Estimates are displayed in tables and a U.S. map (Figure 1). To produce the map showing estimates of past year serious thoughts of suicide, state estimates were first rank ordered from lowest to highest and then divided into quintiles (fifths). States with the lowest estimates (i.e., the lowest fifth) are assigned to the bottom quintile and are shown in dark blue. States with the highest estimates are assigned to the top quintile and are shown in dark red. All other states are assigned to one of three quintiles between the lowest and highest quintiles. Table 1 shows the estimates associated with the map rank ordered from highest to lowest and divided into quintiles.⁹ For the estimates in Table 2, states are listed alphabetically. Ninety-five percent confidence intervals are included as a measure of precision for each estimate. Additionally, the combined 2013–2014 data are compared with combined 2012–2013 data to examine changes over time. The inclusion of a common year (i.e., 2013) in these comparisons increases the precision of the difference and the ability to detect statistically significant differences. Any statistically significant difference between 2013–2014 and 2012–2013 is to be interpreted as the average annual change between 2012 and 2014. All changes discussed in this report are statistically significant at the .05 level of significance.

The combined 2013–2014 NSDUH data indicate that an estimated 2.6 million young adults aged 18 to 25 in the United States had serious thoughts of suicide in the past year. This translates to about 1 in 13 young adults (7.4 percent of the population) having suicidal thoughts in the past year. There were some differences across states. Rates of young adults with past year serious thoughts of suicide ranged from 6.2 percent in Texas to 10.3 percent in New Hampshire (Figure 1 and Table 1).⁹

Of the 10 states with the highest rates of past year serious thoughts of suicide among young adults, 5 were in the West (Alaska, Montana, Nevada, Oregon, and Utah), 4 were in the Midwest (Indiana, Michigan, Nebraska, and Ohio), and 1 was in the Northeast (New Hampshire).¹⁰ Of the 10 states with the lowest rates, 7 were in the South (Arkansas, District of Columbia, Florida, Georgia, Mississippi, South Carolina, and Texas) and 1 each was in the West, Midwest, and Northeast (New Mexico, Kansas, and Connecticut, respectively).

Nationally, there was no change in the percentage of past year serious thoughts of suicide between 2012–2013 and 2013–2014 (Table 2). At the state level, 49 states and the District of Columbia experienced no change in serious thoughts of suicide between 2012–2013 and 2013–2014. The only difference observed was in New Hampshire, where the percentage of 18- to 25-year-olds having serious thoughts of suicide increased from 8.4 percent in 2012–2013 to 10.3 percent in 2013–2014.

Overall, serious thoughts of suicide among young adults remained unchanged in 49 states and the District of Columbia and increased in one state—New Hampshire. With state-level rates of serious thoughts of suicide among young adults reaching as high as 1 in 10, despite the absence of increases, suicide remains a public health issue that transcends geographical boundaries. Behind the statistics on completed suicides are the troubling large numbers of Americans who think seriously about committing suicide every year and do not receive mental health treatment.^3,4,5,11 Preventing suicide and addressing the behavioral health care needs of people at risk for suicidal behavior require public health information-sharing that raises awareness and identifies effective preventive interventions. Highlighting the prevalence of suicidal thoughts across states may help federal, state, and local policymakers continue to plan for and allocate resources to reduce the negative perceptions associated with mental and emotional issues, seek suicide prevention support, and increase access to mental health treatment.

It is critical to provide interventions for people with serious thoughts of suicide. The Substance Abuse and Mental Health Services Administration provides suicide prevention resources (https://www.samhsa.gov/prevention/suicide.aspx) and a toll-free suicide prevention hotline with free and confidential crisis counseling (http://www.suicidepreventionlifeline.org).

The combined 2013–2014 NSDUH state estimates of past year serious thoughts of suicide and 24 additional behavioral health measures are available online at www.samhsa.gov/data/. The 24 additional measures are substance use and mental health outcomes, including initiation and use of illicit drugs (e.g., marijuana, cocaine, nonmedical use of prescription pain relievers), alcohol and tobacco use, perceived great risk of harm associated with alcohol and cigarette use, substance use disorders, needing but not receiving treatment for a substance use issue, serious mental illness, any mental illness, and depression. Maps for all outcomes and tables including percentages and counts for each state and census region and the nation by age group, as well as the methodology that generated the state estimates, are provided.

1. Kochanek, K. D., Murphy, S. L., Xu, J., & Arias, E. (2014, December). Mortality in the United States, 2013 (NCHS Data Brief 178). Retrieved from http://www.cdc.gov/nchs/data/databriefs/db178.htm
2. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control [Producer]. (2015, March). Web-based Inquiry Statistics Query and Reporting System (WISQARS™): 10 leading causes of death by age group, United States—2013. Retrieved from http://www.cdc.gov/injury/wisqars/leadingcauses.html
3. National Center for Injury Prevention and Control. (2012). Suicide: Facts at a glance. Retrieved from http://www.cdc.gov/violenceprevention/pdf/Suicide-DataSheet-a.pdf
4. Mościcki, E. K. (2001). Epidemiology of completed and attempted suicide: Toward a framework for prevention. Clinical Neuroscience Research, 1, 310–323.
5. This estimate is based on a 3.2 percent rate (95 percent confidence interval=2.9 to 3.5 percent) as reported in Han, B., Kott, P. S., Hughes, A., McKeon, R., Blanco, C., & Compton, W. M. (2016). Estimating the rates of deaths by suicide among adults who attempt suicide in the United States. Journal of Psychiatric Research, 77, 125–133. doi:10.1016/j.jpsychires.2016.03.002
6. Center for Behavioral Health Statistics and Quality. (2015). Suicidal thoughts and behavior among adults: Results from the 2014 National Survey on Drug Use and Health. Retrieved from https://www.samhsa.gov/data/
7. SAE is a model-based methodology that provides more precise estimates of substance use at the state level than those based solely on the sample, particularly for smaller states. The precision of the SAE estimates, particularly for states with smaller sample sizes, can be improved significantly by combining data across 2 years (i.e., 2012 and 2013, 2013 and 2014).
8. The difference in sample sizes for each of the states between 2012–2013 and 2013–2014 is due to a sample redesign in 2014. For additional information, go to https://www.samhsa.gov/data/.
9. In this report, state estimates are discussed in terms of their observed rankings because they provide useful context. However, a state having a highest or lowest estimate does not imply that the state's estimate is significantly higher or lower than the estimate of the next highest or lowest state. Similarly, the quintiles were not selected to represent statistical differences across quintiles or to correspond to proximity to a target public health threshold for a particular measure. For example, the division of states into quintiles does not indicate that states in the same quintile are statistically similar to each other. Although a nearly equal number of states are contained in each quintile, the size of the intervals (i.e., the difference between the upper and lower limits of each quintile) that define the map boundaries is not necessarily uniform across each quintile. When comparing two state prevalence estimates, the method of overlapping confidence intervals is more conservative (i.e., it rejects the null hypothesis of no difference less often) than the standard method based on Z statistics when the null hypothesis is true. Even if confidence intervals for two states overlap, the two estimates may be declared significantly different by the test based on Z statistics. Hence, the method of overlapping confidence intervals is not recommended to test the difference of two state estimates. A detailed description of the method of overlapping confidence intervals and its comparison with the standard methods for testing of a hypothesis is given in the following articles: (a) Schenker, N., & Gentleman, J. F. (2001). On judging the significance of differences by examining the overlap between confidence intervals. American Statistician, 55(3), 182–186. (b) Payton, M. E., Greenstone, M. H., & Schenker, N. (2003). Overlapping confidence intervals or standard error intervals: What do they mean in terms of statistical significance? Journal of Insect Science, 3, 34.
10. The West has 13 states: AK, AZ, CA, CO, HI, ID, MT, NM, NV, OR, UT, WA, and WY. The South has 16 states plus the District of Columbia: AL, AR, DE, FL, GA, KY, LA, MD, MS, NC, OK, SC, TN, TX, VA, and WV. The Northeast has 9 states: CT, MA, ME, NH, NJ, NY, PA, RI, and VT. The Midwest has 12 states: IA, IL, IN, KS, MI, MN, MO, ND, NE, OH, SD, and WI.
11. Han B, Compton WM, Eisenberg D, Milazzo-Sayre L, McKeon R, Hughes A. Prevalence and mental health treatment of suicidal ideation and behavior among college students aged 18-25 and their non-college-attending peers in the United States. Journal of Clinical Psychiatry, DOI: 10.4088/JCP.15m09929.

Lipari, R.N., Hughes, A. and Williams, M. State estimates of past year serious thoughts of suicide among young adults: 2013 and 2014. The CBHSQ Report: - June 16, 2016. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD.