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Stephen H. Sheffield / Getty ImagesMore than 8 million Americans thought seriously about suicide in the previous year, according to a new government survey. More adults who considered suicide lived in the Midwest and West than in other parts of the country.
The findings were reported on Thursday by the Centers for Disease Control and Prevention (CDC) in its first state-by-state look at suicide contemplation. Unlike previous research that has tended to focus on rates of actual suicide, the new analysis asked about the thoughts and behaviors that precede it.
"This report highlights that we have opportunities to intervene before someone dies by suicide. We can identify risks and take action before a suicide attempt takes place," said CDC director Dr. Thomas M. Frieden in a statement. "Most people are uncomfortable talking about suicide, but this is not a problem to shroud in secrecy."
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The study was based on responses from 92,264 people aged 18 or older who took part in the National Survey on Drug Use and Health in 2008-09. The survey [PDF], which collects data on health risks related to drug, alcohol and tobacco use, as well as mental health, is conducted every year, but 2008 and 2009 were the first years in which all respondents — not just those who reported suffering from depression — were asked whether they had had serious thoughts about killing themselves at any point in the previous year.
Their answers reveal that suicidal thoughts and behavior vary widely by region. In general, adults in the West and Midwest were more likely to have considered suicide than people in the South and Northeast. Adults in Georgia, for instance, were least likely to report having had suicidal thoughts (2.1%) in 2008-09; residents of Utah, at 6.8%, were most likely.
Georgia also had the lowest rate of suicide planning (0.1%), but it was a northeastern state, Rhode Island, that had the highest: 2.8% of people in the tiny state reported having planned to kill themselves. Overall, 1 in 100 American adults (2.2 million total) said they had planned a suicide in the previous year.
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Georgia and Delaware had the lowest rate of suicide attempts, at 0.1%, or 1 in 1,000 people. Rhode Island again was at the top: 1.5%, or 1 in 67, residents reported having made a suicide attempt. In total, the CDC found, one million Americans said they had attempted suicide in the previous year.
The study didn't explore exactly why suicidal thoughts were more common in some states than in others, but the authors offered some theories.
It could be due to "selective migration," which suggests that people who are at greater risk for suicidal behavior tend to migrate to the same areas. Or it could have to do with sociodemographics. The CDC found that women were more likely to contemplate suicide than men, and younger adults were also more likely to think about it — and to act on those thoughts — than older ones. States with more women and younger people might therefore register more suicidal thinking.
Demographic differences may also help explain why regions that have high rates of suicide contemplation are not necessarily those that have more suicide deaths: while women are more likely to think about suicide than men, they're less likely to actually succeed.
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Other contributors to suicide may lie in the local social environment. Areas with more unemployment and higher divorce rates may have higher rates of suicidal behavior. People living in areas with sparse social networks and inadequate medical support might also be left at greater risk.
In some states with high rates of suicide, residents may have greater access to lethal means, such as guns. Previous research by the CDC has found that states with the highest suicide death rates include Alaska, New Mexico, Wyoming and Montana.
The current data indicate that suicide prevention strategies should be better targeted at the local level, to those in greatest need. Prevention measures can include broad public-education campaigns that improve public awareness of suicide risk, as well as individualized cognitive-behavioral therapy for people who are at risk of committing suicide, such as those with a history of suicide attempts.
"Suicide is a preventable tragedy," said Pam Hyde, administrator of the Substance Abuse and Mental Health Services Administration, which collaborated with the CDC on the new study. "With this new data we will be able to work more effectively to reach people at risk and help keep them safe."
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Sora Song is the editor of TIME Healthland. Find her on Twitter at @sora_song. You can also continue the discussion on Healthland's Facebook page and on Twitter at @TIMEHealthland.
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