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.
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This work was funded by the National Institute of Mental Health (R01-MH121410). The funder/sponsor had no role in the conception, design, or execution of the study.
Conflict of interest
JS and Columbia University declare partial ownership of SK Analytics. SK was a consultant for SK Analytics. JS was a consultant for BNI. KK has been compensated as an expert witness in litigation. No other disclosures were reported.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Tables and Figures Age, period, and cohort effects on suicide death in the US from 1999 to 2018: moderation by sex, race, and firearm involvement
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Martínez-Alés, G., Pamplin, J.R., Rutherford, C. et al. Age, period, and cohort effects on suicide death in the United States from 1999 to 2018: moderation by sex, race, and firearm involvement. Mol Psychiatry 26, 3374–3382 (2021). https://doi.org/10.1038/s41380-021-01078-1
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