Rising US suicides: Achieving health equity

Evidence suggests that increased availability of mental health treatment has not significantly reduced depression prevalence and suicide in the US, and that significant personal (i.e., stigma) or practical/logistical barriers to effective mental health care remain. Mental health treatment has increased in the US since the early 1990s with greater use of antidepressant medications, especially SSRIs, however suicide rates continue to climb, with significant gender, ethnic, geographic, socioeconomic, and other health disparities. Depression rates are at best stable, but are increasing in certain subpopulations such as youths ages 12-17. Combating these distressing trends to achieve health equity will require more attention to promising and evidencebased, sustainable, proactive, practical solutions that address the varied causes, demographics, and differential risk factors and mechanisms of suicide deaths. Herein we explore sociodemographic
disparities that exist in suicide deaths, with emphasis on two of the largest modifiable targets for suicide prevention: untreated or undertreated depression, and access to the lethal means (firearms) that cause more suicide deaths than all other means combined, and thus pose the greatest threat to individual and public health. Furthermore, we newly define increased or unsafe (i.e. disparate) access to firearms as a suicide health disparity that promotes health inequities. To achieve the greatest results in suicide prevention across all groups, we need 1) more emphasis on policies and universal programs shown to reduce suicidal behaviors, and 2) enhanced focus on the two largest modifiable targets for suicide prevention: depression and firearms.