Monday, June 11, 2018

Suicide: A Public Health Crisis

The suicide deaths of designer Kate Spade and the celebrity chef Anthony Bourdain have at least temporarily - the American media has the attention span of a gnat - focused attention on the growing suicide rate in America which, like so many other things (e.g., gun violence) exceeds that of other advanced nations. Having made two serious attempts myself over a decade ago, it's a topic I am familiar with and on which I have strong opinions as to the causation.  While treatment for depression is much more common, much of what is available simply doesn't work, plus there is the impediment of the social stigma than many still hold towards seeking treatment, especially among men.  Like so much in American medicine, the most common approach seems to be simply prescribing drugs to mask the situation rather than deal with underlying causation. Feeling like one's body is not fully one's own and being drugged up is not a satisfactory long term solution.  Getting to the underlying causation, however, means extended therapy and counseling sessions - things for which most American health insurance plans  provide paltry coverage.  Thus, unless one has the ability to pay out of pocket, long term therapy simply doesn't happen in all too many cases.   The consequences can be literally deadly.  A piece in the New York Times looks at the growing public health crisis.  Here are excerpts:

Treatment for chronic depression and anxiety — often the precursors to suicide — has never been more available and more widespread. Yet the Centers for Disease Control and Prevention this week reported a steady, stubborn rise in the national suicide rate, up 25 percent since 1999.
The rates have been climbing each year across most age and ethnic groups. Suicide is now the 10th leading cause of death in the United States. Nearly 45,000 Americans killed themselves in 2016, twice the number who died by homicide.
After decades of research, effective prevention strategies are lacking. It remains difficult, perhaps impossible, to predict who will commit suicide, and the phenomenon is extremely difficult for researchers to study.
One of the few proven interventions is unpalatable to wide swaths of the American public: reduced access to guns. The C.D.C. report found that the states where rates rose most sharply were those, like Montana and Oklahoma, where gun ownership is more common.  It is predominantly men who use guns to commit suicide, and men are much less likely to seek help than women.
The escalating suicide rate is a profound indictment of the country’s mental health system. Most people who kill themselves have identifiable psychiatric symptoms, even if they never get an official diagnosis.
The number of people taking an open-ended prescription for an antidepressant is at a historic high. More than 15 million Americans have been on the drugs for more than five years, a rate that has more than tripled since 2000.
[O]ne recent study, by Danish researchers, supported the benefits of therapeutic intervention.  Using detailed medical records, the investigators studied more than 5,500 people who had been treated for deliberate self-harm, including cutting and clear suicide attempts.
Over decades, the portion of those people who got psychotherapy at suicide clinics were about 30 percent less likely to die or commit further self-harm than those who did not.  “I personally think that it’s the quality of care that matters, not the quantity,” Dr. Insel said. “We need more access, better measures and better quality of care.”
But in this country, many of those who commit suicide have received little or no professional help. Indeed, they rarely tell anyone beforehand of their plan — when there is one. Often the act is impulsive. . . . . the wide majority of people who die by suicide “explicitly deny suicidal thoughts or intentions in their last communications before dying.”
Andrew Spade, Ms. Spade’s husband, said she had seemed fine when he’d talked to her just before her suicide. Mr. Bourdain was filming one of his clever, humorous shows in Strasbourg, France, when his body was discovered.
The rise of suicide turns a dark mirror on modern American society: its racing, fractured culture; its flimsy mental health system; and the desperation of so many individual souls, hidden behind the waves of smiling social media photos and cute emoticons.
More recently, the economists Anne Case and Angus Deaton of Princeton have argued that the hollowing out of the economy and loss of middle and working class supports, like unions, have contributed to a broad increase in self-reported pain in those groups, both mental and physical.
The aggressive marketing of opioids by Purdue Pharma and others eased some of that pain — and helped create a generation of addicts, tens of thousands of whom die each year. Opioids are the third most common drugs found in the systems of suicides, after alcohol and anti-anxiety medications like Xanax, the C.D.C. reported.
A decline in marriage rates has likely played a role, as well. In her research, Dr. Phillips has found that in 2005 single middle-aged women were as much as 2.8 times more likely to kill themselves than married women, and their single male peers 3.5 times more likely than married men to do the same.
“In contrast to homicide and traffic safety and other public health issues, there’s no one accountable, no one whose job it is to prevent these deaths — no one who gets fired if these numbers go from 45,000 to 50,000,” Dr. Insel said.  “It’s shameful. We would never tolerate that in other areas of public health and medicine.”  
With Trump and Republicans dismantling heath care coverage, quality treatment will likely decline and, most likely, the death toll will increase.  Not that Trump or the GOP give a damn about ordinary citizens. 

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK) or go to for a list of additional resources.

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