Suicide rate up in all regions of Washington — but why? ‘No one is exactly sure,’ expert says

Suicide is, for most of us, an uncomfortable subject, one we’d rather not talk about. But last week, two prominent people took their own lives — designer Kate Spade and chef/author Anthony Bourdain — and that’s sparked a national conversation on the topic. Adding to the discussion, the Centers for Disease Control (CDC) released a report showing that the rates of suicide are on the rise in nearly every state.

Washington is among them. From 2014 to 2016, Washington’s suicide rate was 15.1 deaths per 100,000 people. That represents a 19 percent increase from the rate in the period from 1999 to 2001.

There are now more than 1,110 suicide deaths a year in the state, making it the eighth leading cause of death here. And for Washingtonians between the ages of 15 and 34, it ranks as the No. 2 cause, after accidental injuries.

I looked at the CDC data for different regions of the state, and all show an increased rate of suicide. In Puget Sound counties outside the Seattle metro area, the rate has gone up the most, by about 29 percent since the period from 1999 to 2001. The smallest increase is in the southwestern part of the state, at 11 percent. In the Seattle metro (King, Pierce and Snohomish counties), the rate increased by 15 percent.

Why are suicide rates on the rise?

“That’s the question that’s at the front of everyone’s mind in suicide prevention,” said Christopher DeCou, senior fellow at Harborview Injury Prevention and Research Center, which is affiliated with the University of Washington and Harborview Medical Center in Seattle. “The unsatisfying answer is that no one is exactly sure why the rates are continuing to go up, despite the tremendous effort to try to understand the reasons people hurt or kill themselves.”

The CDC data show that southwestern Washington has the state’s highest suicide rate, at 17.8 deaths per 100,000 people. The rate in the easternmost part of the state, and in the Puget Sound counties outside the Seattle area, are only a little lower.

The Seattle area suicide rate is 13.7 deaths per 100,000 people, the lowest in the state.

Data show that rural places have consistently higher rates of suicide than metropolitan areas. We see this in Washington and among the 50 states. Montana has the highest suicide rate, followed by two other sparsely populated states, Alaska and Wyoming. The lowest rates are in the more urbanized Northeast: New Jersey, New York and Massachusetts, in that order.

A major factor behind this difference, DeCou says, is that there’s less access to health care, particularly for mental health, in rural areas. Other risk factors for suicide that can be higher in rural areas include social isolation, rates of alcoholism or drug abuse, and gun-ownership rates (nationally, about half of all suicides are carried out with a firearm).

The suicide rate for men, both in Washington and nationally, is more than three times higher than for women. One of the factors behind that higher rate is that men are much more likely to use a highly lethal means, such as a gun.

Although the suicide rate for men is much higher, the rate for women has been increasing faster. We see this at the state level and nationally, but the reasons behind are not well understood, DeCou says. Women represent about one out of four suicides in Washington, up from one out of five.

Among racial or ethnic groups, both in Washington and nationally, Native Americans have the highest rate of suicide, followed by whites. Latinos, blacks and Asians have a significantly lower rate.

White middle-aged men (age 45 to 54) are a particularly high-risk demographic, representing one out of eight suicides in Washington. Other groups known to have alarmingly high suicide rates nationally are veterans and transgender people.

DeCou says that when a particular subpopulation has a higher rate of suicide, it’s important not to conclude that there is something inherently more at risk about people in that group, but instead to look for the reasons behind it. For example, among Native Americans, limited access to resources and historical trauma are factors that contribute to the increased risk of suicide, he says.

It’s also important to keep in mind that suicide, while not predictable, is often preventable, DeCou says.

“Many people, when they hear about a suicide — especially a celebrity suicide — they think it’s something that happens out of the blue, that it’s sudden,” he said. But in fact, research shows that the process leading up to a person inflicting self-harm is very gradual, and there are many potential points of intervention along the way.

Washington has taken steps to increase the likelihood of such interventions. Forefront, a suicide-prevention center at the University of Washington’s School of Social Work, has successfully advocated for legislation directed at preventing suicide.

In 2012, Washington became the first state in the nation to require all health-care providers — from physicians to physical therapists to pharmacists — to complete training in approaches to suicide risk assessment, management and treatment. This is an important step in prevention because, while many people who die by suicide do not receive mental health counseling, they commonly interact with other types of health-care providers in the months before the suicide.

Forefront is also involved in the “Safer Homes” initiative, a public-health campaign to educate individuals on safe storage of firearms and medications. Placing a barrier between a person who is having a mental-health crisis and the means to access guns or medications is a key approach to suicide prevention.

In addition to other suicide-prevention programs, Forefront provides support to people who are grieving the loss of someone to suicide through their Forefront Cares program.