Suicide risk awareness: Understanding characteristics of suicide attempts and intentional self-harm

Did you know that the risk for suicide attempts and intentional self-harm is highest on Mondays and lowest on Saturdays? Or that there’s a threefold difference in risk between the lowest and highest risk states? As increasing rates of suicide have become a growing concern in the U.S., Milliman’s consultants and researchers are working to leverage our expertise and data resources to help address this important issue. This blog post provides a preview of coming research from Milliman that will highlight some of the statistics regarding suicide attempts and intentional self-harm. Using large national research databases capturing administrative claims data for over 70 million Americans, we are able to shed light on the variation in risk of suicide attempts and intentional self-harm by age, sex, state, day of the week, and other features.1 Below are some of our early findings:

  • By age and sex.  We observed the highest rates of suicide attempts and intentional self-harm occurring between ages 15 to 18 for both males and females. The risk for males was highest at age 17 (19.9 individuals per 10,000 population), while the risk for females was significantly higher and peaked at age 16 (54.7 individuals per 10,000 population).
  • By day of the week.  We observed higher rates of suicide attempts and intentional self-harm occurring on Mondays as compared to other days of the week.
  • By state.  We found that the rates of suicide attempts and intentional self-harm were lowest in California (4.2 individuals per 10,000 population) and the highest in Utah (13.2 individuals per 10,000 population). 

According to the American Foundation for Suicide Prevention and data from the Centers for Disease Control and Prevention (CDC), 1.4 million people attempted suicide and over 47,000 people died by suicide in 2017 in the United States. Suicide rates in the United States have been increasing each year since 2000 and are now at the highest that they have been since the 1940s and World War II. This increase in suicide rates has been deemed an epidemic by some experts, and has devastating consequences for individuals, families, and communities.

While research indicates there is no single cause for the substantial increase in suicide rates since 2000; contributing factors may include:

  • Periods of stress or a lack of sense of security
  • Increased use of social media
  • Access to firearms
  • Opioid-related death
  • Better identification and reporting of attempts

Although the U.S. has faced continual increases in suicide attempt rates, other nations have made strides to alter this deadly curve. For example, Denmark’s rate fell from one of the highest in the world in the 1980s to one of the lowest in high-income nations by 2007 through a series of initiatives including restricted access to more dangerous methods of suicide,2 increased capacity in outpatient treatments, and implementation of suicide prevention clinics, which offer counseling, therapy, and support to those at risk. Our research databases allow us to explore characteristics of suicide attempts and intentional self-harm that are not readily captured in many public data sources. Stay tuned for our full report which will contain further details on the incidence and seasonality of suicide attempts and intentional self-harm, including details by age and sex, geography, insurance payer type, and changes over time, as well as further details regarding the specific categories of self-harm captured in our data, and the risks for repeated suicide attempts or intentional self-harm after an initial event. We hope that this information will be helpful to those working to address this important public health crisis.


 1 Milliman conducted an analysis of non-fatal suicide attempts in 2017 Milliman Consolidated Health Cost GuidelinesTM Sources Database and IBM Watson Health MarketScan Commercial Claims and Encounters Database, collectively representing over 70,000,000 lives.  
 2 Dangerous methods of suicide may include (but are not limited to) firearms, certain prescription drugs, and harmful chemicals or household gases.

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