Why are suicide rates going up after a decline in the 1980s?
Why do people feel that death is a better option than staying alive? Suicide
seems to be like politics. We have simple and terminal solutions to very
complex and nuanced problems. Just like in politics, we keep making the same
mistake by treating suicide as one problem rather than an expression of a
dynamic interaction between the individual and their environment. We have been
trying to change the individual without treating the environment.
Suicide is an unspoken pandemic—where
every country in the world experiences it in silence. Unspoken and shamed despite the fact that
worldwide, every year, over one million people die by suicide. Suicide accounts
for around one in every 50 deaths. On average, for every 100,000 people, 16
will kill themselves. But there is tremendous variation. Generalities hide the
raw reality of suicide.
Suicide rate varies by country, income, gender, age, time
period and ethnicity. These factors all play a major role. Because countries
that top the suicide rates are so diverse, it seems to be an erratic malady.
Countries with the highest suicide include: Guyana in South America, followed
by countries of Eastern Europe, Japan, South Korea, and Europe— with Belgium
leading the continent. The USA lies 50th
in a list of 170 countries.
What is perplexing and worrying is that international
suicide statistics report that rates have increased by 60% in the past 45 years,
in particular since the 1980s. It is not that we are entering a new dystopian
world, but that we have erased the progress we made before. In 2013, in the
United States, the highest suicide rate was among people 45 to 64 years old,
when an estimated 10,189 older Americans committed suicide (particularly White
men). Nearly one in five suicides were among the middle-aged, but this was
closely followed among those 85 years and older. In fact, the rate of suicide
in the oldest group of white men (ages 85+) is over four times higher than the
nation’s overall rate of suicide. In the
United States, while there was a decrease for both men and women aged 75 and
over in 2014, suicide among adolescents and young adults continued to increase.
There are many ways to kill yourself, but the one that is
gaining popularity, for both females and males, is suffocation. This includes
hanging, strangulation, and putting a plastic bag over your head, sometimes
with a gas such as helium. In the USA
suffocation ended one in four suicides in 2014. However, the most common
methods of suicide differed for men and women.
In the USA--where we have over 300 million guns--more than half of male
suicides were caused by firearms, a statistic other countries do not share. While
for women, who are less likely to have access to guns, poisoning was the most
common method. Poisoning includes taking pills. Additionally, females were
likely to jump or drown, and men were likely to jump to their death or cut
themselves with knives (less than 1 in 20 suicides for both gender).
Although men 75 and older have the highest rate of suicide,
for women the highest rate is for middle age 45-64 followed by 25-44 and 65-74
age groups. Therefor men and women must have different triggers. For women, the spur seems to be spread across
a broader age group, yet the triggers for men seem to be concentrated in older
age. For men this finding has been explained as a loss of work identification,
declining health and virility, and a whole list of negative events that older
men are prone to. Is it the loss of income earning, that for the first time
they are no longer the bread winners?
It is only by bringing more information together that a
picture emerges revealing a silent story, something that individual numbers by
themselves cannot express. In 2012, Clare Wyllie and her colleagues in a study
for the Samaritans in the United Kingdom reported that poorer middle-aged men
are more likely to commit suicide than men with higher incomes. And this is not
a solitary finding. A recent study in Greece, by George Rachiotis and his
colleagues with the University of Thessaly, Larissa, Greece, found clear
increase in suicides among persons of working age coinciding with poverty, suggesting
that suicide risk in Greece is a health hazard associated with austerity
measures. In addition to poverty, other factors that promoted suicide were
relationship breakdown, isolation and mental health problems. All of these are inter-related.
The causes of suicide are numerous and connected together. A quick review of
suicide studies will dispel the idea of a quick fix since there are many
factors that can act as triggers. How these triggers work have been a source of
confrontation between academicians and clinical staff. Although intuitively we might accept that
suicide is not just a medical issue, our treatment of it remains purely clinical--medical
and behavioral. Pushing back against this attitude is not new.
The first academic study of suicide did just that. Written
by the father of Sociology, Emile Durkheim, in 1897 Suicide, transformed how we look at this problem. While
psychiatrists at the time were searching for the biology of disease, Durkheim
noticed that stronger social control among Catholics resulted in lower suicide
rates. He highlighted that there are social factors that determine the expression
of suicide. Although Durkheim’s method was flawed--termed as an Ecological
Fallacy; surmising an individual’s traits from generalized statistics—he was
accurate in assigning a social aspect to suicide.
Durkheim saw suicide as a normal reaction to a unique feeling
of detachment from society. As such he saw a social component, especially since
suicide varies by country and that these social factors must be intrinsic to
the country. Durkheim argues that when social conditions fail to provide for
people’s expectations, the most vulnerable react by the only means they know of
stopping the pain. In line with such a sociological perspective, Ben Fincham a
sociologist with the University of Sussex, has argued that the question is not
why people commit suicide but he asks what social factors “contribute to people
feeling as though they wish to die.”
Suicide is seen as a failure. A failure on the part of the
individual who commits or attempts suicide by not being strong enough to
overcome difficulties; Failure on the part of family and parents for a
perceived lack of insight; Spouses feel that the suicide is a reflection of
their lack of engagement in the relationship; Communities respond with shame
that it happened among them; and society looks at suicide as a rejection of their
way of life. But the real failure lies in how clinical and social services deal
with suicide. There are nuances to suicide that we are ignoring.
For every successful suicide there are many failed attempts.
In most cases there are enough warning signs. Although men are four times more
likely to commit suicide then women, women attempt suicide three times more
often than men. Attempted suicide varies
considerably by age as well. It seems that becoming older makes you more adept
at carrying out an effective suicide. For every young person that commits
suicide there are 25 attempts, while for older adults four attempted suicides
results in one death. As a result, there are fewer opportunities to intervene
with suicide among older adults. In 2000, Ulla Agerskov Andersen and her
colleagues with the University of Southern Denmark, repeated the findings that
suicide victims are falling through our safety net to their death. The authors
reported that just under half of the victims had been hospitalized in
psychiatric departments beforehand, one in seven within the last month. Two out
of three of the victims consulted with their primary care physician within the
last month before killing themselves. There is ample supporting evidence for this
behavior. There are muted last pleas for help.
Until we appreciate that suicide is an expression of more
than a mental illness and involves a perceived negative environment, only then
can we look at both sides of these triggers. The fact that vulnerable adults
express silent pleas for help beforehand needs to be the call to action for
clinical and social services. The missing aspect, especially in research, is
the lack of examination of how their environment can be changed to minimize the
likelihood of using suicide as their exit strategy. There are other options for
reducing the pain and it’s not all in the head.
Further reading:
·
Andersen, U. A., Andersen, M., Rosholm, J. U.,
& Gram, L. F. (2000). Contacts to the health care system prior to suicide:
a comprehensive analysis using registers for general and psychiatric hospital
admissions, contacts to general practitioners and practising specialists and
drug prescriptions. Acta Psychiatrica Scandinavica, 102(2), 126-134.
·
Pirkis, J., & Burgess, P. (1998). Suicide
and recency of health care contacts. A systematic review. The British Journal
of Psychiatry, 173(6), 462-474.
·
Luoma, J. B., Martin, C. E., & Pearson, J.
L. (2002). Contact with mental health and primary care providers before
suicide: a review of the evidence.American Journal of Psychiatry, 159(6),
909-916.
·
Isometsa, E. T., Heikkinen, M. E., Marttunen, M.
J., Henriksson, M. M., Aro, H. M., & Lonnqvist, J. K. (1995). The last appointment
before suicide: is suicide intent communicated?. American Journal of
Psychiatry, 152(6), 919-922.
·
Vassilas, C. A., & Morgan, H. G. (1993).
General practitioners' contact with victims of suicide. BMJ: British Medical
Journal, 307(6899), 300.
© USA Copyrighted 2016 Mario D. Garrett
