More than half of those who died by suicide had not been diagnosed with a mental health condition, said Dr. Anne Schuchat, principal deputy director of the CDC. Other contributing factors to suicide can include substance use, financial issues and physical health.
Suicide prevention largely focuses on addressing mental health treatment, the CDC found, suggesting that a wider variety of preventive measures could be taken. The CDC's Vital Signs report notes that the rates of most causes of death have been declining. In addition, to better understand the circumstances surrounding suicide, they turned to more detailed information collected by 27 states on suicides that occurred in 2015. That is why the Centers for Disease Control and Prevention in Atlanta made a decision to take a comprehensive look at suicides from 1999 to 2016.
The report said people without known mental health problems were more likely to die by firearms than those with known mental health problems. The numbers were highest among non-Hispanic whites, and among those ages 45 to 65 years old.
Those two states also experienced the second and third biggest increases, more than 48 percent, in the period studied by the CDC. The rates declined slightly among Black men and people older than 75 during that time. The rate in the new CDC data was 15.4 per 100,000.
The past three decades have presented a morbid puzzle.
Vermont is home to a high proportion of white people, and whites as a group have higher suicide rates than ethnic groups.
The reasons are many, experts said. Montana, Idaho, the Dakotas, and Wyoming all saw increases between 38 and 58 percent. Among middle-aged people across the country, marriage rates have declined, and social isolation has increased.
That means any public health effort to reduce suicides can't exclusively focus on those who have reached out for help. But suicide is such an unpredictable, often impulsive act that no single intervention has proved sufficient.
"I hope people pay attention to those around them", Birndorf said.
Adults ages 45 to 64 had the largest increase in the suicide rate, from 13.2 suicides per 100,000 people in 1999 to 19.2 suicides per 100,000 in 2016.
"You may be thinking about it over time, but that moment when you actually make an attempt is a very short window", he explains.
"If you think of [suicide] as other leading causes of death, like AIDS and cancer, with the public health approach, mortality rates decline", Moutier said.
Public policy changes may also help. They were the source of about half of all suicides, the researchers say, and that percentage has stayed stable over the years.
Firearm ownership is common, and Delaney said "the literature is getting pretty strong" that states with easier access to guns have higher suicide rates. "Our findings show that these laws are associated with reduced gun suicide rates".
The data also shows that about 22%-24% of people who died by suicide, regardless of whether or not they had a diagnosed mental health condition, disclosed their intent at some point, underscoring the importance of taking such comments seriously. Telling someone you care and want to help is always a good idea, and so is letting them do most of the talking about how they're feeling, without judging, shaming, or threatening.