CoChat
Sign Up
Cited by 52Suicide and Self-Harm StudiesHomicide, Infanticide, and Child AbuseGun Ownership and Violence Research

Age, period, and cohort effects on suicide death in the United States from 1999 to 2018: moderation by sex, race, and firearm involvement

Open access
Martínez-Alés, Gonzalo, Pamplin, John R., Rutherford, Caroline, Gimbrone, Catherine, Kandula, Sasikiran, Olfson, Mark, Gould, Madelyn S., Shaman, Jeffrey +1 more·2021·Molecular Psychiatry
DOI 10.1038/s41380-021-01078-1PMC PMC8670065
Open this paper in CoChat — free account

Abstract

The role of sex, race, and suicide method on recent increases in suicide mortality in the United States remains unclear. Estimating the age, period, and cohort effects underlying suicide mortality trends can provide important insights for the causal hypothesis generating process. We generated updated age-period-cohort effect estimates of recent suicide mortality rates in the US, examining the putative roles of sex, race, and method for suicide, using data from all death certificates in the US between 1999 and 2018. After designating deaths as attributable to suicide according to ICD-10 underlying cause of death codes X60-X84, Y87.0, and U03, we (i) used hexagonal grids to describe rates of suicide by age, period, and cohort visually and (ii) modeled sex-, race-, and suicide method-specific age, period, and cohort effects. We found that, while suicide mortality increased in the US between 1999 and 2018 across age, sex, race, and suicide method, there was substantial heterogeneity in age and cohort effects by method, sex, and race, with a first peak of suicide risk in youth, a second peak in older ages—specific to male firearm suicide, and increased rates among younger cohorts of non-White individuals. Our findings should prompt discussion regarding age-specific clinical firearm safety interventions, drivers of minoritized populations’ adverse early-life experiences, and racial differences in access to and quality of mental healthcare.

Integrity signals

Registry

Crossref · 10.1038/s41380-021-01078-1

Cites

51 of 51 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 28 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    From 1999 through 2018, suicide death rates rose in the US for every age, sex, race, and method group.

    “We found that, while suicide mortality increased in the US between 1999 and 2018 across age, sex, race, and suicide method, there was substantial heterogeneity in age and cohort effects by method, sex, and race, with a first peak of suicide risk in youth, a second peak in older ages—specific to male firearm suicide, and increased rates among younger cohorts of non-White individuals.”
    • Also stated in: § Discussion · plain
      “Suicide mortality increased in the US between 1999–2018 regardless of method, sex, race, age, and birth cohort.”
    Quote in the paperSubstantial claim
  • Findingown data

    There was evidence of increasing non-firearm suicides after 2010 for all racial groups.

    “By period, there was evidence of increasing non-firearm suicides after 2010 for all racial groups.”
    Quote in the paperSubstantial claim
  • Findingown data

    There was roughly no cohort effect in non-firearm suicide among American Indian/Alaska Native men.

    “There was roughly no cohort effect in non-firearm suicide among American Indian/Alaska Native men.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Period effects showed increasing non-firearm suicide in recent years across all racial groups.

    “Additionally, period effects indicate an increase in non-firearm suicide in recent years as well, across all racial groups.”
    Quote in the paperSubstantial claim
  • Findingown data

    White men had the highest non-firearm suicide rate after age 40.

    “White men had the highest rate of non-firearm suicides after age 40.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 19
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 7

  • May combine two claims.

    Findingown data

    Women had lower rates of firearm and non-firearm suicide than men, and no elderly spike in firearm suicide.

    “Compared with men, women had lower rates of both firearm and non-firearm suicide, and there was no spike in firearm suicide among the elderly (Fig. 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Firearm suicide rates fell through 2010 but then began to rise for all racial groups.

    “Period effects indicate that firearm suicide rates decreased through 2010 but began to increase soon after, for all groups.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The period effect for firearm suicide risk decreased between 1999 and 2010, while non-firearm suicide increased over the entire study period.

    “While the period effect of firearm suicide risk decreased between 1999 and 2010, non-firearm suicide increased over the whole study period.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Among White men, those born in the 1950s-1960s had the highest non-firearm suicide cohort effects compared with earlier and later-born cohorts.

    “Among Whites, those born in the 1950s–1960s had the highest cohort effects compared to earlier and later-born cohorts.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Non-firearm suicide rates were lower than firearm rates but followed similar trends, except there was no excess among older men.

    “For non-firearm suicides, rates were lower than for firearm suicide, yet trends were similar, save for the lack of excess deaths among older men.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Firearms were the most common method of suicide death, comprising 56.8% of deaths in 1999 and 49.8% in 2015.

    “The modal method of suicide death was firearms (ranging from 56.8% of suicide deaths in 1999 to 49.8% in 2015).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For White men, the young adulthood firearm suicide peak occurred later and the subsequent decline was smaller and shorter.

    “On the other hand, among White men, the young adulthood peak in firearm suicide rate occured later and the subsequent decline was smaller and of shorter duration.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Black men born in younger cohorts (1990-2010) had elevated non-firearm suicide risk, higher than any earlier born cohort.

    “By cohort, Black and especially Asian/Pacific Islander men born into younger cohorts (1990–2010) exhibited elevated non-firearm suicide risk; for Black men the risk was higher than in any earlier born cohort, while Asian/Pacific Islander men born earlier in the 20th century had comparably high suicide rates.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Suicide risk showed an early peak in youth and a later peak in older ages, with the later peak occurring only for male firearm suicide.

    “with a first peak of suicide risk in youth, a second peak in older ages—specific to male firearm suicide”
    • Also stated in: § Discussion · plain
      “there was a second peak in older ages, specific to male firearm suicide and especially salient among White men”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Firearm suicide risk was higher for Black men born between 1970 and the late 1990s, American Indian/Alaska Native men born about 1960-1985, and Asian/Pacific Islander men born after 1990.

    “Firearm suicide risk was higher for Black men born between 1970 and the late 1990s, American Indian/Alaska Native men born approximately between 1960 and 1985, and Asian/Pacific Islander men born after 1990.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Asian/Pacific Islander men born in younger cohorts (1990-2010) had elevated non-firearm suicide risk, while those born earlier in the 20th century had comparably high rates.

    “By cohort, Black and especially Asian/Pacific Islander men born into younger cohorts (1990–2010) exhibited elevated non-firearm suicide risk; for Black men the risk was higher than in any earlier born cohort, while Asian/Pacific Islander men born earlier in the 20th century had comparably high suicide rates.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Male non-firearm suicide had a young adulthood peak for all racial groups, especially American Indian/Alaska Native men, exceeding 20 suicides per 100,000 at age 20.

    “Age effects indicate a young adulthood peak for all racial groups, especially salient among American Indian/Alaska Native men (over 20 suicides per 100,000 at age 20).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Cohort effects were observed in firearm suicide among Black men born in the late 1970s/early 1980s and in non-firearm suicide among Black women born in the early 1980s.

    “Secondly, cohort effects were observed in firearm suicide among Black men born in the late 1970s/early 1980s and non-firearm suicide among Black women born in the early 1980s.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    A clear non-firearm suicide age effect affected younger ages across sex and race, except White women whose peak risk was around age 50, with decreases in older ages except Asian/Pacific Islander individuals.

    “A clear non-firearm suicide age effect affected people at younger ages across sex and races (except for white women, whose peak of risk takes place at around 50 years of age), with subsequent decreases in older ages (except for Asian/Pacific Islander individuals).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Our data showed the same pattern and extended it to Asian/Pacific Islander and American Indian/Alaska Native individuals.

    “Our data reflect the same pattern but extend it for Asians/Pacific Islanders and American Indian/Alaska Native as well.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Non-firearm suicide increased between 1999 and 2018 among all women, especially younger cohorts of non-White women.

    “This indicates that non-firearm suicide increased between 1999 and 2018 among all women, and especially among younger cohorts of non-White women.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Adding age, period, and cohort parameters improved model fit, and removing all of them reduced fit, indicating all three were sufficiently predictive for the final model.

    “Including age, period, and cohort parameters all improved model fit, and removing them all reduced model fit, indicating that all three parameters are sufficiently predictive of variance to be included in a final model.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Recent increases were most salient among females and males aged 10-44, males over 64, predominantly rural counties, and non-firearm suicides.

    “recent increases have been most salient among females and males aged 10–44 years, and males aged >64 years, as well as in predominantly rural counties, and for non-firearm suicides [4, 5]”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [4] Hedegaard H, Curtin SC, Warner M. Increase in suicide mortality in the United States, 1999–2018. NCHS Data Brief. 2020. https://www.cdc.gov/nchs/data/databriefs/db362-h.pdf. source

      Not checked in the free run.

    • cites [5] Baker SP, Hu G, Wilcox HC, Baker TD. Increase in suicide by hanging/suffocation in the U.S., 2000–2010. Am J Prev Med. 2013;44:146–9. source

      Not checked in the free run.

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

    Premisecitation

    Spikes in firearm purchases during 2020 seemingly interrupted that decline.

    “yet spikes in firearm purchases during 2020 have seemingly interrupted this trend [25]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] McKnight R, Levine PB. Three million more guns: The Spring 2020 spike in firearm sales. Brookings. Published July 13, 2020. https://www.brookings.edu/blog/up-front/2020/07/13/three-million-more-guns-the-spring-2020-spike-in-firearm-sales/. Accessed 2 Mar 2021.

      Not checked in the free run.

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

    Premisecitation

    The study used the United States as a whole unit of analysis, and there is long-standing evidence that suicide rates are much higher in sparsely populated Western noncoastal states.

    “Fourth, while we used the United States as a whole unit of analysis, there is long-standing evidence that suicide rates are much higher in sparsely populated Western noncostal states [43].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [43] Stone DM, Simon TR, Fowler KA, Kegler SR, Yuan K, Holland KM, et al. Vital Signs: Trends in state suicide rates—United States, 1999–2016 and circumstances contributing to suicide—27 states, 2015. Morb Mortal Wkly Rep. 2018;67:617–24. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Access to lethal means plays a critical role in suicide mortality risk.

    “Access to lethal means plays a critical role in suicide mortality risk [23].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23] Gunnell D, Eddleston M. Suicide by intentional ingestion of pesticides: a continuing tragedy in developing countries. Int J Epidemiol. 2003;32:902–9. source

      Not checked in the free run.

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

    Interpretationcitation

    These findings are consistent with recent increases in depression and suicidal ideation and behaviors among US adolescents.

    “These findings are consistent with recent increases in depression and suicidal ideation and behaviors among US adolescents [39–42].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [39] Mojtabai R, Olfson M, Han B. National trends in the prevalence and treatment of depression in adolescents and young adults. Pediatrics. 2016;138:e20161878. source

      Not checked in the free run.

    • cites [40] Keyes KM, Gary D, O’Malley PM, Hamilton A, Schulenberg JE. Recent increases in depressive symptoms among US adolescents: trends from 1991–2018. Soc Psychiatry Psychiatr Epidemiol. 2019;54:987–96. source

      Not checked in the free run.

    • cites [41] Plemmons G, Hall M, Doupnik S, Gay J, Brown C, Browning W, et al. Hospitalization for suicide ideation or attempt: 2008–2015. Pediatrics. 2018;141:e20172426. source

      Not checked in the free run.

    • cites [42] Centers for Disease Control and Prevention. Trends in the prevalence of suicide-related behaviors national YRBS: 1997–2017. Youth Risk Behav Surv. 2018. https://www.cdc.gov/healthyyouth/data/yrbs/pdf/trends/2017_suicide_trend_yrbs.pdf.

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    The validity of the results depends on the appropriateness of APC modeling, and all APC models are subject to identification issues that can cause misspecification.

    “Second, the validity of our results depends on the appropriateness of APC modeling. All age-period-cohort models are subject to limitations due to regression identification issues that render models potentially vulnerable to misspecification; however, we conducted extensive sensitivity analysis wherein we varied the reference periods and cohorts.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    A recent study of adults aged 50-84 who died by firearm suicide found a decreasing period effect in firearm suicide mortality among older adults.

    “A recent study analyzed data on adults aged 50–84 years who died by firearm suicide [19] and found a decreasing period effect in firearm suicide mortality among older adults.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Conner A, Azrael D, Miller M. Suicide case-fatality rates in the United States, 2007 to 2014. Ann Intern Med. 2019;171:885–95. source

      Not checked in the free run.

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

    Premisecitation

    Gun ownership slowly declined overall among Americans over the last three decades.

    “gun ownership has slowly declined overall among Americans over the last three decades [24]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] Smith TW, Son J. General Social Survey Final Report: Trends in Gun Ownership in the United States, 1972–2018. Published online in 2020. https://www.norc.org/Research/Projects/Pages/general-social-survey.aspx. Accessed 2 Mar 2021.

      Not checked in the free run.

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

    Premisecitation

    Previous studies reported that the age effect of suicide varies by race, with risk peaking at considerably earlier ages for Black individuals than White individuals.

    “Previous studies have reported an age effect of suicide that varies by race, such that risk peaks at considerably earlier ages for Black individuals relative to White individuals [18].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] Haviland MJ, Rowhani-Rahbar A, Rivara FP. Age, period and cohort effects in firearm homicide and suicide in the USA, 1983–2017. Inj Prev. 2020. https://doi.org/10.1136/injuryprev-2020-043714. source

      Not checked in the free run.

26 of 26

  • The paper relies on this without support.

    Age-period-cohort effects of suicide among racial groups other than Black and White have not been explored.

    “However, the age-period-cohort effects of suicide among people of other races remain unexplored.”

  • The paper relies on this without support.

    Little is known about the age, period, and cohort effects underlying increasing trends of adult non-firearm suicide.

    “Notwithstanding, little is known about the age, period, and cohort effects underlying increasing trends of adult non-firearm suicide.”
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?

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Martínez-Alés, G., Pamplin, J. R., Rutherford, C., Gimbrone, C., Kandula, S., Olfson, M., Gould, M. S., Shaman, J., & Keyes, K. M.
Affiliations
  • New York University (US)
  • Columbia University (US)
ORCID
Venue
Molecular Psychiatry
Publisher
Springer Science and Business Media LLC
Published
2021-04-07
Volume
26
Issue
7
Pages
3374-3382
ISSN
  • 1359-4184 (ISSN-L)
  • 1476-5578
DOI
10.1038/s41380-021-01078-1
PMC
PMC8670065
OpenAlex
W3150483004
Semantic Scholar
35310a51e35f03963e115c41660b3acb0d5af900
Cited by
52
References
50
Citations by year
2026: 6 · 2025: 6 · 2024: 10 · 2023: 15 · 2022: 8 · 2021: 7
FWCI
6.82
Type
journal article
Language
en
Open access
Licence
Locations
  • Molecular Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (R01MH121410)
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 mortality, age-period-cohort effects, suicide methods, firearm suicide, sex differences, racial disparities, youth suicide, cohort effects, suicide prevention, access to mental health care, United States
MeSH terms
Adolescent, Aged, Ethnicity, Humans, Male, Middle Aged, Suicide, United States, Violence, Cohort Effect

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.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review