Changes in Suicide Rates — United States, 2019 and 2020

Daniel C. Ehlman, ScD; Ellen Yard, PhD; Deborah M. Stone, ScD; Christopher M. Jones, PharmD, DrPH; Karin A. Mack, PhD

Morbidity and Mortality Weekly Report. 2022;71(8):306-312.

Discussion

The second consecutive year of declining suicide rates in the United States is encouraging and is consistent with other high-income and upper-middle-income countries that experienced either unchanged or declining suicide rates during the early months of the COVID-19 pandemic.^[6] From 2019 to 2020, the U.S. suicide rate decreased by 3%, with significant declines among both females and males. Overall suicide rates declined in large metropolitan areas and in seven states and remained stable in other county urbanization levels and states. Rates of suicide by fall, poisoning, and suffocation declined significantly. Although, rates among non-Hispanic White females and males declined from 2019 to 2020, the suicide rate among Hispanic males and non-Hispanic multiracial females increased. Although many age groups experienced a decline in rates, rates increased among persons aged 25–34 years; rates were highest among persons aged ≥85 years, followed by those aged 75–84 and 25–34 years. Moreover, whereas rates were stable among most racial/ethnic groups, and in most states and county urbanization levels, some subgroups experienced increases, underscoring that persistent health disparities remain. Provisional data indicate similar case counts in the first half of 2021 compared with the first half of 2020.^[1]

As the nation continues to respond to the COVID-19 pandemic and its long-term effects on isolation, stress, economic insecurity, and worsening substance use, mental health, and well-being, prevention is critical. Existing data suggest that suicide rates might be stable or decline during a disaster, only to rise afterwards as the longer-term sequelae unfold in persons, families, and communities, as was the case in New Orleans 2 years after Hurricane Katrina.^[7]

Suicide is preventable. A comprehensive approach to suicide prevention is urgently needed in all states to continue to build on the progress that began in 2019. A comprehensive approach relies on the use of data to drive decision-making and robust implementation and evaluation of prevention strategies^[3] that address the range of factors associated with suicide, especially among disproportionately affected populations.** Such strategies, as laid out in CDC's Suicide Prevention Technical Package^[3] are especially relevant during the COVID-19 pandemic and should include community partners, such as public health, education, health care, and employers, coming together to enhance resilience and improve well-being by strengthening economic supports (e.g., unemployment benefits), expanding access to and delivery of care (e.g., telehealth), promoting social connectedness, creating protective environments (e.g., safely securing medications and firearms), teaching coping and problem-solving skills, identifying and supporting persons at risk, and lessening harms and preventing future risk (e.g., safe media reporting on suicide).^[3]

The findings in this report are subject to at least two limitations. First, caution should be used when interpreting rate decreases from one year to the next because rates might be unstable, especially in smaller segments of the population. Second, suicides might be undercounted on death certificates for a variety of reasons, including the higher burden of proof to classify a death as a suicide (versus that needed to classify other manners of death), stigma, misclassification, and lack of autopsies or thorough investigations.^[8]

CDC's Suicide Prevention Technical Package and its Comprehensive Suicide Prevention Program,^†† which currently funds 10 states and one university, are helping states and communities prioritize prevention strategies with the best available evidence to save lives. Expansion and adoption of these resources are critical to realizing further declines in suicide and reaching the national goal of reducing the suicide rate by 20% by 2025 set by the American Foundation for Suicide Prevention and the National Action Alliance for Suicide Prevention.^[4]

1 2

**https://www.cdc.gov/suicide/facts/disparities-in-suicide.html
^†† https://www.cdc.gov/suicide/programs/csp/index.html

Table. Annual number of suicides and age-adjusted* rates of suicide ^† per 100,000 population, by selected characteristics — National Vital Statistics System, United States, 2019 and 2020
Characteristic	2019		2020		Absolute change^§	Relative change^¶
Characteristic	No.	Rate (95% CI)	No.	Rate (95% CI)	Absolute change^§	Relative change^¶
Overall
Total	47,511	13.9 (13.8–14.1)	45,979	13.5 (13.4–13.6)	−0.4**	−3.0**
Race/Ethnicity^††
American Indian or Alaska Native	546	22.5 (20.5–24.4)	588	23.9 (21.9–25.9)	1.4	6.5
Asian	1,342	6.7 (6.3–7.1)	1,302	6.4 (6.1–6.8)	−0.3	−4.3
Black or African American	3,115	7.5 (7.2–7.7)	3,286	7.8 (7.5–8.1)	0.3	4.1
Hispanic	4,331	7.3 (7.0–7.5)	4,571	7.5 (7.3–7.8)	0.2	4.0
Multiracial	527	8.8 (8.0–9.6)	599	9.6 (8.7–10.4)	0.8	8.3
Native Hawaiian or other Pacific Islander	90	14.4 (11.5–17.7)	79	12.5 (9.9–15.6)	−1.9	−13.2
White	37,428	17.7 (17.5–17.9)	35,442	16.9 (16.7–17.0)	−0.8**	−4.5**
Unknown	132	(—)^§§	112	(—)^§§	NA	NA
Age group, yrs^¶¶
10–14	534	2.6 (2.4–2.8)	581	2.8 (2.6–3.0)	0.2	9.0
15–24	5,954	13.9 (13.6–14.3)	6,062	14.2 (13.9–14.6)	0.3	2.1
25–34	8,059	17.5 (17.2–17.9)	8,454	18.4 (18.0–18.7)	0.9**	4.6**
35–44	7,525	18.1 (17.7–18.5)	7,314	17.4 (17.0–17.8)	−0.7**	−3.9**
45–54	8,012	19.6 (19.2–20.0)	7,249	18.0 (17.5–18.4)	−1.6**	−8.4**
55–64	8,238	19.4 (19.0–19.8)	7,160	16.9 (16.5–17.3)	−2.5**	−13.0**
65–74	4,867	15.5 (15.0–15.9)	4,716	14.5 (14.1–14.9)	−1.0**	−6.3**
75–84	2,977	18.6 (18.0–19.3)	3,032	18.4 (17.8–19.1)	−0.2	−1.1
≥85	1,329	20.1 (19.0–21.2)	1,389	20.9 (19.8–22.0)	0.8	3.7
Urbanization***
Large central metro	11,762	11.2 (11.0–11.4)	11,058	10.5 (10.3–10.7)	−0.7**	−6.1**
Large fringe metro	10,840	12.6 (12.3–12.8)	10,347	12.0 (11.8–12.2)	−0.6**	−4.6**
Medium metro	10,789	15.2 (14.9–15.5)	10,574	14.9 (14.6–15.2)	−0.3	−2.2
Small metro	5,327	17.4 (16.9–17.9)	5,160	16.9 (16.4–17.4)	−0.5	−2.9
Micropolitan (nonmetro)	5,009	18.1 (17.6–18.6)	5,004	18.2 (17.7–18.7)	0.1	0.4
Noncore (nonmetro)	3,784	20.1 (19.5–20.8)	3,836	20.6 (19.9–21.3)	0.5	2.2
Mechanism of injury
Cut or pierce	921	0.3 (0.2–0.3)	907	0.2 (0.2–0.3)	−0.1	−3.1
Drowning	506	0.2 (0.1–0.2)	498	0.2 (0.1–0.2)	0.0	0.0
Fall	1,183	0.4 (0.3–0.4)	1,074	0.3 (0.3–0.3)	−0.1	−9.8**
Fire or flame	187	0.1 (0.0–0.1)	175	0.1 (0.0–0.1)	0.0	0.0
Firearm	23,941	6.8 (6.8–6.9)	24,292	7.0 (6.9–7.0)	0.2	1.7
Poisoning	6,125	1.8 (1.7–1.8)	5,528	1.6 (1.5–1.6)	−0.2**	−10.7**
Suffocation	13,563	4.2 (4.1–4.3)	12,495	3.9 (3.8–3.9)	−0.3**	−7.4**
Other^†††	1,085	0.3 (0.3–0.4)	1,010	0.3 (0.3–0.3)	0.0	0.0
Female
Total	10,255	6.0 (5.9–6.1)	9,428	5.5 (5.4–5.6)	−0.5**	−8.0**
Race/Ethnicity^††
American Indian or Alaska Native	145	12.1 (10.1–14.1)	144	11.7 (9.8–13.6)	−0.4	−3.3
Asian	392	3.7 (3.3–4.0)	390	3.7 (3.3–4.0)	0.0	0.0
Black or African American	624	2.9 (2.7–3.2)	620	2.9 (2.6–3.1)	0.0	0.0
Hispanic	886	3.0 (2.8–3.1)	870	2.8 (2.6–3.0)	−0.2	−4.1
Multiracial	122	3.9 (3.2–4.7)	166	5.0 (4.2–5.9)	1.1**	29.2**
Native Hawaiian or other Pacific Islander	18	(—)^§§	14	(—)^§§	NA	NA
White	8,046	7.7 (7.5–7.9)	7,200	6.9 (6.8–7.1)	−0.8**	−9.9**
Unknown	22	(—)^§§	24	(—)^§§	NA	NA
Age group, yrs^¶¶
10–14	203	2.0 (1.7–2.3)	204	2.0 (1.7–2.3)	0.0	0.0
15–24	1,154	5.5 (5.2–5.8)	1,203	5.8 (5.4–6.1)	0.3	4.5
25–34	1,526	6.8 (6.4–7.1)	1,572	6.9 (6.6–7.3)	0.1	2.8
35–44	1,710	8.2 (7.8–8.6)	1,591	7.5 (7.2–7.9)	−0.7**	−7.9**
45–54	2,156	10.4 (10.0–10.9)	1,735	8.5 (8.1–8.9)	−1.9**	−18.5**
55–64	1,948	8.9 (8.5–9.3)	1,621	7.4 (7.0–7.8)	−1.5**	−16.7**
65–74	985	5.9 (5.5–6.2)	973	5.6 (5.3–6.0)	−0.3	−4.5
75–84	410	4.6 (4.1–5.0)	387	4.2 (3.8–4.6)	−0.4	−8.2
≥85	158	3.7 (3.2–4.3)	134	3.2 (2.6–3.7)	−0.5	−15.5
Urbanization***
Large central metro	2,682	5.0 (4.8–5.2)	2,433	4.6 (4.4–4.7)	−0.4**	−8.8**
Large fringe metro	2,457	5.6 (5.4–5.8)	2,205	5.1 (4.9–5.3)	−0.5**	−9.8**
Medium metro	2,400	6.7 (6.4–7.0)	2,211	6.1 (5.9–6.4)	−0.6**	−8.7**
Small metro	1,106	7.3 (6.9–7.8)	1,060	7.1 (6.6–7.5)	−0.2	−4.0
Micropolitan (nonmetro)	918	6.9 (6.4–7.3)	888	6.7 (6.3–7.2)	−0.2	−2.1
Noncore (nonmetro)	692	7.9 (7.3–8.5)	631	7.1 (6.5–7.7)	−0.8	−9.6
Mechanism of injury
Cut or pierce	152	0.1 (0.1–0.1)	156	0.1 (0.1–0.1)	0.0	0.0
Drowning	187	0.1 (0.1–0.1)	170	0.1 (0.1–0.1)	0.0	0.0
Fall	333	0.2 (0.2–0.2)	254	0.1 (0.1–0.2)	−0.1**	−27.3**
Fire or flame	59	0.0 (0.0–0.1)	50	0.0 (0.0–0.0)	0.0	0.0
Firearm	3,216	1.8 (1.8–1.9)	3,112	1.8 (1.7–1.9)	0.0	0.0
Poisoning	3,079	1.7 (1.7–1.8)	2,694	1.5 (1.4–1.6)	−0.2**	−14.0**
Suffocation	2,971	1.8 (1.8–1.9)	2,742	1.7 (1.6–1.8)	−0.1**	−6.6**
Other^†††	258	0.1 (0.1–0.1)	250	0.1 (0.1–0.2)	0.0	0.0
Male
Total	37,256	22.4 (22.1–22.6)	36,551	22.0 (21.7–22.2)	−0.4**	−1.9**
Race/Ethnicity^††
American Indian or Alaska Native	401	33.0 (29.7–36.3)	444	36.4 (32.9–39.8)	3.4	10.3
Asian	950	10.1 (9.4–10.7)	912	9.5 (8.9–10.2)	−0.6	−5.1
Black or African American	2,491	12.5 (12.0–13.0)	2,666	13.1 (12.6–13.6)	0.6	5.1
Hispanic	3,445	11.6 (11.2–12.0)	3,701	12.3 (11.9–12.7)	0.7**	5.7**
Multiracial	405	14.2 (12.7–15.7)	433	14.5 (13.0–16.0)	0.3	2.4
Native Hawaiian or other Pacific Islander	72	22.1 (17.3–28.0)	65	20.0 (15.4–25.6)	−2.1	−9.7
White	29,382	28.0 (27.7–28.4)	28,242	27.2 (26.8–27.5)	−0.8**	−3.1**
Unknown	110	(—)^§§	88	(—)^§§	NA	NA
Age group, yrs^¶¶
10–14	331	3.1 (2.8–3.5)	377	3.6 (3.2–3.9)	0.5	14.1
15–24	4,800	22.0 (21.4–22.6)	4,859	22.4 (21.7–23.0)	0.4	1.6
25–34	6,533	28.0 (27.3–28.6)	6,882	29.4 (28.7–30.0)	1.4**	5.0**
35–44	5,815	28.0 (27.2–28.7)	5,723	27.2 (26.5–27.9)	−0.8	−2.8
45–54	5,856	29.0 (28.3–29.8)	5,514	27.7 (26.9–28.4)	−1.3**	−4.7**
55–64	6,290	30.7 (29.9–31.4)	5,539	27.0 (26.3–27.7)	−3.7**	−11.9**
65–74	3,882	26.4 (25.6–27.2)	3,743	24.7 (23.9–25.4)	−1.7**	−6.7**
75–84	2,567	36.7 (35.3–38.1)	2,645	36.6 (35.2–38.0)	−0.1	−0.2
≥85	1,171	49.3 (46.5–52.1)	1,255	52.0 (49.1–54.8)	2.7	5.5
Urbanization***
Large central metro	9,080	17.8 (17.5–18.2)	8,625	16.9 (16.6–17.3)	−0.9**	−5.0**
Large fringe metro	8,383	20.0 (19.6–20.5)	8,142	19.4 (19.0–19.9)	−0.6	−3.0
Medium metro	8,389	24.3 (23.7–24.8)	8,363	24.1 (23.6–24.6)	−0.2	−0.7
Small metro	4,221	27.9 (27.0–28.7)	4,100	27.2 (26.3–28.0)	−0.7	−2.5
Micropolitan (nonmetro)	4,091	29.5 (28.6–30.4)	4,116	29.8 (28.8–30.7)	0.3	0.9
Noncore (nonmetro)	3,092	32.1 (31.0–33.3)	3,205	33.7 (32.5–34.9)	1.6	4.9
Mechanism of injury
Cut or pierce	769	0.4 (0.4–0.5)	751	0.5 (0.4–0.5)	0.1	1.6
Drowning	319	0.2 (0.2–0.2)	328	0.2 (0.2–0.2)	0.0	0.0
Fall	850	0.5 (0.5–0.5)	820	0.5 (0.5–0.5)	0.0	0.0
Fire or flame	128	0.1 (0.1–0.1)	125	0.1 (0.1–0.1)	0.0	0.0
Firearm	20,725	12.3 (12.1–12.4)	21,180	12.5 (12.3–12.7)	0.2	1.8
Poisoning	3,046	1.8 (1.7–1.9)	2,834	1.7 (1.6–1.7)	−0.1**	−6.4**
Suffocation	10,592	6.6 (6.5–6.7)	9,753	6.1 (6.0–6.2)	−0.5**	−7.5**
Other^†††	827	0.5 (0.4–0.5)	760	0.5 (0.4–0.6)	0.0	0.0

Abbreviation: NA = not applicable.
*Age-adjusted rates (suicides per 100,000 population) were calculated using the direct method and the 2000 U.S. standard population. Rates and 95% CIs are rounded to one digit after the decimal, and, as a result, might not exactly match similar rates published elsewhere. Suicides for persons aged <10 years were included in the total numbers and age-adjusted rates but are suppressed for the analysis by age groups because determining suicidal intent in younger children can be difficult.
^†Suicide deaths were identified by using International Classification of Diseases, Tenth Revision underlying cause-of-death codes U03, X60–X84, and Y87.0.
^§Absolute change was the rate in 2020 minus the rate in 2019.
^¶Relative change was calculated using the equation: (2020 rate–2019 rate)/2019 rate x 100. To improve precision, relative change was calculated using rates rounded to three digits after the decimal. However, if the absolute change was 0, the relative change was also listed as 0.
**P<0.05 for difference between 2019 and 2020. Z-tests were used if the number of deaths was ≥100 in both 2019 and 2020; nonoverlapping CIs based on the gamma method were used if the number of deaths was <100 in 2019 or 2020.
^††Data for Hispanic origin should be interpreted with caution; studies comparing Hispanic origin on death certificates and on U.S. Census surveys have shown inconsistent reporting on Hispanic ethnicity. Potential racial misclassification might lead to underestimates for certain categories, primarily American Indian, Alaska Native, Asian, and other Pacific Islander decedents. Single-race estimates are presented and might not be comparable to earlier years produced by bridging multiple races to a single race choice. Hispanic and unknown ethnicity include persons of any race. Racial groups exclude persons of Hispanic or unknown ethnicity. https://www.cdc.gov/nchs/data/nvsr/nvsr70/nvsr70-03-508.pdf https://www.cdc.gov/nchs/data/series/sr_02/sr02_172.pdf
^§§Age-adjusted rates were suppressed for Native Hawaiian or other Pacific Islander females because of unstable rates due to small numbers of deaths (<20). Age-adjusted rates could not be calculated for persons of unknown race/ethnicity.
^¶¶Crude rates (deaths per 100,000) are presented for age groups.
***Urbanization level of the decedent's county of residence was categorized using the 2013 National Center for Health Statistics Urban–Rural Classification Scheme for Counties (https://www.cdc.gov/nchs/data_access/urban_rural.htm). The classification levels for counties are as follows: 1) large central metropolitan (large central metro): part of a metropolitan statistical area with ≥1 million population and covers a principal city; 2) large fringe metropolitan (large fringe metro): part of a metropolitan statistical area with ≥1 million population but does not cover a principal city; 3) medium metropolitan (medium metro): part of a metropolitan statistical area with ≥250,000 but <1 million population; 4) small metropolitan (small metro): part of a metropolitan statistical area with <250,000 population; 5) micropolitan (nonmetro): part of a micropolitan statistical area (has an urban cluster of ≥10,000 but <50,000 population); and 6) noncore (nonmetro): not part of a metropolitan or micropolitan statistical area.
^†††"Other" mechanisms of injury include other land transport, struck by or against, other specified, and unspecified.