Suicide rates rose in all but one state between 1999 and 2016, with increases seen across age, gender, race and ethnicity, according to a report released Thursday by the Centers for Disease Control and Prevention. In more than half of all deaths in 27 states, the individuals had no known mental health condition when they took their own life.

In Maine, the rate of suicide increased by 27.4 percent, which was slightly higher than the national rate of 25.4 percent.

Twenty-seven other states had higher increases than Maine, including eight states that saw increases of 40 percent or more, led by North Dakota’s 57 percent jump. In the most recent period studied (2014-2016), the rate was highest in Montana at 29.2 per 100,000 residents, compared with the national average of 13.4 per 100,000.

Only Nevada saw a decline – of 1 percent – for the overall period, though its rate remained higher than the national average.

Increasingly, suicide is being seen not just as a mental health problem, but a public health one. Nearly 45,000 suicides occurred in the United States in 2016 – more than twice the number of homicides – making it the 10th leading cause of death. Among people ages 15 to 34, suicide is the second leading cause of death.

Overall, the most common method used was firearms.

“The data are disturbing,” said Anne Schuchat, CDC principal deputy director. “The widespread nature of the increase, in every state but one, really suggests that this is a national problem hitting most communities.”

It is hitting many places especially hard. In half of the states, suicide among people 10 years and older increased more than 30 percent.

“At what point is it a crisis?” asked Nadine Kaslow, a past president of the American Psychological Association. “Suicide is a public health crisis when you look at the numbers, and they keep going up. It’s up everywhere. And we know that the rates are actually higher than what’s reported. But homicides still get more attention.”

High suicide numbers in the United States are not a new phenomenon. In 1999, then U.S. Surgeon General David Satcher issued a report on the state of mental health in America and called suicide “a significant public health problem.” The latest data at that time showed about 30,000 suicides a year.

Kaslow is particularly concerned about what’s emerged with suicide among women.

“Historically, men had higher death rates than women,” she noted. “That’s equalizing not because men are [taking their lives] less, but women are doing it more. That is very, very troublesome.”

Among the stark numbers in the CDC report was the one signaling a high number of suicides among people without a known mental health condition. In the 27 states that use the National Violent Death Reporting System, 54 percent of suicides were by individuals without a known mental illness.

But Joshua Gordon, director of the National Institute of Mental Health, said that statistic must be viewed in context.

“When you do a psychological autopsy and go and look carefully at medical records and talk to family members of the victims,” he said, “90 percent will have evidence of a mental health condition.” That indicates a large portion weren’t diagnosed, “which suggests to me that they’re not getting the help they need,” he said.

Cultural attitudes may play a part. Those without a known mental health condition, according to the report, were more likely to be male and belong to a racial or ethnic minority

“The data supports what we know about that notion,” Gordon said. “Men and Hispanics especially are less likely to seek help.”

The problems most frequently associated with suicide, according to the study, are strained relationships; life stressors, often involving work or finances; and recent or impending crises. The most important takeaway, mental health professionals say, is that suicide is not only an issue for the mentally ill but for anyone struggling with serious lifestyle issues.

“I think this gets back to what do we need to be teaching people – how to manage breakups, job stresses,” said Christine Moutier, medical director of the American Foundation for Suicide Prevention. “What are we doing as a nation to help people to manage these things? Because anybody can experience those stresses. Anybody.”

The rates of suicide for all states and the District of Columbia were calculated using data from the National Vital Statistics System. Information about contributing circumstances for those who died by suicide was obtained via the National Violent Death Reporting System, which is relatively new and in place in only 27 states.

“If you think of [suicide] as other leading causes of death, like AIDS and cancer, with the public health approach mortality rates decline,” Moutier said. “We know that same approach can work with suicide.”

The CDC report comes at a time of heightened attention to the issue with the suicide this week of designer Kate Spade. The designer’s husband, Andy Spade, has said she suffered from depression and anxiety for many years.

Press Herald staff writer Eric Russell contributed to this report.