financial relationships.

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer
    Medscape, LLC

    Disclosures

    Disclosure: Laurie Barclay, MD, has disclosed the following relevant financial relationships:
    Stocks, stock options, or bonds: AbbVie Inc. (former)

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  • Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP

    Associate Director, Accreditation and Compliance
    Medscape, LLC

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    Disclosure: Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP, has disclosed no relevant financial relationships.


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CME / ABIM MOC / CE

Suicidal Thoughts and Behaviors Among Adults Aged ≥18 Years — United States, 2015–2019

Authors: Asha Z. Ivey-Stephenson, PhD; Alex E. Crosby, MD; Jennifer M. Hoenig, PhD; Shiromani Gyawali, MS; Eunice Park-Lee, PhD; Sarra L. Hedden, PhDFaculty and Disclosures

CME / ABIM MOC / CE Released: 4/12/2022

Valid for credit through: 4/12/2023

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Abstract and Introduction

Abstract

Problem/Condition: Suicidal thoughts and behaviors are important public health concerns in the United States. In 2019, suicide was the 10th leading cause of death among persons aged ≥18 years (adults); in that year, 45,861 adults died as a result of suicide, and an estimated 381,295 adults visited hospital emergency departments for nonfatal, self-inflicted injuries. Regional- and state-level data on self-inflicted injuries are needed to help localities establish priorities and evaluate the effectiveness of suicide prevention strategies.

Period Covered: 2015–2019.

Description of System: The National Survey on Drug Use and Health (NSDUH) is an annual survey of a representative sample of the civilian, noninstitutionalized U.S. population aged ≥12 years. NSDUH collects data on the use of illicit drugs, alcohol, and tobacco; initiation of substance use; substance use disorders and treatment; health care; and mental health. This report summarizes data on responses to questions concerning suicidal thoughts and behaviors contained in the mental health section among sampled persons aged ≥18 years in all 50 states and the District of Columbia. This report summarizes 2015–2019 NSDUH data collected from 254,767 respondents regarding national-, regional-, and state-level prevalence of suicidal thoughts, planning, and attempts by age group, sex, race and ethnicity, region, state, education, marital status, poverty level, and health insurance status.

Results: Prevalence estimates of suicidal thoughts and behaviors varied by sociodemographic factors, region, and state. During 2015–2019, an estimated 10.6 million (annual average) adults in the United States (4.3% of the adult population) reported having had suicidal thoughts during the preceding year. The prevalence of having had suicidal thoughts ranged from 4.0% in the Northeast and South to 4.8% in the West and from 3.3% in New Jersey to 6.9% in Utah. An estimated 3.1 million adults (1.3% of the adult population) had made a suicide plan in the past year. The prevalence of having made suicide plans ranged from 1.0% in the Northeast to 1.4% in the Midwest and West and from 0.8% in Connecticut and New Jersey to 2.4% in Alaska. An estimated 1.4 million adults (0.6% of the adult population) had made a suicide attempt in the past year. The prevalence of suicide attempts ranged from 0.5% in the Northeast to 0.6% in the Midwest, South, and West and from 0.3% in Connecticut to 0.9% in West Virginia. Past-year prevalence of suicidal thoughts, suicide planning, and suicide attempts was higher among females than among males, higher among adults aged 18–39 years than among those aged ≥40 years, higher among noncollege graduates than college graduates, and higher among adults who had never been married than among those who were married, separated, divorced, or widowed. Prevalence was also higher among those living in poverty than among those with a family income at or above the federal poverty threshold and higher among those covered by Medicaid or the Children’s Health Insurance Program than among those with other types of health insurance or no health insurance coverage.

Interpretation: The findings in this report highlight differences in the adult prevalence of suicidal thoughts, plans to attempt suicide, and attempted suicide during the 12 months preceding the survey at the national, regional, and state levels during 2015–2019. Geographic differences in suicidal thoughts and behavior varied by sociodemographic characteristics and might be attributable to sociodemographic composition of the population, selective migration, or the local cultural milieu. These findings underscore the importance of ongoing surveillance to collect locally relevant data on which to base prevention and intervention strategies.

Public Health Action: Understanding the patterns of and risk factors for suicide is essential for designing, implementing, and evaluating public health programs for suicide prevention and policies that reduce morbidity and mortality related to suicidal thoughts and behaviors. State health departments and federal agencies can use the results from this report to assess progress toward achieving national and state health objectives in suicide prevention. Strategies might include identifying and supporting persons at risk, promoting connectedness, and creating protective environments.

Introduction

Self-directed violence is a major public health issue in the United States[1,2]. It includes a range of behaviors, from nonsuicidal intentional self-harm (i.e., behavior in which the intention is not to kill oneself, as in self-mutilation) to acts of fatal and nonfatal suicidal behavior[3]. In 2019, suicide was the 10th leading cause of death for U.S. persons aged ≥18 years (adults), resulting in 45,861 deaths[4]. Suicide is a problem across all age groups, but rates are particularly high among adults (18.0 per 100,000 population) compared with youths aged 10–17 years (4.9 per 100,000 population)[4]. Apart from a decrease in 2019 rates, suicide rates have risen by approximately 30% since 1999, with rates increasing significantly in most states[5]. As devastating as suicides are, these deaths represent the smallest proportion of the total public health burden of suicidal behavior. For every adult who died by suicide[4], approximately three were hospitalized for nonfatal suicidal behaviors[6], nine were seen in an emergency department for suicidal ideation or behavior[4], 31 reported having attempted suicide in the past year[7], and 234 reported having seriously considered suicide[7]. In addition, thousands more are affected by the suicides or suicide-related injuries of friends or family members[8,9]. A public health approach and broad array of assessment tools are needed to gain a better understanding of the full magnitude of the problem.

The public health approach to prevention comprises four steps: 1) assessing the magnitude of the problem, 2) identifying the risk and protective factors, 3) developing and evaluating interventions and policies to determine what is successful in preventing the condition or contributing factors, and 4) encouraging widespread adoption of evidence-based programs and policies[10]. Various assessment tools are used to understand the extent of suicidal thoughts and behaviors and to collect data on deaths and nonfatal injuries in the United States. The National Vital Statistics System (NVSS) compiles demographic and causal data on all deaths filed in the United States. NVSS final mortality data include all fatalities in the United States but provide limited information about the exact nature and circumstances of the injuries[11]. The National Violent Death Reporting System (NVDRS) provides detailed information about the circumstances surrounding violent deaths, including suicides, drawn from law enforcement reports, coroner and medical examiner reports, and death certificates[12]. Increases in congressional appropriations allow NVDRS to provide a more comprehensive picture of deaths resulting from suicide; data are being collected for all 50 states, the District of Columbia (DC), and Puerto Rico[13]. The National Hospital Care Survey (NHCS) and the Health Care and Utilization Project (HCUP) measure inpatient care and hospital use for nonfatal injuries[14]. Although NHCS and HCUP provide detailed information about the nature of injuries, treatment, and discharge disposition, both are limited because not all states require external cause-of-injury coding, which identifies the intent of the injury on hospital discharge records. Although 47 states and DC provide hospital inpatient data to HCUP, only 36 states and DC provide hospital emergency department data[15]. The National Electronic Injury Surveillance System–All Injury Program (NEISS-AIP) and NHCS collect data on all types and external causes of nonfatal injuries and poisonings treated in either U.S. hospital emergency departments or hospital outpatient departments[4,14]. Although these systems are nationally representative, they do not have state-level samples. The National Survey on Drug Use and Health (NSDUH) complements data from these other systems. Population surveys such as NSDUH can capture data on injuries that do not result in death or severe injury and that are treated outside the hospital environment in settings (e.g., home) for which vital statistics or hospital-based data are unavailable[7].

Population survey data can also supplement information from routine and emergency health care system encounters in addition to complementing data from other systems. Typically, symptom presentation and disease occurrence are captured differently when self-reported rather than when based on a diagnosis by a medical professional. For example, persons might feel more comfortable reporting suicide-related experiences on surveys than they do with their health care providers[16]. In addition, many persons tend to report fewer health problems to a health care provider than they actually have[17,18]. Anonymous population surveys can be perceived to be less intimidating to a respondent than reporting to a potential authority figure such as a physician or other health care provider[16] and thus can often provide more comprehensive data for making population-level comparisons[19]. Population surveys can provide researchers with a different perspective on the prevalence of suicidal thoughts and behaviors than those provided by death certificates or medical records.

To be effective, population surveys should be made relevant to the populations they monitor. National and state estimates of the prevalence of suicidal thoughts and behaviors can be used to understand the overall public health burden, demonstrate the magnitude of the problem, and establish national and state health priorities[20]. Nationally representative data also can be used to examine differences in rates among specific groups (e.g., by age, sex, race, and ethnicity) and geographic regions. Large national surveys also allow for aggregating sufficient numbers of particular types of infrequent injuries for identifying patterns and mechanisms. However, national data alone convey an incomplete picture of the public health burden of suicide-related events because considerable variation exists between geographic areas[21].

Although a previous report provided much needed state-level data on suicide rates[5], state-level prevalence data for suicidal thoughts and behaviors are still lacking, which limits the ability of state prevention specialists to target specific populations on which to focus their primary suicide prevention efforts. Population-based surveys can provide some of this necessary information. This report is a follow-up to a previous report[22] and provides more recent state-level data on suicidal thoughts, planning, and attempts among adults as well as prevalence estimates by region, age group, sex, race and ethnicity, and selected characteristics. Gathering data about nonfatal suicidal behavior is integral to prevention efforts because persons who make suicide attempts are one of the highest risk groups for subsequent death from suicide; persons who make suicide attempts are approximately two times more likely to die by suicide than those without a prior history of a suicide attempt[23]. State health departments and federal agencies can use these state-level data to evaluate progress toward implementing strategies and approaches based on the best available evidence for suicide prevention[24] and to assess progress toward achieving national and state health objectives as part of the National Strategy for Suicide Prevention[2].