Friday, April 22, 2016

The Silent Plague

Funny how worked up we get about things like Sika or Ebola or some other potential public health epidemic, but meanwhile, suicide, which is now killing north of 40,000 people every year in the U.S. goes largely unnoticed or discussed. The CDC (which stands for the Centers for DISEASE Control) itself released another troubling report showing massive increases in the suicide rates in virtually all age, racial and gender demographics (save those over 75, whose rates were already off the chain).

Suicide in the United States has surged to the highest levels in nearly 30 years, a federal data analysis has found, with increases in every age group except older adults. The rise was particularly steep for women. It was also substantial among middle-aged Americans, sending a signal of deep anguish from a group whose suicide rates had been stable or falling since the 1950s.

The suicide rate for middle-aged women, ages 45 to 64, jumped by 63 percent over the period of the study, while it rose by 43 percent for men in that age range, the sharpest increase for males of any age. The overall suicide rate rose by 24 percent from 1999 to 2014, according to the National Center for Health Statistics, which released the study on Friday.

The increases were so widespread that they lifted the nation’s suicide rate to 13 per 100,000 people, the highest since 1986. The rate rose by 2 percent a year starting in 2006, double the annual rise in the earlier period of the study. In all, 42,773 people died from suicide in 2014, compared with 29,199 in 1999.

American Indians had the sharpest rise of all racial and ethnic groups, with rates rising by 89 percent for women and 38 percent for men. White middle-aged women had an increase of 80 percent.

The rate declined for just one racial group: black men. And it declined for only one age group: men and women over 75.

The data analysis provided fresh evidence of suffering among white Americans. Recent research has highlighted the plight of less educated whites, showing surges in deaths from drug overdoses, suicides, liver disease and alcohol poisoning, particularly among those with a high school education or less. The new report did not break down suicide rates by education, but researchers who reviewed the analysis said the patterns in age and race were consistent with that recent research and painted a picture of desperation for many in American society.
Yeah duh. People don't kills themselves when they are not in pain. And once again, lost in all the demographic data, is that precise question: why so much pain?

Nonetheless, the report gives us fresh insight into things like methods and questions whether economic cycles truly have anything to do with suicide trends.
The new federal analysis noted that the methods of suicide were changing. About one in four suicides in 2014 involved suffocation, which includes hanging and strangulation, compared with fewer than one in five in 1999. Suffocation deaths are harder to prevent because nearly anyone has access to the means, Ms. Hempstead said. Death from guns fell for both men and women. Guns went from being involved in 37 percent of female suicides to 31 percent, and from 62 percent to 55 percent for men.

Dr. Alex Crosby, an epidemiologist at the Centers for Disease Control and Prevention, said he had studied the association between economic downturns and suicide going back to the 1920s and found that suicide was highest when the economy was weak. One of the highest rates in the country’s modern history, he said, was in 1932, during the Great Depression, when the rate was 22.1 per 100,000, about 70 percent higher than in 2014.

“There was a consistent pattern,” he said, which held for all ages between 25 and 64. “When the economy got worse, suicides went up, and when it got better, they went down.”

But other experts pointed out that the unemployment rate had been declining in the latter period of the study, and questioned how important the economy was to suicide.
That's not to say economic cycles have no bearing on suicide rates. We certainly noticed the rise coming out of the Great Recession, but it had already been increasing among many demographics prior to that (see also: the spike in military/veteran suicides going back to the post-Iraq War period, 2004+). 

It also makes us wonder whether the economy has truly healed the last several years for all aspects of society. Sure, unemployment is back down to where it was a decade ago, but the rates of suicide have continued to accelerate. Perhaps the economy is doing well for some, but clearly not for uneducated, working class/lower middle class white men and women over the age of 35. It's odd the report only mentions Baby Boomers, yet Generation X (ages 35-55) is clearly in the throes of the middle age portion of the epidemic as well.

Focusing just on economics, however, misses the larger multi-faceted nature of suicide in general. Social isolation is a big factor (caused increasingly by the ironically named "social media"), as is the breakdown of traditional controls against these kinds of suicidal ideations (such as marriage, family and extended family, religion, civic participation via volunteerism, etc.). Throw in loss of job and financial status, and suddenly you're looking at levels of anomie that would make Durkheim cringe.

We think we're so "connected" today with our gadgets and devices and social media outlets, yet this surge in suicide would suggest the opposite: we are becoming more socially atomized and isolated than at any point in modern history. You can sit there and talk to "the world" on your phone, while ignoring the family member/friend/person sitting right there next to you. And it's getting worse.

I'll conclude with the CDC's conclusion:
Suicide is increasing against the backdrop of generally declining mortality, and is currently one of the 10 leading causes of death overall and within each age group 10–64 (4). This report highlights increases in suicide mortality from 1999 through 2014 and shows that while the rate increased almost steadily over the period, the average annual percent increase was greater for the second half of this period (2006–2014) than for the first half (1999–2006). Increases in suicide rates occurred for both males and females in all but the oldest age group (75 and over). Percent increases in rates were greatest for females aged 10–14 and for males, those aged 45–64. The male-female disparity in suicide rates (as measured by rate ratios) narrowed slightly over the period. Poisoning was the most common suicide method for females in 2014, and firearms were the most frequent for males, but both sexes showed increases since 1999 in the percentage of suicides attributable to suffocation. Suicide numbers and rates for females and males by Hispanic origin and race for 1999 and 2014 are also available.
I've never thought of suicide as a democratizing force in society, but that's certainly the way it's shaping up as we move into the second decade of the 21st century. We are killing ourselves, literally, at virtually every demographic turn you can think of. As the report notes, suicide is now in the top 10 killers in the U.S., right up there with cancer, stroke and heart disease, greater even than car accidents.

And yet we still view it as an individual problem, a moral problem, a mental illness problem, a character weakness problem. And until that changes, nothing will ever change at the end of these posts I've been making for almost a decade (and have been writing about in other venues for two decades).

People will gasp for a moment, cluck their tongues, "isn't that terrible?" And then right back to checking in on social media, generating likes and follows and retweets, and trying not trip over the corpses as you pose for your next selfie.

UPDATE: Appropo to the mention of suicide among military veterans, this is a good NYT article on suicide prevention measures, ironically using social media, that occur on the 22nd of each month. While the data is still out regarding its effectiveness, hey, at least people are willing to talk about suicide preventative measures in a public forum.

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