Search­ing for an­swers

Sui­cide ex­perts point to risk fac­tors, but say prob­lem ‘knows no bound­ary’

Modern Healthcare - - Rural Health -

Jerry Reed re­calls clearly the day when Sen. Harry Reid turned to him at a con­gres­sional com­mit­tee hear­ing in 1996 and asked why sui­cide rates in Amer­ica were con­sid­er­ably higher in the nation’s Western moun­tain states.

The moment came not long af­ter the Ne­vada Demo­crat had shared pub­licly at the hear­ing that his fa­ther had com­mit­ted sui­cide years be­fore, some­thing he had dis­cussed with few peo­ple in the 24 years since his fa­ther’s death.

As Reid, now the Se­nate ma­jor­ity leader, re­mem­bered in his 2008 book The Good Fight: “My col­leagues didn’t know. My leg­isla­tive aide at the time on ag­ing is­sues, Jerry Reed, who—in help­ing me pre­pare for the hear­ing had con­tacted the Na­tional In­sti­tute of Mental Health and the Cen­ters for Dis­ease Con­trol to get the lat­est data on de­pres­sion, only to find that Ne­vada leads the nation in older sui­cide—didn’t know ei­ther. Telling the story of my fa­ther’s de­pres­sion and death was lib­er­at­ing,” Reid writes.

As a re­sult of the hear­ing, Reid in­tro­duced Se­nate Res­o­lu­tion 84 in May 1997, which rec­og­nized sui­cide—then the ninth lead­ing cause of death in the U.S., claim­ing more than 31,000 lives an­nu­ally—as a na­tional pub­lic health prob­lem. Ac­cord­ing to the most re­cent num­bers from the Cen­ters for Dis­ease Con­trol and Pre­ven­tion, sui­cide is now the nation’s 11th lead­ing cause of death, ac­count­ing for more than 33,300 deaths in 2007.

For Reed, a so­cial worker who had worked on fam­ily vi­o­lence, do­mes­tic abuse and youth ser­vices is­sues at the U.S. De­fense Depart­ment, the sen­a­tor’s ques­tion led to his re­search on why sui­cide rates are higher in cer­tain re­gions of the coun­try, a sub­ject he an­a­lyzed for his dis­ser­ta­tion, “Vari­a­tion Among States in Older Adult Male Sui­cide,” at Vir­ginia Com­mon­wealth Uni­ver­sity in 2007. To­day, Reed is di­rec­tor of the Sui­cide Pre­ven­tion Re­source Cen­ter, which is op­er­ated by HHS and funded by the Sub­stance Abuse & Mental Health Ser­vices Ad­min­is­tra­tion. He also di­rects the Cen­ter for the Study and Pre­ven­tion of In­jury, Vi­o­lence and Sui­cide at the Ed­u­ca­tion Devel­op­ment Cen­ter in Newton, Mass.

“I looked at data from 2002 to 2004—cer­tainly it was Ne­vada, Wy­oming, Idaho and Ore­gon, but also New Mex­ico, Mon­tana and Alaska—Western, ru­ral, in­ter­moun­tain states,” Reed says. “The low­est were Rhode Is­land, New York, New Jersey and Mas­sachusetts,” he says, adding that in Rhode Is­land the sui­cide rate was 11.6 per 100,000 peo­ple, while it was 67 per 100,000 peo­ple in Ne­vada, or nearly six times as high.

Ac­cord­ing to Reed and his dis­ser­ta­tion ab­stract, the statis­tics on divorce rates, peo­ple per square mile, and the per­cent­age of homes that owned a gun in these Western, ru­ral states led him to iden­tify three ma­jor themes in this re­gion of the coun­try: iso­la­tion, lone­li­ness and ac­cess to lethal means.

“What works in a ru­ral com­mu­nity in Mon­tana with older adults might be very dif­fer­ent from young, ur­ban Lati­nas in New York City,” says Reed, who added that it’s im­por­tant to fo­cus on a wide range of risk and pro­tec­tive fac­tors. These in­clude those that are bi­o­log­i­cal and psy­cho-so­cial, such as mental dis­or­ders, de­pres­sion, hope­less­ness, his­tory of trauma or abuse, and ex­po­sure to sui­cide; en­vi­ron­men­tal, such as re­la­tional or so­cial (death of a spouse or friend), loss of job and fi­nan­cial losses; and so­cio-cul­tural fac­tors, such as a lack of so­cial sup­port, iso­la­tion, bar­ri­ers to ac­cess­ing care and a stigma for seek­ing help.

“I was try­ing to find out if there was a way to ex­plain vari­a­tion,” Reed says. “If you look in the North­east, even if you live in a city and don’t know a soul, you hear the sounds” of peo­ple and civ­i­liza­tion, he adds, whereas in a moun­tain state, “You don’t hear that. You have to go out for it.” Some of the fac­tors Reed de­scribed, namely iso­la­tion, his­tory of trauma, so­cio-cul­tural losses, and do­mes­tic vi­o­lence are the con­tribut­ing fac­tors that Rose Weah­kee cites as prob­lems plagu­ing Amer­i­can In­di­ans and Alaska Na­tives, two

Reed: “I was try­ing to find out if there was a way to ex­plain vari­a­tion.”

Weah­kee: Sui­cide pre­ven­tion ef­forts are a “com­mu­nity re­spon­si­bil­ity.”

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