Suicide Rates by Major Occupational Group--17 States, 2012 and 2015.
During 2000-2016, the suicide rate among the U.S. working age population (persons aged 16-64 years) increased 34%, from 12.9 per 100,000 population to 17.3 (https:// www.cdc.gov/injury/wisqars). To better understand suicide among different occupational groups and inform suicide prevention efforts, CDC analyzed suicide deaths by Standard Occupational Classification (SOC) major groups for decedents aged 16-64 years from the 17 states participating in both the 2012 and 2015 National Violent Death Reporting System (NVDRS) (https://www.cdc.gov/violenceprevention/nvdrs). The occupational group with the highest male suicide rate in 2012 and 2015 was Construction and Extraction (43.6 and 53.2 per 100,000 civilian noninstitutionalized working persons, respectively), whereas the group with the highest female suicide rate was Arts, Design, Entertainment, Sports, and Media (11.7 [2012] and 15.6 [2015]). The largest suicide rate increase among males from 2012 to 2015 (47%) occurred in the Arts, Design, Entertainment, Sports, and Media occupational group (26.9 to 39.7) and among females, in the Food Preparation and Serving Related group, from 6.1 to 9.4 (54%). CDC's technical package of strategies to prevent suicide is a resource for communities, including workplace settings (1).NVDRS combines data on all violent deaths (defined as those resulting from the intentional use of physical force or power, threatened or actual, against oneself, another person, or a group or community), including suicide, based on death certificates, coroner/medical examiner reports, and law enforcement reports. Data on usual lifetime occupation among 22,053 suicide decedents aged 16-64 years from the 17 states* that participated in NVDRS in 2012 and 2015 were analyzed. CDC's National Institute for Occupational Safety and Health Industry and Occupation Computerized Coding System (NIOCCS 3.0) (https://wwwn.cdc.gov/nioccs3) was used to assign 2010 U.S. Census civilian occupation and industry codes to NVDRS decedent records based on decedents' usual lifetime occupation and industry as reported on the death certificate. Results are reported by 2010 SOC major groups, converted from U.S. Census codes by NIOCCS. Records that could not be coded by NIOCCS were manually coded using the NIOCCS computer-assisted feature. All coding assignments were reviewed by industry and occupation coding experts for accuracy.
Suicide counts are presented by year, sex, and usual lifetime occupational group. Suicide rates were calculated using annual civilian noninstitutionalized working population counts by occupational group (based on longest job held during the previous calendar year) from the Current Population Survey Annual Social and Economic Supplement (2) as the denominator; 95% confidence intervals (CIs) were calculated using the National Center for Health Statistics method for death rates (3). The rate change from 2012 to 2015 is presented for each occupational group by sex, as is each group's rank for rate change (i.e., where rank position 1 signifies the greatest suicide rate increase). Decedents whose NVDRS data from coroner/ medical examiner reports or law enforcement reports indicated that the decedent was not employed at the time of death (unemployed, disabled, incarcerated, homemaker, or student) were excluded from rate calculations, as were decedents with military or unpaid occupations, and those with insufficient information to classify occupation. Separate analyses of suicide deaths among males in agriculture-related SOC detailed groups were conducted; such rates were not calculated for female decedents because of small numbers.
NIOCCS classified 83% (8,858 in 2012 and 9,508 in 2015) of decedent records (Table 1); this count includes those that the NIOCCS program determined to have insufficient information to classify occupation. After expert review of NIOCCS automated code assignments, 231 (3%) of 2012 records and 290 (3%) of 2015 records were recoded. The remaining 1,799 (2012) and 1,888 (2015) (17% for both years) records were coded using the NIOCCS computer-assisted feature. For 2012 and 2015 combined, 5,089 (23%) decedents were not included in suicide rate calculations because they were in the military, had unpaid occupations (e.g., did not work, homemaker, or student), or had insufficient information to classify lifetime occupation. Another 2,236 (10%) were excluded because they were not employed at the time of death.
In both 2012 and 2015, the largest percentage of male suicides (19%--20% of decedents) occurred among those in the Construction and Extraction group (SOC 47) (Table 2); the largest percentage of female suicides in both years occurred among decedents with unpaid occupations (29%). The largest percentage of female suicides among classifiable occupations occurred in the Office and Administrative Support group (SOC 43) in both years (15%). In both years, the highest suicide rates among males were in the Construction and Extraction group (43.6 in 2012 and 53.2 in 2015 per 100,000 civilian noninstitutionalized working persons) (Table 3). Among females, the highest suicide rates in both years were in the Arts, Design, Entertainment, Sports, and Media group (SOC 27) (11.7 in 2012 and 15.6 in 2015). Among males, the largest suicide rate increase from 2012 to 2015 (47%) occurred in the Arts, Design, Entertainment, Sports, and Media group (from 26.9 to 39.7), and among females (54%) in the Food Preparation and Serving Related group (SOC 35) (from 6.1 to 9.4). Rate changes among females in six SOC major groups were not reported because of small numbers (<20 decedents in one or both years).
The 2012 and 2015 male suicide rates among Farmers, Ranchers, and Other Agricultural Managers (SOC 11-9013, a subgroup of the SOC 11 Management major group) were 44.9 (CI = 34.2-57.9) and 32.2 (CI = 24.2-42.0) per 100,000, based on 59 and 54 suicides in 2012 and 2015, respectively. The 2012 and 2015 male suicide rates for Agricultural Workers (SOC 45-2000, a subgroup of the SOC 45 Farming, Fishing, and Forestry major group) were 20.4 (CI = 13.8-29.1) and 17.3 (CI = 12.1-23.9), based on 30 and 36 suicides in 2012 and 2015, respectively.
Discussion
Suicide rates varied widely across occupational groups in both 2012 and 2015, and rates among males and females increased in many occupational groups. The etiology of suicide is multifactorial, and identifying the specific role that occupational factors might play in suicide risk is complicated; both work (e.g., little job control or job insecurity) and nonwork (e.g., relationship conflict) factors are associated with psychological distress and suicide (4). The relationship between occupation and suicide might be confounded by access to lethal means on the job and socioeconomic factors such as lower income and education (5,6). Previous studies have employed a range of methodologies to study the proposed association between suicide and occupation and, at times, have arrived at different conclusions. For example, although this analysis aligns with another that found high suicide rates among construction workers in Colorado (7), a meta-analysis using an international occupational classification system found persons in other less-skilled occupations, such as laborers and cleaners, to be at higher risk (6).
A better understanding of how suicides are distributed by occupational group might help inform prevention programs and policies. Because many adults spend a substantial amount of their time at work, the workplace is an important but underutilized location for suicide prevention (8). Workplaces could potentially benefit from suicide prevention activities.
Additional and tailored prevention approaches might be necessary to support workers at higher risk. Workplace suicide prevention efforts to date have focused primarily on early detection and tertiary intervention through the training of persons (i.e. gatekeepers) to identify those at risk for suicide and refer them to supporting services. However, more research on the role of the workplace in primary suicide prevention is needed, including improving working conditions and reducing stress (8).
The findings in this report are subject to at least four limitations. First, because of the nature of the data that were available, and consistent with previous research methods, this report compared decedents' usual lifetime occupation as recorded on the death certificate with occupations of the employed population to calculate suicide rates. Additional data from coroner/medical examiner and law enforcement reports were used to exclude decedents identified as not in the labor force at time of death. Separate analyses indicated that if no such exclusion were applied, suicide rates would have been higher for all groups, although the top and bottom eight ranked occupational groups in 2015 by male suicide rate would maintain the same rank position, as would the top three and bottom four occupational groups by female suicide rate. Second, this report did not address confounding factors that might account for higher or lower rates of suicide between and within occupational groups, including education and income (9,10). Within SOC major occupational groups, employee education and income might vary widely. For example, the Management SOC major group includes farmers, ranchers, and chief executives of large companies, and the Construction and Extraction group includes both employees who might be salaried (e.g., supervisors) and those who might be paid hourly wages (e.g., roofer helpers). Future research might benefit from using more narrowly defined occupational groups and controlling for education and income to refine understanding of the relationship between occupation and suicide. Third, industry and occupation data obtained from death certificates rely on the accuracy and completeness of employment information provided by decedents' family members. It is also possible that completeness and accuracy of that information might be associated with decedents' job history. For example, categorization based on single lifetime industry and occupation might not accurately reflect employment for those persons with multiple lifetime occupations and those who worked across industries. Finally, this report is based on data from 17 U.S. states that participated in NVDRS in 2012 and 2015, and the data are not nationally representative.
To address the multifactorial etiology of suicide, CDC recommends a comprehensive approach to prevention (1). Strategies might include enhancing social connectedness and expanding access to relevant resources, strengthening state or local economic supports, implementing practices that encourage help-seeking and decrease stigma, and providing referrals to mental health and other services (1). Strategies can be implemented to assure support and reduce access to lethal means among persons at risk. Decision makers, including employers, can create a response plan, should a suicide affect their organization. Surviving family and friends can be supported to reduce their own suicide risk. The media can follow reporting recommendations to avoid sensationalized reporting and can refrain from providing details on suicide methods (1). Further workplace prevention resources are available at https://theactionalliance.org/, and help is available at 1-800-273-TALK.
Summary
What is already known about this topic? From 2000 to 2016, the U.S. suicide rate among working aged (16-64 years) adults increased 34% from 12.9 per 100,000 population to 17.3.
What is added by this report?
2012 and 2015 National Violent Death Reporting System data from 17 states indicated the major occupational group with the highest male suicide rate was Construction and Extraction (43.6 [2012] and 53.2 [2015]). The Arts, Design, Entertainment, Sports, and Media major occupation group had the highest female suicide rate in 2012 (11.7) and 2015 (15.6).
What are the implications for public health practice?
A comprehensive approach to suicide prevention, including workplace-based approaches, is needed. CDC's technical package of strategies to prevent suicide is a resource for communities and workplaces to identify prevention strategies with the best available evidence.
Acknowledgments
Jeff Purdin, Matt Hirst, Susan Burton, Jenny Huddleston, Elizabeth Smith, Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, CDC.
References
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(2.) US Census Bureau. Current population survey annual social and economic supplement 2013 and 2016. Washington, DC: US Census Bureau; 2018.
(3.) National Center for Health Statistics. Vital statistics of the United States: mortality, 1999 technical appendix. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2004. https://www.cdc.gov/nchs/data/statab/techap99.pdf
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(7.) Stallones L, Doenges T, Dik BJ, Valley MA. Occupation and suicide: Colorado, 2004-2006. Am J Ind Med 2013;56:1290-5.
(8.) Milner A, Page K, Spencer-Thomas S, Lamotagne AD. Workplace suicide prevention: a systematic review of published and unpublished activities. Health Promot Int 2015;30:29-37. https://doi.org/10.1093/heapro/ dau085
(9.) Daly MC, Wilson DJ, Johnson NJ. Relative status and well-being: evidence from U.S. suicide deaths. Rev Econ Stat 2013;95:1480-500. https://doi.org/10.1162/REST_a_00355
(10.) Phillips JA, Hempstead K. Differences in U.S. suicide rates by educational attainment, 2000-2014. Am J Prev Med 2017;53:e123-30. https://doi.org/10.1016Zj.amepre.2017.04.010
Cora Peterson, PhD [1]; Deborah M. Stone, ScD [2]; Suzanne M. Marsh, MPA [3]; Pamela K. Schumacher [4]; Hope M. Tiesman, PhD [3]; Wendy LiKamWa McIntosh, MPH [2]; Colby N. Lokey, MS [2]; Aimee-Rika T. Trudeau, MPH [2]; Brad Bartholow, PhD [2]; Feijun Luo, PhD [1]
Corresponding author: Deborah M. Stone, dstone3@cdc.gov, 770-488-3942.
[1] Division of Analysis, Research, and Practice Integration, National Center for Injury Prevention and Control, CDC; [2] Division of Violence Prevention, National Center for Injury Prevention and Control, CDC; [3] Division of Safety Research, National Institute for Occupational Safety and Health, CDC; [4] Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, CDC.
All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.
* Alaska, Colorado, Georgia, Kentucky, Maryland, Massachusetts, New Jersey, New Mexico, North Carolina, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia, and Wisconsin.
TABLE 1. Procedure for Identification of analysis cohort of suicide decedents, by occupation--National Violent Death Reporting System (NVDRS)--17 U.S. states* 2012 and 2015 Analytic procedure 2012 no. 2015 no. Suicide decedents obtained from NVDRS data set 12,811 13,967 ([dagger]) Excluded before assignment of occupation code Aged <16 years or >64 years or missing sex 2,154 2,571 Assignment of occupation code Assigned based on decedent usual lifetime 10,657 11,396 occupation Autocoded by NIOCCS 8,858 9,508 Manually reassigned using the NIOCCS computer- 231 290 assisted feature Manually assigned using the NIOCCS computer- 1,799 1,888 assisted feature Rate analysis Decedents presumed to be in the labor force at 6,881 7,847 time of death ([section]) Abbreviation: NIOCCS = National Institute for Occupational Safety and Health Industry and Occupation Computerized Coding System. * Alaska, Colorado, Georgia, Kentucky, Maryland, Massachusetts, New Jersey, New Mexico, North Carolina, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia, and Wisconsin. ([dagger])The total number of deaths (including suicides) reported in the NVDRS data set (June 2018) for the 17 U.S. states analyzed included 19,885 decedents in 2012 and 21,884 decedents in 2015. ([section]) Because annual U.S. population count data by occupational group reflects the longest held job in the previous year among civilian, noninstitutionalized persons, suicide decedents whose NVDRS data from coroner/medical examiner or law enforcement reports indicated no employment (e.g., retired, unemployed, disabled, incarcerated, home maker, or student) at the time of death were excluded from rate analysis. Decedents were excluded if NVDRS current occupation information contained any of the following: "student, unemp*, not empl*, laid off, retir*, disab*, incarcer*, inmate, prisoner, homemaker, home maker, housewife, house wife, never worked, or not working." Manual review of records excluded based on these criteria resulted in five records being reinstated (e.g., "student teacher" and two occupations listed for a decedent with just one occupation explicitly identified as retired). TABLE 2. Number and percentage of suicide decedents* in Standard Occupational Classification (SOC) major group, by year and sex-- National Violent Death Reporting System, 17 states, ([dagger]) 2012 and 2015 Male SOC 2012 2015 code Occupational group no. (%) no. (%) 11 Management 534 (8) 611 (9) 13 Business and Financial 155 (2) 145 (2) Operations 15 Computer and Mathematical 208 (3) 237 (3) 17 Architecture and Engineering 172 (3) 167 (2) 19 Life, Physical, and Social Science 56 (1) 52 (1) 21 Community and Social Service 41 (1) 48 (1) 23 Legal 54 (1) 49 (1) 25 Education, Training, and Library 91 (1) 87 (1) 27 Arts, Design, Entertainment, 140 (2) 186 (3) Sports, and Media 29 Health Care Practitioners and 145 (2) 169 (2) Technical occupations 31 Health Care Support 35 (1) 34 (<1) 33 Protective Service 232 (4) 226 (3) 35 Food Preparation and 214 (3) 301 (4) Serving Related 37 Building and Grounds 316 (5) 315 (4) Cleaning and Maintenance 39 Personal Care and Service 81 (1) 85 (1) 41 Sales and Related 555 (9) 553 (8) 43 Office and Administrative 244 (4) 260 (4) Support 45 Farming, Fishing, and Forestry 68 (1) 71 (1) 47 Construction and Extraction 1,216 (19) 1,404 (20) 49 Installation, Maintenance, and 549 (9) 621 (9) Repair 51 Production 605 (9) 679 (10) 53 Transportation and 736 (11) 817 (11) Material Moving NA Military 228 (3) 203 (2) NA Unpaid 822 (10) 913 (11) NA Insufficient Information to 651 (8) 425 (5) Classify Occupation Female SOC 2012 2015 code Occupational group no. (%) no. (%) 11 Management 117 (7) 118 (7) 13 Business and Financial 81 (5) 84 (5) Operations 15 Computer and Mathematical 22 (1) 32 (2) 17 Architecture and Engineering 10 (1) 15 (1) 19 Life, Physical, and Social Science 15 (1) 21 (1) 21 Community and Social Service 39 (2) 40 (2) 23 Legal 34 (2) 29 (2) 25 Education, Training, and Library 82 (5) 84 (5) 27 Arts, Design, Entertainment, 54 (3) 76 (4) Sports, and Media 29 Health Care Practitioners and 220 (14) 225 (12) Technical occupations 31 Health Care Support 97 (6) 124 (7) 33 Protective Service 29 (2) 32 (2) 35 Food Preparation and 112 (7) 154 (9) Serving Related 37 Building and Grounds 36 (2) 46 (3) Cleaning and Maintenance 39 Personal Care and Service 98 (6) 102 (6) 41 Sales and Related 170 (11) 212 (12) 43 Office and Administrative 234 (15) 268 (15) Support 45 Farming, Fishing, and Forestry 7 (<1) 5 (<1) 47 Construction and Extraction 12 (1) 17 (1) 49 Installation, Maintenance, and 8 (1) NR Repair 51 Production 64 (4) 81 (4) 53 Transportation and 52 (3) 39 (2) Material Moving NA Military 15 (1) 13 (<1) NA Unpaid 724 (29) 795 (29) NA Insufficient Information to 177 (9) 123 (4) Classify Occupation Abbreviation: NA = not assigned; NR = not reported due to cell size <5. * Aged 16-64 years. ([dagger]) Alaska, Colorado, Georgia, Kentucky, Maryland, Massachusetts, New Jersey, New Mexico, North Carolina, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia, and Wisconsin. TABLE 3. Suicide rate per 100,000 civilian, noninstitutionalized working persons aged 16-64 years, by sex, based on suicide decedents (N = 14,728) presumed in the labor force at time of death using Standard Occupational Classification (SOC) major groups--National Violent Death Reporting System, 17 states,* 2012 and 2015 Males SOC code Occupational group 2012 2015 47 Construction and Extraction Rate rank ([section]) 1 1 Rate per 100,000 43.6 53.2 95% CI ([paragraph]) 40.9-46.3 50.2-56.1 Suicide decedents, no. 1,009 1,248 Population, no. 2,313,934 2,345,952 27 Arts, Design, Entertainment, Sports, and Media Rate rank 7 2 Rate per 100,000 26.9 39.7 95% CI 22.1-31.8 33.6-45.8 Suicide decedents, no. 117 162 Population, no. 434,177 408,113 49 Installation, Maintenance, and Repair Rate rank 2 3 Rate per 100,000 31.6 39.1 95% CI 28.7-34.4 35.8-42.3 Suicide decedents, no. 473 542 Population, no. 1,498,263 1,387,681 53 Transportation and Material Moving Rate rank 4 4 Rate per 100,000 28.4 30.9 95% CI 26.2-30.7 28.6-33.1 Suicide decedents, no. 615 721 Population, no. 2,164,530 2,336,133 51 Production Rate rank 3 5 Rate per 100,000 28.4 30.5 95% CI 26.0-30.9 28.1-33.0 Suicide decedents, no. 524 607 Population, no. 1,843,879 1,987,864 33 Protective Service Rate rank 6 6 Rate per 100,000 27.1 28.2 95% CI 23.3-30.9 24.2-32.1 Suicide decedents, no. 198 194 Population, no. 730,044 689,034 37 Building and Grounds Cleaning and Maintenance Rate rank 5 7 Rate per 100,000 27.3 26.8 95% CI 24.1-30.5 23.6-30.0 Suicide decedents, no. 281 276 Population, no. 1,028,779 1,029,385 29 Health Care Practitioners and Technical Rate rank 14 8 Rate per 100,000 20.8 25.6 95% CI 17.1-24.6 21.5-29.8 Suicide decedents, no. 119 145 Population, no. 571,387 565,768 45 Farming, Fishing, and Forestry Rate rank 8 9 Rate per 100,000 26.3 22.8 95% CI 20.0-34.0 17.7-29.0 Suicide decedents, no. 58 67 Population, no. 220,364 293,746 41 Sales and Related Rate rank 11 10 Rate per 100,000 21.3 21.5 95% CI 19.4-23.2 19.6-23.4 Suicide decedents, no. 487 489 Population, no. 2,282,361 2,276,666 35 Food Preparation and Serving Related Rate rank 19 11 Rate per 100,000 14.6 20.9 95% CI 12.5-16.7 18.4-23.3 Suicide decedents, no. 180 276 Population, no. 1,234,381 1,321,800 31 Health Care Support Rate rank 9 12 Rate per 100,000 22.1 19.5 95% CI 14.8-31.7 12.5-29.0 Suicide decedents, no. 29 24 Population, no. 131,497 123,003 17 Architecture and Engineering Rate rank 10 13 Rate per 100,000 21.6 19.4 95% CI 18.1-25.1 16.3-22.6 Suicide decedents, no. 145 147 Population, no. 670,938 756,515 23 Legal Rate rank 12 14 Rate per 100,000 21.3 18.7 95% CI 15.7-28.2 13.4-25.4 Suicide decedents, no. 48 41 Population, no. 225,681 219,171 11 Management Rate rank 17 15 Rate per 100,000 16.4 17.8 95% CI 14.9-17.9 16.3-19.3 Suicide decedents, no. 477 530 Population, no. 2,906,468 2,981,498 39 Personal Care and Service Rate rank 13 16 Rate per 100,000 20.9 16.5 95% CI 16.2-26.4 12.9-20.7 Suicide decedents, no. 68 73 Population, no. 326,037 443,543 15 Computer and Mathematical Rate rank 15 17 Rate per 100,000 18.1 16.1 95% CI 15.5-20.8 13.9-18.4 Suicide decedents, no. 179 202 Population, no. 986,994 1,252,275 43 Office and Administrative Support Rate rank 20 18 Rate per 100,000 14.1 15.8 95% CI 12.2-16.1 13.7-17.9 Suicide decedents, no. 206 223 Population, no. 1,456,242 1,411,453 19 Life, Physical, and Social Science Rate rank 16 19 Rate per 100,000 17.3 15.0 95% CI 12.7-23.0 11.0-20.0 Suicide decedents, no. 47 47 Population, no. 271,690 312,925 21 Community and Social Service Rate rank 21 20 Rate per 100,000 12.8 14.6 95% CI 8.8-17.9 10.7-19.6 Suicide decedents, no. 33 45 Population, no. 258,744 307,829 13 Business and Financial Operations Rate rank 18 21 Rate per 100,000 14.6 13.0 95% CI 12.1-17.2 10.7-15.3 Suicide decedents, no. 125 122 Population, no. 855,329 941,806 25 Education, Training, and Library Rate rank 22 22 Rate per 100,000 10.9 10.9 95% CI 8.6-13.6 8.6-13.5 Suicide decedents, no. 78 79 Population, no. 713,321 727,167 SOC Rate change code Occupational group % Rank ([dagger]) 47 Construction and Extraction Rate rank ([section]) +22% 5 Rate per 100,000 95% CI ([paragraph]) Suicide decedents, no. Population, no. 27 Arts, Design, Entertainment, Sports, and Media Rate rank +47% 1 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 49 Installation, Maintenance, and Repair Rate rank +24% 3 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 53 Transportation and Material Moving Rate rank +9% 8 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 51 Production Rate rank +7% 10 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 33 Protective Service Rate rank +4% 11 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 37 Building and Grounds Cleaning and Maintenance Rate rank -2% 14 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 29 Health Care Practitioners and Technical Rate rank +23% 4 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 45 Farming, Fishing, and Forestry Rate rank -13% 21 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 41 Sales and Related Rate rank +1% 12 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 35 Food Preparation and Serving Related Rate rank +43% 2 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 31 Health Care Support Rate rank -12% 18 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 17 Architecture and Engineering Rate rank -10% 15 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 23 Legal Rate rank -12% 19 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 11 Management Rate rank +8% 9 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 39 Personal Care and Service Rate rank -21% 22 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 15 Computer and Mathematical Rate rank -11% 16 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 43 Office and Administrative Support Rate rank +12% 7 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 19 Life, Physical, and Social Science Rate rank -13% 20 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 21 Community and Social Service Rate rank +15% 6 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 13 Business and Financial Operations Rate rank -11% 17 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 25 Education, Training, and Library Rate rank -1% 13 Rate per 100,000 95% CI Suicide decedents, no. Population, no. Females Occupational group 2012 2015 27 Arts, Design, Entertainment, Sports, and Media Rate rank ([section]) 1 1 Rate per 100,000 11.7 15.6 95% Cl [paragraph]) 8.6-15.5 12.1-19.8 Suicide decedents, no. 47 67 Population, no. 403,305 429,424 33 Protective Service Rate rank 2 2 Rate per 100,000 11.6 12.2 95% CI 7.5-17.1 8.1-17.7 Suicide decedents, no. 25 28 Population, no. 215,345 228,862 31 Health Care Support Rate rank 5 3 Rate per 100,000 8.4 11.0 95% CI 6.7-10.4 8.9-13.0 Suicide decedents, no. 83 108 Population, no. 993,407 984,369 35 Food Preparation and Serving Related Rate rank 11 4 Rate per 100,000 6.1 9.4 95% CI 4.9-7.5 7.8-11.0 Suicide decedents, no. 94 139 Population, no. 1,539,199 1,479,822 23 Legal Rate rank 3 5 Rate per 100,000 11.1 9.2 95% CI 7.5-15.9 5.8-13.9 Suicide decedents, no. 30 22 Population, no. 269,243 238,870 29 Health Care Practitioners and Technical Rate rank 4 6 Rate per 100,000 10.3 9.0 95% CI 8.9-11.8 7.7-10.3 Suicide decedents, no. 195 193 Population, no. 1,890,885 2,140,217 51 Production Rate rank 7 7 Rate per 100,000 7.6 9.0 95% CI 5.8-10.0 7.0-11.3 Suicide decedents, no. 55 72 Population, no. 719,183 800,640 39 Personal Care and Service Rate rank 9 8 Rate per 100,000 6.8 7.7 95% CI 5.5-8.4 6.2-9.5 Suicide decedents, no. 89 92 Population, no. 1,308,535 1,187,811 41 Sales and Related Rate rank 10 9 Rate per 100,000 6.4 7.7 95% CI 5.3-7.4 6.6-8.7 Suicide decedents, no. 148 192 Population, no. 2,325,223 2,505,186 15 Computer and Mathematical Rate rank NR 10 Rate per 100,000 NR 7.3 95% CI NR 5.0-10.5 Suicide decedents, no. 20 30 Population, no. 390,260 408,410 53 Transportation and Material Moving Rate rank 6 11 Rate per 100,000 8.3 6.9 95% CI 6.0-11.2 4.8-9.7 Suicide decedents, no. 43 33 Population, no. 517,082 477,143 21 Community and Social Service Rate rank 8 12 Rate per 100,000 7.3 6.0 95% CI 5.1-10.2 4.2-8.4 Suicide decedents, no. 34 36 Population, no. 464,942 595,582 43 Office and Administrative Support Rate rank 14 13 Rate per 100,000 4.7 6.0 95% CI 4.1-5.4 5.2-6.8 Suicide decedents, no. 201 239 Population, no. 4,267,892 3,985,105 13 Business and Financial Operations Rate rank 12 14 Rate per 100,000 5.7 5.4 95% CI 4.4-7.2 4.2-6.8 Suicide decedents, no. 70 71 Population, no. 1,235,880 1,321,724 37 Building and Grounds Cleaning and Maintenance Rate rank 15 15 Rate per 100,000 4.6 5.2 95% CI 3.1-6.5 3.7-7.2 Suicide decedents, no. 31 36 Population, no. 673,483 688,809 11 Management Rate rank 13 16 Rate per 100,000 5.6 4.9 95% CI 4.5-6.7 4.0-5.9 Suicide decedents, no. 104 103 Population, no. 1,855,055 2,083,968 25 Education, Training, and Library Rate rank 16 17 Rate per 100,000 3.3 3.4 95% CI 2.6-4.2 2.7-4.2 Suicide decedents, no. 69 74 Population, no. 2,091,706 2,186,483 17 Architecture and Engineering Rate rank NR NR Rate per 100,000 NR NR 95% CI NR NR Suicide decedents, no. 10 12 Population, no. 135,632 144,852 19 Life, Physical, and Social Science Rate rank NR NR Rate per 100,000 NR NR 95% CI NR NR Suicide decedents, no. 13 19 Population, no. 225,992 204,566 45 Farming, Fishing, and Forestry Rate rank NR NR Rate per 100,000 NR NR 95% CI NR NR Suicide decedents, no. 7 5 Population, no. 54,068 91,967 47 Construction and Extraction Rate rank NR NR Rate per 100,000 NR NR 95% CI NR NR Suicide decedents, no. 9 14 Population, no. 55,164 76,173 49 Installation, Maintenance, and Repair Rate rank NR NR Rate per 100,000 NR NR 95% CI NR NR Suicide decedents, no. 8 NR Population, no. 73,231 46,136 Rate change Occupational group % Rank ([dagger]) 27 Arts, Design, Entertainment, Sports, and Media Rate rank ([section]) +34% 2 Rate per 100,000 95% Cl [paragraph]) Suicide decedents, no. Population, no. 33 Protective Service Rate rank +5% 9 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 31 Health Care Support Rate rank +31% 3 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 35 Food Preparation and Serving Related Rate rank +54% 1 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 23 Legal Rate rank -17% 15 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 29 Health Care Practitioners and Technical Rate rank -13% 13 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 51 Production Rate rank +18% 6 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 39 Personal Care and Service Rate rank +14% 7 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 41 Sales and Related Rate rank +20% 5 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 15 Computer and Mathematical Rate rank NR NR Rate per 100,000 95% CI Suicide decedents, no. Population, no. 53 Transportation and Material Moving Rate rank -17% 14 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 21 Community and Social Service Rate rank -17% 16 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 43 Office and Administrative Support Rate rank +27% 4 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 13 Business and Financial Operations Rate rank -5% 11 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 37 Building and Grounds Cleaning and Maintenance Rate rank +14% 8 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 11 Management Rate rank -12% 12 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 25 Education, Training, and Library Rate rank +3% 10 Rate per 100,000 95% CI Suicide decedents, no. Population, no. 17 Architecture and Engineering Rate rank NR NR Rate per 100,000 95% CI Suicide decedents, no. Population, no. 19 Life, Physical, and Social Science Rate rank NR NR Rate per 100,000 95% CI Suicide decedents, no. Population, no. 45 Farming, Fishing, and Forestry Rate rank NR NR Rate per 100,000 95% CI Suicide decedents, no. Population, no. 47 Construction and Extraction Rate rank NR NR Rate per 100,000 95% CI Suicide decedents, no. Population, no. 49 Installation, Maintenance, and Repair Rate rank NR NR Rate per 100,000 95% CI Suicide decedents, no. Population, no. Abbreviations: CI = confidence interval; NR = not reported; number of decedents not reported <5, and rates were not calculated for occupational groups with <20 decedents; SOC = Standard Occupational Classification. ([dagger]) Rate change rank refers to each occupational group's rank order for rate change from 2012 to 2015, where rank position 1 signifies the greatest suicide rate increase. ([section]) Occupational groups were ranked by 2015 suicide rate, separately for males and females. Because of rounding, some rate and rate change results are not precisely calculable from the data presented. ([paragraph]) 95% CIs were calculated using CDC's National Center for Health Statistics methods, including confidence limit factors for mortality rates based on <100 decedents.