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After falling for decades, the suicide rate in the United States has risen nearly 40% since 2000.

In “The Re-Emerging Suicide Crisis in the U.S.: Patterns, Causes and Solutions,” coauthored with Benjamin Hansen (University of Oregon), SPA Professor Dave Marcotte reviews this troubling pattern and considers possible drivers. Originally published as an NBER Working Paper, the piece is forthcoming this fall in the Journal of Policy Analysis and Management.

Marcotte studied suicide trends earlier in his career, when the introduction of antidepressant therapy in the 1980s and 1990s contributed to declining suicide rates.

“I had not done much thinking about the topic for 10 or 15 years,” he shared. “But in the last part of the last decade, the suicide rate rose to alarming levels, not seen since World War II. It is scary.”

The retrospective piece used death certificate data from the U.S. Centers for Disease Control, aggregated by county coroners and medical examiners, to provide a broad look at the phenomenon, examine its prevalence among various age groups over time, and consider which factors may have contributed to the dramatic rise.

Insights included a sharp upturn among middle-aged persons between 2005 and 2015 that has since fallen, most likely related to the Great Recession, and a rapid, linear rise in suicide rates among young people. “The increased prevalence of depression among young people during the 2010s was so large it could explain nearly all the increase in suicide mortality among those under 25,” reads the abstract. 

But why? The article discusses various cultural and societal phenomena that may be driving the rise.

“One potential explanation getting a lot of attention is access to social media and the internet,” said Marcotte. “It is very hard to nail that down, because everybody's got social media. We don't have a good control group of what the rate would be like without it.”

In addition, it is difficult to measure and control the level of social media engagement across platforms and usage levels. However, cross-country comparisons may help clarify the issue. For example, while Canada and U.S. share similar levels of social media access, Canada has not seen a similar rise in suicide rates among young people. 

While Marcotte believes that social media plays some role, other candidate explanations emerged from the study, such as political polarization, economic uncertainty, and bullying.

“Political polarization has been hypothesized as causing anxiety for kids,” Marcotte explained. “They are seeing adults they care about not talking to their siblings or parents because of politics. [Also,] the economy is less certain today than it was 30 years ago, ... and college costs may be causing stress for them too.”

LGBTQ kids, he continued, are at high risk for suicide for many reasons, including bullying; this subset of young people is far more likely to face bullying than their straight/cisgendered peers. However, the relationship is complicated.
“For the most part, bullying has not increased over time, so it is probably not a good explanation for the overall rise in suicide,” said Marcotte. “But the number of kids who identify as LGBTQ has increased. If bullying hasn't changed, and kids are moving into higher bullying risk groups, does that increase the overall number of kids who die by suicide? We estimate that may play a very small part, maybe 60 to 100 additional deaths per year.”

The effects of firearms on rising suicide rates are also unclear.
“There's no doubt that firearms are lethal and used for suicide, and that most suicides are a consequence of gunshot wounds,” said Marcotte. “But while guns are especially dangerous, the rise in suicide has occurred without an increase in the number of households owning guns. [Meanwhile,] for older people, suicide rates have been rising and guns are not part of the story.”

The article hypothesizes that, even without increased access to guns, depressed kids continue to find them and use them, highlighting the importance of red flag and cap laws intended to keep firearms secured and away from those at imminent risk for suicide. Similarly, while the opioid crisis is often forwarded as an explanation, areas devastated by the epidemic have not seen larger increases in rates of suicide than other areas.

The article also considers the changing racial and gender demographics of suicide.

“Suicide has historically been a story of its effect on white men,” Marcotte explained. “Suicide rates among men are four times higher than among women and affect whites more than any other ethnic group but Native Americans. But the last 20 years has seen a relative increase for women, faster than men. Further, in 2015-2020, there was a marked increase in suicide among racial and ethnic minorities, which is unusual. Some have hypothesized that these deaths correspond to rising potential threats that Black families feel from being targeted by police or other [institutions].”

The study suggested multiple policy interventions to reverse these alarming trends, led by increased access to mental health treatment and including advancing Child Access Protection and red flag laws, preventing bullying, and promoting the new 988 suicide hotline.

“The mental health crisis is huge, and access to care is not sufficient,” Marcotte explained. “The expansion of Medicaid and the mental health parity laws in the 2000s required health insurance coverage to include adequate mental health care. In practice, however, there's good evidence that even when people are insured, there are too few providers covered by many plans, and it is too difficult to get into care. There are tragic stories of kids in crisis who can't find beds in psychiatric inpatient units, who are treated at emergency departments for days or weeks on end.”