Surveillance for Violent Deaths — National Violent Death Reporting System, 48 States, the District of Columbia, and Puerto Rico, 2020

Results

Violent Deaths in 48 States and the District of Columbia

For 2020, a total of 48 NVDRS states (46 states collecting statewide data, 35 California counties, and four Texas counties) and the District of Columbia collected data on 64,388 incidents involving 66,017 deaths (Supplementary Table S1, https://stacks.cdc.gov/view/cdc/127523). Suicides (n = 38,529; 58.4%) accounted for the highest rate of violent death captured by NVDRS (15.8 per 100,000 population aged ≥10 years). The homicide rate was 7.5 per 100,000 population (n = 20,681; 31.3%). Deaths of undetermined intent (n = 5,429; 8.2%), legal intervention deaths (n = 874; 1.3%), and unintentional firearm deaths (n = 504; <1.0%) occurred at lower rates (2.0, 0.3, and 0.2 per 100,000 population, respectively). Data for deaths by manner that include statewide counts and the rates for California and Texas are available (Supplementary Table S2, https://stacks.cdc.gov/view/cdc/127523).

Suicides

Sex, Age Group, and Race and Ethnicity

For 2020, a total of 48 NVDRS states (46 states collecting statewide data, 35 California counties, and four Texas counties) and the District of Columbia collected data on 38,481 incidents involving 38,529 suicide deaths among persons aged ≥10 years (Supplementary Table S1, https://stacks.cdc.gov/view/cdc/127523). The overall suicide rate was 15.8 per 100,000 population aged ≥10 years (Table 1).

The overall suicide rate for males (25.7 per 100,000 population aged ≥10 years) was 4.1 times the rate for females (6.3 per 100,000 population aged ≥10 years) (Table 1). The suicide rate for males ranged from 1.9 to 18.3 times the rate for females across age groups and 2.7 to 4.7 times the rate for females across racial and ethnic groups. Adults aged ≥85 years (20.1 per 100,000 population aged ≥10 years), 30–34 years (18.7 per 100,000 population aged ≥10 years), and 45–54 years (18.2 per 100,000 population aged ≥10 years) had the highest rates of suicide across age groups. White persons accounted for a majority (78.4%) of suicides; however, AI/AN persons had the highest rate of suicide (31.2 per 100,000 population aged ≥10 years) among all racial and ethnic groups.

Among male suicide decedents, nearly one half (46.2%) were aged 35–64 years (Table 1). By age group, men aged ≥85 years had the highest rate of suicide (51.3 per 100,000 population aged ≥10 years), followed by men aged 75–84 years (36.0 per 100,000 population aged ≥10 years) and 30–34 years (30.3 per 100,000 population aged ≥10 years). Across racial and ethnic groups, AI/AN males had the highest rate of suicide (48.9 per 100,000 population aged ≥10 years), followed by White males (31.2 per 100,000 population aged ≥10 years). The rate of suicide for AI/AN males was 4.0 times the rate for males with the lowest rate (i.e., non-Hispanic Asian or Pacific Islander [A/PI]; 12.2 per 100,000 population aged ≥10 years). The suicide rate was 15.9 per 100,000 population aged ≥10 years for Black males and 14.2 per 100,000 population aged ≥10 years for Hispanic males.

Among females, those aged 35–64 years accounted for 52.6% of suicides (Table 1). Females aged 45–54 years had the highest rate of suicide (8.5 per 100,000 population), followed by those aged 35–44 years (7.5 per 100,000 population) and 55–64 years (7.2 per 100,000 population). The suicide rate was highest among AI/AN females (14.6 per 100,000 population aged ≥10 years), followed by White (7.6 per 100,000 population aged ≥10 years), A/PI (4.6 per 100,000 population aged ≥10 years), and Black and Hispanic (both 3.4 per 100,000 population aged ≥10 years) females. The suicide rate for AI/AN females was 4.3 times the rate for females with the lowest rates (i.e., Black and Hispanic females).

Method and Location of Injury

A firearm was used in more than one half (51.6%; 8.2 per 100,000 population aged ≥10 years) of suicides, followed by hanging, strangulation, or suffocation (27.2%; 4.3 per 100,000 population aged ≥10 years) and poisoning (11.1%; 1.8 per 100,000 population aged ≥10 years) (Table 1). Among males, the most common method of injury was a firearm (56.7%), followed by hanging, strangulation, or suffocation (26.7%). Among females, firearm (31.9%) was also the most common method of injury, followed by hanging, strangulation, or suffocation (29.4%) and poisoning (27.3%). Among all suicide decedents, the most common location of suicide was a house or apartment (71.5%), followed by a motor vehicle (4.9%), a natural area (4.3%), a street or highway (2.6%), and a hotel or motel (2.2%).

Toxicology Results of Decedent

Toxicology tests for blood alcohol concentration (BAC) were conducted for 47.4% of suicide decedents (Table 2). Among those with positive results for alcohol (41.0%), 66.0% had a BAC ≥0.08 g/dL. Tests for the following substances were conducted for the percentage of decedents indicated in parentheses: amphetamines (38.0%), antidepressants (24.4%), barbiturates (31.3%), benzodiazepines (37.0%), cannabis (commonly referred to as marijuana; 34.7%), cocaine (36.9%), and opioids (39.6%). Positive results were found for 17.5% of decedents tested for amphetamines. Among those tested for antidepressants, 36.1% had positive results at the time of death; 2.1% of those tested for barbiturates had positive results, 21.9% of those tested for benzodiazepines had positive results, 28.3% of those tested for cannabis had positive results, and 6.1% of those tested for cocaine had positive results. Test results for opioids (including illicit and prescription opioids) were positive for 22.1% of decedents tested for these substances. Carbon monoxide was tested for a substantially smaller proportion of decedents (4.0%) but was identified in approximately one third of those decedents (35.3%).

Precipitating Circumstances

Circumstances were identified in 32,307 (83.9%) suicides (Table 3). Overall, a mental health problem was the most common circumstance, with approximately one half (47.8%) of decedents having a current diagnosed mental health problem and 31.9% experiencing a depressed mood at the time of death. Among the 15,433 decedents with a current diagnosed mental health problem, depression or dysthymia (73.1%), anxiety disorder (22.5%), and bipolar disorder (15.1%) were the most common diagnoses. Alcohol use problems were reported for 18.4% of suicide decedents, and other substance use problems (unrelated to alcohol) were reported for 17.7% of suicide decedents. Among suicide decedents, 24.1% were receiving mental health or substance use treatment at the time of death and 32.0% had a history of having been treated for a mental health or substance use problem (Table 3).

The most commonly reported interpersonal or life stressor–related precipitating circumstances for suicide were a recent or impending crisis during the previous or upcoming 2 weeks (29.8%), intimate partner problem (26.6%), physical health problem (19.9%), and argument or conflict (17.0%) (Table 3) (Supplementary Table S4, https://stacks.cdc.gov/view/cdc/127523). Among other circumstances related to suicide, 35.5% of decedents had a history of suicidal thoughts or plans, 29.7% left a suicide note, 23.2% had disclosed suicidal intent to another person, and 18.3% had a history of attempting suicide. Among those who disclosed intent, the greatest proportion of disclosures were to a previous or current intimate partner (38.9%), followed by a family member other than an intimate partner (34.8%) and friend or colleague (14.3%).

When examining known circumstances by sex, a larger percentage of female decedents (63.0%) had a current diagnosed mental health problem than did male decedents (43.8%) (Table 3). Male and female suicide decedents had similar percentages of depressed mood at the time of their death (31.8% and 32.3%, respectively). A larger percentage of female decedents (36.3%) than male decedents (20.9%) were known to have been receiving mental health or substance treatment at the time of death. Suicide events (e.g., leaving a suicide note), history of suicidal thoughts or plans, and history of attempting suicide occurred more frequently and at higher rates among females than males.

Homicides

Sex, Age Group, and Race and Ethnicity

For 2020, a total of 48 NVDRS states (46 states collecting statewide data, 35 California counties, and four Texas counties) and the District of Columbia collected data on 19,705 incidents (Supplementary Table S1, https://stacks.cdc.gov/view/cdc/127523) involving 20,681 homicide deaths. The overall homicide rate was 7.5 per 100,000 population (Table 4).

The homicide rates were higher among males than females across nearly all age groups, and the rate was highest among adults aged 20–24 years (18.2 per 100,000 population) (Table 4). The homicide rate for men aged 20–24 years (30.8 per 100,000 population) was six times the rate for females in the same age group (5.1 per 100,000 population). Among males, the rate of homicide was highest among adults aged 20–24 years (30.8 per 100,000 population) and 25–29 years (28.0 per 100,000 population). Among females, the rate of homicide was highest among infants (i.e., children aged <1 year; 5.3 per 100,000 population). Among all children who were homicide victims, the overall homicide rate for infants (6.9 per 100,000 population) was 3.6 times the overall rate for children aged 1–4 years (1.9 per 100,000 population) and 8.6 times the rate for children aged 5–9 years (0.8 per 100,000 population).

Black persons accounted for 61.8% of male homicide victims and more than one half (58.0%) of all homicide victims (Table 4). Black males had the highest rate of homicide compared with males in all other racial and ethnic groups (57.6 per 100,000 population); this rate was 25.0 times the rate for A/PI males (2.3 per 100,000 population), 14.8 times the rate for White males (3.9 per 100,000 population), 5.1 times the rate for Hispanic males (11.2 per 100,000 population), and 2.6 times the rate for AI/AN males (21.9 per 100,000 population). Among females, the homicide rate was also highest among Black females (8.2 per 100,000 population) (Table 4), followed by AI/AN females (6.4 per 100,000 population), Hispanic females (2.2 per 100,000 population), White females (1.8 per 100,000 population), and A/PI females (0.9 per 100,000 population).

Method, Location of Injury, and Victim-Suspect Relationship

The weapons most commonly used in homicides were firearms, used in 76.7% of homicides overall; followed by a sharp instrument (9.1%); a blunt instrument (3.3%); personal weapons (e.g., hands, feet, or fists; 2.5%); and hanging, strangulation, or suffocation (1.5%) (Table 4). The method was unknown in 4.3% of homicides. A firearm was the most common method of injury for both males (80.1%) and females (61.9%); however, the firearm homicide rate for males (9.9 per 100,000 population) was 5.8 times the rate for females (1.7 per 100,000 population). A larger proportion of homicides among females than males involved a sharp instrument (13.0% versus 8.2%, respectively); blunt instrument (5.5% versus 2.8%, respectively); hanging, strangulation, or suffocation (4.5% versus <1.0%, respectively); and personal weapons (3.9% versus 2.1%, respectively). Among all homicide victims, a house or apartment was the most common location of homicide (41.0%); followed by a street or highway (22.3%); a motor vehicle (10.3%); and a parking lot, public garage, or public transport (4.5%). A larger proportion of homicides among females (59.9%) than among males (36.6%) occurred at a house or apartment, whereas a larger proportion of homicides among males (25.0%) than among females (10.4%) occurred on a street or highway.

The relationship of the victim to the suspect was known for 32.8% of homicides (28.4% of males and 51.6% of females) (Table 4). For males, when the relationship was known, the victim-suspect relationship was most often an acquaintance or friend (30.9%); other person known to the victim, but the exact nature of the relationship was unclear (22.2%); a stranger (18.1%); a current or former intimate partner (7.9%); or other relative (7.4%). For females, when the relationship was known, one half (50.0%) of suspects were a current or former intimate partner, followed by an acquaintance or friend (9.2%); a child or other person known to victim, but the exact nature of the relationship was unclear (both 8.4%); or a parent (8.3%).

Precipitating Circumstances

Precipitating circumstances were identified in 69.1% of homicides (Table 5). One third of homicides with known circumstances were precipitated by an argument or conflict (33.9%), and 14.6% of homicides with known circumstances were related to intimate partner violence (Table 5). Intimate partner violence–related deaths include deaths related to conflict or violence between current or former intimate partners and also include deaths associated with intimate partner violence that are not deaths of the intimate partners themselves (e.g., a former boyfriend killing an ex-partner’s new boyfriend). Homicides also were commonly precipitated by another crime (22.9%); in 66.0% of those cases, the crime was in progress at the time of the incident. The most frequent types of precipitating crimes were assault or homicide (38.9%), robbery (32.9%), drug trade^§§ (14.5%), burglary (10.8%), motor vehicle theft (5.0%), rape or sexual assault (2.3%), and arson (1.7%) (Supplementary Table S6, https://stacks.cdc.gov/view/cdc/127523). A physical fight between two persons (13.7%), a drive-by shooting (12.7%), and drug involvement (e.g., relating to a drug habit or illegal drug trafficking; 10.3%) were other common precipitating circumstances.

Among the identified homicide circumstances, several differences were noted by decedent’s sex, and intimate partner violence accounted for the largest percentage difference. Intimate partner violence was a precipitating circumstance for approximately 41.3% of homicides among females but only 7.9% of homicides among males (Table 5). In incidents where intimate partner violence was a precipitating circumstance and victim-suspect relationship was known, the suspect was a current or former intimate partner in 92.8% of homicides among females and 50.3% of homicides among males. Females were more often the direct victims of intimate partner violence–related homicides, whereas males were more often corollary victims. A larger proportion of homicides of females than males also resulted from caregiver abuse or neglect (9.0% versus 2.7%) or were perpetrated by a suspect with a mental health problem (e.g., schizophrenia or other psychotic conditions, depression, or posttraumatic stress disorder) (6.3% versus 1.7%). A larger proportion of homicides of males than females were preceded by a physical fight (14.9% versus 8.9%), involved drugs (11.4% versus 6.0%), or were gang related (8.8% versus 3.3%). A larger proportion of male homicide victims (8.4%) than female homicide victims (1.4%) also were reported to have used a weapon during the incident.

Legal Intervention Deaths

Sex, Age Group, and Race and Ethnicity

For 2020, a total of 48 NVDRS states (46 states collecting statewide data, 35 California counties, and four Texas counties) and the District of Columbia collected data on 868 incidents involving 874 legal intervention deaths (Supplementary Table S1, https://stacks.cdc.gov/view/cdc/127523). The highest rate of legal intervention death by age group was among men aged 30–34 years (1.5 per 100,000 population), followed by men aged 25–29 years (1.4 per 100,000 population) and 35–44 years (1.2 per 100,000 population) (Table 6). Approximately all legal intervention deaths were among males (96.2%). Although White males accounted for nearly one half (49.1%) of all legal intervention deaths, AI/AN males had the highest legal intervention death rate (3.1 per 100,000 population), representing a rate 6.2 times that of White males (0.5 per 100,000 population). The legal intervention death rate for Black males (1.2 per 100,000 population) was 2.4 times the rate for White males. The legal intervention death rate for Hispanic males was 0.7 per 100,000 population.

Method and Location of Injury

A firearm was used in a majority (85.2%) of legal intervention deaths (Table 6). Legal intervention deaths occurred most frequently in a house or apartment (35.5%), followed by a street or highway (25.7%) or a motor vehicle (9.6%).

Precipitating Circumstances

Precipitating circumstances were identified in 90.4% of legal intervention deaths (Table 7). The decedent reportedly used a weapon in 69.4% of legal intervention death cases. In 25.8% of legal intervention deaths with known circumstances, a substance use problem (other than alcohol) was reported as a contributing factor, and 20.1% of decedents reportedly had a current diagnosed mental health problem. An argument or conflict or physical fight precipitated 15.4% and 6.7% of legal intervention deaths, respectively. A recent or impending crisis during the previous or upcoming 2 weeks was reported in 7.6% of legal intervention deaths. Among legal intervention deaths with known circumstances, intimate partner violence (10.3%), being a perpetrator of interpersonal violence during the past month (12.7%), family relationship problems (5.6%), and drug involvement (4.6%) were other notable precipitating circumstances.

Unintentional Firearm Deaths

Sex, Age Group, and Race and Ethnicity

In 2020, a total of 48 NVDRS states (46 states collecting statewide data, 35 California counties, and four Texas counties) and the District of Columbia collected data on 500 incidents involving 504 unintentional firearm deaths (Supplementary Table S1, https://stacks.cdc.gov/view/cdc/127523). Nearly one half (n = 225; 44.6%; data not shown) of these deaths were self-inflicted, and 170 deaths (33.7%; data not shown) were known to be inflicted by another person; for the remaining 109 deaths (21.6%; data not shown), whether the injury was inflicted by the decedent or by another person was unknown. Males accounted for 86.1% of decedents (Table 8). Persons aged ≤24 years accounted for more than one half (55.4%) of all unintentional firearm deaths. The majority of decedents were White persons (52.8%), followed by Black persons (33.1%).

Location of Injury and Firearm Type

Among unintentional firearm deaths, 75.0% occurred in a house or apartment, followed by a motor vehicle (5.8%) or a natural area (4.6%) (Table 8). The majority of unintentional firearm deaths involved a handgun (59.9%), followed by a rifle (8.7%) or a shotgun (6.7%). The firearm type was unknown in approximately one quarter (24.6%) of unintentional firearm deaths.

Context and Circumstances of Injury

The context and circumstances of injury were identified in 81.3% of unintentional firearm deaths (Table 9). Among those with context and circumstance information, the context of injury for nearly one half (47.1%) of unintentional firearm deaths was playing with a gun. Other contexts of injury were showing the gun to others (11.2%), cleaning the gun (7.3%), and loading or unloading the gun (4.6%). Approximately one fourth (27.8%) of unintentional firearm deaths were caused by a person unintentionally pulling the trigger; 10.5% were caused by a person mistakenly thinking the gun was unloaded, and 8.0% of deaths were because of the gun being mistaken for a toy.

Deaths of Undetermined Intent

Sex, Age Group, and Race and Ethnicity

In 2020, a total of 48 NVDRS states (46 states collecting statewide data, 35 California counties, and four Texas counties) and the District of Columbia collected data on 5,386 incidents involving 5,429 deaths of undetermined intent (Supplementary Table S1, https://stacks.cdc.gov/view/cdc/127523). The overall rate of deaths of undetermined intent was 2.0 per 100,000 population (Supplementary Table S10, https://stacks.cdc.gov/view/cdc/127523). The rate of deaths of undetermined intent was higher among males (2.7 per 100,000 population) than among females (1.2 per 100,000 population). Approximately two thirds (69.8%) of deaths of undetermined intent were among adults aged 30–64 years. The rate of deaths of undetermined intent was highest among males aged 30–34 years (4.7 per 100,000 population), followed by males aged 35–44 and 45–54 years (both 4.3 per 100,000 population) and 55–64 years (3.9 per 100,000 population). The rate of deaths of undetermined intent among infants (i.e., children aged <1 year) was 2.7 per 100,000 population. Although White persons accounted for the majority (63.7%; 2.0 per 100,000 population) of deaths of undetermined intent, AI/AN persons had the highest rate (4.3 per 100,000 population). Among males, AI/AN males (5.6 per 100,000 population) and Black males (5.4 per 100,000 population) had the highest rate of deaths of undetermined intent. Among females, AI/AN females also had the highest rate of deaths of undetermined intent (3.1 per 100,000 population), followed by Black females (1.7 per 100,000 population).

Method and Location of Injury

Poisoning was the most common method of injury in deaths of undetermined intent (66.4%), followed by firearm (4.5%); drowning (4.1%); blunt instrument (2.9%); fall (2.8%); motor vehicle (2.7%); and fire or burns or hanging, strangulation, or suffocation (2.0% each). Personal weapons, sharp instruments, intentional neglect, shaking, and other methods were each used as method of injury in <1.0% of undetermined intent deaths (Supplementary Table S10, https://stacks.cdc.gov/view/cdc/127523). Weapon type was unknown for 10.0% of undetermined intent deaths. The majority of deaths of undetermined intent occurred in a house or apartment (63.8%), followed by a street or highway (4.8%), a natural area (4.7%), or a hotel or motel (4.0%).

Toxicology Results of Decedent

Toxicology tests for BAC were conducted for 70.7% of decedents in deaths of undetermined intent (Supplementary Table S11, https://stacks.cdc.gov/view/cdc/127523). Among those with positive results for alcohol (37.4%), 47.2% had a BAC ≥0.08 g/dL. Tests for the following substances were conducted for the percentage of decedents indicated in parentheses: amphetamines (36.5%), antidepressants (34.3%), benzodiazepines (38.3%), cannabis (commonly referred to as marijuana; 33.0%), cocaine (46.4%), and opioids (71.0%). Among decedents tested for amphetamines, 34.3% had positive test results. Among those tested for antidepressants, 52.1% had positive results at the time of death; 40.8% of those tested for benzodiazepines had positive results, 34.5% of those tested for cannabis had positive results, and 43.4% of those tested for cocaine had positive results. Results for opioids (illicit or prescription) were positive in 76.9% of decedents tested. Carbon monoxide was tested for a substantially smaller proportion of decedents (4.1%) but was identified in 65.3% of those decedents.

Precipitating Circumstances

Circumstances were identified in 78.0% of deaths of undetermined intent (Supplementary Table S12, https://stacks.cdc.gov/view/cdc/127523). Among deaths of undetermined intent with known circumstances, 34.3% of decedents had a current diagnosed mental health problem at time of death; depression or dysthymia (54.1%), anxiety disorder (27.2%), and bipolar disorder (21.0%) were the most common diagnoses among these decedents, and 7.9% had a current depressed mood. Substance use problems (other than alcohol; 68.8%) and alcohol problems (25.3%) were the most commonly reported circumstances. Among all deaths of undetermined intent, 20.3% were receiving mental health or substance use treatment at the time of death; 27.7% of decedents had a history of ever being treated for a mental health or substance use problem. Physical health problems (12.7%) and a recent or impending crisis during the preceding or upcoming 2 weeks (9.9%) were other life stressors identified in deaths of undetermined intent (Supplementary Table S13, https://stacks.cdc.gov/view/cdc/127523). Among decedents, 10.5% had a history of suicidal thoughts or plans, 7.3% had a history of attempting suicide, and 4.9% had disclosed intent to die by suicide.

Violent Deaths in Puerto Rico

For 2020, Puerto Rico collected data on 729 incidents involving 790 deaths (data not shown). Homicide (n = 550) accounted for the largest proportion (69.6%) and highest rate (16.8 per 100,000 population) of violent deaths, followed by suicide (n = 210; 26.6%; 7.0 per 100,000 population aged ≥10 years) (Supplementary Tables S14 and S17, https://stacks.cdc.gov/view/cdc/127523).

Homicides

Sex, Age Group, and Race and Ethnicity

In 2020, a total of 500 homicides among males and 49 homicides among females were reported in Puerto Rico (Supplementary Table S14, https://stacks.cdc.gov/view/cdc/127523). The overall homicide rate for males (32.2 per 100,000 population) was 11.5 times the rate for females (2.8 per 100,000 population). Among males, the homicide rate was 79.8 per 100,000 population among adults aged 18–29 years and 66.5 per 100,000 population among those aged 30–44 years. Most (94.5%) homicide victims were Hispanic.

Method, Location of Injury, and Victim-Suspect Relationship

A firearm was used in a majority (88.9%) of homicides (Supplementary Table S14, https://stacks.cdc.gov/view/cdc/127523). A firearm was the most common method used in homicides of both males (89.6%) and females (83.7%); however, the firearm homicide rate for males (28.8 per 100,000 population) was 12 times the rate for females (2.4 per 100,000 population). Among males, a street or highway was the most common location (49.0%) of homicides, whereas a house or apartment was the most common location (40.8%) of homicides for females.

The victim-suspect relationship was known for 48.9% of homicides (Supplementary Table S14, https://stacks.cdc.gov/view/cdc/127523). When the relationship was known, the suspect for male victims was most often a person known to the victim, but the exact nature of the relationship was unclear (39.5%), followed by a rival gang member (30.5%). Among females, the suspect was most often a current or former intimate partner (38.9%), followed by a person known to the victim, but the exact nature of the relationship was unclear (27.8%).

Toxicology Results of Decedent

Tests for BAC were conducted for 99.3% of homicide decedents (Supplementary Table S15, https://stacks.cdc.gov/view/cdc/127523). Among those with positive results for alcohol (26.6%), 34.5% had a BAC ≥0.08 g/dL. Tests for cocaine, cannabis (commonly referred to as marijuana), and opioids were conducted for 99.3%, 75.1%, and 99.3% of decedents, respectively. Results for cocaine, cannabis, and opioids were positive in 18.1%, 31.0%, and 9.0% of decedents tested, respectively.

Precipitating Circumstances

Precipitating circumstances were identified in 97.3% of homicides (Supplementary Table S16, https://stacks.cdc.gov/view/cdc/127523). Among males, more than one half (50.3%) of homicides were gang related, 43.1% involved drugs, and approximately one fourth (22.0%) involved drive-by shootings. Intimate partner violence was identified as a contributing factor in 9.0% of homicides overall; approximately one third (33.3%) of homicides among females were precipitated by intimate partner violence, compared with 6.6% of homicides among males.

Suicides

Sex, Age Group, and Race and Ethnicity

In 2020, a total of 210 suicides among persons aged ≥10 years (178 suicides among males and 32 suicides among females) were reported in Puerto Rico (Supplementary Table S17, https://stacks.cdc.gov/view/cdc/127523). The suicide rate for males was 6.2 times the rate for females (12.5 versus 2.0 per 100,000 population aged ≥10 years). The suicide rates were highest among men aged ≥65 years (16.3 per 100,000 population aged ≥10 years), 45–64 years (16.2 per 100,000 population aged ≥10 years), and 30–44 years (13.5 per 100,000 population aged ≥10 years). The majority (90.5%) of suicide decedents overall were Hispanic.

Method and Location of Injury

Hanging, strangulation, or suffocation was the most commonly used method for suicide among both males (66.9%) and females (50.0%) (Supplementary Table S17, https://stacks.cdc.gov/view/cdc/127523). A firearm was used in 18.0% of suicides among males. The most common location where a suicide took place was a house or apartment both for males (76.4%) and females (93.8%).

Toxicology Results of Decedent

Tests for BAC were conducted for 97.6% of suicide decedents (Supplementary Table S18, https://stacks.cdc.gov/view/cdc/127523). Among those with positive results for alcohol (29.3%), 60.0% had a BAC ≥0.08 g/dL. Other than alcohol, suicide decedents were most often tested for cocaine (97.1%), cannabis (commonly referred to as marijuana; 65.2%), and opioids (97.1%). Results for cocaine, cannabis, and opioids were positive in 12.3%, 8.8%, and 6.4% of decedents tested, respectively.

Precipitating Circumstances

Circumstances were identified in 93.8% of suicides (Supplementary Table S19, https://stacks.cdc.gov/view/cdc/127523). Overall, a mental health problem was the most common circumstance among suicide decedents, with 52.8% having a current diagnosed mental health problem and 49.7% experiencing a depressed mood at the time of death.

Among males, 49.7% of suicide decedents had a current depressed mood, and 49.1% had a current diagnosed mental health problem. Depression or dysthymia was most often the mental health diagnosis experienced by male suicide decedents with a diagnosed mental health problem (77.8%), followed by anxiety disorder (18.5%). Approximately one third (31.5%) of male suicide decedents had a history of ever being treated for a mental health or substance use problem. Approximately one fourth (23.0%) of male suicide decedents had a history of expressing suicidal thoughts and plans, and 22.4% had a history of attempting suicide. Other precipitating circumstances for male suicide decedents included physical health problem (17.6%) and intimate partner problems (15.2%).

Among female suicide decedents, 50.0% had a current depressed mood, and 71.9% had a current diagnosed mental health problem. Depression or dysthymia was most often the mental health diagnosis experienced by female suicide decedents who had a diagnosed mental health problem (73.9%). One half (50.0%) of female decedents had a history of ever being treated for a mental health or substance use problem, 40.6% were known to have been receiving mental health or substance use treatment at the time of death, and 34.4% had a history of attempting suicide.