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Cited by 78Suicide and Self-Harm StudiesHomicide, Infanticide, and Child AbuseGun Ownership and Violence Research

Trends in the Incidence and Lethality of Suicidal Acts in the United States, 2006 to 2015

Open access
Wang, Jing, Sumner, Steven A., Simon, Thomas R., Crosby, Alex E., Annor, Francis B., Gaylor, Elizabeth, Xu, Likang, Holland, Kristin M.·2020·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2020.0596PMC PMC7177650
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Abstract

Importance: Understanding changes in the incidence rates and lethality of suicidal acts may explain increasing suicide rates. Objective: To examine trends in the incidence rates and lethality of suicidal acts from 2006 to 2015 among persons aged 10 to 74 years. Design, Setting, and Participants: This cross-sectional study was conducted from May 2, 2018, to January 30, 2019. Medically treated nonfatal suicide attempts were identified from the 2006 to 2015 Nationwide Inpatient Sample and Nationwide Emergency Department Sample databases. Suicides were identified from the 2006 to 2015 mortality files of the National Vital Statistics System. Main Outcomes and Measures: The incidence rate of suicidal acts was calculated by dividing the number of total suicidal acts by the US population. Lethality was measured through the case fatality rates (CFRs) of suicidal acts by dividing the number of suicides by the total number of suicidal acts. Results: A total of 1 222 419 (unweighted) suicidal acts, which included both suicides and nonfatal suicide attempts, were identified from 2006 to 2015. Overall, the incidence rates of total suicidal acts increased 10% from 2006 to 2015 (annual percentage change [APC], 0.8%; 95% CI, 0.3%-1.3%), and the CFRs of suicidal acts increased 13% during the 2006 to 2015 period (APC, 2.3%; 95% CI, 1.3%-3.3%). In subgroup analyses, incidence rates increased by 1.1% (95% CI, 0.6%-1.6%) per year for female individuals during the 2006 to 2015 period but remained stable for male individuals. The CFRs increased for both sexes (APC, 5.0% [95% CI, 3.1%-6.9%] since 2010 for female individuals; 1.6% [95% CI, 0.6%-2.5%] since 2009 for male individuals). Incidence rates increased among adolescents from 2011 to 2015 and among older adults aged 65 to 74 years throughout the 2006 to 2015 period. Conversely, the CFRs increased since 2009 among persons aged 20 to 44 years (APC, 3.7%; 95% CI, 2.5%-5.0%) and since 2012 for those aged 45 to 64 years (APC, 2.7%; 95% CI, 0.0%-5.4%). Persons aged 20 to 44 years and 45 to 64 years experienced increases in suicidal acts by more lethal means, whereas adolescents and older adults aged 65 to 74 years showed increased incidence by all means. Conclusions and Relevance: This study found increased suicidal acts among female persons, adolescents, and older adults aged 65 to 74 years, implying the need to address emerging or exacerbating suicide risk factors for these populations. The findings on the increased lethality particularly among persons aged 20 to 64 years highlighted the need to reduce access to materials that could be used as lethal means among persons at risk of suicide. These findings on population-level epidemiologic patterns can be used to guide the development of comprehensive suicide prevention strategies.

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Crossref · 10.1001/jamapsychiatry.2020.0596

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Claims the paper makes

0 of 30 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The overall incidence rate of total suicidal acts rose 10%, from 175.0 per 100,000 people in 2006 to 193.0 per 100,000 people in 2015, with an APC of 0.8% (95% CI, 0.3%-1.3%).

    “Overall, the incidence rate of total suicidal acts increased 10%, from 175.0 per 100 000 persons in 2006 to 193.0 per 100 000 persons in 2015 (APC, 0.8%; 95% CI, 0.3%-1.3%).”
    Quote in the paperSubstantial claim
  • Findingown data

    Poisoning was the most common method in suicide attempts, accounting for 63%.

    “the most common means used was poisoning (274 000 [63%])”
    Quote in the paperNot a substantial claim
  • Findingown data

    CFRs among adolescents stayed stable throughout the study period.

    “Meanwhile, the CFRs among adolescents remained stable throughout the study period.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Among adolescents aged 10-19, incidence rates were stable until 2011 and then rose sharply (APC, 7.9%; 95% CI, 5.4%-10.5%).

    “Among adolescents aged 10 to 19 years, incidence rates were stable until 2011 and then increased sharply (APC, 7.9%; 95% CI, 5.4%-10.5%).”
    Quote in the paperSubstantial claim
  • Findingown data

    Nearly 80% of suicide attempts occurred in people under 45 years.

    “Among suicide attempts, nearly 80% occurred among people younger than 45 years (10-19 years: 118 000 [27%]; 20-44 years: 220 000 [50%])”
    Quote in the paperNot a substantial claim
  • May combine two claims. 54
  • Classified as probably not a substantial claim. 14
  • The quote only partly states this claim. 2

  • May combine two claims.

    Findingown data

    CFRs increased for both sexes, more rapidly for female individuals (APC, 5.0% since 2010) than for male individuals (APC, 1.6% since 2009).

    “The CFRs increased for both sexes, but the increase was more rapid for female individuals (APC, 5.0% [95% CI, 3.1%-6.9%]since 2010 for female individuals vs 1.6% [95% CI, 0.6%-2.5%]since 2009 for male individuals)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    CFRs rose since 2009 for people aged 20-44 (APC, 3.7%; 95% CI, 2.5%-5.0%) and since 2012 for those aged 45-64 (APC, 2.7%; 95% CI, 0.0%-5.4%).

    “the CFRs increased since 2009 for persons aged 20 to 44 years (APC, 3.7%; 95% CI, 2.5% to 5.0%) and since 2012 for those aged 45 to 64 years (APC, 2.7%; 95% CI, 0% to 5.4%].”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Since 2010, incidence rates fell for people aged 20-44 (APC, -2.3%; 95% CI, -4.6% to -0.0%) and were stable for those aged 45-64.

    “Since 2010, the IRs declined for persons aged 20 to 44 years (APC, -2.3%; 95% CI, -4.6% to -0.0%) and were stable for those aged 45 to 64 years.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For people aged 45-64, incidence rates rose for firearm (APC, 2.8% from 2006-2012), suffocation (APC, 6.0% from 2006-2015), and other means (APC, 2.3% from 2006-2015); poisoning rose from 2006 to 2010 (APC, 3.8%) and then leveled off.

    “Similar incidence increases by means occurred for those aged 45 to 64 years: firearm (APC, 2.8%; 95% CI, 1.9%-3.6%from 2006 to 2012), suffocation (APC, 6.0%; 95% CI, 4.4%-7.7%from 2006 to 2015), and other means (APC, 2.3%; 95% CI, 1.6%-3.0%from 2006 to 2015).Poisoning rates, however, increased from 2006 to 2010 (APC, 3.8%; 95% CI, 0.5%-7.2%)and then leveled off”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Findingown data

    The study initially included 980,519 suicide attempts and, after exclusions, retained 867,049 unweighted attempts.

    “We initially included 980 519 suicide attempts in the study.Patients who transferred to another hospital (n = 90 181) were excluded to avoid duplicate counts.Patients with a deceased status at discharge (n = 8951) were excluded, assuming they were captured as suicides in death records.To be conservative, we also excluded patients with unknown death status at discharge (n = 14 338), leaving 867 049”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Patients with deceased status at discharge were captured as suicides in death records.

  • May combine two claims.

    Findingown data

    People aged 20-44 and 45-64 had increases in suicidal acts by more lethal methods, while adolescents and older adults aged 65-74 had increased incidence by all methods.

    “Persons aged 20 to 44 years and 45 to 64 years experienced increases in suicidal acts by more lethal means, whereas adolescents and older adults aged 65 to 74 years showed increased incidence by all means.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The overall CFR increased by 13% relative, reaching 8.3% in 2015 from 7.3% in 2006, and trended upward during 2009-2015 (APC, 2.3%; 95% CI, 1.3%-3.3%).

    “Similarly, the overall CFR had a relative increase of 13% from 7.3% in 2006 to 8.3% in 2015, with an upward trend during 2009 to 2015 (APC, 2.3%; 95% CI, 1.3%-3.3%).”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    No single other method made up 3% or more of all suicides.

    “Each of these means accounted for less than 3% of all suicides.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    CFRs were 90% for firearm, 51% for suffocation, 2% for poisoning, and 2% for other means.

    “When CFRs were calculated, suicidal acts by firearms (90%) and suffocation (51%) were more lethal compared with poisoning (2%) or other (2%) means.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Between 2006 and 2015, suicidal acts rose for firearm, suffocation, and other methods, but not for poisoning, in the overall sample and in both sexes.

    “From 2006 to 2015, a general increase was seen in the incidence of suicidal acts by firearm, suffocation, and other means, but not by poisoning for overall and for both sexes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    This study found that both incidence rates and lethality of suicidal acts rose more rapidly in female than male individuals.

    “However, the present study found that both incidence rates and lethality of suicidal acts increased more rapidly in female than male individuals.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For people aged 20-44, incidence rates rose for firearm (APC, 1.6%), suffocation (APC, 4.0%), and other means (APC, 0.8%), while poisoning rates were stable from 2006 to 2010 and then fell (APC, -4.4%).

    “throughout the study period, for persons aged 20 to 44 years, the incidence rates increased for suicidal acts by firearm (APC, 1.6%; 95% CI, 0.9%-2.2%),suffocation (APC, 4.0%; 95% CI, 3.2%-4.8%),and other means (APC, 0.8%; 95% CI, 0.2%-1.3%),but rates of poisoning were stable from 2006 to 2010 and then decreased (APC, -4.4%; 95% CI, -7.1% to -1.7%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Incidence rates for female individuals increased 1.1% per year over 2006-2015, while no statistically significant trend was found for male individuals.

    “The incidence rates increased 1.1% (95% CI, 0.6%-1.6%)per year throughout the 2006-2015 period for female individuals, but no statistically significant trends were observed for male individuals.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Within the other means category, cutting accounted for 70%, drowning 0.3%, jumping 2%, and miscellaneous means 28%.

    “The other category comprised cutting (70%), drowning (0.3%), jumping (2%), and miscellaneous (28%) means.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Firearm was the most common method in suicides, accounting for 48%.

    “the most common means used was firearm (19 282 [48%])”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For people aged 65-74, incidence rates rose from 2006 to 2009 (APC, 5.9%) and from 2009 to 2015 (APC, 2.5%), while CFRs fell from 2006 to 2015 (APC, -0.8%).

    “Among persons aged 65 to 74 years, IRs increased from 2006 to 2009 (APC, 5.9%; 95% CI, 2.7% to 9.2%) and from 2009 to 2015 (APC, 2.5%; 95% CI, 1.6% to 3.4%], while CFRs decreased from 2006 to 2015 (APC, -0.8%; 95% CI, -1.5% to -0.1%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In 2015, there were an estimated 437,000 medically treated suicide attempts and 40,474 suicides among people aged 10 to 74.

    “An estimated 437 000 medically treated suicide attempts and 40 474 suicides among persons aged 10 to 74 years were recorded in 2015.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Patients with deceased status at discharge were captured as suicides in death records.

  • May combine two claims.

    Findingown data

    Firearms were used in about half of all suicides and had the highest CFR among the suicide methods examined.

    “Findings of this study demonstrated that firearms were used in approximately half of all suicides and underscored that firearms had the highest CFR of all the suicide means examined.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Among adolescents, incidence rates of suicidal acts rose by all methods, especially after 2011.

    “Among adolescents, the incidence rates of suicidal acts increased by all means, particularly after 2011.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In 2015, among females aged 10-74, there were 258,000 nonfatal medically treated suicide attempts (59% of total) and 9,659 suicides (24% of total), with a case fatality rate of 4%.

    “Female | 258 000 (59) | 9659 (24) | 4”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Among persons aged 10-19, the incidence rate of suicidal acts by other means increased from 75.9 per 100,000 in 2006 to 115.1 per 100,000 in 2015, with an average annual percentage change of 5.6%.

    “Other c | 75.9 (69.2 to 82.6) | 115.1 (106.3 to | 2006-2011 3.0 (0.0 to 6.1) | 2011-2015 8.9 (5.0 to 13.0) | 5.6 (3.7 to 7.5)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Among persons aged 10-74, the incidence rate of suicidal acts by suffocation increased from 5.7 per 100,000 in 2006 to 9.1 per 100,000 in 2015, with an average annual percentage change of 4.7%.

    “Suffocation | 5.7 (5.4 to 6.0) | 9.1 (8.8 to 9.4) | 2006-2015 4.7 (3.8 to 5.7) | NA | NA | 4.7 (3.8 to 5.7)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Among persons aged 65-74, the incidence rate of suicidal acts by firearms increased from 9.1 per 100,000 in 2006 to 10.7 per 100,000 in 2015, with an average annual percentage change of 1.8%.

    “Firearms | 9.1 (8.9 to 9.3) | 10.7 (10.4 to 11.0) | 2006-2015 1.8 (1.0 to 2.5) | NA | NA | 1.8 (1.0 to 2.5)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Among persons aged 10-74, the incidence rate of suicidal acts by other means increased from 52.0 per 100,000 in 2006 to 63.3 per 100,000 in 2015, with an average annual percentage change of 2.4%.

    “Other c | 52.0 (49.5 to 54.5) | 63.3 (60.4 to 66.2) | 2006-2015 2.4 (1.9 to 2.8) | NA | NA | 2.4 (1.9 to 2.8)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Among persons aged 10-19, the incidence rate of suicidal acts by poisoning increased from 117.9 per 100,000 in 2006 to 161.2 per 100,000 in 2015, with an average annual percentage change of 3.3%.

    “Poisoning | 117.9 (110.8 to | 161.2 (151.6 to | 2006-2011 0 (-2.4 to 2.5) | 2011-2015 7.5 (4.2 to 11.0) | 3.3 (1.8 to 4.9)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Among persons aged 45-64, the incidence rate of suicidal acts by other means increased from 21.7 per 100,000 in 2006 to 25.7 per 100,000 in 2015, with an average annual percentage change of 2.3%.

    “Other c | 21.7 (20.1 to 23.3) | 25.7 (24.1 to 27.3) | 2006-2015 2.3 (1.6 to 3.0) | NA | NA | 2.3 (1.6 to 3.0)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Among persons aged 10-74, the incidence rate of suicidal acts by poisoning changed from 110.6 per 100,000 in 2006 to 112.7 per 100,000 in 2015, with an average annual percentage change of -0.3%.

    “Poisoning | 110.6 (106.7 to | 112.7 (109.3 to | 2006-2015 -0.3 (-1.1 to 0.5) NA | NA | -0.3 (-1.1 to 0.5)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In 2015, among persons aged 10-19, there were 118,000 nonfatal medically treated suicide attempts (27% of total) and 2,470 suicides (6% of total), with a case fatality rate of 2%.

    “10-19 | 118 000 (27) | 2470 (6) | 2”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    In 2015, among persons aged 10-74, suicidal acts by other means included 149,000 nonfatal medically treated attempts (34% of attempts) and 3,294 suicides (8% of suicides), with a case fatality rate of 2%.

    “Other | 149 000 (34) | 3294 (8) | 2”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Among persons aged 45-64, the incidence rate of suicidal acts by firearms increased from 8.8 per 100,000 in 2006 to 10.0 per 100,000 in 2015, with an average annual percentage change of 1.4%.

    “Firearms | 8.8 (8.6 to 9.0) | 10.0 (9.8 to 10.2) | 2006-2012 2.8 (1.9 to 3.6) | 2012-2015 -1.3 (-3.3 to 0.7) | 1.4 (0.7 to 2.1)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In 2015, among persons aged 10-74, suffocation-related suicidal acts included 11,000 nonfatal medically treated attempts (3% of attempts) and 11,485 suicides (28% of suicides), with a case fatality rate of 51%.

    “Suffocation | 11 000 (3) | 11 485 (28) | 51”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Among males aged 10-74, the incidence rate of suicidal acts by firearms increased from 11.8 per 100,000 in 2006 to 13.6 per 100,000 in 2015, with an average annual percentage change of 1.6%.

    “Firearms | 11.8 (11.6 to 12.0) | 13.6 (13.4 to 13.8) | 2006-2010 3.0 (1.4 to 4.7) | 2010-2015 0.4 (-0.6 to 1.4) | 1.6 (0.9 to 2.3)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Among females aged 10-74, the incidence rate of suicidal acts by firearms increased from 2.0 per 100,000 in 2006 to 2.5 per 100,000 in 2015, with an average annual percentage change of 3.0%.

    “Firearms | 2.0 (1.9 to 2.1) | 2.5 (2.4 to 2.6) | 2006-2015 3.0 (2.5 to 3.4) | NA | NA | 3.0 (2.5 to 3.4)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In 2015, among persons aged 65-74, there were 9,000 nonfatal medically treated suicide attempts (2% of total) and 4,201 suicides (10% of total), with a case fatality rate of 31%.

    “65-74 | 9000 (2) | 4201 (10) | 31”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In 2015, among persons aged 10-74, there were 437,000 nonfatal medically treated suicide attempts and 40,474 suicides, yielding a case fatality rate of 9%.

    “Total | 437 000 (100) | 40 474 (100) | 9”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Among persons aged 20-44, the incidence rate of suicidal acts by other means increased from 69.1 per 100,000 in 2006 to 75.5 per 100,000 in 2015, with an average annual percentage change of 0.8%.

    “Other c | 69.1 (64.4 to 73.8) | 75.5 (70.3 to 80.7) | 2006-2015 0.8 (0.2 to 1.3) | NA | NA | 0.8 (0.2 to 1.3)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Among persons aged 10-19, the incidence rate of suicidal acts by suffocation increased from 5.6 per 100,000 in 2006 to 9.3 per 100,000 in 2015, with an average annual percentage change of 5.5%.

    “Suffocation | 5.6 (5.0 to 6.2) | 9.3 (8.4 to 10.2) | 2006-2015 5.5 (3.7 to 7.4) | NA | NA | 5.5 (3.7 to 7.4)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In 2015, among persons aged 10-74, firearm-related suicidal acts included 2,000 nonfatal medically treated attempts (1% of attempts) and 19,282 suicides (48% of suicides), with a case fatality rate of 90%.

    “Firearms | 2000 (1) | 19 282 (48) | 90”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In 2015, among males aged 10-74, there were 179,000 nonfatal medically treated suicide attempts (41% of total) and 30,815 suicides (76% of total), with a case fatality rate of 15%.

    “Male | 179 000 (41) | 30 815 (76) | 15”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In 2015, among persons aged 10-74, poisoning-related suicidal acts included 274,000 nonfatal medically treated attempts (63% of attempts) and 6,413 suicides (16% of suicides), with a case fatality rate of 2%.

    “Poisoning | 274 000 (63) | 6413 (16) | 2”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In 2015, among persons aged 45-64, there were 90,000 nonfatal medically treated suicide attempts (21% of total) and 16,490 suicides (41% of total), with a case fatality rate of 16%.

    “45-64 | 90 000 (21) | 16 490 (41) | 16”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Among persons aged 10-74, the incidence rate of suicidal acts by firearms increased from 6.8 per 100,000 in 2006 to 8.0 per 100,000 in 2015, with an average annual percentage change of 1.8%.

    “Firearms | 6.8 (6.7 to 6.9) | 8.0 (7.9 to 8.1) | 2006-2010 3.0 (1.7 to 4.3) | 2010-2015 0.9 (0.0 to 1.7) | 1.8 (1.3 to 2.4)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Among females aged 10-74, the incidence rate of suicidal acts by other means increased from 51.7 per 100,000 in 2006 to 66.2 per 100,000 in 2015, with an average annual percentage change of 3.1%.

    “Other c | 51.7 (49.1 to 54.3) | 66.2 (63.0 to 69.4) | 2006-2015 3.1 (2.4 to 3.8) | NA | NA | 3.1 (2.4 to 3.8)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In 2015, among persons aged 20-44, there were 220,000 nonfatal medically treated suicide attempts (50% of total) and 17,313 suicides (43% of total), with a case fatality rate of 7%.

    “20-44 | 220 000 (50) | 17 313 (43) | 7”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Among persons aged 45-64, the incidence rate of suicidal acts by poisoning increased from 79.4 per 100,000 in 2006 to 83.9 per 100,000 in 2015, with an average annual percentage change of 0.6%.

    “Poisoning | 79.4 (75.3 to 83.5) | 83.9 (80.4 to 87.4) | 2006-2010 3.8 (0.5 to 7.2) | 2010-2015 -1.8 (-3.7 to 0.1) | 0.6 (-0.7 to 2.0)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    After the switch to ICD-10-CM coding in October 2015, suicide attempt rates showed abrupt changes that were probably caused by the coding change.

    “After the adoption of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding schema in October 2015, suicide attempt rates showed some abrupt changes, which were likely attributable to the coding switch.19”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [19] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The study was exempt from institutional review board review under CDC policy because it used publicly available data.

    “According to the Centers for Disease Control and Prevention's institutional review board policy, this study was exempt from review because it used publicly available data.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A previous report found that suicide by suffocation in the US rose substantially from 2000 to 2010.

    “This finding is consistent with a previous report that suicide by suffocation in the US substantially increased from 2000 to 2010.14”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The rise in suicide rates occurred among both sexes and among people aged 10 to 74 years.

    “The increase occurred for both sexes and for ages 10 to 74 years. 2”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Analyses used SAS and SUDAAN so that the complex sampling of NEDS and NIS was handled.

    “We conducted all analyses with SAS, version 9.1.3(SAS institute Inc), and SUDAAN, version 11.0.1 (Research Triangle Institute), to account for the complex sample design of NEDS and NIS.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Patients transferred to another hospital were excluded to prevent duplicate counting.

    “Patients who transferred to another hospital (n = 90 181) were excluded to avoid duplicate counts.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Patients with unknown death status at discharge were excluded as a conservative measure.

    “To be conservative, we also excluded patients with unknown death status at discharge (n = 14 338), leaving 867 049 (unweighted) suicide attempts in the study.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    CFRs were age-adjusted using the age-group distribution of total suicidal acts in 2006.

    “the CFRs were age-adjusted by the age-group distributions among total suicidal acts in 2006.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Several studies have reported higher incidence of suicide attempts in certain adult subgroups and in youth.

    “A number of studies indicated greater incidence of suicide attempts among certain adult subgroups and youth (Table 1).[7][8][9][10][11][12][13]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [7] source

      Not checked in the free run.

    • cites [8] source

      Not checked in the free run.

    • cites [9] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The age range 10 to 74 years was chosen because determining self-harm intent in children under 10 is difficult and because suicide rates rose from 1999 to 2017 in this age range but not in those 75 or older.

    “This age range was selected because ascertaining the intent to selfharm among children younger than 10 years is difficult, 16 and suicide rates were higher in 2017 than in 1999 among individuals between 10 and 74 years of age but not among those 75 years or older. 2”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [16] source

      Not checked in the free run.

    • cites [2] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Total suicidal act incidence rates were standardized to the age distribution of the 2000 US census.

    “The incidence rates of total suicidal acts were age adjusted to the 2000 US census population.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    NEDS and NIS are large, nationally representative, all-payer databases of emergency department and hospital medical encounters.

    “Both NEDS and NIS are large, nationally representative, all-payer databases containing data on ED and hospital medical encounters.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [17] source

      Not checked in the free run.

    • cites [18] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    From 2000 to 2010 in the US, the suicide rate by suffocation rose 52%, compared with 19% for poisoning and 3% for firearm-related suicide.

    “Between 2000 and 2010, the rate of suicide by suffocation increased 52% compared with a 19% increase in suicide by poisoning and a 3% increase in firearm-related suicides in the US. 14”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [14] source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    The study did not include less severe suicide attempts that did not lead to ED or hospital visits, so it may have underestimated total suicidal act incidence and overestimated lethality.

    “First, it did not include less severe suicide attempts that did not involve visits to EDs or hospitals; therefore, we may have underestimated the incidence of total suicidal acts and overestimated the lethality.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    A systematic review reported that about 16% of people with a self-harm attempt repeated it within 1 year, with no significant change in this proportion across studies over the past 3 decades.

    “a systematic review on repeated self-harm injuries reported that about 16% of individuals with a self-harm attempt repeated the attempt within 1 year of the event, with no significant change in this proportion across studies over the past 3 decades.50,51”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [50]

      Not checked in the free run.

    • cites [51]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    It remains unclear how the conclusions from this analytic approach compare with those from the recommended general framework.

    “Thus, it is unclear how the conclusions of our analytic approach differ from those of the recommended general framework.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductcitation

    In NIS and NEDS, about 90% of records with injury as the primary diagnosis listed E codes, and this percentage was stable during the study period; therefore, E-code underreporting was not a major problem.

    “In NIS and NEDS, approximately 90% of records with injury as a primary diagnosis listed E codes, and this percentage remained stable during the study period 49 ; thus, underreporting of E codes was not a major issue in this study.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [49]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation

    A record-level approach for analyzing trends in complex survey data is recommended.

    “A record-level approach to analyzing the trends in complex survey data is recommended, 52”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [52]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Brent et al found that parental prescription opioid use was associated with a higher risk of suicide attempts in their children.

    “Furthermore, Brent et al 41 found an association between parental prescription opioid use and higher risk of suicide attempts among their children”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41]

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The stable pattern of seeking medical care suggests that the observed increase in incidence cannot be explained by more treatment of less severe attempts over time and that trends based on treated cases may reflect trends based on all cases.

    “This stable pattern of seeking medical care suggests that (1) the increased incidence observed in the present study cannot be explained by the likelihood that less severe suicide attempts would be treated over time and (2) the trends based on treated cases may reflect the trends based on total cases.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Recent studies have reported increases in suicide attempts among adolescents.

    “Recent studies have shown increases in suicide attempts among adolescents.10,11”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [10] source

      Not checked in the free run.

    • cites [11] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A well-documented suicide paradox is that suicide attempt rates are higher in female individuals, while lethality is higher in male individuals.

    “A well-documented suicide paradox exists: suicide attempt rates are higher among female individuals, whereas lethality is higher among male individuals.6”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] source

      Not checked in the free run.

67 of 67

  • The authors state this as an assumption.

    Patients with deceased status at discharge were captured as suicides in death records.

    “Patients with a deceased status at discharge (n = 8951) were excluded, assuming they were captured as suicides in death records.”

  • The paper relies on this without support.

    The reasons for the increase in suicide rates remain unclear.

    “However, the reasons behind this increase remain unclear.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

  • The 2015 total case fatality rate does not match the reported counts

    Minor

    The table reports 40,474 suicides and 437,000 nonfatal attempts. Dividing suicides by all 477,474 suicidal acts gives 8.48%, which rounds to 8%, not the reported 9%.

    Reported 9 · recomputed 8.476692

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Center for Behavioral Health Statistics and Quality, 2016, 2015 National Survey on Drug Use and Health: Detailed Tables

Cited by

Sorted by citations

Related

Authors
Wang, J., Sumner, S. A., Simon, T. R., Crosby, A. E., Annor, F. B., Gaylor, E., Xu, L., & Holland, K. M.
Affiliations
Centers for Disease Control and Prevention (US)
Corresponding author
Wang, Jing
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2020-07-01
Volume
77
Issue
7
Pages
684
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2020.0596
PMC
PMC7177650
OpenAlex
W3017114859
Cited by
78
References
42
Citations by year
2026: 10 · 2025: 13 · 2024: 11 · 2023: 13 · 2022: 17 · 2021: 9 · 2020: 5
FWCI
4.40
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
  • Social Sciences › Health › Gun Ownership and Violence Research
Keywords
suicide, suicide incidence, suicide mortality, case fatality rate, sex differences, adolescents, older adults, temporal trends, United States, emergency department visits, inpatient care, suicide prevention, mental health services, addiction treatment, suicide prevention workforce, suicide prevention training
MeSH terms
Suicide, Completed, Adolescent, Adult, Aged, Child, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Suicide, Attempted, United States, Incidence, Databases, Factual, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-05.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-05.

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