Monday, June 18, 2018

Too Many Suicides, Too Few Answers

Suicides involving high profile celebrities shock Americans and spur an outpouring of sympathy.  However, after a few news cycles, public interest wanes and heartbreak fades.  That is a tragedy considering the alarming increase in suicides in this country and worldwide.

From 1999 to 2016, the suicide rate in the United States rose 28 percent.  There were twice as many suicides (44,965) in 2016 as there were homicides (19,362) in the country.  Suicide is the second leading cause of death among young people between the ages of 10 and 36.

Those statistics were reported by the American Foundation For Suicide Prevention (AFFSP), which estimates the costs of suicide at $69 billion annually in medical expenses and lost wages.  Firearms were used in more than half (22,963) of the reported suicides. 

Worldwide more than 600,000 people committed suicide in 2015, confirms the latest data from the World Health Organization.  The United States ranks 48th in the world, eclipsed by countries such as Sir Lanka, Guyana and Mongolia, where the suicide rates are three times higher than our nation.

For every suicide, 25 Americans attempt to end their lives, reports the AFFSP.  Research shows that for every reported suicide death about 11.4 people visit a hospital for self-harm injuries.  The data does not distinguish between intentional and non-intentional injuries, weakening the linkage.  

All this disturbing evidence sheds light on a subject that for too long has been taboo.  Unfortunately,  the stigma attached to suicide often obfuscates the publicly available information.  As a result, unscientific beliefs replace facts which undermines an intelligent national discussion on prevention.  

For instance, most people who kill themselves are not mentally deranged in the clinical sense.  We tend to believe that, however, because seemingly well adjusted people are not supposed to end their lives.  But the scientific data and research do not support that commonly held belief.

Based on data from the National Violent Death Reporting System, one-third of suicide victims tested positive for alcohol.  In 24 percent of the cases, an antidepressant was discovered during the autopsy.  One-fourth (20 percent) tested positive for opiates, including heroin and pain killers. 

Those statistics, distributed by the Centers for Disease Control (CDC),  indicate that mental health issues may have contributed to the usage of drugs, pain killers and alcohol.  But there is no evidence that suicides are the work of primarily mentally ill people.

Another oft repeated misconception is that most suicides could be prevented if an adult or mental health professional would have intervened.  A recent study reported in the Journal of Depression and Anxiety found most (54%) emergency room doctors said "few" suicides could have been prevented.

Research by the American Association of Suicidology (sic) found than less than 10 minutes pass between a the average person's decision to commit suicide and the actual attempt.  In those precious minutes, the overwhelming impulse to take your own life outweighs common sense and logic.

Depression has been found to be one of the top risk factors for suicide.  But it is just one cause on a long list of contributing influences.  Other markers include substance abuse, a family history of suicide, being a bullying victim, eating disorders, incarceration, hopelessness and low job security.

There far too many other factors to innumerate.  That's one of the obstacles to preventing suicide.  It is nearly impossible to know what precisely triggers each suicide.  If you cannot predict the underlying cause in advance, how do you stop a person from committing suicide?

Health experts always suggest people look for warning signs that someone may attempt suicide.  But no one can see what a person is feeling inside.  While the professionals admit that, they persist in telling people to look for signs of anxiousness, agitation, changes in eating habits, hopelessness.

Sadly, the list of warning signs is just as lengthly as the risk factors, which means no one can pinpoint a single influence with absolute confidence.  It shouldn't deter people helping others. But the truth is Americans need better tools to recognize the symptoms of suicidal behavior.

Promising research has been launched in recent years to discover if there is a gene marker for suicide.  That would help identify high-risk individuals.  However, we remain years perhaps even decades away from learning if there indeed is a gene or perhaps a gene mutation linked to suicide.

Some health officials point to the rising rates of depression, anxiety and anger to explain the hike in suicides. But few have answers to the most critical question: "Why is this increase happening?" Without more scientific evidence, physicians and patients are left to try to cope the best they can.

In the absence of more actionable research, suffering will continue for those left behind by the suicide of a friend, relative or loved one.  These innocent bystanders experience guilt, remorse and a stinging sense of loss.  There is nothing worse in life.  Their pain is a cry for answers to prevent suicide.  

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