The document summarizes epidemiological data on self-directed violence (suicide) in the United States. It finds that in 2013 suicide was the 10th leading cause of death, accounting for over 41,000 deaths. Suicide rates vary significantly by age, sex, ethnicity, and state. Firearms are the most common method used in suicide attempts. Reducing suicide is an important public health issue due to its health and societal impacts.

1. The epidemiology of self-directed violence
Alex E. Crosby
Division of Violence Prevention
Centers for Disease Control and Prevention
Feb 2015
National Center for Injury Prevention and Control
Division of Violence Prevention/Etiology and Surveillance Branch
"The findings and conclusions in this report are those of the author(s)
and do not necessarily represent the official position of the Centers
for Disease Control and Prevention/the Agency for Toxic Substances
and Disease Registry.”

2. Why is suicidal behavior a public
health issue?
• Morbidity and mortality
•
10th
leading cause of death in 2013 accounted for over 41,000 deaths
•
Estimated 483,586 emergency dept visits for self-inflicted injury in 2012 (NEISS)
•
Health consequences in many areas
•
Physical, mental, behavioral, reproductive, sexual transmitted diseases
• Potential for impact by public health
•
Focus on prevention
•
Science base
•
Stresses multi-disciplinary approach
• Mission of public health includes this issue
“ … to reduce the amount of disease, premature death, and disease-producing
discomfort and disability in the population.”
J. Last, Dictionary of Epidemiology 1988

3. Leading causes of death – United States,
2013
Rank Cause Number of deaths
1 Heart Disease 611,105
2 Malignant Neoplasms 584,881
3 Chronic Lower Respiratory Ds 149,205
4 Unintentional Injuries 130,557
5 Cerebrovascular Ds 128,978
6 Alzheimer’s Disease 84,767
7 Diabetes mellitus 75,578
8 Influenza and pneumonia 56,979
9 Nephritis 47,112
10 Suicide 41,149
11 Septicemia 38,156
Source: CDC vital statistics

4. Leading causes of death for selected age
groups – United States, 2013
Rank 10-14 years 15-19 years 20-29 years 30-39 years 40-49 years 50-59 years
1 Unintentional
Injuries
Unintentional
Injuries
Unintentional
Injuries
Unintentional
Injuries
Malignant
Neoplasms
Malignant
Neoplasms
2 Malignant
Neoplasms
Suicide Suicide Suicide Heart
Disease
Heart
Disease
3 Suicide Homicide Homicide Malignant
Neoplasms
Unintentional
Injuries
Unintentional
Injuries
4 Congenital
Malformations
Malignant
Neoplasms
Malignant
Neoplasms
Heart
Disease
Suicide Liver
Disease
5 Homicide Heart
Disease
Heart
Disease
Homicide Liver
Disease
Chronic
Lower Respiratory
Ds
6 Heart
Disease
Congenital
Malformations
Diabetes
Mellitus
Liver Disease Diabetes
Mellitus
Diabetes
Mellitus
7 Chronic
Lower Respiratory
Ds
Influenza and
Pneumonia
Congenital
Malformations
Diabetes
Mellitus
Cerebro-
Vascular
Suicide
8 Influenza and
Pneumonia
Chronic
Lower
Respiratory Ds
HIV Cerebro-
Vascular
Homicide Cerebro-
Vascular
Source: CDC vital statistics

5. Leading causes of death by ethnicity –
United States, 2013
Source: CDC Vital Statistics
Rank White Black
American
Indian/AN Asian Latino
1
Heart Disease Heart Disease Heart Disease Malignant
Neoplasms
Malignant
Neoplasms
2
Malignant
Neoplasms
Malignant
Neoplasms
Malignant
Neoplasms
Heart Disease Heart Disease
3
Chronic Low
Respiratory
Cerebro
Vascular
Unintentional
Injuries
Cerebro
vascular
Unintentional
Injuries
4
Unintentional
Injuries
Diabetes Mellitus Diabetes Mellitus Unintentional
Injuries
Cerebro
vascular
5
Cerebro
vascular
Unintentional
Injuries
Liver Disease Diabetes Mellitus Diabetes Mellitus
6
Alzheimer’s Disease Chronic Low
Respiratory
Chronic Low
Respiratory
Influenza and
pneumonia
Liver Disease
7
Diabetes Mellitus Nephritis Cerebro
Vascular
Chronic Low
Respiratory
Chronic Low
Respiratory
8
Influenza and
pneumonia
Homicide Suicide Alzheimer’s Disease Alzheimer’s
Disease
9
Suicide Septicemia Influenza and
pneumonia
Nephritis Influenza and
pneumonia

6. 0
5
10
15
20
25
30
1933
1938
1943
1948
1953
1958
1963
1968
1973
1978
1983
1988
1993
1998
2003
2008
2013
Year
Rateper100,000population
Male
Female
Total
Source: CDC vital statistics
Suicide among all persons by sex
-- United States, 1933-2013

7. Suicide rates among persons aged
15-19 years -- United States, 1956-2013
0
2
4
6
8
10
12
14
16
18
20
1956
1959
1962
1965
1968
1971
1974
1977
1980
1983
1986
1989
1992
1995
1998
2001
2004
2007
2010
2013
Year
Rateper100,000
population
Male
Total
Female
Source: CDC vital statistics

8. 0
500
1000
1500
2000
2500
3000
3500
4000
4500
0-4
^5-9^10-14^15-19^20-24^25-29^30-34^35-39^40-44^45-49^50-54^55-59^60-64^65-69^70-74^75-79^80-84
^85+
Age Group
Numberofdeaths
0
3
6
9
12
15
18
21
Rateper100,000population
Rate
Number
Source: CDC vital statistics
Suicides and suicide rates among all
persons -- United States, 2013

9. 0
10
20
30
40
50
00-04
05-09
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
Age Group in years
Rateper100,000population
Males
Females
Suicide rates among all persons by
age and sex--United States, 2013
Source: CDC vital statistics

10. Suicide by method – United States,
2013
Firearms
51.4%
Suffocation
24.5%
Poisoning
16.1%
Fall
2.4%
Other
5.7%
Source: CDC vital statistics

11. Age-adjusted suicide rates among all persons
by state -- United States, 2013 (U.S. avg 12.6)
Rates per 100,000 population
5.8 to 11.6
11.7 to 12.5
12.6 to 15.6
15.7 to 23.7
Source: Centers for Disease Control and
Prevention (CDC) vital statistics
Wash., D.C.

12. 0
5
10
15
20
25
30
35
40
00-04
05-09
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65+
Age Group in years
Rateper100,000population
Eur-Amer NonLatino
Afr-Amer NonLatino
Native American Non-Latino
Asian-PI Non-Latino
Latino
Suicide rates by ethnicity and age
group -- United States, 2009-2013
Source: CDC Vital Statistics

13. Burden of injury
Hospitalizations
Emergency Dept visits
Events reported on surveys
Unreported events
Deaths

14. Public Health Burden of suicidal
behavior -- United States, 2012
*Source: CDC’s National Vital Statistics System
¶Source: Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization
Project - Nationwide Inpatient Sample (HCUP-NIS)
§ Source: CDC’s National Electronic Injury Surveillance System – All Injury Program

15. Number and ratio of persons affected by suicidal thoughts and
behavior among adults aged ≥18 years — United States, 2012
*Source: CDC’s National Vital Statistics System,
†
Source: Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project - Nationwide Inpatient Sample
(HCUP-NIS)
§
Source: Source: CDC’s National Electronic Injury Surveillance System-All Injury Program
¶
Source: SAMHSA’s National Survey on Drug Use and Health
** Source: SAMHSA’s National Survey on Drug Use and Health
Number in parentheses represent the ratio of deaths to other categories
Deaths*
Hospitalizations †
Emergency Department visits§
Suicide attempts ¶
Seriously considered suicide**
39,426 (1)
129,205 (3.3)
405,000 (10.3)
1,129,000 (32.7)
9,031,000 (229.1)

16. 0
50
100
150
200
250
300
350
400
450
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65+
Age Group in years
Rateper100,000population
Males
Females
Self-inflicted injury among all persons by
age and sex--United States, 2013
Source: CDC WISQARS NEISS

17. Suicidal ideation and behavior among high
school students by category and sex* --
United States, 2013
0
5
10
15
20
25
Seriously consider
suicide
Suicide plan Attempted suicide^ Suicide attempt with
medical
Category
Percentageofallstudents
Female
Male
Total
Source: CDC Youth Risk Behavior Survey
* During the 12 months preceding the survey
^One or more times

18. Percentage of high school students who
report suicidal behavior* by sex – U.S., 1990-
2013
0
2
4
6
8
10
12
14
1990
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
2013
Year
Percentageofallstudents
Source: Youth Risk Behavior Surveillance System
*At least one attempt during the 12 months preceding the survey
Female
Male
Total

19. Resources and internet-based
Statistics
• National Center for Injury Prevention and
Control
• Division of Violence Prevention
• www.cdc.gov/ncipc
• www.cdc.gov/ncipc/wisqars/default.htm
• Injury mortality and leading cause of death
statistics available by:
• Intent, Method
• Year
• State
• Demographics
• Age, Sex, Race
• Injury morbidity
• Hospital emergency dept events
• Natl Violent Death reporting System

20. For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: cdcinfo@cdc.gov Web: www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official
position of the Centers for Disease Control and Prevention.
Thank you
National Center for Injury Prevention and Control
Division of Violence Prevention
www.cdc.gov/injury; 770-488-4410