A few short days ago, the very tragic deaths of fashion designer Kate Spade and international chef Anthony Bourdain stunned us. Our national suicide rate is skyrocketing, and now exceeds the annual number of deaths due to car accidents.
At almost the same time, the CDC released alarming new suicide statistics that confirm our concerns. This new information shows that suicide rates have increased by more than a shocking 25% from 1999 to 2016. In the latter year, nearly 45,000 lives were lost to suicide. Further, suicide rates went up more than 30% in more than half of the states since 1999, and more than half of those who died by suicide did not have a known mental health condition.
It is very well known that depression is a major cause of suicide. Common factors in depression include loss of a relationship, job or housing, personal financial problems, poor academic performance, social isolation, failure to meet one’s own expectations, or many other factors. Less well known is the fact that opioid use can lead to depression in as little as 30 days. Hence, persons who use opioids frequently are at high risk of suicide. A similar linkage can occur for excessive alcohol use.
Fortunately, a national suicide hotline is available (800-273-8255). However, if one searches online for the phrase “national suicide hotline,” many sites are identified, but this critical number is not obvious among the site leads. Similarly, in a master’s paper at Johns Hopkins University completed last year, a principal finding was that rural counties and counties without a behavioral health program were much less likely to offer any suicide prevention services or even to offer a telephone number to connect to services. Clearly, we need to identify strategies to correct critical deficits such as these.
What would a good suicide prevention strategy actually entail?
First, and perhaps foremost, our local communities, families and work organizations need to become welcoming places that promote strong friendships and other healthy interpersonal ties. Extreme social isolation, alienation and anonymity are fertile breeding grounds for suicide. The famous sociologist Emile Durkheim defined these relationships very clearly more than a century ago.
Second, our social media should mimic and extend our communities and our families to persons who live in places where strong interpersonal ties are not easily available. Examples would include seniors who live in remote rural areas or even millennials who are anonymous in a crowd at college or at a job. Real time connections via Zoom or Skype, as well as chat and shared interest groups on social media, are key ways that important social connections can be sustained.
Third, an assessment for suicide risk should become part of every primary care or behavioral healthcare visit. Many suicide attempts occur within 30 days of a visit to a health provider. Thus, such visits can become the occasion for essential counseling and intervention. We must improve capacity to do this as integrated care becomes a predominant mode of service delivery.