AUSTIN—Suicide rates in Texas were more than triple for white people than for black and Hispanic people in 2015, according to a new analysis from The University of Texas System and UT Health Northeast.

3,403 Texans died from suicide in 2015, the most recent year for which there are numbers. This is more than double the number killed by homicide, and was the second leading cause of death for ages 15-24, after unintentional injuries (e.g. car accidents). Suicide was the fourth leading cause of death for ages 15-64.

The suicide rate among whites has been trending up since 2000, according to mortality data from the National Center for Health Statistics.

“Suicides in Texas have increased by 23 percent over the past 15 years, but that overall trend obscures a lot of racial, geographic and age-related variation,” said Eileen Nehme, Ph.D, author of the report and assistant professor of epidemiology at UT Health Northeast. “The rates are essentially flat for black and Hispanic people. It’s the 46 percent increase in the suicide rate among white people that is almost entirely responsible for the overall increase.”

In Texas in 2013, 3.5 percent of high school students reported a suicide attempt in the prior year that required medical treatment. This proportion was highest among 10th graders, at 4.1 percent, and lowest among seniors, at 1.9 percent.

“Particularly troubling is the 3.5 percent of our kids in high school who have had to seek medical attention for suicide attempts,” said David Lakey, M.D., chief medical officer and associate vice chancellor for population health for The University of Texas System. “As parents we know that this is a serious problem. We’re seeing it at our kids’ schools.”

Over the past 15 years, rural areas have had consistently higher suicide rates than urban areas. While rates are increasing in urban areas, the urban/rural gap appears to be widening. Substantial gender differences in death by suicide also exist.

Males are much more likely to die by suicide than are females. Rates have been rising in both sexes, however, and somewhat faster among women.

“There is no one silver bullet strategy for preventing suicide, but there are multiple, reinforcing approaches that have been shown to work,” said Molly Lopez, Ph.D., director of the Texas Institute for Excellence in Mental Health at the School of Social Work at The University of Texas at Austin. “These include universal screening for suicide risk, safety planning with those who have attempted suicide or who are at high risk, and reducing access to the lethal means people might use to attempt suicide.”

Lopez is the principal investigator on the Zero Suicides in Texas project, which is led by the Texas Health and Human Services Commission (HHSC) and funded by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). The project is working with local mental health departments to implement protocols and procedures to reduce suicide, particularly among youth.

“We know that a high percentage of those who die by suicide have been seen in the mental or physical health system in the month before their death, so that is an opportunity for intervention,” said Lopez. “We also know that many people who are served in an ER or psychiatric hospital following a suicide attempt do not go on to get outpatient care, so interventions that can be done briefly, like safety planning intervention and reducing access to lethal means, can be really important.”

Suicide rates are considerably higher among veterans than among the general population. According to a recent study from the Veterans Affairs Office of Suicide Prevention, the overall rate is 21 percent higher among veterans compared to U.S. civilians. Texas has the second highest number of veterans in the U.S., with more than 1.6 million.

“The VA is doing a good job of treating veterans, but the ones who aren’t using the services are the ones who are generally in the worst shape,” said Madhavi K. Reddy, Ph.D., assistant professor in the Department of Psychiatry and Behavioral Sciences at UTHealth in Houston and chief of psychology services at the Harris County Psychiatric Center “The suicide rate is about 9 percent higher for veterans who use VA services, but 38-39 percent higher among those who don’t use VA services. If we intervene, or if people get help, they may be less likely to attempt or complete suicide.”

Reddy, who is director of the Clinical and Translational Research Program on Traumatic Stress at UTHealth, said that some of the habits and cognitive tendencies that are adaptive for serving in the military, particularly in combat, may increase the likelihood of suicide back on the home front.

“There is some evidence that higher tolerance for pain, and less fear of death, may make it easier to take that final step,” Reddy said. “Those traits make sense for a soldier, and in fact some cases we train soldiers to have them. But when you pair them with other risk factors for suicide, like PTSD, depression, environmental stressors, and certain other dispositional and cognitive biases, it may increase the risk.”