"I just snapped" is how Jessica Lioy describes her attempt in April to kill herself.
After a tough year in which she'd moved back to her parents' Syracuse, N.Y., home and changed colleges, the crumbling of her relationship with her boyfriend pushed the 22-year-old over the edge. She impulsively swallowed a handful of sleeping pills. Her mom happened to walk into her bedroom, saw the pills scattered on the floor and called 911.
In 2017, 1.4 million adults attempted suicide, while more than 47,000 others did kill themselves, making suicide the 10th-leading cause of death in the United States, according to the federal Centers for Disease Control and Prevention. And the rate has been rising for 20 years.
Like other states, Lioy's home state of New York has seen its rate increase. But New York has consistently reported rates well below those of the U.S. overall. Compared with the national rate of 14 suicides per 100,000 people in 2017, New York's was just 8.1, the lowest suicide rate in the nation.
What gives? At first glance, the state doesn't seem like an obvious candidate for the lowest rank. There's New York City, all hustle and stress, tiny apartments and crowds of strangers. And upstate New York, often portrayed as bleak and cold, is famously disparaged in the Broadway musical "A Chorus Line" with the comment that "to commit suicide in Buffalo is redundant."
Experts say there's no easy explanation for the state's lowest-in-the-nation rate. "I can't tell you why," said Dr. Jay Carruthers, a psychiatrist who is the director of suicide prevention at the New York State Office of Mental Health.
There's no single answer, but a number of factors probably play a role, according to Carruthers and other experts on suicide.
Low rates of gun ownership are likely key. Guns are used in about half of suicide deaths, and having access to a gun triples the risk that someone will die by suicide, according to a study in the Annals of Internal Medicine. Because guns are so deadly, someone who attempts suicide with a gun will succeed about 85% of the time, compared with a 2% fatality rate if someone opts for pills, according to a study by researchers at the Harvard Injury Control Research Center.
"The scientific evidence is pretty darn good that having easy access to guns makes the difference whether a suicidal crisis ends up being a fatal or a nonfatal event," said Catherine Barber, who co-authored the study and is a senior researcher at the Harvard center.
New York has some of the strongest gun laws in the country. In 2013 -- after the mass shooting at Sandy Hook Elementary School in Newtown, Conn. -- the state broadened its ban on assault weapons, required recertification of pistols and assault weapons every five years, closed a private sale loophole on background checks and increased criminal penalties for the use of illegal guns.