GRAND FORKS-The suicide rate in North Dakota between 1999 and 2016 is the highest in the country, according to a recent report by the Centers for Disease Control and Prevention.
With a 57.6 percent increase, the state's suicide rate is "a much steeper increase than the national average rate," said Alison Traynor, director of the North Dakota Suicide Prevention program in the state health department.
"The next highest state is Vermont, at 10 points less," she said. "It's deeply concerning."
Across the nation, death by suicide is up 25 percent between 1999 and 2016, according to the CDC. Nearly 45,000 lives were lost to suicide in 2016 in the U.S.
Suicide rates are on the rise in almost every state in the country-and, since 1999, those rates have increased more than 30 percent in half of the states, the CDC says.
The increases in suicide rates in North Dakota's neighboring states-rising 44.5 percent in South Dakota, 40.6 percent in Minnesota and 38 percent in Montana-in that time frame are also raising serious concern among public health officials and others.
In 2016, 134 North Dakota residents died by suicide, a figure that constitutes a rate of nearly 20 deaths per 100,000, said Traynor.
North Dakota's increasing rate of suicide is "quite alarming," said Dr. Eric Tee, general adult psychiatrist at Prairie St. John's, a mental health care facility in Fargo.
"A rate (increase) of almost 60 percent is a crisis," Tee said. "Something needs to be done at all levels of government-federal, state, community-to reduce depression and suicide."
In Minnesota, the suicide rate is in the bottom half of the United States, but it's increasing faster than all but seven states, CDC figures show.
In 2000, Minnesota's annual suicide rate was just short of 11 per 100,000 people ages 10 and older, with a male suicide rate of 18.3 and a female rate at 3.6.
Since then, suicide rates for both genders have increased steadily to 23.3 for men during 2014 to 2016, an increase of 27 percent, while women's rate of suicide nearly doubled, to 6.9-resulting in a combined rate of 15 suicides per 100,000 residents.
'A serious public health problem'
Suicide ranks among the top 10 causes of death in North Dakota-a ranking that varies "depending on the year," Traynor said.
"It's the 10th leading cause of death for all ages," she said. But "if you look at causes of death among youth, 10 to 24 years of age, or teens, it's the second leading cause of death, behind car crashes."
Nationally, the 55- to 65-year-old age group has the third-highest rate of suicide, with 18.71 death for every 100,000 Americans, the CDC says.
That's the age group of noted designer Kate Spade and celebrity chef Anthony Bourdain, whose suicides were highly publicized when they occurred only days apart earlier this summer.
"It's a serious public health problem," Traynor said. And one that "cuts across all ethnicities and social classes."
Suicide is particularly problematic "in rural states and communities, mostly impacting Native Americans, military veterans and working-age white males," Traynor said.
Kora Dockter, of Bismarck, a retired nurse who chairs the North Dakota Suicide Coalition, also sounded the alarm about suicide in North Dakota.
"I believe we are at a crisis stage," she said.
She was especially struck by a finding in the state's Youth Risk Behavior Survey.
"About 20 to 25 percent of youth identified themselves as feeling hopeless," she said. "That's startling to me. If as a youth, you're hopeless, how do we deal with that?"
Experts say causes of suicide vary, including isolation, relationship problems, job stress, problematic substance use, and financial and physical health problems.
Some suicides may not be reported accurately. They may have been reported in the past as accidental deaths, Traynor said.
"The opioid overdose rate is increasing in rural communities," she said. People in those communities "are less likely to report (the death) for what it is."
Dockter said, "There are multiple potential reasons why" people die by suicide. "I definitely think our long winters play a part."
The stigma surrounding poor mental health and "the unwillingness of people to accept it as an actual illness" also contribute to the state's increasing suicide rate, Dockter said.
Her son, a married father of three, died by suicide at age 33 in 2014.
"He was afraid to ask at work for time off" to get mental health care, she said.
"I encourage employers to take mental health care needs as seriously as the need for surgery or care after a heart attack."
Statistics show that men are more prone to complete suicide at significantly higher rates than women. Nationally, male suicide occurs three times more often than female.
In North Dakota, about four in five suicide victims are male.
"Men have more means to carry out a plan (for suicide)," said Tee. "Women say they're too scared to."
A reluctance by men to seek help may be cultural and "may have something to do with how they were raised," Traynor said.
Insufficient access to care
In the CDC report, Tee said he found it most interesting that "more than half of the people who commit (suicide) didn't have a known mental health condition."
The increased suicide rate in North Dakota may be due to the lack of access to psychiatric care in this rural, sparsely populated state, said Tee, who relocated from Chicago to Fargo last year.
"There's not many of us here," he said. "Illinois has 8,000 or 9,000 psychiatrists. North Dakota has about 70 to 80. I think that's a big part of it-it's hard to access psychiatrists here."
"A lot of our patients from rural areas are traveling from five or six hours away," he said, "and this is the first time... they're seeing a professional for mental health problems, and they're late in their 50s or 60s."
National statistics reveal that 20 veterans die each day by suicide in this country, Traynor said. "Fourteen of them are not connected to VA services, research shows."
Depending on their role in the military, they might not qualify for services, Traynor said. "Or, if they have Post Traumatic Stress (disorder), that could be why they're not reaching out."
What can be done?
Dockter recommended that "we pay more attention to what people are saying and doing," she said.
"There are so many opportunities to be kind and caring. If we could become kind to people and be mentors, that would make a huge difference."
Tee also recommends taking a direct approach.
"Be more observant (of others)," he said. "If someone looks depressed or their behavior is strange or 'off,' ask them about it.
"Many people who come to us say, 'I'm here because someone asked me, and I told them what was wrong. They brought me here.'
"If you are experiencing depression or have thoughts of suicide, don't be afraid to ask for help or to get involved in chatting online for crises," he said. "There are tons of resources to help."
Suicide Prevention Lifeline: (800) 273-8255 (answered locally by FirstLink)
Source: North Dakota Suicide Prevention Program
Nearly 45,000 lives lost to suicide in 2016 in the U.S.
From 1999 to 2016, the suicide rate in North Dakota rose 57 percent, the highest in the country.
North Dakota residents (107 male, 27 female) died by suicide in 2016. For each life lost to suicide, 25 people attempt suicide.
Minnesota residents died by suicide in 2016.
More than half of people who died by suicide in 1999 through 2016 in the U.S. did not have a known mental health condition.
Suicide rates went up more than 30 percent in half of states since 1999. Suicide rates have increased in every state, except Nevada, since 1999.
Suicide is the second leading cause of death for 15 to 24-year-olds, and the 10th leading cause of death for people of all ages, in the U.S.
U.S. Centers for Disease Control and Prevention, North Dakota Department of Health, Minnesota Department of Health