Only half of the people had a known mental health condition. "Suicide is one of the top 10 causes of death in the USA right now, and it's one of three causes that is actually increasing recently, so we do consider it a public health problem - and something that is all around us", Schuchat said. Rates have risen steadily in most age and ethnic groups, even as rates of psychiatric treatment and diagnosis have also greatly increased.
A 2012 CDC study of 17 states found that workers in farming, fishing and forestry had the highest rate of suicide - about 84.5 per 100,000 people. KDADS also offers training regarding suicide prevention. Asked whether that was a deliberate omission, because of the political climate surrounding gun control, Stone said that suicide rates have been increasing across all methods. "If we only look at this as a mental health issue, we won't make the progress that we need".
Adults ages 45 to 64 had the largest increase in the suicide rate, from 13.2 suicides per 100,000 people in 1999 to 19.2 suicides per 100,000 in 2016.
Although there is no single cause for suicide, information from coroners' reports suggests numerous deaths followed relationship problems, substance use, and financial crises, according to the CDC.
"Suicide is a leading cause of death for Americans - and it's a tragedy for families and communities across the country", Schuchat said in a statement. That continues a trend that began after 2010 when the number of suicides was 606. Historically, the suicide rate tracks with recessions, rising when times are bad and falling when they're better. Experts in the field have speculated the reported rate of 1 in every 400 physicians committing suicide is an underestimate, pointing to differing death classifications in known cases. "But these issues were [found] in all, with or without a mental health condition".
And finally, Vermont has a lot of military veterans, and veterans as a group are twice as likely to die by suicide than the general population, Delaney said.
Overall, South Carolina sees a higher suicide rate than the rest of the country, according to the United Health Foundation.
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"Many of us have been personally impacted by this unfortunate reality", said Greg Lakin, the chief medical officer of the Kansas Department of Health and Environment. "Those can all be risk factors", Kajimura said. People can be isolated in rural areas, or they can find a protective community in small towns.
To the knowledge of her family and investigators, Spade did not have a previously diagnosed mental health condition, though her sister Reta Saffro has said she suspected that Spade had begun drinking heavily as a way to cope.
"New Hampshire definitely has access to guns", Tilley said.
Rhode Island and CT are among the 10 states with the lowest suicide rates, while ME is in the top quarter. The most recent rates, for the years 2014 to 2016, ranged from a low of 6.9 per 100,000 residents per year in Washington, D.C., to a high of 29.2 per 100,000 residents in Montana.
The rates of suicide for all states and the District of Columbia were calculated using data from the National Vital Statistics System.
If you or someone you know needs help, contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).