SUICIDE FACTS—Abstracted from a recent AAFP article on Suicide
The ambiguity most of us feel about the difference of physical and mental illness makes for some startling reflection. The notion that public health might require treatment for a problem that kills 47,000 people a year would be a no-brainer if we were talking AIDS, or Flu, or Covid.
I take that back; the word “no-brainer” is problematic: one of my unfortunate turns of phrase. But you get the point ie by tradition, infections drive a policy supported by government going back for generations. AIDS on average has killed 13,000 people in the USA a year. The total deaths in the USA since the early 1980’s when it was recognized comes in around 700,000—reasonably close to the number of Covid related deaths that we will have observed since the Winter of 2000.
In 2017 suicide was successful in 47,000 American citizens; related to this, the deaths from firearms in the USA (no small controversy making that a public health issue) in 2019 was 38,300 (of which 23,900 were from suicide).
I choose to not divide the psyche from the body when considering how to heal and prevent illness. With this orientation in mind, I ask all of us to consider some salient facts about suicide in our country and make the analogy with AIDS—if you are aware of life/health choices and see a loved one suddenly changing and becoming ill, consider the situation and what you can do to prevent a tragedy. Ask the question. Listen. Be supportive and interested even if your concern is rejected.
TRENDS:
Before Covid, suicide rates increased 20-30 percent between 2005 and 2015.
With Covid in mind, a recent article from the CDC pointed out that in the early months of 2021, the visit to emergency rooms for suspected suicide attempts increased about 50% for adolescent girls compared to the same period in 2019.
People most at risk to attempt suicide: people who attempted it in the past, people who abuse drugs or alcohol, and people without “social supports.”
In 2017, suicide was the second leading cause of death for people between 10 and 34 years of age.
Tools used for successful suicides: firearms 50% of the time, 25% suffocation and 14% by drug use.
Women attempt suicide twice as often as men across the board but men are four times likely to succeed. Men use firearms and suffocation; women tend to use drugs.
Adolescents and young adults have the highest rates of contemplating suicide on confidential surveys. The middle aged (45-54 years) and geriatric (75-84 years) populations are most likely to act on the impulse.
Despite the fact that suicide rates among troops sent to Iraq and Afghanistan had drastically increased (by double) until 2009, the rates among those who were never deployed actually tripled. Suicide among those in the military tends to fluctuate based on whether our country is currently at war. The potential risk of being deployed into combat is often what leads many people to take their own life.
In Medical School, I was taught that Dentists had the highest suicide rates within “white collar” professional classes. That is no longe true. Number1? Doctors. If not wanting to display weakness or have ones confidentiality is an issue for all of us, it is accentuated within the medical professions. A corollary was that surgeons crashed their private planes more often than other professionals; to this data, some lawyers refer to private planes as, “doctor killers.” I suppose when you make God-like decisions every day, you don’t think bad things can happen to you…………or that your judgement might be flawed………..
Does it help to screen everyone for depression? It is not clearly helpful and many people scoring low on the screening for risk do go on to commit suicide. The tool is not good for predicting the act. What can be helpful is engagement. In the medical world, this is about a therapist or nurse or doctor having their ears and eyes open and engaging the patient to flesh out their state of depression or loss. The technical skill of the provider and the empathy they can demonstrate is far more important than a “tool” of screening questions.
An interesting and painful reality is that treating depression with medication is a foundational intervention and yet with adolescents, it is known that SSRI anti-depressants are associated in some cases with increased suicide attempts. These drugs treat depression but also “relax” mental inhibitions. In the adolescent who thinks about suicide, this drug can lower the mental processes that usually inhibit the actions leading to suicide.
It is common for people who are depressed and contemplating suicide to reassure their therapist that they don’t have a plan and won’t go forward out of a sense of guilt or sense of love toward their family. When they do commit suicide, the family members usually feel great guilt for not having seen the problem or acted to prevent it. My stories will demonstrate how this hit home for me personally.
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