The apparent suicide of designer Kate Spade on June 5 did more than shock and sadden her fans across the country. It also reignited a conversation about the many faces—and causes—of suicide.
The exact circumstances around Spade’s death remain unclear. But in a statement provided to the New York Times, Spade’s husband, Andy Spade, said, “Kate suffered from depression and anxiety for many years. She was actively seeking help and working closely with her doctors to treat her disease, one that takes far too many lives.”
The tragedy underscores a disturbing reality in the U.S. Suicide is a growing public-health problem that doesn’t discriminate on the basis of demographics.
“This is not a condition that is related to success or failure,” says Dr. Anne Schuchat, principal deputy director of the U.S. Centers for Disease Control and Prevention (CDC). “No one is immune.”
Federal data shows that suicide rates have increased steadily across nearly every demographic over the past two decades, rising by 28% from 1999 to 2016. Almost 45,000 Americans died by suicide in ’16, making it the 10th most common cause of death that year, according to the CDC. Increases have been so drastic that researchers have blamed suicide, along with substance abuse, for recent declines in overall U.S. life expectancy, according to an editorial published in a recent issue of the BMJ.
While suicide is most common among middle-aged and older adults, rates are on the rise in many age groups. Almost twice as many children were hospitalized for thinking about or attempting suicide in 2015 as in ’08, according to a study published in May in the journal Pediatrics.
Young women appear to be disproportionately affected by the overall increase. The suicide rate among girls ages 10 to 19 rose by 70% from 2010 to ’16—from 423 deaths to 687—and it hit a 40-year high among female teens in ’15, according to CDC data. This increase has been substantial enough to narrow the well-established gender gap between the numbers of boys and girls who die by suicide.
Looking beyond the figures, the questions they raise—why is this trend happening, and why now?–are complicated.
Pressing public-health issues, such as the opioid crisis and rising rates of depression, anxiety and loneliness, are likely related to the increase in suicides, Schuchat says. And research suggests that high-profile suicides like Spade’s can spur “suicide contagion,” a known public-health issue. In the months following actor Robin Williams’ highly publicized death by suicide in 2014, there was a 10% spike in suicides nationwide, according to a study published in February in the journal PLOS One. Upticks in suicide have also historically coincided with economic turmoil, Schuchat says, so the 2008 financial crisis and its aftermath may have influenced suicides in recent years.
At the individual level, however, there is almost never a single cause of suicide. “Multiple factors are often involved,” Schuchat says. Addressing and treating mental-health issues are an important part of suicide prevention, but social connectedness and support from friends, family, communities and institutions may also help people who are struggling for any reason.
“We need to be more connected and there for each other,” Schuchat says. “[Suicide is] widespread enough, and so, so difficult for those left behind, that we really want to do all we can.”
If you or someone you know may be contemplating suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255
This appears in the June 18, 2018 issue of TIME.