Suicide by hanging and suffocation dramatically increased among middle-aged US citizens from 2000 through 2010, new research shows.

Investigators at Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland, found that the overall suicide rate in the United States increased by 16% from 2000 through 2010.

However, suicide by hanging and suffocation more than doubled during the study interval in individuals aged 45 to 59 years.

In suicide, suffocation occurs most commonly by hanging, but a person can also suffocate by putting a plastic bag over his or her head.

Suicide by hanging and suffocation also increased steadily in all other age groups except in individuals aged 70 years and older, among whom there was a slight decline in suicide overall.

Suicide by poisoning increased by 85% among individuals aged 60 to 69 years.

"Substantial increases in suicide by hanging/suffocation and poisoning merit attention from policymakers," the authors observe.

And they "call for innovations and changes in suicide prevention approaches."

The study is published in the December issue of the American Journal of Preventive Medicine.

More Deaths by Suicide

Suicide recently exceeded motor vehicle accidents as the leading cause of death by injury in the United States.

However, descriptions of how people commit suicide and details such as age and social influences have not been previously reported.

Investigators therefore obtained data from the Centers for Disease Control's Web-Based Injury Statistics Query and Reporting System (WISQARS) to measure the percentage change in suicide rates from 2000 through 2010.

Morbidity data used in WISQARs Nonfatal Injury Reports were obtained from an expansion of the National Electronic Injury Surveillance System (NEISS).

NEISS is based on data from roughly 500,000 injury-related emergency department cases a year.

In 2010, 38,364 suicides were reported in the United States at a case rate of 12.1 suicides per 100,000 population.

In 2000, the case rate was 10.4 suicides per 100,000 population.

"Taken together, suicide by firearm, hanging/suffocation, and poisoning constituted 93% of suicide by all methods," investigators note.

However, most of the increase in suicides from 2000 to 2010 was due to an increase in hanging and suffocation, from 19% of all suicides in 2000 to 26% of all suicides in 2010.

The authors also note that suicides by poisoning increased from 16% of all suicides in 2000 to 17% of all suicides in 2010.

In contrast, the proportion of suicides by firearm — although still the predominant method used — decreased from 56% in 2000 to 50% in 2010.

The suicide rate also declined by 8% among those aged 70 years and older.

Table: Hanging/Suffocation Suicide Rate per 100,000 Population by Age Group, 2000 – 2010 (US)

Age 2000 2010 Percentage Change in Rate All 2.0 3.1 52% 15 - 24 2.9 4.2 44% 25 - 44 3.1 4.6 47% 45 - 59 2.0 4.2 104% 60 - 69 1.2 2.1 77% ≥70 1.8 1.6 -13%

Special Concern

Suicide rates increased faster among women than among men. Suicide rates also increased in whites, Asians, and Native Americans, whereas they declined among blacks.

The case fatality rates for suicide by hanging and suffocation were close to those by firearm, ranging from 69% to 84%.

Specifically, in 2010, case fatality rates were 81% for suicide by firearm, 75% for hanging/suffocation, and 2% for poisoning.

"The increase in suicide was evident beginning in 2001, prior to the economic downturn," the authors write.

However, the increase accelerated after 2005 and may have been influenced by the recession, they add.

The authors also note that the dramatic increase in suicide by hanging/suffocation in the United States is of "special concern" because of the widespread availability of rope and other accessories used in hanging.

Strategies to prevent hanging within inpatient settings might include installation of break-away closet bars, lowering the height of anchor points, and increased awareness of risk indicators.

The authors have disclosed no relevant financial relationships.

Am J Prev Med. Full article