Depression

Why Are More People Taking Their Lives?

What’s really behind the 50 percent increase in female suicide? What can we do?

Posted Jul 30, 2018

Nearly 45,000 Americans died from suicide in 2016.

That’s 1 death every twelve minutes. [1]

The news stories have been overwhelming – Avicii, Anthony Bourdain, Kate Spade, Alexander McQueen and so many more… Suicide has been omnipresent. And according to the Center for Disease Control and Prevention, this isn’t simply a coincidence - suicide rates have drastically increased in the United States since 2000, particularly for women.

Suicide is now the second leading cause of death for American males and females aged 10-34 years old. [2] Suicide is a national health problem that can have lasting effects on the individuals, families, and communities affected by an individual’s death.

Historically, data reveals women were more likely to attempt suicide while men tend to complete suicide. However, this new data shows that more women are accomplishing a completed suicide, and this news is very troubling.

We live in an increasingly complex society, driven by technology advancements and lives that are heavily affected by social media and online communications. While technology and social media offer many benefits, could they have created a socially disconnected society? One where we feel more and more alone, isolated and unable to reach out for help? 

One study in particular, has found that adolescents have far more screen time than young people before 2010. [3] It found that screen time is associated with increased depressive symptoms and suicide in this period (and this was after they accounted for other variables!). 

Understanding Suicide

Defining Suicide

First, let's look at what is suicide and how it's defined for data collection and prevention programs.

Suicide

Suicide occurs when an individual causes self-directed injuries with an intent to die that results in death.

In the United States, the most frequent method of suicide for males involves firearms (55.4 percent), followed by suffocation (26.1 percent). In women, poisoning is the most used method (34.1 percent), followed by firearms (32.1 percent) and suffocation (25.3 percent). [4]

Suicide Attempt

A suicide attempt occurs when an individual causes self-directed potentially injurious behavior with an intent to die but does not result in death.

A suicide attempt differs from deliberate self-harm which is a self-injurious act that does not involve the intent to die. For example, the individual may engage in intentional self-inflicted injury (cutting, burning, hitting) to obtain relief from negative feelings or thoughts, to create positive emotions, or resolve an interpersonal difficulty.

Suicidal Ideation

Suicidal ideation occurs when an individual is thinking about, or planning suicide. This can sometimes be on a continuum from fantasizing about escape (from negative pain) to a well-considered plan for suicide.

Statistics on Suicide

From 2000 to 2016, there has been a 30% overall increase in suicide rates in the United States. To put this in perspective, this increase means that about 10,000 more people die every year in the U.S. as a result of suicide now, when compared to the year 2,000. A similar increase in opiate overdoses has been termed an “epidemic.” The increase is sharpest among females, where the suicide rate has increased by 50%. The rates increased for females in every age group, particularly for young girls aged 10-14 years. In 2016, the highest female suicide rate was in women aged 25 to 64 years.

Men's rates are still higher overall than women. However, the rates haven't spiked as much as in females in the last 16 years. 

Suicidal behavior can occur at any age but is mostly seen in adolescence and early to late adulthood. Approximately 25-30% of individuals who have attempted suicide, will make further attempts. In fact, prior suicide attempts are one of the most significant risk factors for later accomplished suicide.

Why Do People Take Their Lives?

Why people commit suicide is a complicated question and attempting to understand the reason for the radical increase is also complicated.

Some experts believe the rise in suicide may be linked to the economic recession, but this neglects to explain why U.S. suicide rates have increased in every age group, including young girls aged 10 and up.

Many experts agree that a lack of mental health support and resources is a significant problem. It's possible that healthcare services are missing many of these cases (of depression and suicidality). It may also be due to financial strain, as some people cannot afford to access healthcare. In the U.S. healthcare is very expensive, and in many cases individuals go untreated, especially when it comes to mental health difficulties. Many serious mental illnesses are associated with an increased risk of suicide, especially when they go undetected.  Also, people with drug and alcohol problems are at risk of severe depression and suicide, and the access to certain drugs (benzodiazepines, alcohol, opiates, GHB, etc.) can make accidental or purposeful suicide more likely. 

Suicide Risk Factors

There are a number of individual, biological, social, relational and environmental factors that contribute to the risk of suicide in women. These factors are not necessarily directly causal but may work in conjunction with other factors to increase risk in some individuals. These include:

·       A family history of suicide

·       Previous suicide attempts

·       Childhood trauma and abuse

·       History of mental health issues (primarily depression)

·       History of alcohol and/or substance abuse

·       Social isolation (both perceived an actual)

·       Significant losses (e.g., relationships, work, deaths, financial)

·       Physical illness and chronic pain

·       Access to lethal tools

·       Lack of help-seeking behavior (due to stigma)

In my work, I have seen many individuals who struggle with these issues but present no suicidal ideation yet their presence, especially when compounded (as in multiple risk-factors combined), increases the risk.

Research has also identified certain protective factors that buffer people from having suicidal ideation or attempting suicide. These factors include:

·       Effective treatment for psychological or physical health problems (including addictions)

·       Access to a variety of healthcare services

·       Ongoing support from healthcare services

·       Individual coping strategies that promote problem-solving and help-seeking

Mental Illness and Suicide

Suicidal behavior often exists in the context of a major mental illness such as bipolar disorder, major depressive disorder, schizophrenia as well as substance use (especially alcohol) disorders, anxiety disorders and eating disorders. Suicide is also more prevalent among individuals diagnosed with borderline personality disorder and antisocial personality disorder. [6] The hopeless and chronic nature of these conditions could be one of the reasons for this association, which is one of the reasons that I am not a big supporter of the haphazard and quick diagnosis habits I have witnessed, especially within the addiction treatment industry.

Depression, Suicide and Social Disconnection

A study of American high school students found that when comparing students from 2016 to 2010, they found that adolescents spend more time on screens and less time in non-screen activities (e.g., social interactions, hobbies, etc.). There was a marked increase in depression in adolescents overall since 2010, but especially in those who reported more hours on screen time. In fact, there was a correlation between more hours spent on screen and higher rates of depression symptoms. The study accounted for variables such as economic recession and found no link for this in those years.

What is most interesting about this study in light of the increased rates of suicide in the U.S. female population, is that screen time was associated with increased mental health issues over that period (2010-2016).

Could screen time, and therefore less face-to-face social interactions explain why people are becoming more depressed, less likely to seek help and at higher risk of suicide?

What Prevents Women From Seeking Help?

Resistance to help-seeking remains relatively unchanged in recent decades. From the obvious, stigma and shame of mental illness and addiction, to financial restraints and limited access to healthcare.

However, one of the less talked about reasons for not reaching out for help is a consequence of the mental illness itself. People who experience severe depression experience low motivation, low energy, social withdrawal and negative thought patterns (preoccupied with guilt, shame, fear of judgment) and it is these symptoms of mental illness that can interfere with someone getting the help they need. The problem is made worse by the notion that having a depressive episode makes you a “depressed person.” This can create a sense of hopelessness and helplessness. So, what happens when people feel depressed, shut themselves off from those they care about and won't ask for help? Well, that's where you come in.

How Can You Help?

If one of the reasons for depression is social isolation and disconnectedness and one of the identifying symptoms of depression is social withdrawal, then it’s clear this is an area that needs to be further addressed. While we may not have much influence on a systemic level to initiate national change, we can as individuals reach out to those in need. We must help stay connected to those who are depressed or considering suicide. That’s why it’s important to reach out, in person (not just through text messages!), to friends, colleagues, family members to make sure they are okay. The power of connection cannot be overstated.

Ask Them

Many people believe that by asking someone if they are considering suicide, then they will put the idea in their head. This is simply not true. For many people contemplating suicide, it can be a relief to have those awful thoughts aired and shared with another person. Being trapped inside your head and feeling alone is often far worse than revealing to others that you’re not perfect, especially if the person you are sharing your pain with can remain supportive and non-judgmental. Don’t be afraid to ask.

“Are you having thoughts of hurting yourself or someone else?”

What Happens If They Say Yes?

If someone tells you they are considering suicide, then please, stay calm. Listen. Be non-judgmental and take a long, deep breath. Try to avoid saying unhelpful statements such as “don’t be silly,” or “you can’t think like that.”

Explore Their Thought Processes

If you’ve asked and they’ve responded yes, they have considered taking their life. Then you can assess the likelihood of them following through with this by asking them about their intent or plans.

Have you thought about how you may take your life?

Do you have a plan?

This will determine whether someone has been fantasizing about escaping all of their problems (which is actually very common!) or whether they have a solid plan to follow through with their thoughts.

Did you know that 9.9 million Americans have had serious thoughts about suicide? Of those, 2.8 million have made an actual plan, and 1.3 million have attempted suicide.

If they’ve had thoughts, but no plans, then seek professional help as soon as possible. Take them to their local doctor or mental health service for support. Book them in to see a psychologist or healthcare professional.

If they’ve disclosed a clear plan and intent to follow through, then you must ensure their safety by seeking immediate medical assistance. Call a paramedic, or if they are willing, take them to the emergency department at the local hospital. Nearly every jurisdiction allows for the involuntary hospitalization of an individual who is at imminent risk to themselves or someone else. These 72 hour holds, called 5150 in California because of the government code used to identify them, allow for psychiatric evaluations and potential treatment when warranted. These have been made somewhat famous because of their use in some celebrity cases, but they are relatively commonly used when a person is at risk of suicide.

What Next?

Stay connected to your friend (or family member) and don't be afraid to check back in. If this person is severely depressed, then it will take some time for them to receive treatment and see some improvements in the life.

In Summary

In today’s society where we stay socially connected through our screens and spend less time with people in-person, it’s more important than ever to reach out to those who are experiencing depression or addiction and let them know you’re there for them. Suicide is a national health problem, but it’s one where as an individual you can make a difference.

If you know someone who is struggling with depression or addiction and might be at risk for suicide, ask them and take a real interest in their well-being. You may just save a life. The suicide prevention hotline, at 1-800-273-8255, can be used to access live counseling when someone is at imminent risk. Together, we can help step this tide!

Copyright 2018 Adi Jaffe

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References

1.     Preventing Suicide (2018). National Center for Injury Prevention and Control. Sourced from: https://www.cdc.gov/violenceprevention/pdf/suicide-factsheet.pdf

2.     10 leading causes of death by age group (2016). National Center for Injury Prevention and Control. Sourced from: https://www.cdc.gov/injury/wisqars/pdf/leading_causes_of_death_by_age_group_2016-508.pdf

3.     Twenge, J.M., Joiner, T.E., Rogers, L.M., & Martin, G.N. (2018). Increases in depressive symptoms, suicide-related outcomes, and suicide rates among U.S. adolescents after 2010 and links to increased new media screen time. Clinical Psychological Science, 6(1), 3-17. Sourced from: https://www.avaate.org/IMG/pdf/suicidio2167702617723376.pdf

4.     Curtin, S.C., Warner, M., & Hedegaard, H. (2016). Increase in suicide in the United States 1999-2014. NCHS Data Brief, 241. Retrieved from: https://www.cdc.gov/nchs/data/databriefs/db241.pdf

5.     Centers for Disease Control and Prevention (CDC): WISQARS Leading Causes of Death Reports (2016). Retrieved from: https://webappa.cdc.gov/sasweb/ncipc/leadcause.html

6.     American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.