On July 1, 2016, the CDC reported that, in 2012, approximately 40,000 suicides were reported in the United States, making suicide the 10th leading reported cause of death for people 16 years old or older. From 2000 to 2012, rates of suicide among persons in this age group increased 21.1%, from 13.3 per 100,000 to 16.1.
To inform suicide prevention efforts, the CDC analyzed suicide by occupational group, by ascribing occupational codes to 12,312 suicides in the most recent data set available from the National Violent Death Reporting System (NVDRS), which includes data from 17 states from 2012. The frequency of suicide in different occupational groups was examined, and rates of suicide were calculated by sex and age group for these categories. Persons working in the farming, fishing, and forestry group had the highest rate of suicide overall (84.5 per 100,000 population) and among males (90.5); the highest rates of suicide among females occurred among those working in protective service occupations (14.1). Overall, the lowest rate of suicide (7.5) was found in the education, training, and library occupational group. Suicide prevention approaches directed toward people 16 years old or older that enhance social support, community connectedness, access to preventive services, and the reduction of stigma and barriers to help-seeking are needed.
The CDC’s NVDRS collects information on violent deaths, including suicides, from multiple sources, including death certificates, coroner and medical examiner reports, and law enforcement reports, to monitor trends, understand violent death characteristics and risk factors, and inform prevention efforts.
NVDRS Occupation Title and Industry Title fields were used to assign each suicide decedent to one of the major occupational groups defined by the national Standard Occupational Classification (SOC) system. The decedent’s usual occupation at the time of death was coded, and each decedent was assigned to only one occupational group. Additional codes for decedents who were classified as homemakers/housewives, students, never worked/disabled (and not working), retired, prisoners, unemployed, and self-employed (unspecified industry) were created by the authors.
Descriptive data were analyzed, including the number of suicides and rates of suicide by occupational group. Occupational groups were stratified by sex, and rates of suicide were calculated for each group using denominators derived from the U.S. Census Bureau’s Current Population Survey March Supplement, which includes a question about the person’s primary occupation during the previous calendar year. Rates were not calculated for occupation codes created by the authors, because the Current Population Survey data set does not provide denominator data for these groups. Because U.S. child labor laws prohibit persons under 16 years old from working full-time, only decedents people 16 years old or older were included. SOC code 55 (i.e., military specific occupations) was not included in the analysis because it was not possible to reliably determine whether these decedents were on active duty or retired, or what occupation they held in the military. If a decedent had a specific coded job and was employed by the military, that decedent was coded according to the occupation (e.g., an engineer working for the military would be included in the “Architecture and engineering” occupational group).
Among the 12,312 suicide decedents included in the 2012 data set, 9,509 (77.2%) were male, and 2,801 (22.8%) were female. Decedents ranged in age from 16 to 102 years. However, 84.5% were aged 16 to 64 years. Nearly one third of all suicides occurred among persons in the following four occupational groups: construction and extraction (1,324; 10.8%); management (1,049; 8.5%); production (953; 7.7%); and installation, maintenance, and repair (780; 6.3%). The highest proportion (22.7%) of suicides occurred among persons aged 45 to 54 years, and the lowest proportion (11.6%) occurred among persons aged 16 to 24 years.
Rates of suicide were highest in the following three occupational groups: farming, fishing, and forestry (84.5 suicides per 100,000 persons); construction and extraction (53.3); and installation, maintenance, and repair (47.9). Rates of suicide varied by sex, with higher rates among males than females in all occupational groups. Among males, the highest suicide rates were among persons in the following three occupational groups: farming, fishing, and forestry (90.5 per 100,000); construction and extraction (52.5); and installation, maintenance, and repair (47.5). Among females, the highest suicide rates occurred among persons in the following three occupational groups: protective service occupations (e.g., law enforcement officers and firefighters) (14.1 per 100,000); legal (13.9); and healthcare practitioners and technical (13.3).
Earlier studies of suicide by occupation type in the United States have examined one occupational group at a time, such as police suicides, or have studied data from a specific U.S. state. This analysis includes recent data from 17 states and an analysis by sex. The proportions of suicides among males (77.2%) and females (22.8%) in this analysis were similar to those reported nationally in 2012 (78.3% and 21.7%, respectively).
Occupational groups with higher suicide rates might be at risk for a number of reasons, including job-related isolation and demands, stressful work environments, and work-home imbalance, as well as socioeconomic inequities, including lower income, lower education level, and lack of access to health services. Previous research suggests that farmers’ chronic exposure to pesticides might affect the neurologic system and contribute to depressive symptoms. Other factors that might contribute to suicide among farmers include social isolation, potential for financial losses, barriers to and unwillingness to seek mental health services (which might be limited in rural areas), and access to lethal means. Construction workers might be at higher risk because of financial and interpersonal concerns related to lack of steady employment, and fragmented community or isolation. It has been hypothesized that one possible factor contributing to higher suicide risk among workers in installation, maintenance, and repair occupations might be long-term exposure to solvents that can cause neurotoxic damage, including memory impairment and depressive symptoms. Research has suggested that higher suicide rates among police are related to stressors including exposure to traumatic, violent, and lethal situations; work overload; shift work; and access to lethal means. Females in protective service occupations might also experience additional stressors in these traditionally male-dominated occupations. Of note, while management occupations had the 10th highest rate of suicide, they accounted for the second largest percentage of suicide deaths overall. Therefore, it is important to target prevention strategies to managers as well.
The findings in this report are subject to at least four limitations. First, for 729 (5.9%) cases, an occupation or workforce status could not be determined. Second, using an automated system such as NIOCCS, a computer algorithm, and human coders to assign occupation codes might introduce errors in categorizing industry and occupation. However, interrater reliability checks suggested a high level of consistency. Third, coding of industry and occupation in NVDRS, which uses open-ended fields, depends on the completeness of information available from the NVDRS data sources and accuracy of information provided by informants to these systems (e.g., coroner/medical examiner and family members). Variations in coding might occur depending on the abstractor’s amount of experience. For this reason, the CDC provides abstractor training, and states conduct blinded re-abstraction of cases to test consistency and identify training needs. Industry and occupation categories assigned in NVDRS are a decedent’s “usual occupation,” which might not reflect the decedent’s actual position or positions at the time of death. Finally, the 17 NVDRS states examined in this report are not nationally representative. Analyses of forthcoming data from the expansion of NVDRS into 32 states in 2014 might provide more representative findings, and permit examination of occupational trends over time.
Suicide prevention activities directed toward people 16 years old or older include enhancing connectedness to family and friends, encouraging help-seeking for persons exhibiting signs of distress or suicidality, and supporting efforts to reduce stigma associated with help-seeking and mental illness. Some potential suicide prevention strategies include workplace approaches, such as employee assistance programs, which might serve as gateways to behavioral health treatment. Workplace wellness programs can provide education and training for staff members and supervisors to aid in recognition of suicide warning signs (e.g., withdrawal, increased substance abuse, agitation, and putting affairs in order). Employers also can use technology to provide online mental health screenings, web-based tools for mental health information, and mental health screening kiosks for their employees, as well as ensure that employees are aware of the National Suicide Prevention Lifeline (1-800-273-8255).
The National Action Alliance for Suicide Prevention (NAASP) Workplace Task Force has developed a Comprehensive Blueprint for Workplace Suicide Prevention that addresses suicide prevention strategies, such as screening, mental health services and resources, suicide prevention training, life skills and social network promotion, and education and advocacy. The NAASP online site has resources targeted specifically to the construction and law enforcement industries. Evidence-based suicide prevention strategies implemented in the workplace have the potential to reduce the number of suicides among all occupational groups.
See the CDC Report
Also see the NAASP Comprehensive Blueprint for Workplace Suicide Prevention
See also Medical Law Perspectives, March 2015 Report: Post-Traumatic Stress Disorder: Diagnosis and Treatment Failures
See also Medical Law Perspectives, December 2014 Report: Beyond the Holiday Blues: When Depression Leads to Liability