Missouri is one of the majority of states in the United States that saw a significant increase in suicide rates between 1999-2016, and the same federal health agency that released that finding is calling for more comprehensive care and support approaches that address the factors that can contribute to death by suicide - not just mental health conditions.
The U.S. Centers for Disease Control and Prevention released a report this week that found suicide rates in the United States overall rose nearly 30 percent between 1999-2016. Suicide rates increased significantly in 44 states, and 25 states experienced increases of more than 30 percent.
Missouri's neighbors Kansas and Oklahoma saw an increase in suicide rates of 38-58 percent. Several other Great Plains and Mountain West states - Minnesota, the Dakotas, Montana, Wyoming, Utah and Idaho - saw the same level of greatest increase in the United States, along with South Carolina, New Hampshire and Vermont.
The CDC's data show Missouri saw an increase in suicide rates of 31-37 percent - which still puts the state's increase ahead of more populous states such as California, Texas, Florida and New York.
Nationwide, suicide is the 10th leading cause of death and one of only three causes that are increasing, according to the CDC. Rates of emergency room visits for non-fatal self-harm - a main risk factor for suicide - increased 42 percent between 2001-16, according to the report.
In addition to the loss of life - 45,000 people in 2016 alone - suicides and self-harm cost the United States $70 billion per year in direct medical and work loss costs.
Between 2005-15, 9,648 people died by suicide in Missouri, according to the state's Department of Health and Senior Services. Between 2004-14, 46,532 people in the state were hospitalized for self-inflicted injuries, and there were 38,612 emergency room visits for such injuries.
In Cole County, there were 121 deaths by suicide between 2005-15, and 738 hospitalizations and 308 emergency room visits for self-inflicted injuries between 2004-14.
Cole, Boone, Miller and Morgan counties' suicide death rates were a little lower than the state's 14.49 per 100,000 people, but Callaway and Osage counties' were above the state rate.
The CDC's data from 27 states in 2015 show young adult and middle-aged white men between ages 25-64 continue to be at risk for suicide, and while Missouri's data doesn't show gender, white people in the state between the ages 20-64 also had the highest rates of death by suicide.
However, the nationwide increases were among men and women, all age groups younger than 75 years old, all racial and ethnic groups, and in cities and rural areas.
The suicide rates among women increased in more states than among men between 1999-2016 - 34 for men and 43 for women.
"It's males and females. We probably shouldn't think that it's one specific group," Cole County Health Director Kristi Campbell said.
The CDC report also suggests communities should think beyond mental health awareness and resources in order to stem the rising rate of suicides.
The data from 27 states in 2015, not inclusive of Missouri, show more than half of people who died by suicide - 54 percent - were not known to have mental health conditions. Even people with diagnosed mental health conditions who died by suicide often had other contributing circumstances of stress and trauma in their lives.
"In addition to mental health conditions and prior suicide attempts, other contributing circumstances include social and economic problems, access to lethal means (e.g., substances, firearms) among persons at risk and poor coping and problem-solving skills," according to the CDC's report.
Firearms are the leading cause of death in suicides - and people without known mental health conditions are more likely to die by firearm in suicides.
Campbell said people with firearms should be aware of where they are and keep them locked up.
The CDC's list of comprehensive care and support strategies to fight suicide includes suggestions such as financial support for households; promotion of social connectivity within communities that can link people to information and support they need; creation of workplace policies that promote help-seeking; support of family and friends after a suicide; and encouragement for media outlets to follow safe reporting recommendations.
"They need to be aware if their friends or loved ones are having changes in behavior that are uncharacteristic for them," Campbell said of how people should look out for one another.
Some local resources she referred to were depression screenings by the health department for new mothers and Pathways - the local community mental health center, which has an office in the Community Health Center.
The CDC's data show dealing with physical health problems or hospitalization can themselves be contributing factors for death by suicide, among people with and without diagnosed mental health conditions.
"Just be supportive" and available to talk, Campbell said of care people can take for loved ones who have recently or will soon be hospitalized. She added living a healthy lifestyle that can prevent chronic health conditions, such as with preventive screenings, also helps.
Among people with and without mental health conditions, 42 percent of deaths by suicide involved relationship problems as a contributing factor. Some kind of intimate partner, physical health, legal, family or job crisis in the past two or upcoming two weeks was involved 29 percent of the time. Problematic substance abuse was involved in 28 percent of suicides.
The CDC's full report is available at cdc.gov/mmwr/volumes/67/wr/mm6722a1.htm?s_cid=mm6722a1_w.