Deborah M Stone

• ScD, MSW, MPH
• Researcher at U.S. Department of Health and Human Services

Introduction Approximately 49,000 persons died by suicide in the United States in 2022, and provisional data indicate that a similar number died by suicide in 2023. A comprehensive approach that addresses upstream community risk and protective factors is an important component of suicide prevention. A better understanding of the role of these facto...

Objectives. To examine trends in overdose deaths by intent and drug category to better understand the recent decrease in overdose suicides amid the overdose epidemic. Methods. We examined trends in rates of overdose deaths by intent (unintentional, suicide, or undetermined) across 9 drug categories from 1999 to 2022 using US National Vital Statisti...

To assist community leaders in public health, mental health, education, and other fields with developing a community response plan for suicide clusters or for situations that might develop into suicide clusters, in 1988, CDC published Recommendations for a Community Plan for the Prevention and Containment of Suicide Clusters (MMWR Suppl 1988;37[No....

This is the third of three reports in the MMWR supplement that updates and expands CDC’s guidance for assessing, investigating, and responding to suicide clusters based on current science and public health practice. The first report, Background and Rationale — CDC Guidance for Communities Assessing, Investigating, and Responding to Suicide Clusters...

This report is the second of three reports in the MMWR supplement updating CDC’s guidance for investigating and responding to suicide clusters. The first report, Background and Rationale — CDC Guidance for Assessing, Investigating, and Responding to Suicide Clusters, United States, 2024, describes an overview of suicide clusters, methods used to de...

The suicide rate among the U.S. working-age population has increased approximately 33% during the last 2 decades. To guide suicide prevention strategies, CDC analyzed suicide deaths by industry and occupation in 49 states, using data from the 2021 National Vital Statistics System. Industry (the business activity of a person's employer or, if self-e...

Importance: Suicide prevention is an important component of depression management. Knowledge about depressed adolescents with increased risk for suicide can inform suicide prevention efforts. Objective: To describe the risk of documented suicidal ideation within a year following a diagnosis of depression and to examine how the risk of documented...

Examine characteristics associated with increased odds of nonfatal suicidal behaviors among former active-duty servicemembers (F-ADSM) using data from the 2013–2019 National Survey on Drug Use and Health (NSDUH). F-ADSM were respondents who reported being separated/retired from the military and previously serving on active-duty. For each outcome of...

Background Suicide disproportionately affects American Indians/Alaska Native persons (AI/AN), and in 2020 non-Hispanic AI/AN persons had the highest rate of suicide (27.7 per 100,000); nearly double their rate in 2000. Aim These data will examine associated characteristics and circumstances of suicide between AI/AN and non-AI/AN populations to inf...

Compared with the general U.S. population, American Indian or Alaska Native (AI/AN) persons, particularly those who are not Hispanic or Latino (Hispanic) AI/AN, are disproportionately affected by suicide; rates among this group consistently surpass those among all other racial and ethnic groups (1). Suicide rates among non-Hispanic AI/AN persons in...

Introduction Suicide among males is a major public health challenge. In 2019, males accounted for nearly 80% of the suicide deaths in the U.S., and suicide was the eighth leading cause of death for males aged ≥10 years. Males who die by suicide are less likely to have known mental health conditions than females; therefore, it is important to identi...

Introduction: The majority of homicides (79%) and suicides (53%) in the United States involved a firearm in 2020. High firearm homicide and suicide rates and corresponding inequities by race and ethnicity and poverty level represent important public health concerns. This study examined changes in firearm homicide and firearm suicide rates coincidi...

Introduction This study compares rural and urban differences in the rates of nonfatal self-harm in the U.S. in 2018. Methods Nationwide Emergency Department Sample and Census data were analyzed to calculate the RR of emergency department visits for self-harm between rural and urban residents. The analyses were conducted in 2021. Results Among a w...

In 2020, suicide was the 12th leading cause of death for all ages in the United States, changing from the 10th leading cause in 2019 due to the emergence of COVID-19 deaths and increases in deaths from chronic liver disease and cirrhosis (1). As the second leading cause of death in people aged 10-34 and the fifth leading cause in people aged 35-54,...

Suicide was among the 10 leading causes of death in the United States in 2020 among persons aged 10-64 years, and the second leading cause of death among children and adolescents aged 10-14 and adults aged 25-34 years (1). During 1999-2020, nearly 840,000 lives were lost to suicide in the United States. During that period, the overall suicide rate...

Firearm homicides and suicides represent an ongoing public health concern in the United States. During 2018-2019, a total of 28,372 firearm homicides (including 3,612 [13%] among youths and young adults aged 10-19 years [youths]) and 48,372 firearm suicides (including 2,463 [5%] among youths) occurred among U.S. residents (1). This report is the fo...

To examine the association between child neglect and adult suicide risk as well as the underlying mechanism. Adults aged 18 or older from the National Epidemiological Survey on Alcohol and Related Conditions Wave 3 who did not have suicide attempts before 18 were included (N = 35,275). Child neglect was categorized into emotional and physical negle...

Introduction: It is widely accepted that suicides—which account for more than 47 500 deaths per year in the United States—are undercounted by 10% to 30%, partially due to incomplete death scene investigations (DSI) and varying burden-of-proof standards across jurisdictions. This may result in the misclassification of overdose-related suicides as ac...

Beginning in March 2020, the COVID-19 pandemic and response, which included physical distancing and stay-at-home orders, disrupted daily life in the United States. Compared with the rate in 2019, a 31% increase in the proportion of mental health-related emergency department (ED) visits occurred among adolescents aged 12-17 years in 2020 (1). In Jun...

This study examined the effectiveness of LET’s CONNECT (LC), a community mentorship program based on the positive youth development model. Participants were 218 youth (66.5% girls), ages 12 to 15, who reported peer victimization, bullying perpetration, and/or low social connectedness. These youth were randomized to LC or the control group (communit...

Suicide is the 10th leading cause of death in the United States overall, and the second and fourth leading cause among persons aged 10-34 and 35-44 years, respectively (1). In just over 2 decades (1999-2019), approximately 800,000 deaths were attributed to suicide, with a 33% increase in the suicide rate over the period (1). In 2019, a total of 12...

Importance: The coronavirus disease 2019 (COVID-19) pandemic, associated mitigation measures, and social and economic impacts may affect mental health, suicidal behavior, substance use, and violence. Objective: To examine changes in US emergency department (ED) visits for mental health conditions (MHCs), suicide attempts (SAs), overdose (OD), an...

Suicide is the second leading cause of death among high school-aged youths 14-18 years after unintentional injuries. This report summarizes data regarding suicidal ideation (i.e., seriously considered suicide) and behaviors (i.e., made a suicide plan, attempted suicide, and made a suicide attempt requiring medical treatment) from CDC's 2019 Youth R...

Lesbian, gay, and bisexual (LGB) youths continue to experience more violence victimization and suicide risk than heterosexual youths; however, few studies have examined whether the proportion of LGB youths affected by these outcomes has varied over time, and no studies have assessed such trends in a nationally representative sample. This report ana...

Objectives To determine whether peer companionship delivered by an aging services agency to socially-disconnected older adult primary care patients was associated with improvement in suicidal ideation depression, anxiety, and psychological connectedness. Design Pragmatic, non-blinded, parallel-group, randomized controlled trial comparing peer comp...

Objectives. To document the increasing influence of firearm suicide on the incidence of traumatic brain injury (TBI)–related death in the United States. Methods. We used national vital statistics data from 2008 to 2017 to identify TBI-related deaths, overall and by cause, among US residents. National counts stratified by year, sex, and age group (t...

PurposeMiddle-aged men are at high risk of suicide. While about half of those who kill themselves visit a primary care clinician (PCC) shortly before death, in current practice, few spontaneously disclose their thoughts of suicide during the visits, and PCCs seldom inquire about such thoughts. In a randomized controlled trial, we examined the effec...

Suicide is a growing public health problem in the United States, claiming approximately 47,000 lives in 2017 (1). However, deaths from suicide represent only a small part of a larger problem because each year millions of persons experience suicidal ideation and engage in suicidal and nonsuicidal self-directed violence, both risk factors for suicide...

In 2017, nearly 38,000 persons of working age (16-64 years) in the United States died by suicide, which represents a 40% rate increase (12.9 per 100,000 population in 2000 to 18.0 in 2017) in less than 2 decades.* To inform suicide prevention, CDC analyzed suicide data by industry and occupation among working-age decedents presumed to be employed a...

Objective To describe epidemiological characteristics of emergency department (ED) visits related to suicidal ideation (SI) or suicidal attempt (SA) using syndromic surveillance data.IntroductionSuicide is a growing public health problem in the United States.1 From 2001 to 2016, ED visit rates for nonfatal self-harm, a common risk factor for suicid...

Objective To describe national-level trends in nonfatal self-harm and suicidal ideation among 10-19 year old youth from January 2016 through December 2017 and examine the impact of popular entertainment on suicidal behavior.IntroductionIn 2016, a half million people were treated in U.S. emergency departments (EDs) as a result of self-harm. 1 Not on...

Introduction: This study describes characteristics of nonfatal self-inflicted injuries and incidence of repeat self-inflicted injuries among a large convenience sample of youth (aged 10-24 years) with Medicaid or commercial insurance. Methods: In 2018, Truven Health MarketScan medical claims data were used to identify youth with a self-inflicted...

Purpose: The aim was to assess the associations of antibullying U.S. state statutes that enumerate sexual orientation with exposure to bullying and other stressors and with suicidal ideation and suicide attempts in sexual minority and non sexual minority youth. Methods: We analyzed data from the 2015 national school-based Youth Risk Behavior Sur...

During 2000-2016, the suicide rate among the U.S. working age population (persons aged 16-64 years) increased 34%, from 12.9 per 100,000 population to 17.3 (https://www.cdc.gov/injury/wisqars). To better understand suicide among different occupational groups and inform suicide prevention efforts, CDC analyzed suicide deaths by Standard Occupational...

Youths identifying as lesbian, gay, bisexual, or another nonheterosexual identity (sexual minority youths) report more violence victimization, substance use, and suicide risk than do heterosexual youths (1). These disparities are generally attributed to minority stress (the process through which stigma directed toward sexual minorities influences h...

Background Non-fatal self-inflicted (SI) injuries may be underidentified in administrative medical data sources. Objective Compare patients with SI versus undetermined intent (UI) injuries according to patient characteristics, incidence of subsequent SI injury and risk factors for subsequent SI injury. Methods Truven Health MarketScan was used to...

Objectives: Nearly half of all men who die by suicide visit a primary care clinician (PCC) in the month before death, yet few disclose suicide thoughts. We solicited stakeholders' views to guide development of a tailored multimedia program to activate middle-aged men experiencing suicide thoughts to engage with PCCs. Methods: We conducted semi-s...

Introduction: Suicide rates in the United States have risen nearly 30% since 1999, and mental health conditions are one of several factors contributing to suicide. Examining state-level trends in suicide and the multiple circumstances contributing to it can inform comprehensive state suicide prevention planning. Methods: Trends in age-adjusted s...

This study examined the effectiveness of LET's CONNECT (LC), a community mentorship program for youths who report peer social problems, which is based on a positive youth development framework. Participants were 218 youths (66.5% girls), aged 12 to 15 years, who were recruited from an urban medical emergency department and screened positive for bul...

In the United States, youth have the highest burden of nonfatal self-inflicted injury (ie, deliberate physical harm against oneself, inclusive of suicidal and nonsuicidal intent) requiring medical attention.¹ One study found that emergency department (ED) visits for these injuries during the 1993 to 2008 period varied by age group, ranging from 1.1...

Youth who feel connected to people and institutions in their communities may be buffered from other risk factors in their lives. As a result, increasing connectedness has been recommended as a prevention strategy. In this study, we examined connectedness among 224 youth (ages 12–15), recruited from an urban medical emergency department, who were at...

Manner of death (MOD) classification (i.e., natural, accident, suicide, homicide, or undetermined cause) affects mortality surveillance and public health research, policy, and practice. Determination of MOD in deaths caused by drug intoxication is challenging, with marked variability across states. The Centers for Disease Control and Prevention hos...

Garcia-Williams, A. G., Stone, D., Holland, K, Bartholow, S., Gabree, S., Reed, J. (2017, April). Epidemiology of railway suicide deaths - National Violent Death Reporting System, 18 states, United States, 2003-2014. Poster presentation at the 66th Annual Epidemic Intelligence Service Conference, Atlanta, GA.

Suicide is a major and continuing public health concern in the United States. During 1999-2015, approximately 600,000 U.S. residents died by suicide, with the highest annual rate occurring in 2015 (1). Annual county-level mortality data from the National Vital Statistics System (NVSS) and annual county-level population data from the U.S. Census Bur...

Background Physicians play a major role in influencing acceptance and uptake of vaccines. However, little is known about physicians’ perspectives on influenza vaccination of pregnant women in Thailand, for whom vaccine coverage is estimated at <1%. Method In 2013, a self-administered questionnaire on physicians’ perceptions, attitudes and practice...

(CSV)

(XLSX)

Introduction: Between 1999 and 2013, rates of suicide in mid-life increased more than 30%. The purpose of this study is to examine life stressors impacting middle-aged suicide, to determine whether these stressors vary by sex, and to explore their co-occurrence. Methods: A random sample of 315 men and 315 women aged 35-64 years was selected from...

In 2012, approximately 40,000 suicides were reported in the United States, making suicide the 10th leading reported cause of death for persons aged ≥16 years (1). 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 (1). To inform suicide prevention efforts, CDC analyzed suicide by occup...

Suicides among men aged 35-64 years increased by 27% between 1999 and 2013, yet little research exists to examine the nature of the suicide risk within this population. Many men do not seek help if they have mental health problems and suicides may occur in reaction to stressful circumstances. We examined the precipitating circumstances of 600 suici...

The impact of types of social connectedness-family, other adult, and school-on suicide ideation and attempts among all youth, the relative impact of each type, and effect modification by sexual orientation was assessed. Data were from the 2007-2009 Milwaukee Youth Risk Behavior Surveys. Multivariable logistic regression analyses calculated the risk...

Suicide is a public health problem affecting people across the lifespan. It is currently the 10th leading cause of death, with rates having remained relatively flat for the past century. This article summarizes the problem of suicide and suicidal behavior along with suicide prevention efforts in the United States. Part 1 provides an overview of the...

Objectives: We examined (1) whether sexual minority youths (SMYs) are at increased risk for physical dating violence victimization (PDVV) compared with non-SMYs, (2) whether bisexual youths have greater risk of PDVV than lesbian or gay youths, (3) whether youths who have had sexual contact with both sexes are more susceptible to PDVV than youths w...

Suicide is a public health problem affecting people across the lifespan. It is currently the 10th leading cause of death, with rates having remained relatively flat for the past century. This article summarizes the problem of suicide and suicidal behavior along with suicide prevention efforts in the United States. Part 1 provides an overview of the...

Objectives: We examined the associations between 2 measures of sexual orientation and 4 suicide risk outcomes (SROs) from pooled local Youth Risk Behavior Surveys. Methods: We aggregated data from 5 local Youth Risk Behavior Surveys from 2001 to 2009. We defined sexual minority youths (SMYs) by sexual identity (lesbian, gay, bisexual) and sex of...

Background: Youth dating violence is prevalent in the U.S. Victims of dating violence are more likely to have a variety of negative physical, social, and mental health outcomes. Despite extensive studies of dating violence in the general youth population, little research has been done on dating violence in lesbian, gay, and bisexual (LGB) youths....

There is a pressing public health need to find interventions that reduce suicide risk in later life. Psychiatric and physical illness, functional decline, and social factors place seniors at risk for suicide. Reflecting this body of evidence, the Centers for Disease Control and Prevention (CDC) has identified the promotion and strengthening of soci...

This chapter describes the prevalence of early childhood trauma in the general population of the USA using data from the National Comorbidity Study-Replication (NCS-R). It discusses some of the methodological issues around assessing the prevalence of childhood trauma, focusing on estimates of child maltreatment as a specific example. The chapter ex...

Although injury is the leading cause of death for Americans aged 40 and under, curricula in U.S. Schools of Public Health rarely include training on injury prevention or control. Domestically and internationally, when the topic of injury is addressed, the focus is often on unintentional injuries. Yet intentional injuries from violence and self-harm...

Suicide is a serious public health problem, and training in suicide prevention has not kept pace with recent rapid growth of the field. To address this concern, the Harvard Injury Control Research Center and Education Development Center, Inc., launched the National Center for Suicide Prevention Training (NCSPT) with funding by the Maternal and Chil...

Suicide is a leading cause of death among youth, and schools have an important role to play in preventing suicide. Schools are the center of many adolescents' lives and they can influence students' personal and social development. Therefore, it is appropriate that the first line of suicide prevention strategies should lie within the educational sys...