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If you are in crisis, call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week. The service is available to anyone. All calls are confidential. http://www.suicidepreventionlifeline.org

Demographics

Crude suicide rate calculations take population size within subgroups in any given year or timeframe into account. They can be a useful tool for understanding the relative proportion of people affected within different demographic groups.

Figure 2 shows the crude rates of suicide within sex and age categories in 2019.

Among females, the suicide rate was highest for those aged 45-64 (9.6 per 100,000).

Among males, the suicide rate was highest for those aged 75 and older (39.9 per 100,000).

Figure 2

Figure 3 shows the crude rates of suicide for race/ethnicity groups in 2019 based on data from the CDC's WISQARS Fatal Injury Data Visualization Tool.

The crude rates of suicide were highest for American Indian, Non-Hispanic males (33.4 per 100,000) and, followed by White, Non-Hispanic males (29.8 per 100,000). Among females the crude rates of suicide were highest for American Indian, Non-Hispanic females (11.1 per 100,000) and White, Non-Hispanic females (8.0 per 100,000).

Figure 3

Suicide Rates by State

Just as state population numbers and age distributions vary, suicide rates can vary widely from state to state. Based on data from the CDC WISQARS Fatal Injury Data Visualization Tool, Figure 4 shows a map of the United States with each state's age-adjusted suicide rate in 2019 indicated by color.

Figure 4

Source: CDC - WISQARS (Web-based Injury Statistics Query and Reporting System) Fatal Injury Mapping
Website: https://wisqars.cdc.gov:8443/cdcMapFramework/mapModuleInterface.jsp Applied Filters: Suicide All Injury Deaths
States: All States
Race: All Races
Ethnicity: All Ethnicities
Sex: All Sexes
Year Range: 2019-2019
Age Range: All Ages

Percent of Suicide Deaths by Method

Figure 5 shows the percentages of suicide deaths by method among females and males in 2019. Among females, the most common methods of suicide were firearm (31.4%), poisoning (30.0%), and suffocation (29.0%). Among males, the most common methods of suicide were firearm (55.6%) followed by suffocation (28.4%).

Figure 5

Figure 6 shows that 4.8% of adults age 18 and older in the United States had serious thoughts about suicide in 2019.

Among adults across all age groups, the prevalence of serious suicidal thoughts was highest among young adults aged 18-25 (11.8%).

The prevalence of serious suicidal thoughts was highest among adults age 18 and older who report having multiple (two or more) race (6.9%).

Figure 6

* Persons of Hispanic origin may be of any race; all other racial/ethnic groups are non-Hispanic.
NH/OPI = Native Hawaiian / Other Pacific Islander / AI/AN = American Indian / Alaskan Native

Figure 7 shows that in 2019, 0.6% of adults age 18 and older in the United States report they attempted suicide in in the past year.

Among adults across all age groups, the prevalence of suicide attempt in the past year was highest among young adults 18-25 years old (1.8%).

Among adults age 18 and older, the prevalence of suicide attempts in the past year was highest among those who report having multiple (two or more) races (1.5%).

Figure 7

* Persons of Hispanic origin may be of any race; all other racial/ethnic groups are non-Hispanic.
NH/OPI = Native Hawaiian / Other Pacific Islander / AI/AN = American Indian / Alaskan Native

Figure 8 shows that in 2019, 12.0 million adults aged 18 or older reported having serious thoughts of suicide, and 1.4 million adults attempted suicide during the past year.

Figure 8

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If you are in crisis, call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week. The service is available to anyone. All calls are confidential. http://www.suicidepreventionlifeline.org Crude suicide rate calculations take population size within subgroups in any given year or timeframe into account.

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how many teens and young adults die of cancer each year - Google Search

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Apr 27, 2018 ... Adolescents and Young Adults with Cancer .... Cancer has a major impact on society in the United States and across the world. ... Statistics tell us things such as how many people are diagnosed with and die from cancer each year, the ...

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Suicide rate by county 2016-2020 average rate per 100,000

Suicide is a major national public health issue in the United States. The country has one of the highest suicide rates among wealthy nations. In 2020, there were 45,799 recorded suicides, up from 42,773 in 2014, according to the CDC's National Center for Health Statistics (NCHS). On average, adjusted for age, the annual U.S. suicide rate increased 30% between 2000 and 2020, from 10.4 to 13.5 suicides per 100,000 people. In 2018, 14.2 people per 100,000 died by suicide, the highest rate recorded in more than 30 years. Due to the stigma surrounding suicide, it is suspected that suicide is generally underreported. In April 2016, the CDC released data showing that the suicide rate in the United States had hit a 30-year high, and later in June 2018, released further data showing that the rate has continued to increase and has increased in every U.S. state except Nevada since 1999. From 2000 to 2020, more than 800,000 people died by suicide in the United States, with males representing 78.7% of all suicides that happened between 2000 and 2020. In 2022, around 49,500 people died by suicide according to the CDC, which is the highest number ever recorded. Surging death rates from suicide, drug overdoses and alcoholism, what researchers refer to as " deaths of despair", are largely responsible for a consecutive three year decline of life expectancy in the U.S. This constitutes the first three-year drop in life expectancy in the U.S. since the years 1915-1918.

In 2015, suicide was the seventh leading cause of death for males and the 14th leading cause of death for females. Additionally, it was the second leading cause of death for young people aged 10 to 34. From 1999 to 2010, the suicide rate among Americans aged 35 to 64 increased nearly 30 percent. The largest increases were among women aged 60 to 64, with rates rising 60 percent, than men in their fifties, with rates rising nearly 50 percent. In 2008, it was observed that U.S. suicide rates, particularly among middle-aged white women, had increased, although the causes were unclear. As of 2018, about 1.7 percent of all deaths were suicides.

The U.S. government seeks to prevent suicides through its National Strategy for Suicide Prevention, a collaborative effort of the Substance Abuse and Mental Health Services Administration, Centers for Disease Control and Prevention, National Institutes of Health, Health Resources and Services Administration, and the Indian Health Service. Their plan consists of eleven goals aimed at preventing suicides. Older adults are disproportionately likely to die by suicide. Some U.S. jurisdictions have laws against suicide or against assisting suicide. In recent years, there has been increased interest in rethinking these laws.

Suicide has been associated with tough economic conditions, including unemployment rate.

There are significant variations in the suicide rates of the different states, ranging from 28.89 per 100,000 people in Montana to 8.11 per 100,000 people in New York.

A firearm is used in approximately half of suicides, accounting for two-thirds of all firearm deaths. Firearms were used in 56.9% of suicides among males in 2016, making it the most commonly used method by them.

On July 16, 2022, the United States transitioned the National Suicide Hotline from the former 10-digit number into the 988 Suicide & Crisis Lifeline, linking both the National Suicide Hotline, the Veterans Crisis Line, and a network of more than 200 state and local call centers run through SAMHSA, the Substance Abuse and Mental Health Services Administration.

The spike in suicide rates in the United States during the 21st century has gained public and clinical attention. Studies have found that despite efforts to minimize suicide rates, rates have steadily increased by approximately 2% per year from 2006 to 2014. A national epidemiologic survey of 69,341 US adults found the percentage of adults attempting suicide increased from 0.62% in 2004 through 2005 to 0.79% in 2012 through 2013. Because of this, clinicians aim to determine whether this is a coincident national increase in suicide attempts. In order to achieve this, trends in suicide attempts are characterized among sociodemographic and clinical groups. It was found that suicide attempts impact "younger adults with less formal education and those with antisocial personality disorder, anxiety disorders, depressive disorders, and a history of violence" at disproportional rates. It is important for trends in suicide attempts to be investigated and researched for they help to determine the cause of the increase in suicide rates. Knowing the trends in suicide also allow preventative measures to be taken. Suicide prevention is possible through early identification and treatment of individuals deemed high risk. Nearly 50,000 persons committed suicide in 2022, up roughly 2.6% from the previous year.

Suicide prevention has been thought of as the responsibility of mental health professionals within clinical settings between 2000 and 2010. As of 2019, suicide prevention is being recognized as a public health responsibility rather than within clinical settings due to the trend in increasing suicide rates. In 1960-2010, population-based risk reduction approaches have been used for other diseases such as myocardial infarction. However, as of 2019, the urgency of development of effective suicide prevention has been recognized by the CDC. While suicide is often thought of as an individual problem, suicides may impact families, communities, and society in general. The responsibility of public health would be to develop policies to reduce people's risk of suicidal behavior through addressing factors at the individual to societal levels. "Public health emphasizes efforts to prevent violence (in this case, toward oneself) before it happens. This approach requires addressing factors that put people at risk for, or protect them from, engaging in suicidal behavior."

The CDC has created a National Suicide Prevention Lifeline where they provide free and confidential support for people in distress, prevention and crisis resources for people who are in need of such help, and best practices for professionals. In May 2019, Bloomberg reported that in spite of the recent mental health crisis, insurance companies, including UnitedHealth Group, are doing what they can to limit coverage and deny claims for mental health related issues.

A 2019 study by the National Bureau of Economic Research found a direct causal link between worker's wages and suicide rates, and that raising the minimum wage would result in a quick drop in the suicide rate.

In August 2020, during the COVID-19 pandemic, a survey conducted by the CDC found that 25.5 percent of people aged between 18 and 24 have seriously contemplated suicide within the last 30 days. For the age group 25 to 44, it was 16 percent. Glenn Greenwald of The Intercept said of the findings:

In a remotely healthy society, one that provides basic emotional needs to its population, suicide and serious suicidal ideation are rare events. It is anathema to the most basic human instinct: the will to live. A society in which such a vast swath of the population is seriously considering it as an option is one which is anything but healthy, one which is plainly failing to provide its citizens the basic necessities for a fulfilling life.

CDC data on suicides by age group in 2015

CDC data on suicide rate by race and gender in 2015

The National Violent Death Reporting System (NVDRS) keeps data on U.S. suicides.

Based on the NVDRS 2016 data, the New York Times acknowledged that, among men, those over 65-who make up a smaller proportion of the population -are at greatest risk of death by suicide. The NVDRS 2015 data showed that, among men of all races, men over 65 were the most likely to die of suicides (27.67 suicides per 100,000), closely followed by men 40-64 (27.10 suicides per 100,000). Men 20-39 (23.41 per 100,000) and 15-19 (13.81 per 100,000) were less likely to die of suicides.

The American Foundation for Suicide Prevention reported that in 2016 suicide was the tenth leading cause of death in the U.S., imposing a cost of $69 billion to the US annually. In 2016, middle aged white males were considerably more likely to die than other demographic groups, however Native Americans had the highest age-adjusted suicide rate. The suicide rate increased considerably among middle aged white women from 1999-2017.

Native Americans and White Americans have the highest suicide rate in the United States. However, more recently, the CDC reported that suicides have sharply increased among people of color, while the white American suicide rate has decreased. The suicide rate increased by nearly 20% for African Americans, while the Native American rate increased by 26%. White Americans were the only group in America to experience a decline in suicide rate. The age-adjusted non-Hispanic white suicide rate declined by nearly 4%. Suicide rates are higher for older white men. Suicide rates have increased for black children.

There are significant variations in the suicide rates of the different states. A number of theories for these differences have been suggested, ranging from socioeconomics ( rural poverty) to access to firearms and social isolation (low population densities), and a study in 2011 found a correlation between altitude above sea level and suicide.

For college students, suicide is the second highest cause of death. The risk tends to be underestimated, as many falsely believe that young people do not have thoughts about suicide. The suicide rate for male students is about three times higher than that of female students. The study of suicide rates and trends was not common in the past, but it has gained more attention in 2019. From 1990 to 2004, about 1,404 college students died by suicide. This is about 6.5 percent of those who died by suicide nationwide. In 2014, the adjusted age rate was higher for male than female: the suicide rate for males was 20.7 per 100,000 while the rate for females was 5.8 per 100,000.

While counseling services can help prevent suicide, resource availability may be insufficient. Students who do not go to counseling services are at 18 times more at risk of suicide compared to those who do. If a college student has any suicidal thoughts, it is always critical to let others, such as members of the school, family, or friends know.

Military veterans

A United States Army suicide prevention poster

A 2009 U.S. Army report indicates military veterans have double the suicide rate of non-veterans, and more active-duty soldiers have died from suicide than in combat in the Iraq War (2003-2011) and War in Afghanistan (2001-2021). Colonel Carl Castro, director of military operational medical research for the Army noted "there needs to be a cultural shift in the military to get people to focus more on mental health and fitness." In 2012, the US Army reported 185 suicides among active-duty troops, exceeding the number of combat deaths in that year (176). This figure has significantly increased since 2001, when the number of suicides was 52.

According to a June 2021 study published by Brown University's Cost of War Project, deaths from suicide among active U.S. military personnel and veterans of the post-9/11 conflicts outnumber combat deaths for those same conflicts by four times, with the numbers being 30,177 and 7,057 respectively.

Healthcare workers

The yearly suicide rate per 100,000 person-years varied between 21.4 for health care support workers, 16 for registered nurses, 15.6 for health technicians, and 13.1 for physicians, according to Columbia University researchers, compared to 12.6 for non-health care professionals.

Suicide rates among veterinarians are a growing problem: suicide rates among male veterinarians are twice the national average, and among female veterinarians the suicide rate is 3.5 times the national average.

Attempted suicide rates for lesbian, gay, bisexual, transgender and questioning ( LGBTQ) youth and adults in the U.S. are higher than national rates. According to the Centers for Disease Control and Prevention report, nearly half of LGBTQ students said they had seriously considered suicide.

Patients with chronic pain are twice as likely to attempt suicide compared with those without chronic pain.

Studies have found very high rates of suicide in people with autism spectrum disorders, including high functioning autism and what was formerly known as Asperger syndrome. Autism and particularly Asperger syndrome are highly associated with clinical depression and as many as 30 percent or more of people with Asperger syndrome also suffer from depression.

Those with ADHD are 3-5 times more likely to die by suicide. A comorbidity of depression with ADHD is the best predictor of suicidal thoughts in adolescence.

Murder-suicide

There have been many high-profile incidents in the United States in the 1990s, 2000s and 2010s of individuals thought to be attempting " suicide by cop" or killing others before killing themselves. Examples include the 1999 Columbine High School massacre, the 2007 Virginia Tech massacre, the 2010 Austin plane crash, the 2012 Sandy Hook Elementary School shooting, the 2014 Isla Vista killings, and the 2017 Las Vegas shooting.

Trend of suicide deaths from 1960 to 2007 for Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States

Suicide vs violent deaths 2016

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Suicide in the United States - Wikipedia

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Suicide is a major national public health issue in the United States. The country has one of the highest suicide rates among wealthy nations. In 2020, there were 45,799 recorded suicides, up from 42,773 in 2014, according to the CDC's National Center for Health Statistics (NCHS). On average, adjusted for age, the annual U.S.

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College students' mental health is a growing concern, survey finds

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College students with significant psychological problems is a growing concern, with anxiety and depression top concerns.

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Everyone is at risk of mental illnesses, its not just every few people its almost everyone teens, children, adults and people who already have serious medical issues (pyshically)

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Mental health is now a serious political issue. This week, Jeremy Corbyn became the latest political leader to include a reference to mental health in his party conference speech. His argument was that the commitment to parity of esteem for mental health must be more than an empty 'slogan'. We've heard commitments from all parties, now it's time they were universally held to account on their promises.

Parity of esteem should mean that those seeking help for a mental health problem should expect to receive the same level of response from the NHS as if they were presenting with a physical health problem. There is a long way to go to achieve this. A couple of stark statistics illustrate the point.

Mental health problems account for 22.8 per cent of the demand facing the NHS but only 11 per cent of NHS expenditure. Ninety two per cent of people with physical health problems receive the treatment they need, but by comparison, only 26 per cent of people with mental health problems do.

For those individuals with mental health problems and their families, this means it can be harder to access help when it is needed, that there is less access to evidence-based interventions and less choice than would be the case for a physical health problem. At its worst, the issues are reflected in the situations where young people in severe mental distress have ended up in police custody or in hospitals 200 miles away from home.

So, if as Jeremy Corbyn suggests, parity of esteem for mental health is taken be seriously what has got to change?

The first thing is attitudes. Negative attitudes and stigma have been a major reason why it has been deemed "acceptable" to offer a second class response to those with mental health problems. The good news is that campaigns like Time to Change have made significant steps in improving attitudes and making it easier for people to talk about their experiences of mental ill-health. The more visible mental health is as an issue, the more likely it will be taken seriously by politicians.

The second is standards. Target are not everything but there is no doubt that our experience of physical health care has been transformed by the priority given to waiting times, whether in A&E or for elective care. Until recently, no such standards existed for mental health so the commitment made by the Coalition Government to introduce standards for early intervention for psychosis and access to talking treatments for people with depression and anxiety were welcome. This must be, though, just the start.

The third is training. Mental health problems do not just present in mental health services. Many people with long term physical health problems, like diabetes, will also be affected by a mental health problem. Many people presenting frequently in A&E and at their GP will be suffering from issues which are fundamentally psychological in character. Yet many NHS staff working in those settings can have very limited training in how to respond to those issues. It is possible to be a doctor specialising in physical health and do as little as five weeks on mental health in the whole of their clinical training. This must change. GPs needs to be equipped with the necessary skills for early and effective diagnosis of mental health conditions and better preventative and physical health care for people with serious and enduring mental health problems.

The bottom line though is resources. Achieving parity of esteem has to mean a serious long term commitment to increase funding in mental health care. With some exceptions, the opposite appears to be happening. Reports earlier in the year found that mental health funding had fallen by 8.25 per cent despite rising demand.

With enormous pressures on public sector budgets, some will argue that this is no surprise. We however perceive greater investment in mental health services as offering a solution to the pressures with which many hospitals and GPs are struggling to cope.

We know that there are many positive things to build on about mental health care in this country. It is unacceptable, however, that there remains such a gap in what the NHS can offer people with mental health problems compared to physical health issues. It is an issue which leaves those with serious mental health problems, like schizophrenia, with a life expectancy two decades shorter than the general population. Tackling this problem head on will require not just fine words, but a major shift in culture and resources. On this Jeremy Corbyn is right.
Paul Jenkins is the Vice Chair of the Cavendish Square group. Twitter: @PaulJThinks

The Independent has launched its #FinalSay campaign to demand that voters are given a voice on the final Brexit deal.

Sign our petition here

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Corbyn is right. We must take mental health as seriously as physical

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Mental health is now a serious political issue. This week, Jeremy Corbyn became the latest political leader to include a reference to mental health in his party conference speech. His argument was that the commitment to parity of esteem for mental health must be more than an empty 'slogan'.

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kids grow up and have no idea what mental illnesses are and they have the symptoms of mental illness but never get help because they dont understand whats going on

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Mental Illness causes suicide and by treating mental illness more seriously we could prevent suicide

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It’s time to recognize mental health as essential to physical health

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Mental health must be recognized as essential to physical health, not an extraneous element of it, before we have truly complete modern medicine.

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providing health care can save lives of many people

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In the midst of the complex, politically-charged health care debate unfolding in Washington, medical researchers say the science is clear: being uninsured increases one's risk of dying.

That's the headline out of a new big-picture analysis of existing research that explores the relationship between insurance coverage and mortality.

"Losing insurance is lethal and gaining insurance reduces the death rate. That is completely consistent numerically across the different studies," Dr. Steffie Woolhandler, a professor at the School of Urban Public Health at Hunter College and co-author of the literature review, told CBS News. "The politicians in Washington need to deal with that as a fact and not pretend there's disagreement on this issue. There's not disagreement on this issue if you examine the science."

The analysis, published Monday in the journal Annals of Internal Medicine, provides an update to a 2002 review of 130 studies on the subject, incorporating additional studies completed since that time. Both then and now, the research shows that people who are uninsured generally have "poorer health and shortened lives."

"The thing that's most surprising is how consistent the literature is. There's really not much disagreement in the scientific literature," Woolhandler said.

Co-author Dr. David Himmelstein said the reason is simple: "People get to see the doctor or nurse practitioner... and get their health problems taken care of." For example, "If you don't have health insurance you're unlikely to get treatment for your or your depression."

How big a difference does having health insurance coverage make?

The studies covered in Woolhandler and Himmelstein's paper "all suggest roughly the same thing -- that insurance has a modest, but real, effect on all-cause mortality. Something to the tune of a 20 percent relative reduction in death compared to being uninsured," F. Perry Wilson, M.D., wrote in an analysis for MedPage Today.

In addition to lower overall death rates, the study also cites "other well-established benefits of health insurance: improved self-rated health, financial protection, and reduced likelihood of depression."

Both authors of the study are affiliated with Physicians for a National Health Program, an organization that advocates for a single-payer health care system covering all Americans.

CBO projects Senate health bill would drive up number of uninsured

About 28.4 million Americans are uninsured, according to the latest government figures.

If the Senate Republican bill to replace the Affordable Care Act passes, 22 million more people will find themselves without insurance in the next decade, according to an analysis released Monday by the nonpartisan Congressional Budget Office. The bill specifically affects funding for , the federal-state health insurance program for low-income Americans.

The latest research directly contradicts a recent claim by Rep. Raúl Labrador, a Republican from Idaho, who said at a town hall last month: "Nobody dies because they don't have access to health care."

Video of Labrador's comments went viral, and the congressman later tried to clarify on Facebook: "I was trying to explain that all hospitals are required by law to treat patients in need of emergency care regardless of their ability to pay and that the Republican plan does not change that," he posted.

Last week, Sen. Orrin Hatch, R-Utah, pushed back forcefully against Sen. Bernie Sanders' assertion that "thousands of people will die if the Republican health care bill becomes law," retorting: "The brief time when we were *not* accusing those we disagree with of murder was nice while it lasted."

The brief time when we were *not* accusing those we disagree with of murder was nice while it lasted. https://t.co/qr1rzon1cg
- Senator Hatch Office (@senorrinhatch) June 23, 2017

People without insurance often go without preventative services, from pap smears to mammograms to blood pressure checks, as well as treatment for chronic diseases.

For some, the stress of dealing with serious health issues while being uninsured can also take a toll.

"When I didn't have insurance, I was so much more stressed about the fact that I didn't have back up behind me, that it actually caused me to have worse symptoms," Fred Zorn, a patient with inflammatory bowel disease, told CBS News.

For researchers, the relationship between health insurance and mortality is tricky to study. In the U.S., many individuals cycle in and out of coverage over the years, making it difficult to discern the differences in health outcomes between the insured and uninsured. The study points out that ethical considerations prevent doing a randomized clinical trial in which certain people are deliberately kept uninsured. Additionally, the insured and uninsured are not neatly defined groups: for instance, becoming ill often directly causes individuals to qualify for public insurance, losing a job often results in losing insurance, and so on, leading to thorny questions of causality.

Senate Republicans are working overtime to finalize the bill and vote on it before lawmakers leave Washington for the July 4th recess. The bill needs 51 votes to pass, but the leadership has not yet secured enough support.

More than a dozen leading health and medical groups oppose the Senate bill, including the American Medical Association, the American Academy of Pediatrics, the American Lung Association, AARP and the American Hospital Association.

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Health insurance can make a life or death difference, study says

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In the midst of the complex, politically-charged health care debate unfolding in Washington, medical researchers say the science is clear: being uninsured increases one's risk of dying. That's the headline out of a new big-picture analysis of existing research that explores the relationship between insurance coverage and mortality.

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health care should be a normal human right

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Our Work - Partners for Dignity & Rights

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Partners for Dignity and Rights provides multi-disciplinary and direct support to our partners' campaigns. This includes strategy, policy, research and documentation, advocacy, communications, and alliance building support. We work with our partners to advance bold ideas on how to organize our society and shift the debate on the need for public goods, equity and inclusion of all communities.

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if everyone has healthcare it can actually lower the cost of healthcare for the US

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Proponents say it would stop medical bankruptcies and improve public health. Opponents say it is socialism and should be an individual’s responsibility.

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improving saftey for people in all areas of life (school, work, communtities, etc.)

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Sexual violence (SV) is a serious problem that can have lasting, harmful effects on victims and their family, friends, and communities. CDC's goal is to stop SV from happening in the first place. The solutions are just as complex as the problem.

In order to prevent SV, we must understand and address risk and protective factors at the individual, relational, community, and societal levels.

CDC developed a resource, Sexual Violence Prevention Resource for Action [3 MB, 46 Pages] to help communities take advantage of the best available evidence to prevent sexual violence. This resource is available in English and Spanish [17MB, 48 Pages, 508] and can impact individual behaviors and the relationship, family, school, community, and societal factors that influence the risk and protective factors for violence. Many of the strategies focus on reducing the likelihood that a person will engage in sexual violence. The strategies and their corresponding approaches are listed in the table below.

S

Promote Social Norms that Protect Against Violence

Bystander Approaches

Mobilizing men and boys as allies

T

Teach Skills to Prevent Sexual Violence

Social-emotional learning

Teaching healthy, safe dating and intimate relationship skills to adolescents

Promoting healthy sexuality

Empowerment-based training

O

Provide Opportunities to Empower and Support Girls and Women

Strengthening economic supports for women and families

Strengthening leadership and opportunities for girls

P

Create Protective Environments

Improving safety and monitoring in schools

Establishing and consistently applying workplace policies

Addressing community-level risks through environmental approaches

SV

Support Victims/Survivors to Lessen Harms

Victim-centered services

Treatment for victims of SV

Treatment for at-risk children and families to prevent problem behavior including sex offending

Example Programs

Below are some examples of programs described in the STOP SV technical package.

See Sexual Violence Resources for more publications, data sources, and other resources about preventing sexual violence.

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Sexual violence (SV) is a serious problem that can have lasting, harmful effects on victims and their family, friends, and communities. CDC's goal is to stop SV from happening in the first place. The solutions are just as complex as the problem.

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people are shamed for being a victim of sexual violence and it needs to stop

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Being sexually assaulted in one of the most shame-inducing traumas that a person can experience. So it is understandable that victims don't need to be further shamed by being shamed for not reporting the crime. And yet, that is exactly what happens whenever we hear, for the first time, about a sexual assault that occurred months or years ago. "Why didn't she report it before?" we ask. "Why didn't she come forward a long time ago, right after it happened?"

Sixty-three percent of sexual assaults are not reported. Why is this the case? This article is intended to answer that question. I wrote a similar article on why women don't come forward when they are sexually harassed at work and received a lot of positive feedback thanking me for explaining this phenomena. I hope this article will be as beneficial in addressing sexual assault.

Not every victim reacts the same way or has the same reasons for not reporting, but based on my forty years working as a psychotherapist I believe there are ten major reasons for non-reporting:

1. Victims are too ashamed to come forward. Shame is at the core of the intense emotional wounding women (and men) experience when they are sexually violated. Sexual assault is, by its very nature, humiliating and dehumanizing. The victim feels invaded and defiled while simultaneously experiencing the indignity of being helpless and at the mercy of another person.

This is what a former client shared with me about her experience of being shamed by a sexual assault:

"I felt so humiliated when I was raped. I felt dirty and disgusting. The thought of this horrible man being inside me made me want to vomit. I felt contaminated. I didn't want to see anyone. I was afraid to look anyone in the eyes because I felt so much shame."

-Sylvia, age 24

Victims of sexual assault also feel shame because as human beings we want to believe that we have control over what happens to us. When that personal power is challenged by a victimization of any kind, we believe we "should have" been able to defend ourselves. And because we weren't able to do so, we feel helpless and powerless. This powerlessness causes us to feel further humiliated. This is especially true for boys and men who are sexually assaulted since males are raised to believe they should be tough and strong and be able to fight off any attacker. Males who were unable to do so experience horrific shame.

2. Victims of sexual assault blame themselves. Most victims of sexual assault blame themselves in some way. This is true whether the victim is male or female, young or old.

I have first-hand experience with this self-blame, which I wrote about in my newly published memoir, Raising Myself: A Memoir of Neglect, Shame and Growing Up Too Soon:

"My mother was asleep when I got home, so I hid my bloody underwear and torn dress where she wouldn't find them and went to bed. As I lay alone in my dark room I vowed to myself that I would never tell anyone what happened, not even my mother-or rather, especially not my mother. I felt so alone with my pain, but I didn't feel like I deserved any comforting. Mostly, I didn't want anyone to know what a stupid idiot I had been to go out with Harvey in the first place."

As Matt Atkinson wrote in his book, Resurrection After Rape: A Guide to Transforming from Victim to Survivor, "Self-blame is by far, the most devastating after effect of being sexually violated. This is particularly true for former victims of child sexual abuse and adult victims of sexual assault. In fact, ninety percent of rape trauma recovery is undoing a victim's tendency to self-blame. Ten percent is everything else. But the ten percent has to come after the end of self-blame: it can't happen while the former victim is still ashamed and guilty."

3. Victims are afraid of being blamed. This makes sense since we have a victim blaming culture in which we make the assumption that if something bad happens to you it is somehow your own fault. This is particularly true for the way we blame women. "She shouldn't have gone to that party," "What does she expect if she wears a dress that short. She's just asking for it." "It's her own fault for drinking so much." Blaming the victim is by far the most common reaction people have when a victim tells others that she was sexually assaulted and is, by far, the most damaging. The idea is that the victim "put herself in that position" or was "asking for it." Not only does the victim not receive the comfort and support she needs, she is also further shamed by being blamed for her own victimization. As one former client told me: "My boyfriend got so angry with me. He yelled at me for going to that party in the first place. 'I told you those guys were trouble! You should have never been there.' And then he yelled at me for not leaving the party earlier: 'And why didn't you leave when Linda did? That was so stupid of you to stay there all alone! And you were probably drunk, weren't you? Dammit Gina, what did you expect?'"

It is fairly common for boyfriends and husbands to blame the victim. Men are extremely tribal. They identify with one another so intensely that some feel personally attacked whenever another man is being accused of something like rape. Because of this, some, will defend the man and blame the victim. Other men have the belief that women are the ones who bear the duty to prevent rape. But women are guilty of blaming the victim as well. This can be a way of convincing themselves that they will never be raped because they would never put themselves in that position.

4. Victims are afraid they will not be believed. Sexual misconduct is the most under-reported crime because victims' accounts are often scrutinized to the point of exhaustion and there is a long history of women not being believed when they attempted to report a sexual violation. Although friends and family usually believe a woman when she tells them she was sexually assaulted, when it comes to reporting the crime, it is another story. Most women have heard horror stories about how other victims have had jump through hoops in order to be believed and often the perpetrator's word is taken over hers, especially when the rape has occurred on a college campus or when the perpetrator is a popular guy on campus, such as a star football player. This was the situation with my former client Courtney:

"I was raped at a party by a popular football player," she told me. "When I reported it to the police it ended up being my word against his. And I became the town pariah. Everyone at school hated me and constantly made comments like, 'How could you accuse Randy of doing such a thing!' 'You're ugly-he can get any girl he wants, why would he chose you?' 'You're just trying to hurt him-why would you do such a thing?' It got so bad I had to drop out of school. But Randy just kept on playing football. By the time the case went to court I couldn't even step outside my house. There was a mistrial because half of the people on the jury supported Randy. My family had to move out of town so I could get a new start."

Young college women are being sexually assaulted in record numbers. Many are afraid to report the rape to their college administration because of a long history of cases being mishandled. How can victims get past their fear of not being believed and not being supported by their college administrators when they continue to be treated badly?

5. They are afraid of retaliation by the perpetrator. Eight out of ten victims know their rapist and because of this, many are afraid that if they report it to the authorities their perpetrator will retaliate in some way. In addition, rapists who are strangers often threaten to kill their victim if she reports the sexual assault. There have been only a few well-known cases of a rapist returning to harm a former victim, but enough to scare women with this possibility.

6. They are afraid of having their reputation ruined. Male and female victims are afraid of the stigma connected to sexual assault. They are afraid of it getting out and it hurting their reputation. This is especially true of adolescents, who focus on their "reputation" obsessively. And there is good reason for them to be concerned. I've had many adolescent clients whose named were smeared after the news that they were sexually assaulted came out at school. Girls often called "whores" and "sluts" and received many rude and threatening comments and gestures from the boys at school. Males who are sexually assaulted have even more fear of their reputation being ruined and many are labeled "queer" or are considered "weak" if the news gets out.

7. They don't believe it will do any good. Most victims know that very few rapists are caught and even fewer are convicted and serve any jail time. In fact, ninety-nine percent of perpetrators walk free. With these odds, it is understandable that victims would have serious doubts about reporting and that they would question whether it is worth having their integrity and their character questioned. Those with a history of childhood sexual abuse who never received justice are particularly prone to feeling it will do no good to report a current sexual violation.

8. They want to put it behind them-to forget it ever happened. I often hear clients tell me that this is why they didn't report the sexual assault. "I just wanted to move on," they will say. Unfortunately, this doesn't work. Former victims can't just put it out of their minds. The pain and fear and shame surrounding sexual trauma continues to haunt them. They suffer from troubling flashbacks, nightmares and difficulty sleeping, depression, extreme anxiety, and have difficulties with issues such as trust and low self-esteem. Their sexuality suffers, either causing them to have difficulty engaging in the sexual act or the other extreme, to become promiscuous. Many repeat the trauma by continuing to be victimized or by becoming abusive themselves.

9. They don't want to go through the "hassle" of reporting it to the authorities. This is an interesting excuse when you compare sexual assault to what happens when someone gets their car stolen or their house broken into. We seldom, if ever, hear people say, "I didn't want to go through the trouble of reporting the robbery to the police," in these circumstances. Most people don't get their car or other valuables back when they are stolen but this does not stop them from reporting the theft to the police. The truth is, this excuse probably reflects the victim's lack of self-esteem.

10. They are too traumatized to report the assault. This is more common than you would imagine and brings up some issues that not everyone is aware of. For example, most people are familiar with PTSD ( Post-Traumatic Stress Disorder), a severe anxiety disorder with characteristic symptoms that develop after the experience of an extremely traumatic stressor, such as a violent assault on one self. Many understand that those who suffer from PTSD often relive the experience through nightmares and flashbacks, have difficulty sleeping, and feel detached and estranged, and these symptoms can be severe enough and last long enough to significantly impair the person's daily life. What many don't realize, however, is that PTSD is marked by clear biological changes as well as psychological symptoms and is complicated by the fact that it frequently occurs in conjunction with related disorders such as depression, substance abuse, and problems of memory and cognition.

In some cases, the symptoms of PTSD can become more debilitating than the trauma. Some characteristics of PTSD can actually run counter to a victim reporting the sexual assault. She may be so overwhelmed by avoidance symptoms such as emotional numbing, or a strong desire to stay away from anything that reminds her of the assault, that she is incapable of taking the action of reporting. Or, she may be overtaken by feelings of helplessness and passivity that can be symptomatic of PTSD.

Instead of asking why victims don't tend to report sexual assault, we need to ask, "What are we doing to make it safe for them to report?" and "What can we do to make reporting processes less threatening and more trauma-sensitive for victims?"

We have an epidemic on our hands when it comes to sexual assault, with 321,500 Americans twelve and older being sexually assaulted each year. Here are some possible ways for us to educate and de-stigmatize sexual assault so that more victims will come forward to report and get the help and support they need.

- We need to better educate girls and women about the risks of sexual assault and coach them in how and where to report sexual violations. For example, those young women entering college are particularly at risk of being sexually assaulted. It was estimated that in the fall of 2016, a total of 20.5 million students attended American colleges and universities, females making up the majority of students-about 11.7 million students. Most parents don't sit their teenage or twenty-something daughters down and explain the possible risks they'll face at college or the best ways to protect themselves from sexual assault or sexual harassment. Most don't explain their rights, how and whom to report an incident to, and how and whom to seek counseling from if they are sexually assaulted or harassed.

- We need to stop blaming victims. In fact, our entire culture is guilty of victim blaming. At its core, this tendency to blame the victim comes from our cultural intolerance of weakness in any form. We can't tolerate weakness in others because it reminds us of our own weakness and vulnerability. What better way to avoid this than by blaming the victim for her own victimization?

We blame the woman who was raped for wearing sexy clothes, or for drinking too much, or for being at the wrong place at the wrong time because we want to hold on to the fantasy that we all have choices-that we are in control. We don't want to admit to ourselves that sometimes we don't have a choice -that sometimes we are not in control.

Even some misguided therapists sometimes believe that their job is to help their client see how she participated in the rape by "putting herself in that position." Others focus on what the victim can do differently next time to prevent being raped again, implying that she had something to do with her own victimization. These therapists seem to believe the old line, "Nobody can abuse you without your consent."

The truth is, victims do not cause themselves to be raped. People can and frequently do abuse and rape others "without their permission," and people can and do control others against their will. There is only one thing that causes a woman to be raped: a rapist.

- We need to help women understand that they need to stop blaming themselves for sexually harassing and sexually abusive comments and behavior. Even in today's culture, women tend to blame themselves (and other women) when a man tries to force himself on them. This belief has been ingrained in women's psyches for decades and is based on the idea that: 1) women are responsible for men's unacceptable behavior, and 2) it is a woman's job to never arouse a man unless she wants to follow through by having sex with him. This arcane belief needs to be unearthed and exposed as the lie that it is. No one is responsible for a man's behavior but the man himself.

- We need to encourage girls and women to acknowledge and get help for their experiences with child sexual abuse. In the past several years there has been a focus on raising the self-esteem of girls. Unfortunately, sexual violations do more damage to a girl's self-esteem, body image, and sexual self-esteem than anything else. A girl who is sexually abused in childhood starts out her life with a huge deficit and she is far more likely to be sexually assaulted as an adult than a woman who has not been abused in childhood. In order to be truly empowered, women and girls need to acknowledge their shame, pain and fear at having been sexually violated in the past.

- We need to understand that there are good reasons why victims often do not fight back and then educate both males and females about this. Time after time, clients have told me about how ashamed they are because "I should have fought more" or "I just lay there and let him do it." My client Ramona told me, "I felt so ashamed of myself because I couldn't defend myself. I didn't fight back, I didn't even try to scream. I was just frozen in fear and I just let him do whatever he wanted to do to me. He had a knife and he told me he would kill me if I moved or made a sound and I believed him. I felt so weak, like such a victim. I should have tried to fight him off. I should have screamed. Maybe someone would have heard me and come to my rescue."

Clients like Ramona usually don't consider the possibility that if they had fought back, they might have been harmed even worse. Most people have heard that rape is about power and control. But few understand that in order to maintain control, a rapist will use a level of aggression that exceeds any resistance he receives from his victim. That means that the more a victim resists, the more danger she or he may be in.

- We need to take the stigma out of "not fighting back" against sexual assault. For example, most people will do anything to avoid being killed. As a way of illustrating this instinct, rape counselors in training are given the example of a man being mugged. The man cooperatively hands over his wallet and does anything else demanded of him out of a desperate hope that the assault will end without further injury or death. No one questions this cooperation: police even advise it. People who hear about the episode later will support the man and assure him that he did the right thing. No one will blame him for carrying money. No one will claim the incident was probably a cash transaction that "got out of hand." Yet when the crime becomes sexual, people lose all these same insights about the importance of compliance to reduce harm. Suddenly the victim starts to question herself: Why didn't I fight back? What would have happened if I had resisted him?

And there is still another factor that may help those who feel shame for not resisting more: During a sexual assault the body's sympathetic nervous system takes over, instinctively regulating the bodies' responses for the sake of survival. That means our conscious mind stops choosing what to do, and our physical systems take control, producing one of three basic responses: flight, flee, or freeze.

Each of these three instincts have both helpful and harmful aspects to them; they may either increase or decrease your safety. Contrary to what we see in movies or what we read in material written by the self-defense industry, the "fight instinct" is actually rather rare in both women and men. By far the most common instinct we all default to is the "freeze instinct," which causes the body to become very still, rigid, and silent-the "deer in the headlights" response. This is called "tonic immobility," and it is a simple but powerful survival behavior. During rape, temporary paralysis is very common; in fact, it occurs in up to 88 percent of rape victims.

If the victim did not fight back or scream during the assault, she or he needs to stop berating and chastising themselves. And we need to stop blaming them. Their behavior wasn't passive, it was a biologically driven form of resistance! It is very important that we all understand this. In fact, one study it was found that the link between this "temporary paralysis" during the rape and later feelings of guilt and self-blame are directly related to increased depression, anxiety, and PTSD.

The bottom line: while tonic immobility is often a source of shame for former victims, it is actually a common self-preservation aid and a basic response to threatening situations. Research has found that this instinct to freeze is just as common among male victims of sexual assault.

In my upcoming book, I'm Saying No!: Standing Up to Sexual Pressure, Sexual Harassment and Sexual Assault, I offer many other suggestions for educating girls and women about the dangers of sexual assault, and I encourage them to report any sexual assault to the authorities, not only as a way of empowering themselves but as a way to protect other potential victims.

Please note: I do realize that males are also sexually assaulted, especially gay men and transsexuals. I tried to include this population in my article but I did so in a limited way since there are far more females who are sexually assaulted than males, and because of the current focus on the sexual assault of females given the current #MeToo climate.

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Stop Shaming Victims of Sexual Assault for Not Reporting

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Being sexually assaulted in one of the most shame-inducing traumas that a person can experience. So it is understandable that victims don't need to be further shamed by being shamed for not reporting the crime. And yet, that is exactly what happens whenever we hear, for the first time, about a sexual assault that occurred months or years ago.

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educate students on how to protect themselves and teach them that its wrong to sexually assult another person

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Chris Linder
As we ramp up to begin another academic year, college and university administrators and educators are also ramping up their efforts to educate students about campus sexual violence. Unfortunately, in many cases, this means that we're hearing a lot about the ways that potential victims can reduce their risk of being sexually assaulted. Although it is certainly important to remind people of some of the ways they can take care of themselves, the reality is that for campus sexual violence, many of the "safety tips" we offer students are misleading, confusing, victim-blaming, and ineffective.

For example, the most common "safety tips" I have observed on the campuses I have worked over the past several years consist of the following:

Be aware of your surroundings; never walk alone; use the "buddy system."

Reduce your alcohol consumption.

If you see someone "taking advantage" of another person, call the police or find another way to intervene.

Although well-intended, each of these "safety tips" stops short of actually addressing the root of sexual violence: power.

The first tip to be aware of one's surroundings is a generally good suggestion as it is important for people to be mindful of their environments; however, as it relates to campus sexual violence, it may actually be harmful. The vast majority of sexual assaults involving college students (upwards of 90%) happen between two people who know each other; perpetrators target people they know and with whom they have a relationship. As a former victim advocate on a college campus, I heard several stories from survivors who were assaulted by the very person they thought they were safe with - the "friend" they asked to walk them home so that they did not have to walk alone.

Certainly, I am not advocating that we stop telling college students to be mindful of their surroundings; however, we must go further - we must teach college students about the actual realities of sexual violence on our campuses. We must make them aware that perpetrators often target people they know and that even though they don't want to believe it, they are far more likely to be assaulted by someone they know than by a stranger jumping out of the bushes.

Next, many campus education programs focus on telling people to reduce their alcohol intake, which is not inherently a bad message; however, when used as a strategy for reducing sexual violence, it is confusing and victim-blaming. Educators hear the statistic that alcohol is "involved" the majority of campus sexual assaults and they automatically think that they can reduce victims' risk of assault by telling them not to drink. However, when one digs a little deeper into the research about alcohol and sexual violence, the research actually indicates that perpetrators use alcohol as a weapon and excuse to commit sexual assault. Some perpetrators intentionally use alcohol to get their target drunk to reduce their inhibitions so that they can "take advantage of them." In these cases, it is important to teach college students to pay attention to patterns of perpetrators - to note when someone is insisting that they drink and continually feeding them alcohol.

Additionally, research indicates that alcohol actually exacerbates perpetrators' likelihood of committing sexual assault - men (98% of perpetrators are men) who already participate in sexist, entitled behavior related to sexual behavior become even more aggressive when they consume alcohol. So again, teaching college students about the risks of over-consuming alcohol is not inherently bad - the problem is that we're not teaching correct information about the relationship between alcohol and sexual assault. The message must be more complex than "don't drink and you won't get raped" because THAT IS NOT TRUE! Plenty of survivors were completely sober when an ill-intended perpetrator raped them. Instead, we must teach students about the ways perpetrators use alcohol as a weapon and excuse for their behavior so that college students can be more informed about the actual dynamics of sexual violence.

Finally, many campuses have moved toward incorporating bystander intervention programs as a part of the sexual violence education and prevention programming. While bystander intervention programs have begun to shift the focus to perpetrators of sexual violence, rather than solely teaching potential victims how not to be assaulted, these programs still stop short of actually intervening with perpetrators. Further, many bystander intervention programs conflate alcohol and sexual violence when teaching students bystander intervention skills, which again, distorts the problem to being about alcohol, rather than about a person with the intent to cause harm or disregard another person's boundaries.

Perhaps most harmful, bystander intervention programs may exacerbate myths and stereotypes about perpetrators and victims of sexual violence. In one study, white women indicated they would be less likely to intervene in a potential sexual assault situation if the potential victim was Black. Similarly, given the racist history of sexual violence, it is likely that people would be more likely to intervene if a supposed perpetrator was a man of color or a "creepy" guy (aka "stranger") than if they were a "good," white middle-class, college man. Again, although it is important to teach college students some potential signs and patterns of sexual assault, relying on bystander intervention as our primary prevention strategy without teaching students about the intersections of racism and other forms of oppression with our perceptions of who is a legitimate survivor or perpetrator of sexual violence actually causes further harm to already marginalized students on our campuses, and doesn't actually reduce sexual assault.

So what? What do we do?

We must focus on power as the root of sexual violence. Rather than protecting the feelings of dominant groups - namely, cisgender heterosexual men (and wealthy parents) - we must be clear about the actual patterns of perpetration and the actual dynamics of sexual violence. It makes people feel good to believe that they can prevent sexual assault by teaching college students to reduce their alcohol consumption or to be aware of their surroundings, but in reality, these strategies are not enough and they are not working - we have not seen a reduction in rates of sexual violence on college campuses in over 60 years.

We must be honest about the fact that one in 10 college men has admitted to engaging in sexual violence. These are not "strangers" to our campuses and they are most certainly not all men of color. If we admit that we have a problem, and that perpetrators of sexual violence are, in fact, members of our community, then we have a responsibility to intervene. We have a responsibility to both potential victims and potential perpetrators. Clearly, we have a responsibility to protect people from being sexually assaulted - and one really important way to do that is to intervene with potential perpetrators to stop their behavior before it starts.

Another uncomfortable truth is that not all perpetrators understand their behavior as harmful - they have been socialized to engage in sexual behavior using power. When we understand that not all perpetrators have ill-intent, yet they still cause harm to many members of our communities, we can design more effective intervention programs to serve these members of our communities as well. Stopping perpetrators from committing sexual violence will not only protect potential victims, it also restores the humanity of the people causing harm, often as a result of their own insecurities and pain.

Campus sexual violence is a complex, power-laden problem. Failing to address power - and even more specifically, perpetrators - in our efforts to reduce sexual violence is not serving anyone, and is certainly not reducing rates of sexual violence on our campuses. My experience tells me that most college students are more than ready to engage in complex, nuanced discussions about power. Maybe the problem isn't that college students "aren't ready" to discuss this issue from a complex lens; maybe the problem is that we educators haven't done the work we need to in order to effectively engage with college students about this complex, nuanced problem.
is an assistant professor of higher education at the University of Utah, USA. She is the author of Sexual Violence on Campus: Power-Conscious Approaches to Awareness, Prevention, and Response. Follow her on Twitter @proflinder.

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Educating College Students about Sexual Violence