Hands up - how many of you have seen the statistic "mental illness is found in approximately 90% of those who've died by suicide"?
How about "Over 90% of those who die by suicide had diagnosable depression"?
Or "60-90% of those who die by suicide have diagnosed mental health problems"?
Where have you seen these statistics?
On the cover of a brochure? In a PowerPoint presentation? On a television public service announcement?
Who are you?
A teacher? A psychologist? A teenager?
Finally, what message did you take away when you read or heard these statistics?
The 90% statistic is perhaps the one most often used in advocacy and communication efforts related to suicide prevention. But it is used in so many different ways, and often inaccurately or inappropriately, that the truth of the data behind the statistic is lost. I'm joking when I say that at least 40% of statistics are made up, but I'm not joking when I say that statistics are often used poorly to communicate what we really mean to say.
I imagine that a lot of people who use the 90% statistic want to demonstrate the importance of suicide prevention. Ninety percent is big! It draws attention, and it ideally will make people think about suicide as a preventable outcome. It's exciting to think that if we can just help people with mental illness, we can prevent suicide.
When we think critically about how the information presented in these statistics is processed by those who receive it, we're faced with a challenge. From how people define mental illness to how people determine causality, using this statistic can set off a range of thoughts, reactions, and responses.
Since a crucial question to ask when using any statistic is what action this particular piece of information will inspire an audience to take, it's important to be as accurate as possible when using statistics.
You've probably heard or read all of those versions of the 90% statistic, so the problem with the 90% statistic, as I hope I've demonstrated above, is that it is not consistently or accurately used. The truth that lies beneath is that 90% refers to diagnosable mental illness and/or substance abuse combined. Any single diagnosis, like depression or substance abuse, is a lower statistic. So, saying "Over 90% of those who die by suicide had diagnosable depression" is incorrect.
How many people-on-the-streets think of substance abuse as a mental illness? The fact that substance abuse is included in the 90% statistic may be glossed over, but it is vitally important.
Finally, mental illness and substance abuse are not the only explanation for suicide. Most people who have mental illness or engage in substance abuse do not engage in suicidal behavior. The reason for promoting a comprehensive approach to suicide prevention is that we know that there is no single element that leads to suicide. We don't want to imply that mental illness - and a broad-brush definition of it at that - is the single cause of suicide.
As I "tag" my posts each week with the topic of "Depression," I struggle to find a more accurate way to signify the topic I'm addressing. Depression is an important piece of the puzzle in understanding and preventing suicide, but it's not the be all and end all. How we communicate about suicide risk, though, just might be.
A great deal of credit for originality of thought is owed to my colleague Linda Langford. Her presentation at the 2008 American Association of Suicidology Meeting, "Mental Illness, Substance Use Disorder & Suicide: Implications for Messaging," provided inspiration for this post, as well as some of the facts and insights I've presented in the post.
