Suicide attempts continue to increase in the United States, particularly among young adults with lower education levels and greater economic challenges, according to an analysis published Sept. 13.
These conclusions are based on data gleaned from two studies – the 2004-2005 wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-II) and the 2012-2013 NESARC-III. Of the 69,341 people surveyed, 57.2% were women, and the mean age was 48.1 years.
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However, the demographic groups that had the most notable increases were young adults aged 21-34 (ARD, 0.48%; 95% CI, 0.09%-0.87%; P = .02) and those with no more than a high school education (ADR, 0.49%; 95% CI, 0.18%-0.80%; P less than .002).
Dr. Olfson and his coauthors also found an increase in suicide attempts among adults with certain psychiatric disorders. Specifically, the risk for suicide attempts was higher for adults with antisocial personality disorder; among that group, the risk increased from 0.07% (95% CI, –0.09% to 0.23%) in 2004-2005 to 2.16% (95% CI, 0.61%-3.71%) in 2012-2013. “Other high-risk groups included persons with ... schizotypal ... personality disorders and those with anxiety and depressive disorders,” according to Dr. Olfson and his coauthors. “These findings highlight an increasing prevalence of suicide attempts and underscore the prominent role of mental disorders ... in risks for suicide attempts at the population level.”
Almost two-thirds of the adults who had recent suicide attempts in both NESARC survey groups had borderline personality disorder, the investigators reported. However, a finding the coauthors called “encouraging” is that “although most of the adults in the 2012-2013 survey who had recent suicide attempts had borderline personality disorder, the risk of attempted suicide among adults with borderline personality disorder significantly decreased during the study period,” Dr. Olfson and his coauthors wrote. They speculated that this decrease could be tied to findings showing that 40.8% of U.S. psychiatry residency programs offer training in dialectical behavior therapy for borderline personality disorder (Acad Psychiatry. 2013 Jul 1:37[4]:287-8). Clinician training programs are needed to help frontline clinicians manage self-harm among patients with borderline personality disorder, the investigators said.
In addition to many other risk factors, the investigators emphasized the correlation between recent suicide attempts and prior suicide attempts. About one-half of adults who reported a recent attempt also reported a prior attempt (95% CI, 16.46-33.67). “Because 15% to 25% of adults who die by suicide have received treatment for a suicide attempt within the past year, a substantial proportion of suicide deaths” could be subject to prior intervention that could be associated with an attempt, they said.
The data were limited in that adults who are homeless or incarcerated or who have schizophrenia were not surveyed. In addition, the coauthors cited the retrospective nature of NESARC self-reports as a limitation. Given the nature of the study, no data were collected from individuals who died of suicide. “This lack may have led to an underestimation of suicide attempts in each survey,” they wrote.
The study was supported by grants from the National Institutes of Health and the New York State Psychiatric Institute. The surveys were funded in part by the NIH Intramural Research Program. The authors did not report any financial disclosures.