Suicide and suicidality in Oklahoma: Trends, risks, and prevention strategies

If you or someone you know is thinking of suicide, call 988, available 24/7, to reach a trained mental health counselor.

For nearly two decades, Oklahoma has had a higher suicide rate than the national average — among the top 10 highest in the country, according to the most recent data available. While suicide rates have climbed across the U.S. in recent years, this increase has been even more dramatic in Oklahoma.  

Suicide affects Oklahomans from all walks of life, across age, race, gender, and geography. But data show us that some groups die at higher rates and face higher risk than others.

In this analysis, we use 10 years’ worth of data from the Oklahoma Violent Death Reporting System, along with readily available state and national data spanning nearly two decades, to answer critical questions about suicide in Oklahoma. We delve deeply into data to identify factors that contribute to Oklahoma’s high rates of suicide and suicidality, and we make recommendations to drastically decrease these deaths. ‍

Download the full report or a one-page summary

With a better understanding of suicide in Oklahoma, we can implement strategies that prevent deaths and connect people to life-saving care.‍

Key takeaways

• Suicide rates have risen faster in Oklahoma than in the U.S. as a whole. We see higher rates of suicide in rural areas than in urban ones and among Native American and white Oklahomans compared to other races.

• The factors behind suicide are complex. Over half of Oklahomans who died by suicide had a history of mental illness or substance use, and about a third had a problem with an intimate partner that appeared to contribute to their death. A physical health problem appeared to be a factor in about 1 in 5 suicide deaths.

• Children and youth have lower rates of suicide compared to adults, but suicidality is highest among young Oklahomans. About 1 in 7 adolescents in Oklahoma had serious thoughts of suicide, and about 4% attempted suicide.

• Suicidality is costly. In 2022, suicide-related emergency room visits and hospitalizations in Oklahoma cost about $139 million. Early and upstream care is not only compassionate, but it is also significantly more cost-effective.

• Most suicides in Oklahoma are gun deaths. Men and boys were far likelier to use a firearm as a means for suicide, which in turn makes them less likely to survive a suicide attempt.
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Findings

Disparities by race, gender, age, and geography

Suicide affects every corner of Oklahoma, but our analysis revealed how suicide rates are unevenly distributed across the state’s population. From 2004 to 2022, Native American and white Oklahomans had the highest rates of suicide in Oklahoma. Black Oklahomans had lower rates of suicide, but those rates have increased in recent years.  

Nationally, people over 75 have the highest rates of suicide. While older adults still had high suicide rates in Oklahoma, the highest were among young and middle-aged Oklahomans.

Death rates were higher in more rural parts of Oklahoma, especially the southeast. We also found that suicide death rates and broadband access are correlated — suicide rates are higher where access to broadband is lower and vice versa. These factors raise questions about how isolation plays a role in rural residents’ mental health.
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Data also revealed disparities in suicidality by gender: between 2004 and 2022, more men and boys than women and girls died by suicide in Oklahoma, and the rate of increase in suicide rates for Oklahoma males was even faster than the national increase.

In 2022, Oklahoma women and girls had more emergency room visits for suicidal ideation or attempts, but men and boys had higher inpatient hospital admissions for suicidality. Altogether, suicide-related ER visits and hospitalizations in 2022 cost nearly $139 million.
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Mental health and substance use history

Through data from the Oklahoma Violent Death Reporting System, we gained insight into the circumstances around Oklahomans’ suicide deaths between 2013 and 2022, including their mental health history. The data we analyzed was presented in aggregate; no personal health information about any individual was part of our analysis.  

Because these figures rely on information from relatives or friends after a person’s death, they are likely underestimations. Loved ones may not have known, for example, that a person was in treatment for a mental health condition, or even that the person was considering suicide.
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The data showed that over half of Oklahomans who died by suicide had a mental health or substance use disorder, or both. But only about a quarter of Oklahomans who died by suicide were receiving treatment for these conditions at the time of their death.  

Of the Oklahomans who had a mental health condition and died by suicide, depression was by far the most common.

Nearly a quarter of Oklahomans who died by suicide had a positive toxicology result for alcohol at the time of their death. About 1 in 10 were positive for amphetamines.

Youth suicide and suicidality  

Oklahoma children and youth have lower rates of suicide relative to older age groups, but suicide is still the second-leading cause of death for ages 10 to 24 in Oklahoma.  

And unlike suicide death rates, suicidality — considering, planning, or attempting suicide — is highest among youth.

About 4.4% Oklahoma children ages 12 to 17 attempted suicide in 2021–2022, the most recent data available. About 1 in 7 youth in this age group, approximately 14%, experienced serious thoughts of suicide. This is far higher than what we see in Oklahoma adults, which is about 5.5%, or 1 in 20.
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It’s important to note that most youth who consider, plan, or attempt suicide will not die by suicide. But these experiences represent extreme emotional distress, and people who have attempted suicide previously have a higher risk of dying in a future suicide attempt.

Young Oklahomans (ages 6 through 17) who died by suicide had unique social factors present at the time of their deaths: compared to older age groups, they were almost three times as likely to have had a family problem that appeared to contribute to their death, and school problems appeared to be a factor in about 23% of deaths.  

Circumstances and social factors  

Our analysis also uncovered illuminating details about the social and environmental factors that preceded Oklahomans’ deaths by suicide.  

For example, about a third of Oklahomans who died by suicide in the past decade had problems with a current or former intimate partner before their death. This was even more likely to be a factor for Oklahomans ages 25 to 44: nearly half of this age group had intimate partner problems that appeared to contribute to their death.

Physical health problems were prevalent among Oklahomans who died by suicide: about 1 in 5 had a physical health issue that appeared to contribute to their death. This factor, as well as the death of a loved one, was magnified for older Oklahomans.

Our findings also illustrated how social determinants of health relate to suicide risk. In nearly a quarter of suicide deaths in Oklahoma, the person was dealing with criminal or civil legal problems. And in about 1 in 10 deaths, housing instability or homelessness appeared to be a factor.

Recommendations

Reduce access to lethal means  

Oklahoma cannot seriously address its high suicide rates without also addressing the role firearms play in these deaths. Like across the U.S., the vast majority of suicide deaths in Oklahoma were firearm deaths, and the rate of Oklahomans who died by suicide using firearms increased faster than the national average between 2004 and 2022.  
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While firearms are the most common means of death for males and females, Oklahoma men and boys were far likelier to use a firearm as a means of suicide compared to women and girls. Likewise, because men and boys are more likely to use a firearm as a means for suicide, they are more likely to die by suicide, despite being less likely to express signs of suicidality. Men and boys also had higher rates of inpatient hospital admissions after a suicide attempt or self-harm, largely a reflection of their tendency to use more lethal means during a suicide attempt.  

Understanding this, Oklahoma should take steps to reduce access to lethal means of suicide — namely, firearms. Reducing access to firearms, especially for younger Oklahomans who are more prone to impulsive behavior, is essential to reducing our state’s suicide rate.

To do this, we recommend common-sense policies, such as requiring secure gun storage and gun owners to prevent children from accessing firearms. Oklahoma can also pursue ways for people to voluntarily surrender their firearms and have them securely stored when they are in a mental health crisis — and alleviate concerns about liability for the person who is asked to store the gun.

Finally, we urge Oklahoma lawmakers to repeal the state’s “anti-red flag law,” which prohibits the use of extreme risk protection orders in the state. These orders allow a judge to temporarily prohibit firearm access for someone who is displaying high-risk behavior toward themselves or others.  

For example, if a person has a gun and is threatening to kill themselves, a friend, family member, or law enforcement (depending on the state) could petition a judge to grant an extreme risk protective order that would temporarily limit the person’s access to firearms. Research has found that these types of protective orders can reduce suicide and homicide deaths.

If Oklahoma repealed its anti-red flag law, local jurisdictions could choose to allow emergency risk protection orders. And in accordance with best practices, jurisdictions could also ensure that people subjected to these orders are connected to treatment for mental health and substance use, when appropriate.

Promote strategies to screen every Oklahoman for suicide risk  

Oklahoma misses opportunities to detect and treat suicide risk: more than 40% of Oklahomans who died by suicide and had a known behavioral health condition were not receiving treatment when they died.

Regular, universal screening for suicide risk in schools and health care settings could help identify more people at risk of suicide and connect them with crucial mental health supports.

Further, our findings revealed that many Oklahomans who died by suicide faced problems with an intimate partner or family member, criminal or legal issues, financial stress, or housing instability. Screening for factors like these could offer opportunities to intervene and connect people with treatment or resources — and could be a way to detect risk even when someone may not volunteer information about experiencing suicidality.

Along with screening all Oklahomans, we must ensure the people conducting screenings have the appropriate tools to respond and intervene when someone expresses suicidality or screens positive for suicide risk. Schools, health care settings, and other organizations can develop plans and protocols to connect a person to care, which can include safety planning and discussions around a person’s access to lethal means.

Tailor prevention strategies for groups at higher risk  

In addition to universal screening, Oklahoma must tailor suicide prevention strategies to groups at higher risk.

Given Oklahoma’s high rates of youth suicidality, school-based prevention for young Oklahomans is especially important. Every school should have the resources necessary to deploy proven prevention services as part of a comprehensive, district-wide mental health strategy. One such prevention program being implemented in Oklahoma, PAX Good Behavior Game, can be used in classrooms as early as first grade to create a focused learning environment and instill healthy habits and skills that can prevent and increase resilience around behavioral health problems that could show up later in a student’s life.  

Similarly, Oklahoma has opportunities to scale up evidence-based practices for suicide prevention among specific populations. For example, the state is working toward statewide adoption of the “Program to Encourage Active Rewarding Lives,” or PEARLs, an evidence-based program to connect older adults with information about depression and how to access important resources to live healthier lives.

Native Connections is another example of an evidence-based program that focuses on a specific population: its programming works to reduce suicidal behavior and substance use among Native young people.

There are also evidence-based suicide prevention strategies specific to veterans, construction workers (who face high suicide rates nationally), and LGBTQ+ and Two-Spirit people, among others. Using data about the groups that face higher suicide risk in Oklahoma and nationally, state leaders and agencies can select strategies for maximum impact.

Develop leadership and accountability around suicide prevention initiatives

Oklahoma needs strong, collaborative leadership to make lasting policy changes around suicide and suicidality.

To that end, we recommend restoring the Oklahoma Suicide Prevention Council, which led Oklahoma’s statewide suicide prevention strategy before it was disbanded. Oklahoma needs a dedicated, cross-sector working group to develop and carry out a statewide plan for suicide prevention.  

Not only would this group set a vision and direction for state policy changes to prevent suicide — including advocating for funding for these efforts — but the group could also weigh in with policymakers on how proposed legislation of all types could help or hinder suicide prevention efforts.  

By committing to proven strategies in the areas we identify in this report, and by tailoring prevention efforts to groups facing especially high suicide risk, we can make meaningful positive change for the mental health of generations of Oklahomans.