BOSTON (CBS Local) — In the wake of Kate Spade’s suicide, a newly released study says suicide rates have increased nearly 30 percent in the U.S. in the last 20 years.

Research shows suicides are up in almost every state across the country. In 2016, nearly 45,000 people took their lives. More than half did not have a known mental health diagnosis.

“We found that many common life stressors were present in the period preceding the suicide, in relationship problems, financial and job issues, physical health concerns,” said Dr. Anne Shuchat, deputy director with the Centers for Disease Control.

Locally, suicide rates in Massachusetts rose 35.3 percent between the years of 2009 and 2016; in New Hampshire suicides increased a staggering 48.3 percent over those seven years.

p0607 vs suicide prevention 600 Suicide Rates Up In Nearly Every State; Up 35% In Mass.

Credit: CDC

Signs and symptoms to look for include isolation, agitation, anger, alcohol or drug use and changes in sleep patterns.

Experts say it’s important to have a conversation if you’re concerned about someone.

“Be quite direct and say, ‘I’m concerned about you, here’s what I’ve noticed,’ and if they’re expressing feelings of hopelessness, I would encourage anyone to ask the question: ‘When it gets that way for you, do you ever think of ending your life?’ And just like that, that will open up a space where they can talk about what’s really going on,” said Dr. Christine Moutier, chief medical officer with the American Foundation for Suicide Prevention.

The National Suicide Prevention hotline is 1-800-273-TALK or text “TALK” to 741741.

The biggest increase in suicides was in North Dakota, where the rate jumped more than 57 percent.

The CDC says there were a higher number of suicides in areas hard hit by the economic downturn, especially in rural areas in western states.

If you or somebody you know might be at risk of suicide, here are resources that can help.