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Suicide: What Contributes to It and What We Can Do About It

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The CDC recently released new and disturbing data about an increase in suicide by Americans between the ages of 35 and 64; the new rate is 17.6 per 100,000. The New York Times offered a front page story on this bad news, and the comments on the story offer their own sad narrative. Readers are quick to blame the economic downturn and the sorry state of our culture, with its emphasis on youth, money and status, and our loss of faith and traditional values. But these issues obscure more important contributors to suicide. The truth is that suicide is most often about untreated or ineffectively-treated mental illness, a serious problem that leaves people more vulnerable to life's misfortunes. Those who commit suicide usually suffer from depression, though bipolar illness and schizophrenia are also common, and not infrequently complicated by alcohol or substance abuse. If we were able to identify those at risk, if they could openly ask for help and we could provide that help, we'd lose fewer loved ones to this curse.

Why do I push back against the tendency to blame the economy? Because it's too easy an explanation, and it prevents us from taking the right steps toward fixing the real problem. New and major stressors can surely exacerbate depression, and the loss of a home and/or a job is devastating. But consider some additional data to put suicide rates among middle aged Americans into context. In the U.S., the economic downturn has been worse for minorities than for whites, yet suicide rates in whites remain higher. If we look at global data, prosperity does not translate into lower suicide rates. Korea's economy is booming. Unfortunately, their WHO reported suicide rate for men is 39.9/100,000, more than twice our rate. Japan's economy may not be growing, but the Japanese enjoy a very high living standard, yet suffer from a male suicide rate of 36.2 per 100,000 men.

The highest rate globally, according to WHO data, is in Russia, with a whopping 53.9 suicides per 100,000 men. There are also high rates in many countries near Russia, including Estonia, Ukraine, Latvia and Hungary. Are our numbers lower because we have had a freer market for longer? Or are theirs higher because they are in the midst of a destabilizing shift toward our type of economy? Is it alcohol abuse? Or is there a genetic component, in which increased risk for suicide is shared by those with common ancestry? Many factors, including current stressors and genetics, may play a role, but the main story is about inadequate attempts to reach and help those with mental illness. As Dr. Kathleen M. Pike, Director of the Global Mental Health Program at Columbia University Medical Center says in her TEDxTokyo talk aptly titled "Don't Call Me Crazy," the stigma of mental illness ironically results in our spending billions and billions of dollars around the globe ignoring mental illness -- in lives lost, disability, and lost work productivity,

There are many mysteries in the phenomenon of suicide, and a great deal of work to do before we can conquer this scourge. For instance, throughout the article above, I've quoted national suicide rates for men. Generally, the rates for women are drastically lower. Why should that be? Rates of depression are actually higher in women, as are suicidal thoughts and attempts. Men, however, use more lethal means when they attempt suicide, bringing their rates of "success" to far higher levels. In the U.S., by far the most common means of self-murder is a gun, though rates of hanging are on the increase. Women tend to use pills, which take longer to kill and so leave more options for rescue. The horrifying exception is China, which has high suicide rates overall and significantly higher rates for women than men below the age of 60. Because of the size of its population and the high rate of female suicides, China accounts for roughly half of all female suicides globally.

Bad news falls hardest on the most vulnerable. For those who are already depressed, have other mental illness, or a high risk because of family history, an additional loss may lead to suicide. The economy is the last straw, not the first. We need to make it easier for people in trouble to seek help, and for their families to do the same. We need to make effective treatment available and affordable. We need to address misconceptions about treatment, such as that it is for the weak or spoiled. (Many who are comfortable exacerbating depression through alcohol are very wary of the real but lesser risks of antidepressants.) We need to see suicide as a global problem, for every kind of person in every kind of nation. Blaming the economy lets us off the hook. We have effective treatments, and we need to get them to people in need.

Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.

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