Suicide rates rose in nearly every U.S. state from 1999 to 2016, with the rate spiking by more than 30 percent in half of the country, the Centers for Disease Control and Prevention (CDC) reported Thursday.

Though mental health is often blamed for suicides, more than half of the people who took their own lives in 27 states in 2015 had not been diagnosed with mental illnesses, the CDC said.

While suicide rates rose across age groups, the CDC said people ages 45-64 had the biggest rate increase. That age group also had the highest rate. People ages 10-24 had the lowest rate.

“It’s a national problem of wide scope that we need comprehensive approaches for,” said Anne Schuchat, a CDC deputy director.

Nearly 45,000 people committed suicide in 2016, making it one of three leading causes of death on the rise in the United States, along with Alzheimer’s disease and drug overdoses.

The death of designer Kate Spade by suicide in New York this week shocked the fashion world. Her husband said in a statement Wednesday that she had suffered from depression and anxiety for many years.

The CDC said suicides were rarely caused by any single issue.

In addition to mental health conditions and suicide attempts as risk factors, other contributing circumstances include social and economic problems, access to the means to commit suicide, and poor coping and problem-solving skills, the health agency said in its Morbidity and Mortality Weekly Report.

The CDC found that suicides had increased in every state except Nevada, where they decreased by 1 percent. However, Nevada had the ninth-highest suicide rate in the country.

North Dakota had the highest increase, at nearly 58 percent over the studied time period.

Montana had the highest suicide rate, at 29.2 per 100,000 people per year, while the District of Columbia had the lowest, at 6.9 suicides per 100,000 people per year.

The CDC recommended a broad approach to suicide prevention, including boosting economic support by states, supporting family and friends after a suicide, and identifying and supporting people at risk for suicide.

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