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Three psychiatrists explain their work

Rising Suicide Rates: Have We Simply Failed?

We know that suicide rates are increasing. What we don't know is why.

The news from the Centers for Disease Control shows a striking increase in sucide rates.  Among those ages 35 to 64 years old  (the baby boomers), there is a 28% increase in suicide rates from 1999 to 2010. It holds for males (up 27%), females (up 31%), and across different regions of the country.  The peaks were seen in men in their 50's and women in their early 60's.  The gender difference continues to show that men die of suicide at three times the rate of women, and suicide is now the 4th cause of death for that age group.  More people die of suicide than car accidents.  The rise is most striking in non-Hispanic whites and Native American Alaskan Indians, groups that have always had the highest rates.  The  suicide rate is now 17 per 100,000, up from 13 per 100,000.  And while we worry more about homicide, suicide rates are twice the homicide rates.  Marriage is protective, as is a college education, and in fact the suicide rate in college-educated women went down.


The rates show trends, but not reasons why.  That is left to conjecture.  This cohort of baby boomers had higher suicide rates when they were adolescents, so perhaps they carry this risk with them.  There is a lot of thought that economic instability may be driving people to desperate measure.  Also, we have more guns and more access to  prescription pain killers.

 Mostly, there is a lot that we don't know.  While the figures are startling, the causes are likely multi-factorial.  Loneliness, alienation, financial decline, low socioeconomic status, and feeling like a burden may be contributing factors.

So why the rise?  I don't know.  Is it our economy and financial disasters?  Is it alienation?  Is it the easy accessibility to guns and narcotics or other lethal medications?  Is suicide contagious among older people as it certainly seems to be among teens? Does our preoccupation with our computers, phones, televisions, videogames, and social media take us away from real world connections?  Is there less stigma to suicide, so it more acceptable (I hope not)?  Less religious affiliation that might prohibit against suicide? Is there a rise in mental illness?  Is there less access to psychiatric care?

We know that roughly 10% of adults are taking SSRIs.  But what we don't know from this data is very important. Let me put those questions out there:

-- Are the people who commit suicide the same people who have psychiatric disorders?

-- Have the victims of suicide been in psychiatric care?  In the past?  At the time they die?

--Have the victims attempted to get care and was it easy to access?

-- Are the victims of suicide more or less likely than the general public to be on  psychiatric medications? 

-- Which medications?  Is there any association between a given medication and an increase risk of death by sucide?

-- If the patient was in treatment: what type of mental health professional/s were they seeing?  At what frequency?  Does it matter if you see a psychiatrist, a psychologist, or a social worker and does it matter if you go twice a week or twice a year?

--What role does hospitalization have?  If someone had been involuntarily hospitalized in the past, were they less likely to seek care and die of suicide?  If someone had a good experience with hospitalization, are they more likely to seek care and less likely to die of suicide.  This may be an impossible question to answer.

Any way you dice it, I think a notable increase in suicide rates reflects a failure of our mental health system, whether it's a issue of education, access, of efficacy.

Information for this post was obtained from Forum, a public media show on WQED in Northern California.  The link to the show is here.

Host: Dave Iverson

Guests:

Ellen Idler, professor of sociology at Emory University

Eve Meyer, executive director of San Francisco Suicide Prevention, the oldest volunteer crisis line in the United States, founded in 1963

Thomas Joiner, psychology professor at Florida State University and author of "Why People Die By Suicide"

Thomas Simon, deputy associate director for science in the Division of Violence Prevention and Control at the Centers for Disease Control and Prevention (CDC) and an author of the new issue of the CDC's Morbidity and Mortality Weekly Report

 And thank you to the Shrink Rap reader who sent me the link to this important show.

 

 

 

 

Dinah Miller, M.D., is a psychiatrist and writer in Baltimore, Maryland. She is co-author of the book Shrink Rap: Three Psychiatrists Explain Their Work.

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