摘要：There is now a substantial literature on risk factors for suicide across the life course. Therefore, it is essential to extend this knowledge by considering more fully which age- and gender-specific groups bear the greatest public health burden owing to suicide and its antecedents. With this in mind, suicide mortality rates alone may not sufficiently inform U.S. policy makers who must distribute scarce suicide prevention resources. We compared age- and gender-specific mortality rates, age- and gender-specific estimates of years of potential life lost, and age- and gender-specific present value of lost earnings that individuals would have contributed to society had they lived to their full life expectancies. Men in the middle years of life contribute disproportionately to the public health burden because of completed suicide. The substantial burden evident in this group has not translated into a public health priority. THERE IS NOW A SUBSTANTIAL literature on risk factors for suicide in the United States to suggest that suicide 1 – 19 is a public health problem of considerable magnitude. 3 , 5 , 20 There were 31655 deaths from suicide in 2002 (the 11th leading cause of death) and 17638 deaths from homicide (the 14th leading cause of death 21 ). But the death toll from homicide draws much more attention, and many more resources are spent to reduce associated violent crime. Since the 1950s, the rate of youth suicide has tripled, 3 and there has been an alarming gradual upswing in suicide among young African-American males in the United States between 1980 and 1995. 22 , 23 Substantially higher rates of suicide in elders in the United States have been observed consistently for some time. 24 These statistics are informative, but they relay only a partial picture of the true public health burden of suicide. The consideration of other groups that also may bear a significant public health burden because of suicide is necessary in order to assist policymakers who are tasked to establish appropriate target populations for effective intervention. Estimates of morbidity and mortality typically are good indicators for establishing national health priorities, such as the broad initiatives to prevent heart disease over the last 50 years. But suicide, like heart disease, occurs within a background of complex interacting clinical disorders and biological, social, and environmental risk factors. In contrast to preventive cardiology, we have few measures to fully assess the true public health burden attributable to suicide and the myriad of its antecedents, such as depression and attempted suicide. Furthermore, estimates of suicide mortality rates are likely underreported in the United States. 25 , 26 The 2002 report released from the President’s New Freedom Commission on Mental Health 5 established suicide prevention as a national priority. If this vision is to be fully realized, it will be imperative to clearly illuminate the full extent of the loss of life and related morbidity attributable to suicide and attempted suicide in this country. Another crucial component of the current challenge to move from rhetoric to action relates to our imprecise estimates of the true magnitude of the overall public health burden because of suicide. Suicide, although not a disease, is a tragic end point or a “tip-of-the-iceberg” 27 indicator of multiple competing risks. When a person is diagnosed with HIV infection, serious heart disease, or treatable but incurable cancer, a key measure of disease burden entails determining the time of survival after initial diagnosis. 28 There is presently no comparable method for estimating the burden of antecedent conditions that lead to death from suicide, yet it is just such metrics that are required to estimate accurately the costs that are associated with this highly deleterious outcome. Developing the methods to comprehensively address these deficiencies is beyond the scope of this article, even as it remains an area for future investigation. We examined the absolute risk of suicide and the rates of suicide across the life cycle, comparing the rates of suicide to other measures that may extend our understanding of the public health burden attributable to suicide.
