Access to lethal means, economic instability contribute to increased suicide rates, CU Boulder study finds

Mar. 6—Access to lethal means and increasing economic hardship matters when looking at rising suicide rates among U.S. adults.

According to a new University of Colorado Boulder study, increased access to potentially lethal prescription opioids has made it easier for women, especially, to die by suicide. Additionally, less support from the federal government in economically difficult times has contributed to rising suicide rates among American adults between the 1990s and 2017.

"It doesn't have to be like this," said Daniel Simon, first author of the study and a CU Boulder doctoral candidate in sociology. "American life is increasingly dangerous. It's increasingly precarious, and that has implications or consequences for suicide mortality. I think this is the result of policy choices, but I think they can be fixed or remedied by shoring up social safety nets, by better-regulating pharmaceuticals and making American life more safe."

The researchers looked at broader patterns and causes for the national uptick in suicide fatality rates rather than individual risk factors. They analyzed 16 million deaths among U.S. adults between 1990 and 2017 and separated the nearly 600,000 suicide deaths by intentional poisoning versus non-poisoning. Two notable spikes in suicide deaths emerged from the data in 1997 and 2007.

The year 1997 marks one year after opioids like OxyContin began being used. Prescription opioids were approved by the Food and Drug Administration in 1995 and introduced to the market in 1996.

"Women's suicide rates by poisoning reversed course and began rising by about 2% per year after experiencing declines," Simon said. "So they began increasing right at the same time OxyContin and other opioid-based (painkillers) hit the market."

The other spike in suicide deaths hit in 2007, lining up with the onset of the housing and financial crash that kicked off the Great Recession, causing rates to spike and continue to climb.

"The fact that (suicide deaths) track so strongly with changes in drug environment and economic environment in the United States has given us added insights into the importance of structural factors that shape population health in the U.S.," said Ryan Masters, CU Boulder sociology professor and senior author of the study.

Lena Heilmann, director of the Office of Suicide Prevention for the Colorado Department of Public Health and Environment, said economic stability and lethal means safety are two of the important factors that can contribute to and compound suicide risk.

"We've long seen that suicide rates in the United States increase during economically stressful times, such as recessions, periods of high unemployment, increasing poverty rates and difficulty covering expenses like medical costs, food and housing bills," Heilmann said. "Economically stressful times can also exacerbate the prevalence of homelessness and evictions, which can also contribute to suicide risk. Reducing these economic stressors can help prevent suicide."

As the federal government has taken a "backseat stance," Masters said, it's increased the vulnerability of Americans to "boom and bust" economic cycles. When looking at housing prices, unemployment and poverty in U.S. states from 1990 to 2017, there's a strong correspondence between changes in these economic indicators and state suicide rates.

"When a state acts to intervene quite aggressively with economic policy and expansion of the welfare state it can mitigate and soften the blow for a population," Masters said.

He said the conversation needs to shift away from "despair narrative thinking" and only talking about poor mental health when discussing suicide death rates.

"We would like the conversation to be broadened and policy makers take note that the proliferation of firearms and drugs and the retreat of the federal government from providing economic security to populations, especially in economic decline, is fostering a dangerous and lethal environment in which the United States lives," Masters said.

The researchers noted that the uptick in suicide deaths they saw was not because of more suicide attempts or more thoughts of suicide, rather the prevalence of lethal means. Between the 1990s and 2006, the rates of non-poison suicide deaths decreased, and the only factor driving the increase was an uptick in poison deaths.

"If you take out poisonings as a cause of suicide deaths among women in the U.S., there would not have been an increase in suicide death rates between 1990 and 2007," Masters said.

The lethality of means matters, Heilmann said. Most people who feel suicidal don't attempt suicide, and temporarily removing lethal means from an environment can save a life. For every one death by suicide, about 275 people have thoughts of suicide but don't attempt.

Firearms are the leading cause of suicide deaths for all Colorado residents, especially men. For women, CDPHE sees firearms and asphyxiation as the two highest methods of suicide death in Colorado, followed closely by overdose or poisoning.

"In Colorado, women attempt suicide by overdose and die more often than men, according to our most recent data," Heilmann said.

Nationally, suicide rates have been increasing slightly over time. In Colorado, suicide fatality rates have remained statistically steady. In Colorado in 2022, 997 men and 290 women died by suicide.

"Suicide fatality rates in Colorado generally have been remaining statistically steady. There's been no statistically significant change in Colorado's age adjusted suicide fatality rate since 2014. In fact, our Colorado data showed a slight overall decrease in 2022 compared to 2021," Heilmann said, adding, "We're hoping these are optimistic signs that working together we can continue to reduce and lower the suicide rate across all ages here in Colorado."

Masters said expanding government programs like welfare and healthcare access and reducing unemployment can be viewed as suicide prevention tools.

"We need to go back to committing ourselves to the proper welfare of the United States population, otherwise we are going to continue to see these awful, horrific and terrible trends we are documenting," Masters said.



Those seeking support for themselves or others can call the Colorado crisis services at 844-493-8255 or call or text 988 for the national suicide and crisis prevention lifeline.