Sui­cide rates rose sharply in US, re­port shows

The Mercury News Weekend - - FRONT PAGE - ByAmy El­lisNutt

Sui­cide rates rose in all but one state be­tween 1999 and 2016, with in­creases seen across age, gen­der, race and eth­nic­ity, ac­cord­ing to a re­port re­leased Thurs­day by the Cen­ters for Disease Con­trol and Preven­tion. In more than half of all deaths in 27 states, the peo­ple had no known men­tal health con­di­tion when they ended their lives.

In North Dakota, the rate jumped more than 57 per­cent. In the most recent pe­riod stud­ied (2014 to 2016), the rate was high­est in Mon­tana, at 29.2 per 100,000 res­i­dents, com­pared with the na­tional av­er­age of 13.4 per 100,000.

Only Ne­vada recorded a de­cline — of 1 per­cent — for the over­all pe­riod, although its rate re­mained higher than the na­tional av­er­age.

In­creas­ingly, sui­cide is being viewed not only as a men­tal health prob­lem but a public health one. Nearly 45,000 sui­cides oc­curred in the United States in 2016— more than twice the num­ber of homi­cides — mak­ing it the 10th-lead­ing cause of death. Among peo­ple ages 15 to 34, sui­cide is the sec­ond-lead­ing cause of death.

The most com­mon method used across all groups was firearms.

“The data are dis­turb­ing,” said Anne Schuchat, the CDC’s prin­ci­pal deputy di­rec­tor. “The wide­spread na­ture of the in­crease, in ev­ery state but one, re­ally sug­gests that this is a na­tional prob­lem hit­ting most com­mu­ni­ties.”

It is hit­ting many places es­pe­cially hard. In half of the states, sui­cide among peo­ple age 10 and older in­creased more than 30 per­cent.

“At what point is it a cri­sis?” asked Na­dine Kaslow, a past pres­i­dent of the Amer­i­can Psy­cho­log­i­cal As­so­ci­a­tion. “Sui­cide is a public health cri­sis when you look at the num­bers, and they keep go­ing up. It’s up ev­ery­where. And we know that the rates are ac­tu­ally higher than what’s re­ported. But homi­cides still get more at­ten­tion.”

One fac­tor in the ris­ing rate, say men­tal health pro­fes­sion­als as well as economists, so­ci­ol­o­gists and epi­demi­ol­o­gists, is the Great Re­ces­sion that hit 10 years ago. A 2017 study in the jour­nal So­cial Science and Medicine showed ev­i­dence that a rise in the fore­clo­sure rate dur­ing that con­cus­sive down­turn was as­so­ci­ated with an over­all, though mar­ginal, in­crease in sui­cide rates. The in­crease was higher for white males than any other race or gen­der group, how­ever.

“Re­search for­many years and across so­cial and health science fields has demon­strated a strong re­la­tion­ship be­tween eco­nomic down­turns and an in­crease in deaths due to sui­cide,” Sarah Bur­gard an as­so­ciate pro­fes­sor of so­ci­ol­ogy at the Univer­sity of Michi­gan, ex­plained in an email Thurs­day.

The dra­matic rise in opi­oid ad­dic­tion also can’t be over­looked, ex­perts say, though un­tan­gling ac­ci­den­tal from in­ten­tional deaths by over­dose can be dif­fi­cult. The CDC has cal­cu­lated that sui­cides from opi­oid over­doses nearly dou­bled be­tween 1999 and 2014, and data from a 2014 na­tional sur­vey showed that in­di­vid­u­als ad­dicted to pre­scrip­tion opi­oids had a 40 per­cent to 60 per­cent higher risk of sui­ci­dal ideation. Ha­bit­ual users of opi­oids were twice as likely to at­tempt sui­cide as peo­ple who did not use them.

High sui­cide num­bers in the United States are not a new phe­nom­e­non. In 1999, then- Sur­geon Gen­eral David Satcher is­sued a re­port on the state of men­tal health in the coun­try and called sui­cide “a sig­nif­i­cant public health prob­lem.” The lat­est data at that time showed about 30,000 sui­cides a year.

Kaslow is par­tic­u­larly con­cerned about what has emerged with sui­cide among women.

“His­tor­i­cally, men had higher death rates than women,” she noted. “That’s equal­iz­ing not be­cause men are [com­mit­ting sui­cide] less but women are do­ing it more. That is very, very trou­ble­some.”

Among the stark num­bers in the CDC re­port was the one sig­nal­ing a high num­ber of sui­cides among peo­ple with­out a known men­tal health con­di­tion. In the 27 states that use the Na­tional Vi­o­lent Death Re­port­ing Sys­tem, 54 per­cent of sui­cides were by peo­ple with­out a known men­tal illness.

But Joshua Gor­don, di­rec­tor of the Na­tional In­sti­tute of Men­tal Health, said that statis­tic must be viewed in con­text.

“When you do a psy­cho­log­i­cal au­topsy and go and look care­fully at med­i­cal records and talk to fam­ily mem­bers of the vic­tims,” he said, “90 per­cent will have ev­i­dence of a men­tal health con­di­tion.” That in­di­cates a large por­tion weren’t di­ag­nosed, “which sug­gests to me that they’re not get­ting the help they need,” he said.

Cul­tural at­ti­tudes may play a part. Those with­out a known men­tal health con­di­tion, ac­cord­ing to the re­port, were more likely to be male and be­long to a racial or eth­nic mi­nor­ity.

“The data sup­ports what we know about that no­tion,” Gor­don said. “Men and His­pan­ics es­pe­cially are less likely to seek help.”

The prob­lems most fre­quently as­so­ci­ated with sui­cide, ac­cord­ing to the study, are strained re­la­tion­ships; life stres­sors, of­ten in­volv­ing work or fi­nances; sub­stance use prob­lems; phys­i­cal health con­di­tions; and recent or im­pend­ing crises. The most im­por­tant take­away, men­tal health pro­fes­sion­als say, is that sui­cide is an is­sue not only for the men­tally ill but for any­one strug­gling with se­ri­ous life­style prob­lems.

“I think this gets back to what do we need to be teach­ing peo­ple — how to man­age breakups, job stresses,” said Chris­tine Moutier, med­i­cal di­rec­tor of the Amer­i­can Foun­da­tion for Sui­cide Preven­tion. “What are we do­ing as a na­tion to help peo­ple to man­age th­ese things? Be­cause any­body can ex­pe­ri­ence those stresses. Any­body.”

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