Suicide rates across the U.S. have spiked to the highest levels in decades, hitting the indigenous community hardest.

The suicide rate in 2017 was 33% higher than it was in 1999, according to the Center for Disease Control. The increase was seen in both men and women and across all races, but during that time disproportionately rose among Native Americans and Alaska Natives. Indigenous women saw a 139% increase and men saw a 71% increase.