In addition to mental health conditions and suicide attempts as risk factors, other contributing circumstances include social and economic problems, access to the means to commit suicide, and poor coping and problem-solving skills, the health agency said in its Morbidity and Mortality Weekly Report.
The report says Montana's suicide rate grew by 38 percent between 1999 and 2016. A little over half of the suicides, 54 percent, committed suicide with no known previous mental health issues.
"The data are disturbing", said Anne Schuchat, the CDC's principal deputy director.
Much of the support comes from the Department of Mental Health and Addiction Services and federal funding such as the Garrett Lee Smith Campus Suicide Prevention grant program. Among the less-common factors presumed to have contributed to the suicides studied were physical health problems, legal difficulties, a family relationship issue or a job-related problem.
Higher rates of substance abuse and drug addiction are also associated with higher suicide rates, Duarte said. Suicide rates went up more than 30% in half of states since 1999.
In 2014, the state topped the national list.
Dagle said she believes numerous victims of suicide die partly because they are prevented by social pressure from seeking help. "We have to ask people who are at risk if they have a firearm, and while they're in recovery or treatment, recommend safe storage of that firearm", he said.
And as evidenced by the deaths of Spade and Bourdain it's important to remember that sometimes people struggle with mental health challenges friends or family may not know about. In 2015, more than 78% of those global suicides occurred in low- and middle-income countries. Firearms was the most common method used by both groups, followed by suffocation, poisoning and "other".
"It's been rough not having my youngest sister there, where I can take her for her first auto drive or help her buy her first vehicle or help her experience her first time for anything", said Monroe. The cause of death was suicide.
"With all of us working together and by collectively making a massive investment in suicide prevention research, resources and quality mental health care we can and we will reverse the rising suicide rate".
Mental Illness is one major cause. The rate declined in just one state, Nevada, where it has historically been higher than average. "And so a report like this really draws attention to the fact that we need to do a whole lot more to prevent suicide, to save lives".
For clinical trainings on best practices for suicide prevention contact the Center for Practice Innovations here.