Suicide Rate Rises Among Middle-Aged In The U.S., CDC Reports

By Mike Stobbe
The Associated Press
Published May 2, 2013

The suicide rate among middle-aged Americans climbed a startling 28 percent in a decade, a period that included the recession and the mortgage crisis, the government reported Thursday.

The trend was most pronounced among white men and women in that age group. Their suicide rate jumped 40 percent between 1999 and 2010.

But the rates in younger and older people held steady. And there was little change among middle-aged blacks, Hispanics and most other racial and ethnic groups, the report from the Centers for Disease Control and Prevention found.

Why did so many middle-aged whites – that is, those who are 35 to 64 years old – take their own lives?

One theory suggests the recession caused more emotional trauma in whites, who tend not to have the same kind of church support and extended families that blacks and Hispanics do.

The economy was in recession from the end of 2007 until mid-2009. Even well afterward, polls showed most Americans remained worried about weak hiring, a depressed housing market and other problems.

Pat Smith, violence-prevention program coordinator for the Michigan Department of Community Health, said the recession – which hit manufacturing-heavy states particularly hard – may have pushed already-troubled people over the brink. Being unable to find a job or settling for one with lower pay or prestige could add "that final weight to a whole chain of events," she said.

The entire story is here.

Wars on Drugs

By Richard Friedman
The New York Times - Opinion
Originally published April 6, 2013

LAST year, more active-duty soldiers committed suicide than died in battle. This fact has been reported so often that it has almost lost its jolting force. Almost.

Worse, according to data not reported on until now, the military evidently responded to stress that afflicts soldiers in Iraq and Afghanistan primarily by drugging soldiers on the front lines. Data that I have obtained directly from Tricare Management Activity, the division of the Department of Defense that manages health care services for the military, shows that there has been a giant, 682 percent increase in the number of psychoactive drugs — antipsychotics, sedatives, stimulants and mood stabilizers — prescribed to our troops between 2005 and 2011. That’s right. A nearly 700 percent increase — despite a steady reduction in combat troop levels since 2008.

The prescribing trends suggest that the military often uses medications in ways that are not approved by the Food and Drug Administration and do not comport with the usual psychiatric standards of practice.

The military tests prospective enlistees with an eye toward screening out those with serious psychiatric disorders. So you would expect that the use of these drugs in the military would be minimal — and certainly less than in the civilian population. But the opposite is true: prescriptions written for antipsychotic drugs for active-duty troops increased 1,083 percent from 2005 to 2011; the number of antipsychotic drug prescriptions in the civilian population increased just 22 percent from 2005 to 2011, according to IMS Health, an independent medical data company.

The entire article is here.

Suicide Risk Linked to Rates of Gun Ownership, Political Conservatism

Science Daily
Originally published April 4, 2013

Residents of states with the highest rates of gun ownership and political conservatism are at greater risk of suicide than those in states with less gun ownership and less politically conservative leanings, according to a study by University of California, Riverside sociology professor Augustine J. Kposowa.

The study, "Association of suicide rates, gun ownership, conservatism and individual suicide risk," was published online in the journal Social Psychiatry & Psychiatric Epidemiology in February.

Suicide was the 11th leading cause of death for all ages in the United States in 2007, the most recent year for which complete mortality data was available at the time of the study. It was the seventh leading cause of death for males and the 15th leading cause of death for females. Firearms are the most commonly used method of suicide by males and poisoning the most common among females.

Kposowa, who has studied suicide and its causes for two decades, analyzed mortality data from the U.S. Multiple Cause of Death Files for 2000 through 2004 and combined individual-level data with state-level information.

The entire story is here.

The journal article can be found here.

Evangelical Pastor Rick Warren's son recently suicided by hand gun.

That story is here.

Perspectives on Suicide in the Army National Guard

By James Griffith & Mark Vaitkus
Armed Forces & Society published online 22 February 2013

Abstract

Suicides in the US military were observed rising in 2004, most notably in the Army and Marine Corps, and particularly, in the Army National Guard (ARNG). Alarmed, Army leaders and researchers have offered various explanations and prescriptions, often lacking any evidence. In the present study, three data sets were used to examine evidence for various perspectives on suicide—dispositional risk, social
cognitive, stressor-strain, and social cultural/institutional, each having different emphases on relevant explanatory variables and underlying mechanisms of suicide. Primary risk factors associated with having committed suicide among the 2007–2010 ARNG suicide cases were age (young), gender (male), and race (white), supporting the dispositional risk perspective on suicide. Some evidence supported the stressor-strain perspective in that postdeployment loss of a significant other and a
major life change showed statistically significant, yet weaker associations with increased suicide intentions. Implications of results are discussed for future research and preventive strategies.

Here is part of the discussion:

Military-related variables, including having been deployed and combat exposure, showed little relationship to suicide. These findings are consistent with analyses of the active component Army suicides. US Army Public Health Command has consistently reported suicide cases as occurring disproportionally among males, Caucasians, younger in age (eighteen to twenty-four years), and often having an untreated behavioral condition and/or substance abuse.

The entire journal article is here.

Advocates Seek Mental Health Changes, Including Power to Detain

By BRANDI GRISSOM
The Texas Tribune/The New York Times
Published: February 23, 2013

Here are some excerpts:

Mr. Thomas, who confessed to the murders of his wife, their son and her daughter by another man, was convicted in 2005 and sentenced to death at age 21. While awaiting trial in 2004, he gouged out one of his eyes, and in 2008 on death row, he removed the other and ate it.

At least twice in the three weeks before the crime, Mr. Thomas had sought mental health treatment, babbling illogically and threatening to commit suicide. On two occasions, staff members at the medical facilities were so worried that his psychosis made him a threat to himself or others that they sought emergency detention warrants for him.

Despite talk of suicide and bizarre biblical delusions, he was not detained for treatment. Mr. Thomas later told the police that he was convinced that Ms. Boren was the wicked Jezebel from the Bible, that his own son was the Antichrist and that Leyha was involved in an evil conspiracy with them.

He was on a mission from God, he said, to free their hearts of demons.

Hospitals do not have legal authority to detain people who voluntarily enter their facilities in search of mental health care but then decide to leave. It is one of many holes in the state’s nearly 30-year-old mental health code that advocates, police officers and judges say lawmakers need to fix. In a report last year, Texas Appleseed, a nonprofit advocacy organization, called on lawmakers to replace the existing code with one that reflects contemporary mental health needs.

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Hospital officials say they face a Catch-22 under current law: if they detain a mentally ill person against his or her will, they face liability because they have no legal authority to do so. If they allow the person to leave and something tragic happens, they risk a lawsuit like the one the Boren family filed.

The entire story is here.

The Op-Ed: Antidepressants & Controversial Studies

By Ed Silverman
Pharmalot.com
Originally published February 11th, 2013

Several years ago, the Black Box warnings that were added to antidepressants over suicidal thoughts and behaviors for youngsters caused a backlash, as some suggested the language had pushed physicians and parents to avoid usage when the medications could have done some good. The debate may have slipped from view, but never really ended. A pair of papers published last year, in fact, renewed the controversy, and Glen Spielmans, an associate professor of psychology at Metropolitan State University, recounts why the issue remains fraught with challenges and a recent spat that erupted when an effort was made to critique the papers.

Antidepressants can cause suicidality – suicidal thoughts and behaviors – in children and adolescents. This message has been widely disseminated since October 2004, when the FDA placed a Black Box warning on such medications. The warning was based on findings from placebo-controlled trials, in which kids taking antidepressants had an elevated rate of suicidal thoughts and behaviors (see this). But research led by Dr. Robert Gibbons, professor of biostatistics at the University of Chicago, suggests that this warning is counterproductive, scaring parents and kids away from getting safe and effective antidepressant treatment.

Gibbons was the main author on two papers published in 2012 in psychiatry’s premier journal, Archives of General Psychiatry (which was changed to JAMA Psychiatry last month). One paper examined the potential association between antidepressants and suicidality and the other focused on the efficacy of antidepressants.

The entire op-ed is here.

VA report: 22 veterans commit suicide each day

The number of veterans who commit suicide each day is more than 20 percent higher than previously estimated
 

By Kevin Freking

Salon.com
Originally published February 1, 2013

The number of veterans who commit suicide each day is more than 20 percent higher than the Department of Veterans Affairs has previously estimated, but the problem doesn’t appear to be getting worse for veterans compared to the rest of the country, according to a VA study released Friday.

Indeed, the overall percentage of suicides by veterans has declined in recent years. VA researchers say the trend suggests that efforts to reduce suicide among veterans may be having an effect.

About 22 veterans committed suicide each day in 2010. Previous estimates from the VA put the number at 18.

While much attention has been paid to suicides by veterans of Iraq and Afghanistan, the report indicates the problem is worse among older veterans. About 70 percent of veterans who commit suicide are over age 50.

The latest projections from the VA incorporate data from about two dozen states that recorded the cause of death on death certificates. Previous estimates focused only on those getting care from the VA’s hospitals and clinics. The department described the study as the most comprehensive it has ever taken on the issue. 

“We have more work to do, and we will use this data to continue to strengthen our suicide prevention efforts and ensure all veterans receive the care they have earned and deserve,” said VA Secretary Eric K. Shinseki.

Prevalence, Correlates, and Treatment of Lifetime Suicidal Behavior Among Adolescents

Results From the National Comorbidity Survey

Matthew K. Nock, PhD; Jennifer Greif Green, PhD; Irving Hwang, MA; Katie A. McLaughlin, PhD; Nancy A. Sampson, BA; Alan M. Zaslavsky, PhD; Ronald C. Kessler, PhD

JAMA Psychiatry. 2013;():1-11. doi:10.1001/2013.jamapsychiatry.55.

ABSTRACT

Context
Although suicide is the third leading cause of death among US adolescents, little is known about the prevalence, correlates, or treatment of its immediate precursors, adolescent suicidal behaviors (ie, suicide ideation, plans, and attempts).

Objectives
To estimate the lifetime prevalence of suicidal behaviors among US adolescents and the associations of retrospectively reported, temporally primary DSM-IV disorders with the subsequent onset of suicidal behaviors.

Design  
Dual-frame national sample of adolescents from the National Comorbidity Survey Replication Adolescent Supplement.

Setting
Face-to-face household interviews with adolescents and questionnaires for parents.

Participants
A total of 6483 adolescents 13 to 18 years of age and their parents.

Main Outcome Measures
Lifetime suicide ideation, plans, and attempts.

Results 
The estimated lifetime prevalences of suicide ideation, plans, and attempts among the respondents are 12.1%, 4.0%, and 4.1%, respectively. The vast majority of adolescents with these behaviors meet lifetime criteria for at least one DSM-IV mental disorder assessed in the survey. Most temporally primary (based on retrospective age-of-onset reports) fear/anger, distress, disruptive behavior, and substance disorders significantly predict elevated odds of subsequent suicidal behaviors in bivariate models. The most consistently significant associations of these disorders are with suicide ideation, although a number of disorders are also predictors of plans and both planned and unplanned attempts among ideators. Most suicidal adolescents (>80%) receive some form of mental health treatment. In most cases (>55%), treatment starts prior to onset of suicidal behaviors but fails to prevent these behaviors from occurring.

Conclusions  
Suicidal behaviors are common among US adolescents, with rates that approach those of adults. The vast majority of youth with suicidal behaviors have preexisting mental disorders. The disorders most powerfully predicting ideation, though, are different from those most powerfully predicting conditional transitions from ideation to plans and attempts. These differences suggest that distinct prediction and prevention strategies are needed for ideation, plans among ideators, planned attempts, and unplanned attempts.

The original research is here.

The year of the suicide

Suicide rates among Americans are steadily rising and have been for years. Why are we killing ourselves?

BY KERA BOLONIK
Salon.com
Originally published Decemeber 31, 2012


Let’s call 2012 the year of the suicide: On Friday, the Department of the Army released a report revealing that suicides continue to outnumber combat-related deaths among American soldiers —an average of one suicide a day— a number that’s increasing despite the fact that the armed forces have installed new training and awareness programs over the past few years. Stateside, suicide has become the leading cause of death by injury, and is the 10th leading cause of death overall. According to a CDC report released over the summer, suicide attempts by high-school students has risen to from 6.3 percent in 2009 to 7.8 percent in 2011, and accounts for 13 percent of all deaths among people between the ages of 10 and 24 — the third leading cause of death in that age group.

These are sobering statistics. And with the statistics comes more data to explain them: The Washington Post reported that “the stress on the force after more than a decade of lengthy and multiple deployments for many troops in support of the wars in Iraq and Afghanistan,” while Defense Secretary Leon Panetta attributed the high rate to “substance abuse, financial distress and relationship problems … that will endure beyond war.” Among civilians, the number of suicides have been attributed to the recession — historically, there is a spike with every economic downturn. And 20 percent of high-school teenagers say they are being bullied — 16 percent say they’ve been cyber-bullied through texting, IM-ing, email, and Facebook or other social media.

The entire story is here.

War Tragedies Strike Families Twice

By MICHAEL M. PHILLIPS
The Wall Street Journal
Originally published on December 20, 2012

One night in March 2008, William and Christine Koch opened their front door to see two soldiers in green dress uniforms bearing news that their son, Army Cpl. Steven Koch, had been killed by a suicide bomber in Afghanistan.

Two years later, Mr. and Mrs. Koch opened the door to see two police officers in blue. This time, they learned their daughter, Lynne, brokenhearted over her brother's death, had killed herself with an overdose of prescription drugs.

She is a casualty of this war, and I don't care what anybody says," Mrs. Koch said. "If my son was not killed, my daughter would be here."

The military tracks suicides among the troops. The Department of Veterans Affairs studies self-inflicted deaths among people who have left the service. Nobody collects data on suicides among the parents, siblings and spouses of the more than 6,500 Americans killed in Afghanistan and Iraq.

But anecdotal evidence from military families, support groups and suicide survivors suggests that over the past 11 years of war, the U.S. has experienced a little-recognized suicide outbreak among the bereaved. This second round of tragedy often takes place years after a loved one's death, when the finality of the loss becomes inescapable.

"We've all had the idea of suicide at one time or another," said Nadia McCaffrey of Tracy, Calif., whose son Patrick died in an ambush in Iraq in 2004. She said she personally knows a half dozen military parents who have killed themselves.

To learn more about war grief, researchers at the Uniformed Services University of the Health Sciences, a federal institution in Bethesda, Md., are recruiting 3,000 people to participate in a first-ever U.S. study of bereavement among families of those killed on active duty.

"We don't know whether or in what ways military-service deaths—combat-related, accidents or suicides—differ from similarly sudden or violent civilian deaths in their impact on bereaved family members," said Stephen Cozza, a psychiatrist involved in the research.

The violent and faraway nature of combat death—often following months of dread—may make it harder to accept for those left behind, said Bonnie Carroll. She founded the Tragedy Assistance Program for Survivors, or TAPS, after her husband, an Army general, died in a 1992 plane crash.

"To have someone come to the house and deliver this devastating information that you'd never see them again is impossible to absorb," Mrs. Carroll said. In her grief after her husband's death, she found herself taking high-speed, late-night drives along the Alaska coast, as if daring herself to join him.

The entire story is here.

Physician Suicide Linked to Work Stress

By Crystal Phend, Senior Staff Writer
MedPage Today
Originally published November 14, 2012

Suicide among physicians appears to follow a different profile than in the general population, with a greater role played by job stress and mental health problems, a national analysis showed.

Problems with work were three times more likely to have contributed to a physician's suicide than a nonphysician's, Katherine J. Gold, MD, MSW, of the University of Michigan in Ann Arbor, and colleagues found.

Their analysis of the National Violent Death Reporting System also showed that known mental illness prior to suicide was 34% more common among physicians than nonphysicians.

"The results of this study paint a picture of the typical physician suicide victim that is substantially different from that of the nonphysician suicide victim in several important ways," the group wrote online in General Hospital Psychiatry.

The entire story is here.

The original article is here.

Here is the conclusion from the abstract:

Mental illness is an important comorbidity for physicians who complete a suicide but postmortem toxicology data shows low rates of medication treatment. Inadequate treatment and increased problems related to job stress may be potentially modifiable risk factors to reduce suicidal death among physicians.

U.S. Suicide Rate Jumped During Recession as Unemployment Rose

By Phil Serafino
Bloomberg News
Originally posted November 4, 2012


The suicide rate in the U.S. increased during the recession, a sign that rising joblessness took a toll on Americans’ mental health, researchers said.

About 1,580 additional suicides occurred annually in the U.S. from 2008 to 2010 than would have been expected based on statistical trends before the recession, according to a letter published today in the Lancet journal by researchers from the U.K., Hong Kong and the U.S. They looked at suicide mortality statistics from the U.S. Centers for Disease Control and Prevention for 1999 through 2010, according to the letter.

The findings add to evidence from other countries that the recession and debt crisis have harmed mental health. Previous studies found that Greece and Spain, two of the countries hit hardest by the economic duress, showed increases in illnesses including depression.

The entire story is here.

Former City Official’s Blog Chronicled His Fall From Grace and Plans for Suicide

By RUSS BUETTNER
The New York Times
Originally published October 7, 2012

After years of using his blog to settle scores with journalists, former fellow city officials and even his own father, Russell A. Harding began his final post with an unsettling mix of humility and humor.

“While you read this try and hear the Doors playing in the background for the right feel,” he wrote. “Just kidding, trying to lighten the mood.”

“Well, this is my last post,” he added. “I am hoping and praying that by the time you read this I have not botched this suicide attempt.”

By the time the 3,000-word post, “The End,” was posted on Sept. 30, Mr. Harding, 48, had taken his own life.

His body was found by the police at his apartment in Dobbs Ferry, N.Y., on Saturday, Sept. 29, apparently two days after he had committed suicide. A friend of Mr. Harding’s called the police there, and said he had received a letter that made him “concerned about his friend’s welfare,” Dobbs Ferry Police Sgt. Manuel Guevara said.

The entire story is here.

Suicide Outbreak Prompts CDC Assessment

Community education and availability of mental health resources are called essential in efforts to limit suicidal behavior.

By Christopher White
Psychiatric News
Originally published September 21, 2012

In the first five months of this year, 11 young people completed suicide in Kent and Sussex counties in Delaware, an increase from the yearly average of four in those aged 12 to 21 from 2009 to 2011.

Reflecting the state’s concern about this troubling development, the Delaware Department of Health and Human Services asked the federal Centers for Disease Control and Prevention (CDC) to conduct an epidemiological study to determine the rates of fatal and nonfatal suicide behaviors in the area, analyze risk factors, and recommend strategies to prevent future suicides.

Of the 11 decedents, four were students at the same high school, two were students at other local high schools, one was a student at a middle school, one had dropped out of high school, two had graduated from area high schools and were still living in Sussex County, and one was an adult with unknown education history.


The entire story is here.

Suicide, Not Car Crashes, #1 Cause of Injury Death

By Jennifer Warner
WebMD Health News
Originally published September 20, 2012

Suicide has overtaken car crashes as the leading cause of injury-related deaths in the U.S.

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The top five leading causes of injury-related deaths were:

1. Suicide
2. Motor vehicle crashes
3. Poisoning
4. Falls
5. Homicide

Researchers say the findings demonstrate that suicide is now a global public health issue.

"Our finding that suicide now accounts for more deaths than do traffic crashes echoes similar findings for the European Union, Canada, and China," they write.

Researchers say deaths from unintentional poisoning rose, in part, because of a sharp rise in prescription drug overdoses.

The entire article is here.

Preventing Suicides in US Service Members and Veterans: Concerns After a Decade of War

By Charles W. Hoge, MD, & Carl A. Castro, PhD
JAMA. 2012;308(7):671-672. doi:10.1001/jama.2012.9955

Before the wars in Iraq and Afghanistan, the incidence of suicide in active duty US service members was consistently 25% lower than that in civilians, attributable to "healthy-worker" effects from career selection factors and universal access to health care.

Between 2005 and 2009, the incidence of suicide in Army and Marine personnel nearly doubled.
From 2009 through the first half of 2012, the incidence of suicide among Army soldiers remained elevated (22 per 100 000 per year), with the number dying of suicide each year exceeding the number killed in action.

High rates of suicide have also been reported for US veterans, although incidence studies in veteran populations have drawn conflicting conclusions.

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"Examining communication strategies is also critical. Stigmatizing attitudes may be unwittingly reflected in cliches, such as 'zero tolerance' or 'one suicide is one too many,' expressed by well-intentioned VA or military leaders.  These slogans convey an implicit message: suicides are different from any other medical condition, the result of a bad 'choice' by the individual or negligence by peers or leaders.  These types of communications would not be used to describe attitudes toward depression, PTSD, or cancer."

The entire article is here.

Thanks to Ken Pope for this information.

Self-harm and suicide in adolescents

The Lancet, Volume 379, Issue 9834, Pages 2373 - 2382, 23 June 2012
by K. Hawton, K. Saunders, and R. O'Connor
Originally published June 23, 2012

Summary

Self-harm and suicide are major public health problems in adolescents, with rates of self-harm being high in the teenage years and suicide being the second most common cause of death in young people worldwide. Important contributors to self-harm and suicide include genetic vulnerability and psychiatric, psychological, familial, social, and cultural factors. The effects of media and contagion are also important, with the internet having an important contemporary role. Prevention of self-harm and suicide needs both universal measures aimed at young people in general and targeted initiatives focused on high-risk groups. There is little evidence of effectiveness of either psychosocial or pharmacological treatment, with particular controversy surrounding the usefulness of antidepressants. Restriction of access to means for suicide is important. Major challenges include the development of greater understanding of the factors that contribute to self-harm and suicide in young people, especially mechanisms underlying contagion and the effect of new media. The identification of successful prevention initiatives aimed at young people and those at especially high risk, and the establishment of effective treatments for those who self-harm, are paramount needs.

Suicides Outpacing War Deaths for Troops

by Timothy Williams
The New York Times
Originally published on June 8, 2012

The suicide rate among the nation’s active-duty military personnel has spiked this year, eclipsing the number of troops dying in battle and on pace to set a record annual high since the start of the wars in Iraq and Afghanistan more than a decade ago, the Pentagon said Friday.

Suicides have increased even as the United States military has withdrawn from Iraq and stepped up efforts to provide mental health, drug and alcohol, and financial counseling services.
      

The military said Friday that there had been 154 suicides among active-duty troops through Thursday, a rate of nearly one each day this year. The figures were first reported this week by The Associated Press.

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Mr. Rieckhoff attributed the rise in military suicides to too few qualified mental health professionals, aggravated by the stigma of receiving counseling and further compounded by family stresses and financial problems. The unemployment rate among military families is a particular problem, he said.

The entire story is here.

Suicide: The fourth-leading cause of American deaths abroad

By Gary Stoller
USA Today
Originally published May 4, 2012

Tom Miller jumped from the eighth floor of a hotel in the Philippines in February, and Gerhard Habel hanged himself in his apartment in Thailand last April.

These incidents aren't entirely unrelated. Suicide by an American in a foreign country is a more common occurrence than might be thought. It's the fourth-leading cause of death abroad from non-natural causes after road accidents, homicides and drowning, according to the Centers for Disease Control and Prevention.

The deaths of Miller and Habel stand out, though, because they were reported to the media by local police, and some information about the tragedies was made public.

Though more than 125 American suicides abroad are reported annually to the State Department, there is no public profile of most who commit the tragic act. For privacy reasons, the State Department will not provide victim information such as name, age, gender or addresses abroad.

"The travel medicine community could take preventative steps if there was more knowledge about risk factors and circumstances of those individuals who are committing suicide abroad," says Stephen Hargarten, director of the Injury Research Center at the Medical College of Wisconsin.

The entire story is here.

The Tragic Suicide Death of Junior Seau

By John M. Grohol, PsyD.

World of Psychology Blog

The evidence is in, and the death of NFL football player Junior Seau has been ruled a suicide. The speculation is that he suffered from depression as a result of the concussions he sustained as a pro football player in the U.S. Seau spent most of his football career as a San Diego Charger.

Many in the news media are portraying this as some sort of new news — that having your head repeatedly banged and bashed can cause long-lasting brain damage. Even with a padded helmet, there’s been a wealth of research demonstrating that head injuries still occur. The human head just wasn’t meant for years and years of such repeated abuse.

It’s also not the first time we’ve known of this link between football playing, concussions, and being at a much higher risk for depression (and even dementia). Perhaps this time the message will get through.

The entire blog is here.