They say government agencies always wait until late Friday to release bad news, so when I got an email at 4:36 p.m. on Friday, Nov. 1 from the Orange County Health Care Agency announcing that it had just released its new report on suicide deaths in the county from 2014 to 2018, I knew the results wouldn’t be good.

Though the report notes that the county “tends to have lower suicide rates compared to the nation and state of California” and “has never exceeded national rate of suicide death for the past two decades,” the rate of suicide in Orange County in 2018 was at an “all-time high” for the 21st century. What’s more, the report states that “OC’s suicide rate has been steadily increasing about 1.3 percent per year since 2000.”

There were 10.8 suicide deaths per 100,000 individuals in Orange County in 2018, according to the report. The suicide rate for California in 2017 (the most recent available year) was about 10.5 per 100,000, and the rate for the nation in 2017 was 14 per 100,000.

The report also notes very specific, and troubling, demographic patterns to suicide in Orange County.

“The most at-risk demographic groups in Orange County were predominantly White, male, middle-aged and older adults,” states the report. “Geographically, the cities most affected by higher suicide rates generally have larger populations fitting this demographic profile (55 years and older and White), usually coastal cities, compared to their inland neighbors.”

The numbers are stark. Whites accounted for 68 percent of all suicides in Orange County from 2014 to 2018, with Hispanics coming in at 16 percent, Asian/Pacific Islanders at 12 percent, Blacks at 1 percent and “other” at 2 percent. Furthermore, 75 percent–fully three-quarters–of those who killed themselves in the period were men.

In terms of age, seniors had the highest suicide rates in the county. “[T]hose 85 years and older had the highest age-specific rate of 19.5 deaths per 100,000, almost double the county rate of suicide,” states the report. “Middle-aged persons, 45 to 54 years (n=319) and 55 to 64 years (n=324) had the highest total number of suicide deaths during this five-year period.”

Suicides were also distributed unevenly throughout the county. Coastal cities like Seal Beach, Laguna Beach and

Dana Point saw comparatively high rates of suicide, while other cities like Stanton, Placentia and Anaheim had far lower rates.

About a third of Orange County suicides were by strangulation, another third were by firearm and the remainder was a mix of other methods, states the report.

I asked county health officials why the statistics broke this way, but they really couldn’t say.

“On a national basis, suicide rates for youth and young adults are on the rise,” said Dr. Jeffrey Nagel, Director of Behavioral Health Services with the OC Health Care Agency, in a Nov. 4 email. “Multi-pronged suicide prevention strategies for all age groups, including youth and young adults, is a continuing priority for the County of Orange and the OC Health Care Agency.”

Nagel further elaborated on the overall difficulty of explaining suicide:

Suicide deaths are complex, often with many contributing factors, which increase the risk including: previous suicide attempts, mental illness, substance use disorders, trauma (resulting from physical abuse, bullying, active combat), recent losses, painful physical illnesses, and access to lethal means. Suicide is associated with several risk and protective factors. Suicide, like other human behaviors, has no single determining cause. Instead, suicide occurs in response to multiple biological, psychological, interpersonal, environmental and societal influences that interact with one another, often over time. The social ecological model—encompassing multiple levels of focus from the individual, relationship, community, and society—is a useful framework for viewing and understanding suicide risk and protective factors identified in the literature. Risk and protective factors for suicide exist at each level. For example, risk factors include: • Individual level: history of depression and other mental illnesses, hopelessness, substance use, certain health conditions, previous suicide attempt, violence victimization and perpetration, and genetic and biological determinants • Relationship level: high conflict or violent relationships, sense of isolation and lack of social support, family/ loved one’s history of suicide, financial and work stress • Community level: inadequate community connectedness, barriers to health care (e.g., lack of access to providers and medications) • Societal level: availability of lethal means of suicide, unsafe media portrayals of suicide, stigma associated with help-seeking and mental illness.

I also sent a copy of the report to the American Foundation for Suicide Prevention (AFSP) and asked the same questions I asked the county.

“The big answer is we don’t know,” said Alexis O’Brien, an AFSP spokesperson. “But the numbers mimic what’s happening on the national scale.”

O’Brien also noted that though suicide is the 10th leading cause of death in the United States, it isn’t really thought of in those terms. Nor is there a large, concerted effort, she said, to combat it in the same way national efforts are made to fight cancer, heart disease and so forth (not that those diseases are getting too much money or resources).

The rise of men killing themselves has been happening in the U.S. for some years now. In this June 28, 2018 Slate story, Gary Barker of the Brazilian nonprofit organization Promundo advances a possible sociological explanation: the historic socialization of men to suppress their emotions.

“Quite simply, if men can’t recognize negative or troubling emotions, and can’t or don’t seek help or talk about them, we don’t know what to do when we face them,” Barker wrote. “Our ideas about manhood mean that asking for help is seen as weak, feminine, or even gay. Seeking medical support and mental health support by men is not only frowned upon, but also seen as unmanly. To even recognize pain—physical or emotional—is to risk being told by your male friends or family that you’re not a ‘real man.'”

It’s a complex but compelling theory, which Barker further elaborates here:

Suicide is far more common among white men in the U.S., the same category of men who feel the world owes them a well-paying stable job, and the respect that comes with that. They have lost employment or face a personal stress, often divorce or estrangement from their families. Current data show that between 1 in 4 and 1 in 5 working-age men—about 20 million—aren’t working, three to four times what it was during the 1950s. Many men among those feel a sense of what sociologist and masculinities expert Michael Kimmel calls “aggrieved entitlement.”

Like Nagel said above, there is no single cause for a person’s suicide. But if society itself is contributing to a rise in people’s decisions to end their lives, then we all bear some responsibility for finding out why, and doing what we can to make things better.

Also, on a personal note, I should note that two close friends of mine have ended their lives. I wrote about both. The first happened when I was in high school, though I did not discover the truth about that until last year. You can read about him here. Another friend killed himself in 2014, six months after he was honorably discharged from the U.S. Army. You can read about him here.

The national suicide prevention hotline is 800-273-8255. Please call if you, or someone you know, is contemplating suicide.