The deaths of Anthony Bourdain and Kate Spade spotlight a growing public health issue.

Suicide rates in the United States have increased dramatically across nearly every state, sex, race, and age demographic since 1999.

In many states, suicide rates increased more than 30 percent over the last 19 years.

The statistics come from a new report by the Centers for Disease Control and Prevention (CDC) that highlights the growth of suicide as a national public health concern.

“It’s startling and of tremendous concern that the rates are going up really to such a high rate across the board,” Dr. Robert Dicker, associate director of child and adolescent psychiatry at Zucker Hillside Hospital in New York, told Healthline.

The high-profile suicides of Anthony Bourdain and Kate Spade have reminded the public that being rich and famous doesn’t exclude individuals from depression and suicide.

Suicide is the 10th leading cause of death for adults and the second leading cause of death among teens and adolescents in the United States.

In 2016 alone, nearly 45,000 individuals died by suicide.

Geographically, states in the north-central part of the country, including Montana, Wyoming, Idaho, South Dakota, and North Dakota, were the most heavily affected. These states saw an average increase between 38 and 58 percent. North Dakota led the country with a 57.6 percent increase in its suicide rate since 1999.

Delaware had the lowest increase at 5.9 percent. Nevada was the only state not to see an increase during this period. However, its suicide rate remains one of the 10 highest in the nation.

In addition to the dramatic growth of suicide rates across the country, the report also reveals troubling nuances about the problem.

For example, more than half of individuals (54 percent) that died by suicide had no prior diagnosed mental health condition. Among those without mental health conditions, a relationship problem, such as a breakup, was a significant contributing factor, occurring in 45.1 percent of cases.

Despite mountains of data accumulated by the CDC through programs such as the National Violent Death Reporting System (NVDRS), there is no obvious answer as to why the rate of suicide has increased so dramatically.

“Some people point to the economy and the stresses and strains of a failing economy,” said Dicker. “Did that have more lasting impact regardless of the economy coming back? Is that an issue? The changing rates of different substances that are being used. Does that have an impact on that rate? There are a lot of different speculations and questions about the undue pressure of living today in our society.”

Indeed, what is made clear by the CDC report is that there isn’t one single issue to blame for this trend.

“I don’t think we have a very good interpretation of this data,” said Dr. Waguih W. Ishak, professor and vice chairman of the department of psychiatry at Cedars Sinai Medical Center in Los Angeles.

“It’s pretty disturbing and I don’t think there’s a good explanation so far. Because there are certain factors that have not really changed,” he said.

A family history of suicide, depression, and substance abuse are all risk factors for suicide. Further contributing socioeconomic factors noted by the CDC report include physical health problems (22 percent), financial problems (16 percent), and legal problems (9 percent).

Firearms were the most common method of suicide, contributing to nearly half of all deaths. Other recent studies have pointed out that guns are a significant risk factor for suicide.

Higher rates of gun ownership in certain geographic areas (rural versus urban environments, for example) have been correlated with higher rates of suicide.

States with stricter gun laws also have the lowest rates of suicide.

“If you think about what is the most reliable predictor of completing suicide or even attempting it becomes that issue of hopelessness,” said Ishak. “When you don’t see a way out. We all kind of function on the notion that tomorrow will be better than today. Tomorrow is going to bring some relief from the suffering. To people who are contemplating [suicide], it doesn’t look like it’s going to get better at all.”

The deaths of Bourdain and Spade that shocked their fans have served as a catalyst for people across the country to pay more attention to mental health.

“I do believe that it’s a tremendous help that over the last week not only is there more dialogue but every time there’s an article or news report, people are presented with phone numbers that they can utilize. That has not always been the case,” said Dicker.

According to the CDC, there are at least 12 warning signs for suicide:

  • feeling like a burden
  • being isolated
  • increased anxiety
  • feeling trapped or in unbearable pain
  • increased substance use
  • looking for a way to access lethal means
  • increased anger or rage
  • extreme mood swings
  • expressing hopelessness
  • sleeping too little or too much
  • talking or posting about wanting to die
  • making plans for suicide

Improving communication between friends and family can help to decrease the stigma around mental health and help to provide treatment to suicidal individuals.

“Reach out and talk to loved ones, people that you trust, letting them in on what your experience is. Not allowing some of the stigmas related to mental health issues interfere with your looking and seeking help,” said Dicker.

“I think that some people think that if you talk about suicide that the person is going to be suggestible and they are going to start thinking about it — there’s not evidence of that,” he said.

Looking forward, there is also hope that suicide and mental health can also be addressed better, particularly when it comes to education and awareness.

“We need to do a lot more reaching out to people and making them more aware: more public education. Look how much was done with exercise and nutrition in terms of educating the public. It’s amazing, but when it comes to stress management or suicide or depression, I think we’re still lagging behind,” said Ishak.

If you are having thoughts of suicide, you can contact the National Suicide Prevention Lifeline at 800-273-TALK (8255) for support. If you or a loved one is having suicidal thoughts, call 911.