Disparities in Suicide
Some groups are at greater risk for suicide.
Suicide is a serious public health problem that can have lasting harmful effects on individuals, families, and communities. People of any age, race, ethnicity, or sex can experience suicide risk, but certain groups have substantially higher rates of suicide than the general U.S. population (13.9 per 100,000).
Veterans, people who live in rural areas, sexual and gender minorities, middle-aged adults, and tribal populations may disproportionately experience factors linked to suicide. These factors include substance use, job or financial problems, relationship problems, physical or mental health problems, and/or easy access to lethal means. Additionally, people who have experienced violence, including adverse childhood experiences (such as physical abuse), bullying, or sexual violence, have a higher suicide risk.1 Some of these groups may also be impacted by other health disparities. Health disparities are differences in health outcomes and their causes among groups of people.2
Groups can be defined by factors such as age, sex, race, ethnicity, geographic location (such as state, county, or rural or urban), sexual orientation, and gender identity. CDC is concerned with groups disproportionately impacted by suicide and tracks and monitors suicide rates in these groups.
CDC supports states, tribes, territories, non-governmental organizations, and university research programs to address our four strategic priority areas in suicide prevention: data, science, action, collaboration.
Middle-aged adults (aged 35–64 years) account for 47.2% of all suicides in the United States, and suicide is the 9th leading cause of death for this age group.3
- Among middle-aged men, suicide rates were highest for non-Hispanic American Indian or Alaskan Native (AI/AN) men (36.0 suicides per 100,000), followed closely by non-Hispanic white men (35.3 per 100,000).3
- Among middle-aged women, suicide rates were highest among white women (10.5 per 100,000) and non-Hispanic AI/AN women (9.8 per 100,000).3
Adults aged 75 and older account for fewer than 10% of all suicides but have the highest suicide rate (19.1 per 100,000). Men aged 75 and older have the highest rate (40.5 per 100,000) compared to other age groups. Older non-Hispanic white men had the highest suicide rate compared to other racial/ethnic men in this age group (47.8 per 100,000).3
What CDC and funded partners are doing to prevent suicide among middle-aged adults
Massachusetts, Michigan, and Maine are working to reduce suicide disparities in middle-aged adults. Massachusetts and Maine are working to identify and support middle-aged adults at risk by implementing gatekeeper training, which teaches community members how to identify people at risk of suicide and refer them to care. Massachusetts is also identifying and supporting at-risk middle-aged adults by implementing provider training in evidence-based screening and treatments. Finally, Massachusetts will identify and support middle-aged adults at-risk by collaborating with partners to educate healthcare providers around suicide risk and response to individuals at risk.
Massachusetts aims to reduce access to lethal means by promoting safe storage. Massachusetts is working to increase access to and education on the benefits of firearm storage safes and trigger locks, and to promote lock bags, locked cabinets, and safe disposal of over-the-counter drugs among middle-aged males.
Youth and young adults ages 10–24 years account for 14% of all suicides. The suicide rate for this age group (10.5 per 100,000) was lower than other age groups.3 However, suicide is the third leading cause of death for young people, accounting for 6,643 deaths.3 For youth ages 10-14, suicide is the second leading cause of death.3
Some groups of young people (ages 10-24 years) most at-risk for suicide include non-Hispanic AI/AN, with a suicide rate of 33.0 per 100,000.3 Sexual minority youth are also at increased risk (see below).
Youth and young adults aged 10-24 have lower suicide rates, but they have higher 2019 rates of emergency department (ED) visits for self-harm (342.5 per 100,000) compared to people ages 25 years and older (121.9 per 100,000).3
- There was an estimated 217,447 ED visits for self-harm among this younger age group.3 Girls and young women aged 10-24 are at particularly high risk, with their ED visit rate (487.9 per 100,000) being twice the rate of ED visits among boys and young men (203.3 per 100,000).
- Further, the rate of ED visits among girls in 2019 was double compared to 2001 (244.3 per 100,000).3
In 2019, 9% of high school students reported attempting suicide during the previous 12 months.4 Suicide attempts were reported most frequently among girls compared to boys (11% vs. 6.6%) and among non-Hispanic American Indian/Alaska Native students (25.5%).5
*Rates reflect 2020 data unless otherwise noted.
What CDC and funded partners are doing to prevent youth suicide
- Colorado, Connecticut, Massachusetts, and Tennessee are working with their states’ departments of education to advance and provide social-emotional learning programs to promote coping and problem-solving skills or implement at least one positive youth development activity in schools to prevent suicide among school-aged children and youth.
- Colorado, Connecticut, North Carolina, and Vermont are helping to reduce access to lethal means for children and youth by implementing Counseling on Access to Lethal Means (CALM) in EDs and educating families on safe storage of lethal means (such as firearms, medications, and sharp objects) within the home.
Data are limited on the rate of suicide among people who identify as sexual minorities. However, research has shown that people who identify as sexual minorities have higher rates of suicide attempts compared to heterosexual people.4
Almost a quarter (23.4%) of high school students identifying as lesbian, gay, or bisexual reported attempting suicide in the prior 12 months.4 This rate is nearly four times higher than the rate reported among heterosexual students (6.4%).4
The rate of self-reported suicide attempts in the prior 12 months among sexual minorities decreases with age, from 5.5% among people ages 18-25 to 2.2% among people ages 26-49.6
What CDC and funded partners are doing to prevent LGBT suicide
Maine is working on promoting connectedness among sexual minority youth by:
- Implementing a program to enhance resiliency among LGBT youth in both in and out of school.
- Promoting a training to equip youth-serving providers with skills in facilitating family connectedness and positive relationships among LGBT young people and their caregivers.
Veterans have an adjusted suicide rate that is 52.3% greater than the non-veteran US adult population.7 People who have previously served in the military account for about 13.7% of suicides among adults in the United States.7
In 2019, 1.6% of former active-duty service members aged 18-25 years reported making a suicide attempt during the previous 12 months. This was an increase from 0.9% in 2009.8
What CDC and funded partners are doing to prevent veteran suicide
Massachusetts, North Carolina, Louisiana, and the University of Pittsburgh are identifying and supporting veterans at risk by implementing gatekeeper training.
- Massachusetts is requiring all staff working in Massachusetts Career Centers to complete gatekeeper training.
- North Carolina offers gatekeeper training as an option to healthcare providers.
- University of Pittsburgh will provide gatekeeper trainings targeted to their veteran population to ensure that anyone likely to encounter a veteran at risk of suicide is educated on the risk factors and warning signs for suicide.
- Louisiana is working to implement gatekeeper trainings for nine local health department regions serving veteran populations.
Massachusetts, Louisiana, and the University of Pittsburgh are promoting connectedness among veterans.
- Massachusetts is promoting connectedness through community engagement to increase diversity, inclusion, and representation of veterans on the MassMen website. MassMen features articles, blog posts, self-assessments, and men’s stories to help men find solidarity, promote wellness, and increase help seeking.
- The University of Pittsburgh is working to promote connectedness and decrease social isolation among veterans in the Commonwealth of Pennsylvania through community engagement by implementing community greening projects.
- Louisiana is working to promote connectedness among their veteran population by developing peer-to-peer norm groups. Peer norm programs seek to promote connectedness and normalize protective factors for suicide such as help-seeking, reaching out, and talking to trusted adults.
North Carolina, Louisiana, and the University of Pittsburgh are strengthening access to and delivery of suicide care. North Carolina and Louisiana aim to reduce provider shortages by providing increased veteran access to telemental health services. The University of Pittsburgh is working to strengthen access to and delivery of suicide care for veterans by working towards equal coverage of mental health conditions. The University of Pittsburgh is also working to raise awareness and education among healthcare providers and community members on existing mental health parity laws.
Age-adjusted suicide rates are highest among non-Hispanic AI/AN people (23.9 per 100,000) and non-Hispanic white people (16.9 per 100,000) compared to other racial and ethnic groups.3
- Suicide is the 9th leading cause of death among AI/AN people.3
- Non-Hispanic AI/AN people have a much higher rate of suicide (23.9 per 100,000) compared to Hispanic AI/AN people (2.0 per 100,000).3
- The suicide rate among non-Hispanic AI/AN males ages 15–34 is 68.4 per 100,000.3
- Suicide is the 12th leading cause of death for both Hispanic and non-Hispanic people of all races. Between 2019 and 2020, age-adjusted suicide rates decreased 4.5% among non-Hispanic white persons. At the same time, they increased 4.0% among non-Hispanic black people and 6.2% among non-Hispanic AI/AN people.3
What CDC and funded partners are doing to prevent suicide in tribal communities
Southern Plains Tribal Health Board and Wabanaki Public Health and Wellness are working to increase capacity to adapt, implement, and evaluate suicide prevention programs to reduce suicide-related morbidity and mortality. Each tribal organization is:
- Reviewing existing data to describe the general problem and identify a subgroup that is at increased risk for suicide compared to the general tribal population
- Developing an inventory of existing suicide prevention programs for the general tribal population and the selected subgroup to identify gaps and opportunities that will complement existing programs
- Selecting at least one program from CDC’s Suicide Prevention Resource for Action, or another evidence-informed program, to fill prevention gaps and complement existing programs
- Adapting the selected program to fit the cultural context of the tribe, and implement and evaluate the approach or program
- Conducting listening sessions to obtain input during the project to adapt the approach of program
- Disseminating results, success stories, and lessons learned
Limited data are available on suicide among people with disabilities. However, a recent survey highlighted that in 2021, adults with disabilities were three times more likely to report suicidal ideation in the past month compared to persons without disabilities (30.6% versus 8.3% in the general U.S. population).9 Prior research has also reported on increased mental distress among this group which is a risk factor for suicide.10
What CDC and funded partners are doing to prevent suicide among people with disabilities
- Vermont is working to reduce suicide disparities among people with disabilities. Vermont is working to create protective environments by reducing access to lethal means through training primary care providers to promote safe storage.
- Vermont is also strengthening delivery and access to care through systems change by supplementing and scaling up the state’s Zero Suicide work by engaging primary care providers serving people with disabilities.
CDC researchers have studied suicide rates by industry and occupation. Industry is the type of activity at a person’s place of work and occupation is the kind of work a person does to earn a living. A 2020 CDC study found that the suicide rate among workers in certain industries was significantly greater than the general U.S. population.11 The industry groups that had the highest suicide rates are:
- Mining, Quarrying, and Oil and Gas Extraction (males: 54.2 per 100,000)
- Construction (males: 45.3 per 100,000)
- Other Services (such as automotive repair; males: 39.1 per 100,000)
- Agriculture, Forestry, Fishing, and Hunting (males: 36.1 per 100,000)
- Transportation and Warehousing (males: 29.8 per 100,000; females: 10.1 per 100,000)
The suicide rate was also greater than the general population for the following major
- Construction and Extraction (males: 49.4 per 100,000; females: 25.5 per 100,000)**
- Installation, Maintenance, and Repair (males: 36.9 per 100,000)
- Arts, Design, Entertainment, Sports, and Media (males: 32.0 per 100,000)
- Transportation and Material Moving (males: 30.4 per 100,000; females: 12.5 per 100,000)
- Protective Service (females: 14.0 per 100,000)
- Healthcare Support (females: 10.6 per 100,000)
† Rates reflect 2016 data
**No other industry group among females had a rate of suicide greater than the general female population
What CDC and funded partners are doing to prevent suicide for people in at-risk occupations
- Massachusetts is working to reduce suicide rates among persons working in occupations that are at greater risk for suicide. Massachusetts is working to:
- Promote connectedness by implementing peer norm programs for at-risk occupations.
- Identify and support occupations at higher risk of suicide via healthcare provider education.
- The workplace provides an important opportunity for suicide prevention efforts because it is where many adults spend a great deal of their time. Visit the National Institute for Occupational Safety and Health website for more information about workplace suicide prevention strategies.
Suicide rates can vary substantially across geographic regions, and rural areas experience much higher rates of suicide than urban areas. Suicide rates increase as population density decreases and an area becomes more rural:12
- Large central metropolitan: 10.9 per 100,000
- Large fringe metro: 12.5 per 100,000
- Medium metro: 15.3 per 100,000
- Small metro: 17.2 per 100,000
- Micropolitan (non-metro): 18.3 per 100,000
- Noncore (non-metro): 20.5 per 100,000
Suicide rates in rural areas are highest among non-Hispanic AI/AN males (59.6 per 100,000) and non-Hispanic white males (37.9 per 100,000).3
What CDC and funded partners are doing to prevent suicide in rural communities
- North Carolina and Vermont are creating protective environments by reducing access to lethal means through promoting safe storage of firearms in rural areas.
- North Carolina and Tennessee are identifying and supporting people at risk. Both states are also implementing gatekeeper trainings among rural counties and areas in their respective states. North Carolina is also promoting gatekeeper trainings among staff in rural schools.
In addition to the specific suicide prevention projects listed above, CDC is supporting states, tribes, territories, non-governmental organizations, and university research programs to address our four strategic priority areas in suicide prevention:
- Data: Using new and existing data to better understand, monitor, and prevent suicide and suicidal behavior
- Science: Identifying risk and protective factors and effective policies, programs, and practices for suicide prevention in populations at increased risk for suicide
- Action: Building the foundation for CDC’s National Suicide Prevention Program
- Collaboration: Developing and implementing wide-reaching partnership and communication strategies to raise awareness and advance suicide prevention activities
Additionally, CDC funds the Comprehensive Suicide Prevention program, which aims to reduce suicide among groups that experience health disparities in suicide. These programs use suicide prevention strategies based on the best available evidence to help states and communities prevent suicide. These strategies can be found in CDC’s Suicide Prevention Resource for Action, and include:
- Strengthen economic supports
- Create protective environments
- Improve access and delivery of suicide care
- Promote healthy connections
- Teach coping and problem-solving skills
- Identify and support people at risk
- Lessen harms and prevent future risk
- Preventing Multiple Forms of Violence: A Strategic Vision for Connecting the Dots. Atlanta, GA: Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 2016. https://www.cdc.gov/violenceprevention/about/connectingthedots.html
- Centers for Disease Control and Prevention. Community Health and Program Services: Health Disparities Among Racial/Ethnic Populations. S. Department of Health and Human Services: Atlanta, GA. 2008.
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. [Feb 17, 2022]. Available from URL: www.cdc.gov/injury/wisqars
- Ivey-Stephenson AZ, Demissie Z, Crosby AE, et al. Suicidal Ideation and Behaviors Among High School Students —Youth Risk Behavior Survey, United States, 2019. MMWR Suppl 2020;69(Suppl-1):47–55. DOI: http://dx.doi.org/10.15585/mmwr.su6901a6
- Centers for Disease Control and Prevention (CDC). 1991-2019 High School Youth Risk Behavior Survey Data. Available at http://nccd.cdc.gov/youthonline/. Accessed on March 3, 2021.
- SAMHSA. National Survey of Drug Use and Health: Lesbian, Gay, and Bisexual Adults [online]. 2020 [Accessed: Sep 9, 2021]. Available from URL: https://www.samhsa.gov/data/report/2019-nsduh-lesbian-gay-bisexual-lgb-adults
- Department of Veteran’s Affairs: 2021 National Veteran Suicide Prevention Annual Report. 2021. [Accessed: Sep 9, 2021]. Available from URL: https://www.mentalhealth.va.gov/docs/data-sheets/2021/2021-National-Veteran-Suicide-Prevention-Annual-Report-FINAL-9-8-21.pdf
- SAMHSA. National Survey of Drug Use and Health: Veteran Adults [online]. 2020 [Sep 9, 2021]. Available from URL: https://www.samhsa.gov/data/sites/default/files/reports/rpt31103/2019NSDUH-Veteran/Veterans%202019%20NSDUH.pdf
- Czeisler M&, Board A, Thierry JM, et al. Mental Health and Substance Use Among Adults with Disabilities During the COVID-19 Pandemic — United States, February–March 2021. MMWR Morb Mortal Wkly Rep 2021;70:1142–1149. DOI: http://dx.doi.org/10.15585/mmwr.mm7034a3
- Cree RA, Okoro CA, Zack MM, Carbone E. Frequent Mental Distress Among Adults, by Disability Status, Disability Type, and Selected Characteristics — United States, 2018. MMWR Morb Mortal Wkly Rep 2020;69:1238–1243. DOI: http://dx.doi.org/10.15585/mmwr.mm6936a2
- Peterson C, Sussell A, Li J, Schumacher PK, Yeoman K, Stone DM. Suicide Rates by Industry and Occupation — National Violent Death Reporting System, 32 States, 2016. MMWR Morb Mortal Wkly Rep 2020;69:57–62. DOI: http://dx.doi.org/10.15585/mmwr.mm6903a1
- Stone DM, Jones CM, Mack KA. Changes in Suicide Rates — United States, 2018–2019. MMWR Morb Mortal Wkly Rep 2021;70:261–268. DOI: http://dx.doi.org/10.15585/mmwr.mm7008a1