Suicide in Hawaii

Hawaii

Suicide is the 12th-leading cause of death in the United States. It is the second-leading cause of death for Americans ages 10-14 and 24-34, the third-leading cause for Americans ages 15-24 and the fourth-leading cause among Americans ages 25-44. In 2021, an estimated 3.5 million people planned a suicide, 1.7 million attempted suicide and 48,183 died by suicide. More than half of all suicides that year involved firearms and there were almost twice as many suicide deaths as homicide deaths.

When someone dies by suicide, as with any cause of death, the loss is felt by many people. The ripples of loss spread from close family and friends to community members, acquaintances and even people the deceased did not know. All of those exposed to the loss may experience different levels of grief and trauma. 

Mental health and substance use disorders are the most significant risk factors for suicidal behaviors. In addition, environmental factors such as stressful life events and access to lethal means such as firearms or drugs may increase the risk of suicide. Previous suicide attempts and a family history of suicide are also important risk factors. 

In 2020 suicide cost the U.S. $255.6 million in medical expenses and $475.7 billion in loss of life.

According to America’s Health Rankings data, the rate of suicide is higher among: 

• Males, who have a rate 4.0 times higher than females.
• The American Indian/Alaska Native population, who have a rate more than 3 times higher than the Asian population.
• Adults ages 85 and older compared with adults of other age groups.
• Veterans compared with non-veteran adults.
• Those living in rural areas compared with those living in urban areas.
• LGBTQ adults and youth compared with heterosexual adults and youth.

Strategies to reduce suicide include:

• Universal screening at emergency rooms to identify patients at higher risk of suicide.
• Safety planning at emergency rooms to assist patients with suicidal behaviors by providing them with a prioritized list of evidence-based coping strategies and sources of support.
• Cognitive behavioral therapy to identify and manage suicidal thoughts. 
• Reducing access to lethal means such as firearms, lethal doses of medications and alcohol. Studies over the past two decades show a strong association between household firearm ownership and increased suicide rates. At the community level, the Gun Shop Project provides educational materials on firearm suicide prevention and builds partnerships between public health experts and firearms retailers, instructors and customers. 
• Devoting resources to the 10 public health domains of suicide prevention outlined in The State of State, Tribal and Territorial Suicide Prevention report.

The Suicide Prevention Resource Center has detailed information on implementing effective suicide prevention in schools, universities, emergency departments, American Indian/Alaska Native communities and other organizations that serve populations with high suicide risk. The 988 Suicide & Crisis Lifeline provides free, confidential support for people in distress 24/7 anywhere in the United States. Their website offers additional forms of crisis support, and the previous National Suicide Prevention Lifeline number (1-800-273-TALK(8255)) is still active and usable.

Reducing the suicide rate is a Healthy People 2030 leading health indicator.

Allchin, Adelyn, Vicka Chaplin, and Joshua Horwitz. “Limiting Access to Lethal Means: Applying the Social Ecological Model for Firearm Suicide Prevention.” Injury Prevention 25, no. Suppl 1 (September 1, 2019): i44–48. https://doi.org/10.1136/injuryprev-2018-042809.

Conner, Kenneth R., Jeffrey A. Bridge, Dustin J. Davidson, Carly Pilcher, and David A. Brent. “Metaanalysis of Mood and Substance Use Disorders in Proximal Risk for Suicide Deaths.” Suicide and Life-Threatening Behavior 49, no. 1 (2019): 278–92. https://doi.org/10.1111/sltb.12422.

Dunlap, Laura J., Stephen Orme, Gary A. Zarkin, Sarah A. Arias, Ivan W. Miller, Carlos A. Camargo, Ashley F. Sullivan, et al. “Screening and Intervention for Suicide Prevention: A Cost-Effectiveness Analysis of the ED-SAFE Interventions.” Psychiatric Services 70, no. 12 (August 27, 2019): 1082–87. https://doi.org/10.1176/appi.ps.201800445.

Kennedy, Katrina S., Andrea Carmichael, Margaret Melissa Brown, Aimee Trudeau, Pedro Martinez, and Deborah M. Stone. “The State of State, Territorial, and Tribal Suicide Prevention: Findings from a Web-Based Survey.” Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, 2021. https://www.cdc.gov/suicide/pdf/State-of-the-States-Report-Final-508.pdf.

National LGBT Health Education Center. “Suicide Risk and Prevention for LGBTQ People.” Boston, MA: The Fenway Institute, September 2018. https://www.lgbtqiahealtheducation.org/wp-content/uploads/2018/10/Suicide-Risk-and-Prevention-for-LGBTQ-Patients-Brief.pdf.

Office of Mental Health and Suicide Prevention. “2021 National Veteran Suicide Prevention Annual Report.” Washington, D.C.: U.S. Department of Veterans Affairs, September 2021. https://www.mentalhealth.va.gov/docs/data-sheets/2021/2021-National-Veteran-Suicide-Prevention-Annual-Report-FINAL-9-8-21.pdf.

Opoliner, April, Deborah Azrael, Catherine Barber, Garrett Fitzmaurice, and Matthew Miller. “Explaining Geographic Patterns of Suicide in the US: The Role of Firearms and Antidepressants.” Injury Epidemiology 1, no. 1 (March 20, 2014): 6. https://doi.org/10.1186/2197-1714-1-6.

Stanley, Barbara, Gregory K. Brown, Lisa A. Brenner, Hanga C. Galfalvy, Glenn W. Currier, Kerry L. Knox, Sadia R. Chaudhury, Ashley L. Bush, and Kelly L. Green. “Comparison of the Safety Planning Intervention With Follow-up vs Usual Care of Suicidal Patients Treated in the Emergency Department.” JAMA Psychiatry 75, no. 9 (September 1, 2018): 894–900. https://doi.org/10.1001/jamapsychiatry.2018.1776.

Steelesmith, Danielle L., Cynthia A. Fontanella, John V. Campo, Jeffrey A. Bridge, Keith L. Warren, and Elisabeth D. Root. “Contextual Factors Associated With County-Level Suicide Rates in the United States, 1999 to 2016.” JAMA Network Open 2, no. 9 (September 4, 2019): e1910936–e1910936. https://doi.org/10.1001/jamanetworkopen.2019.10936.