ROCHESTER, N.Y. -- As admirers of celebrity chef Anthony Bourdain and fashion designer Kate Spade ask why following a difficult week, a new U.S. Centers for Disease Control and Prevention report shows that suicide rates in 49 out of 50 states are on the rise. In New York, it's up 28.8 percent.

In 2016, the final year of the study, more than 450,000 people took their own lives, according to reports from family members, coroners and police. The final report, published Thursday, shows the largest increase in suicide rates among middle-aged adults between 45 and 64 years of age. 

Bourdain, who was found dead in his hotel room Friday in France, was 61. Spade, found dead inside her Park Avenue apartment in New York City, was 55.

"Most people think it's teenagers and young people because that's what gets attention, but it's not," said Karen Heisig, a board member of the American Foundation for Suicide Prevention in Rochester.

The report shows the highest contributing factors being relationship problems, an immediate crisis or problematic substance abuse, but experts along with the CDC say most commonly it is a result of a combination of factors.

"You don't die by suicide as a result of a divorce or bullying or a job loss. There are other factors going on," said Heisig.

The CDC report notes that half of the suicides reported were committed by individuals with no known mental health issues, but according to the American Foundation for Suicide Prevention, one in four people will be diagnosed with a mental illness in their lifetime yet half never seek treatment.

"Is it because of the availability of places that you can go for treatment? Is it because of the stigma that is associated with mental health? There's a lot of factors that go into it but that's another big piece of that report that came out," said Heisig.

Overall, suicide is the tenth leading cause of death but the foundation says that because of the stigma surrounding mental illness, it can be hard for people to seek help.

Since losing both her husband and brother-in-law to suicide, Heisig has become an advocate.

"When I talk about my husband, I talk about what an amazing guy he was," she said. "He was a combat army veteran, he was a really successful sales representative for a pharmaceutical company, he had two great kids, he was loved by everybody. I don't talk about him as a person who died by suicide because that was how he died. He had this whole 38 years before that was a life beautifully lived."

She says to be on the lookout for changes in anyone's talk, behavior or mood it's important to have a conversation.

"You have to trust your gut because you might be the only person to reach out."

The National Suicide Prevention Lifeline is 1-800-273-8255.