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Minnesota’s climbing suicide rate is a heartbreaking public health trend.

“Each year for the past 20 years or so, it’s gone up fairly consistently,” said Stefan Gingerich, senior epidemiologist at the Minnesota Department of Health (MDH).

A reader wanted to know more about this troubling statistic.

“Why is the suicide rate going up in Minnesota, especially in greater Minnesota?” they asked Curious Minnesota, the Star Tribune’s reader-powered reporting project. “And what can the state, schools, the community, family and friends do about it?”

More than 700 Minnesotans die by suicide annually in Minnesota, according to recent MDH data. The state’s suicide rate — the number of suicide deaths per 100,000 people — has increased by more than 50% over the past two decades, the agency said.

Also, Minnesota’s health care providers typically treat more than 10,000 self-harm or suicidal injuries each year.

The increase closely follows a national pattern, though the national suicide rate has generally been slightly higher than Minnesota’s.

Deciphering why this is happening has proven vexing to experts studying the issue. There are many possible explanations, but suicides involve so many factors that it is difficult to pin down a common thread.

“An accumulation of a lifetime of stressors and negative events can lead to that place,” Gingerich said. “It’s not just lack of access to mental health care. It’s not just having the means. It’s not just the economy.”

The coronavirus pandemic that upended lives across the country appeared to actually have a dampening effect on suicide rates, however. This is possibly because shutdown rules left families confined at home together, said Sue Abderholden, executive director of NAMI Minnesota, the state branch of the National Alliance on Mental Illness.

Clues in the data

As the reader noted, the suicide rate is higher in Greater Minnesota than in the Twin Cities. The rate was roughly a third higher outside of the seven-county metro area in 2020, the latest year for which county-level breakdowns are available.

That gap has widened in recent years. Two decades ago, the Greater Minnesota rate was about 16% higher.

Rural areas around the country have higher suicide rates in part because people are more isolated, have less access to mental health care and are more likely to own guns, Abderholden said.

Roughly half of Minnesota’s suicides in 2021 involved a gun, according to the Centers for Disease Control and Prevention. More than half of gun deaths generally are suicides.

Males typically make up about 80% of suicide deaths in Minnesota. This is partly because males here and around the world generally use more lethal methods, according to Dan Reidenberg, executive director of Bloomington-based SAVE (Suicide Awareness Voices of Education), and managing director of the National Council for Suicide Prevention.

The suicide rate among Native Americans is highest among Minnesota’s large racial groups — close to three times that of white people.

White people have the second-highest suicide rate among racial groups, despite white advantages in most other health metrics. The white suicide rate in Minnesota is roughly double the rate among Black Minnesotans.

Why is the rate rising?

“The answer to the question boils down to, ‘It’s complicated,’ ” Reidenberg said.

In Minnesota, county medical examiners determine causes of death based on physical and other evidence. With stigma around suicide fading, families may be more willing to offer information that the person had been depressed, or had attempted suicide in the past, Reidenberg said.

That could lead to a conclusion of suicide in cases that, without that information, might have been classified as “undetermined.”

Other possible factors include economic downturns and the influence of social media, especially on young people, Reidenberg said.

Suicide is the second-most common cause of death among Minnesotans ages 10 to 24, according to a 2021 MDH report. These tragedies among young people can cause other youth to also commit suicide, known as the contagion effect or suicide clusters.

“Among communities where suicide is prevalent, the risk of suicide among adolescents can increase by as much as four times following the loss of a friend or family member to suicide,” the report stated.

How to help

Last July, the Federal Communications Commission designated 988 as a nationwide three-digit phone number people can call for emergency mental health assistance and suicide prevention services. It is too early to measure its effects, Abderholden said.

Individuals and professionals can play their part by learning how to identify and aid people who may be at risk. Warning signs include the person talking about wanting to die or feeling they are a burden to others; withdrawing from friends, giving away important possessions or saying goodbye; exhibiting extreme mood swings or taking dangerous risks, such as driving extremely fast.

NAMI Minnesota offers a number of training programs, including Question, Persuade, Refer (QPR). That refers to the three steps people can take to help prevent a suicide, and NAMI offers the most widely taught program of its kind in the country.

Don’t ignore the symptoms, Abderholden said. When talking to someone who might be at risk for suicide, you can ask them about it directly without fear that you’re planting the idea.

“You ask, ‘Are you thinking about killing yourself?’ and ask them if they have a plan,” she said. “What you don’t want to do is guilt them, because that doesn’t work. At that point their pain is so deep that they’re not thinking about anybody else.”

NAMI also sponsors in-school programs for middle- and high-school students called Ending the Silence, which provides mental health information in general, including suicide prevention and where to get help.

Research shows as little as five minutes can elapse between people deciding to take their own lives and actually doing it, Abderholden said. A program called Freeze the Keys encourages people to put the keys to their gun cabinet in a container of water and freeze it, delaying their ability to act on the impulse.

“When you know someone’s struggling, reach out,” Abderholden said. “Don’t wait for them to reach out to you. They don’t have energy to reach out to someone. Take the person for a walk. … Try to give them hope to get through another day.”

Where to find help

Families can find mental health information and resources for crisis care on NAMI Minnesota’s website, namimn.org. If you or someone you know is struggling with suicidal thoughts, call the 988 Suicide and Crisis Lifeline by dialing 988. You can also text HOME to 741741 to connect with a Crisis Text Line counselor.

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