Suicide attempts among teen girls rise – but suicides fell….

There is a strange disconnect among findings that came out a few weeks ago from the Centers for Disease Control, and I think it is one worth examining.

First, from the Centers for Disease Control:

In the early months of 2021, visits to emergency departments for suspected suicide attempts increased roughly 50 percent for adolescent girls compared with the same period in 2019, according to a report released Friday by the Centers for Disease Control and Prevention.

The same article makes a few other very salient points:

  • Suicide attempts began to rise in May 2020.
  • Suicide attempts among girls rose 50.6% compared to the prior year, but a mere 3.7% among boys.
  • Similar increases were NOT observed amongst men and women, aged 18-25.

There’s a lot of places to look at this, and the gender differentiation is genuinely fascinating. What on earth could cause such a difference in terms of the differences between men and women?

That being said, there’s a different question I want to ask: How is it possible that ATTEMPTS rose so much, but suicide deaths declined? As I wrote about previously – and has been written about by people much smarter than me – preliminary data indicates that suicides declined by 5.6% during the same time period that suicide visits among this demographic increased so dramatically. How can this be?

There are, of course, many possible answers.

First, the data released by the CDC is preliminary. There isn’t a breakdown of completed suicides by demographics. This means that it is very possible that suicide attempts – and completed suicides – rose among the demographic we are discussing, but that they declined enough in other demographics to offset this rise. It’s also possible that the suicide attempts were less serious attempts that were less likely to result in death. Typically, women are more likely to survive a suicide attempt, as they tend to use less lethal means. It is also worth noting that women are three times more likely to attempt suicide than men, but men are 3-5 times more likely to die of suicide than women.

The one thing that the report does make clear – and that is unquestionably true – is that this could have major public health implications and implications for parents. Young women seem to be in a more fragile state of mental health than their male counterparts, and it is incumbent upon us to ensure that we are taking the steps necessary to protect their mental health.

I’d also go one step further: What are the health implications for the poor young women who wound up in a hospital? What health risks do they face? What ongoing care do they need at home, and at school? What questions do we need to answer?

Regardless, this is something that is unquestionably worth monitoring in the future.

Okay, seriously…how is it possible that suicide numbers dropped during the pandemic?

We may be close to the end of the COVID-19 pandemic, but the scars of this battle will remain with society for a long, long time. Among the more devastating damages of COVID-19 have been the toll on mental health, with increasing signs of mental illness, greater addiction rates, increased use of mental health resources

…and a decline in suicides…

Wait, what?

Yeah. I don’t get it either. But, according to preliminary data, suicides went down in 2020:

 From 2019 to 2020, deaths by suicide declined by 5.6%, from 47,511 to 44,834, per the CDC. It was the third consecutive year of decline. Suicides [also] went down in April and May of last year, a different trend than in years past, Farida Ahmad, health scientist at the National Center for Health Statistics, tells Axios.

This is astonishing. And it defies expectations, with many predicting that COVID and the economic shutdowns would lead to a massive spike in suicide. And yet, that hasn’t been the case, despite the increase in every other category that would be a predictive factor for an increase in suicides, including mental illness, unemployment, and suicide.

This begs the question…why? What’s going on here? I’ve read a few articles on the subject, and they offer some different thoughts:

  • Telehealth played a big role. In many states, it became easier than ever to access mental health resources, as regulations were waved that enabled people to get access to telehealth. As a result, more people may have been able to seek mental health resources, thus saving their life.
  • There were huge, concentrated efforts to encourage people to get mental health help – maybe more so than ever before. Governor’s across the country spoke about it. People still do to this day. As a result, it seems possible that stigma – once a formidable barrier – was shattered. This may have put more people into mental health help.
  • Some noted that it seemed possible that a “heroism effect” was in place – similar to that which occurs at the start of a war or another catastrophe – where a sense of “we’re all in this together” kept more alive. If this is truly the case, then we need to be cautious, as it seems like that such an impact would fade over time.
  • The pandemic forced a massive reevaluation of the way we look at our lives, as more people found that they could live without certain things, and are thus able to live better lives. This is an interesting philosophical argument, one that may also be playing a role in the decline of workers across the economy.

It is also worth noting that a more advanced look at the data is needed: For example, did suicide decrease more in some groups? Did it particularly spike among teenagers and young adults, groups that were believed to be facing particular difficulties during this pandemic? Furthermore, what about differences among racial and economic demographics? What about people who could work at home versus those who could not?

My opinion? All of the above, and then some. I’d also offer this caution…there is no way, no way, that this is it, that we are now on a glide path towards a permanent reduction of suicide. I am absolutely concerned about the long-term impacts this will have on mental health, as well as how this may drive up suicide rates. There is so much more to this story that we absolutely do not understand, and I really hope that others have more insight than me!

Anything to add? Any thoughts about why suicide may have dropped as it did? Let us know in the comments below!

The Smallest Things Can Make the Biggest Difference

As an elected official, I tend to get captured by big ideas. That’s not a bad thing, obviously. Personally, I think this world needs more big ideas and big plans to tackle big problems, and I wish we had more energy to move in these directions.

That being said, sometimes, big ideas come with little problems. When you hear a big plan to tackle an issue like mental illness or suicide, you think that these are the ONLY things that can tackle depression or suicide. That leads to even more dangerous thoughts: You can’t do anything about it. That’s not true. That’s not true at all.

There is no question that grand gestures and big plans often work, and work well, preventing us from getting into trouble in the first place. But, on an interpersonal level, it is the little things that matter. In fact, more often than not, I’d put money down that it’s the little things that you remember. And, in the long wrong, “little things” is a misnomer. Little things can make a big blessing.

This leads to the obvious question: What are the little things that you can do – that all of us can do – that can save a life or help someone who is struggling feel better?

The Shortest Note: I always got a kick out of this study. In the 1970s, two doctors sent follow up letters to a group of patients who had just been released from the hospital, checking in, expressing concern, and saying that they wanted to stay in touch. Another group didn’t get such letters. The results? Of the group who did get the letters, which came on a regular basis, 1.8% died by suicide within two years. In the group that didn’t? 3.52%.

The conclusion? If the study’s findings are accurate, the smallest thing – the smallest little thing – can help to keep someone alive. This remarkable finding shows that people just want to know someone cares, someone values them, and someone is there if they reach out. Does this mean you can stop a suicide? Not necessarily. But it does mean that regularly checking on someone – letting them know that you value them – can help ease their pain. And yeah, maybe keep them alive.

Call Them By Their Name: The rates of suicide or suicide attempts among the transgender community are hellaciously high: Greater than 50% of transgender male teenagers reported a suicide attempt, with nearly 30% for transgender females. These rates of mental illness and suicide are tied to a few factors, including family rejection, bullying, harassment, or perceived danger. However, there is nothing inherent to being transgender that leads to higher risk of suicide, as transgener individuals who do get the support and acceptance they deserve do not have a higher risk of suicide.

So, what does that support look like? Well, accepting these people for who they are. Puberty blockers reduce the risk of suicide. So does the most simple thing: Calling a person by their chosen name and gender. Calling someone by the name they want reduces their risk of suicide and depression.

Again – it’s the little things.

Ask: There is a misnomer out there – that talking about suicide can implant the idea of suicide in someone’s head. To be clear, this isn’t true. In fact, the opposite is true: Bringing up the subject can save a life. This is because discussing the subject and asking specific questions, such as, “Are you thinking about hurting yourself? Have you been thinking about ending your life? Do you have any plans on it?” can actually check on someone. If done in a caring, compassionate matter, you can tell someone that you are concerned about them, and thus make it clear: You’re here to help. Asking someone if they are in pain or considering suicide will NOT make them more likely to make an attempt. In fact, the opposite may be true.

I need to be clear about something: Not stopping someone from dying by suicide is never someone’s fault. Suicide is a complex, complicated process that almost always involves multiple factors. It’s never just one thing, and it’s virtually impossible for it to be your fault. However, while stopping suicide may not be our fault, it is something we should all take responsibility for. Thankfully, you don’t have to be a doctor. You don’t need formal training. The smallest measures of kindness and compassion can save a life.

“…how life sometimes simply gave you a whole new perspective by waiting around long enough for you to see it.”

I recently finished the Midnight Library by Matt Haig. When I read it, I had absolutely no idea the book would have such strong mental health implications – hell, it was recommended to me by my Mom, who just thought I would like the book because it had a neat plot. That being said, it was a fantastic book, and well worth reading if you have an interest in mental health or suicide prevention.

First, the true story of why I had heard of the author, Matt Haig:

Matt Haig, as noted on his profile, his a suicide attempt survivor:

I didn’t exactly realize it when I started reading it, but the Midnight Library deals with suicide. The summary:

Somewhere out beyond the edge of the universe there is a library that contains an infinite number of books, each one the story of another reality. One tells the story of your life as it is, along with another book for the other life you could have lived if you had made a different choice at any point in your life. While we all wonder how our lives might have been, what if you had the chance to go to the library and see for yourself? Would any of these other lives truly be better?

In The Midnight Library, Matt Haig’s enchanting new novel, Nora Seed finds herself faced with this decision. Faced with the possibility of changing her life for a new one, following a different career, undoing old breakups, realizing her dreams of becoming a glaciologist; she must search within herself as she travels through the Midnight Library to decide what is truly fulfilling in life, and what makes it worth living in the first place.

From here, spoilers ahead.

Continue reading ““…how life sometimes simply gave you a whole new perspective by waiting around long enough for you to see it.””

Are suicides increasing during COVID-19?

It was a frequently used argument during the pandemic, one often used against lockdowns: Suicide rates would increase as a result of social isolation, financial hardships, and more limited access to proper medical care. This fear was repeated by medical professionals and medical health care experts. Even Donald Trump repeated the line at one point, arguing that extensive lockdowns would lead to “thousands” of suicides. So great that he and so many others suddenly care about mental health when they spent years defunding services that would prevent suicide and trying to rip health care away from millions, but that’s a completely different story, so let’s move on, let’s move on.

We’re about four months into some of the various lock-downs and quarantines. The question is obvious: What does the data say? Are suicide rates on the rise?

It seems like its too early to tell. We will only be able to more definitively tell the numbers when the annual suicide numbers come out at the beginning of the year, and even then, it will be extremely difficult to determine the cause of the suicide. However, there is some evidence to indicate that things are not as bad as many of us feared they would be – though that could very, very easily change.

First, let’s look at what data is available and what data has been misleading. At the beginning of the pandemic, a doctor said that his California hospital had seen “a year’s worth of suicide attempts” during a four-week period. That report was utterly debunked: Numbers had barely increased at the hospital in question, and locals reported that they believed the local rate had remained stable in the area.

Apparently, calls to some suicide hotlines have increased. Outreach to suicide prevention text lines has increased as well. However, this may not be a bad thing, as it may be a reflection of people turning to the closest support line to get help. Indeed, if these hotlines are working, the increase in calls may be a good thing. Again, unfortunately, there’s no evidence to say one way or the other.

I couldn’t find any hard data discussing whether or not there was any evidence of suicide rate increases in the United States – if someone has that, please correct me. However, I did find evidence that suicide rates have actually dropped 20% in Germany. This is a preliminary finding, so it is likely too early to draw hard conclusions from it.

There is no question that COVID-19 will cause a massive spike in a wide array of social problems, and suicide would certainly seem to be one of these problems. However, as noted by many articles on the subject, it’s more nuanced than simply saying that “The lockdowns led to more deaths.” The pandemic also ripped apart the economy, threw us into a recession, and maybe a depression. There is clear evidence that down economies lead to higher rates of mental illness and suicide. As such, it is difficult to say that lockdowns lead to suicides. It is much more complex than that.

So, what’s the conclusion? There’s no conclusion. Not yet. Time will tell. But, more importantly, policymakers and the community at large must continue to work to mitigate the economic and social impacts of COVID – particularly on the mentally ill. I’m hoping to be able to work on that one over the summer.

New Suicide Statistics Show that Things Are Still Getting Worse, but…

The CDC has released new suicide statistics for 2018 (previous numbers were for 2017). The results, by and large, were problematic. In a nutshell:

  • Suicide deaths in America went from roughly 47,173 to 48,344. That’s an increase of about 1.4%.
  • Believe it or not, there’s good news here. The slope of the increase is starting to flatten: Suicides increased 4% from 2016-2017. This would imply…hopefully…that the rate of suicides is starting to slow down.
  • Suicide remains the 10th leading cause of death in the United States.

More data will likely be available in the future, including a breakdown of suicide methods and age breakdowns of those who died. That information, of course, will be particularly insightful. On a personal level, I’m deeply interested in the numbers in Pennsylvania. Since 2013, we’ve had suicide rates that are above the national average. I suspect that those trends remain unchanged and that we will see a small increase over the 2,030 people who took their lives in 2017.

There are two ways to look at these numbers, and I think that both are valid perspectives. On one hand, the problem continues to get worse. Suicide numbers are accelerating, and the numbers continue to get worse, as they have roughly ever year since around 2004.

On the other hand, as the American Foundation for Suicide Prevention accurately noted, there are reasons to be hopeful:

  • The rate of increase has slowed.
  • Awareness about the problems of mental illness and suicide continues to grow.
  • More and more people are going public with their own struggles.
  • More and more units of government are comprehensively addressing suicide and suicide prevention. Such a strategy appears to be working for opioid overdoses, and that should give us all hope when it comes to suicide prevention.

Indeed, articles like the one run by the Huffington Post on the subject do a great job of discussing suicide. They present the statistics in a rational, reasonable manner. They also present stories of hope and specific, concrete suggestions for how to deal with mental illness and suicide. Those suggestions – reach out, be non-judgemental, understand that suicide is a comprehensive illness – they are all evidence-based.

So, yes. There are reasons to be hopeful, but we must continue to acknowledge that we have a major mental health crisis in front of us. One which will require – demand – public policy decisions.

 

New study: 13 Reasons Why did not cause an increase in suicides, and may have done some good

I’ve written repeatedly about Netflix’s 13 Reasons Why, and usually in a pretty damning light. Like others (who are far more informed and educated than I am), I’ve expressed my real concern that the show has unintentionally glamorized suicide, and there has been evidence to suggest that it actually led to an increase in suicides.

However, a new study shows that this may not be the case, and, in fact, that 13 Reasons Why may have done some good.

First, a review. 13 Reasons Why tells the story of Hannah Baker, a teenage girl who dies by suicide and leaves behind tapes for people to listen to, explaining why she died and their role in her demise. The show was criticized by many for glamorizing suicide and presenting it as a possible choice, and Netflix eventually removed the three-minute, highly graphic scene in which Hannah dies.

Of course, that removal came after being viewed millions of times, and at least one report directly tied the show to a rise in suicides.

However, a new study came to the opposite conclusion:

But a recent reanalysis of the data by Dan Romer, research director of the Annenberg Public Policy Center at the University of Pennsylvania, found no evidence of an increase in suicides for boys, and (like the original study) an insignificant increase for girls. Romer adjusted the data to factor in trends like an overall increase in adolescent suicides since 2007.

That’s important. But it’s not as important as this finding:

But when Romer conducted a study on 13 Reasons Why’s effects on self-harm, published last April, he found that teens who watched the entire second season of the show were less likely to purposely injure themselves or seriously consider suicide, even when compared with those who did not watch the show. He said that this could be because of the Papageno effect, which occurs when stories that portray people overcoming their suicidal crisis end up reducing suicide rates. The effect is named for a character in Mozart’s opera The Magic Flute who considered suicide until his friends showed him a different way to solve his problems.

The second season of 13 Reasons Why features a character who is depressed and considers suicide – but survives. This is important, and it feeds in with a larger theme in the mental health universe: We have to share stories of hope, of survival, and of seeking help successfully.

Part of the reason that so many (myself included) thought 13 Reasons Why was so damning, as portrayed, is because it features a character dying by suicide in a graphic manner. This can create copycat scenarios. However, the good news is that the Papageno Effect is real and has been repeatedly backed up by science. This is great news: If you can show someone finding hope, you can inspire others to do the same.

I appreciated this alternative perspective of 13 Reasons Why, and I appreciated the hope that it could potentially inspire in others. It also reinvigorates what I have said for ages: Share your story. It’s why I’m so passionate about sharing mine.

You can save a life.

Another Study Ties Higher Minimum Wage with Reduced Suicides

I’ve written about it before: Economics and suicide are tied. To be clear, that’s not to say that poor people are more likely to die by suicide; by and large, suicide crosses economic boundaries. What is more likely to be associated with increases or decreases in suicide rates is a change in economic status: An increase leads to lowered suicide rates, while a decrease leads to higher rates.

And that brings us to this study, published in the Journal of Epidemiology & Community Health. The study examined 25 years of economic and suicide rates in all fifty states and Washington, D.C. From the results of the study:

The effect of a US$1 increase in the minimum wage ranged from a 3.4% decrease (95% CI 0.4 to 6.4) to a 5.9% decrease (95% CI 1.4 to 10.2) in the suicide rate among adults aged 18–64 years with a high school education or less. We detected significant effect modification by unemployment rate, with the largest effects of minimum wage on reducing suicides observed at higher unemployment levels.

In other words, an increase in the minimum wage can save lives.

This study was picked up in numerous major media outlets, including CNN and NPR. As the CNN story noted, if you assume that the data from this story is accurate, an increase of $2 could have saved upwards of 40,000 lives between 2009-2015.

This study shows many things, but there are two, in particular, I want to focus on.

First: It challenges the idea that suicide is exclusively related to mental health, or at least adds a qualifier and a modifier to that idea. I think that when most people think of suicide, they think that a person who dies by suicide must be mentally ill. That makes sense, of course, and it’s a perfectly logical conclusion to reach. However, it’s not completely supported by the evidence. If depression was the only thing that mattered when it came to a suicide attempt, the minimum wage wouldn’t make a difference unless you assume that economic status is tied directly to mental health.

What this shows, again, is that suicide is not simply a matter of mental illness.

And that leads me to my second point: Everything is connected. Mental health is deeply connected to economics, and if we can ensure a robust social safety net, fair wages and equal opportunity, we can reduce suicides and save lives. This study proves it – again – and it isn’t even the first to make the argument that work and work hours are tied to minimum wage.

As public policymakers, we have a job to address major problems (like the massive spike in suicides) in a manner that is holistic and comprehensive. That means not only improving access to mental health care but reducing the causes of suicide.

That means increasing the minimum wage.

Will new three-digit Suicide Prevention Hotline lead to a surge in calls?

As you may have seen last week, the FCC voted to formally approve the regulatory process which would take the Suicide Prevention Hotline number (currently 1-800-273-8255) and turn it into a three-digit number, 9-8-8. It will take at least a year for the new line to go live.

For many reasons, this is a big deal in the suicide prevention world, and a wonderful development which will save lives. I can think of two reasons why this is so important off the top of my head. First is obvious: It’s an easy number to remember, like 911. Most people haven’t remembered the suicide prevention hotline number (I always have to Google it when I do blog entries like this, and I’m very in tune with the mental health world), and that’s an extra step. When someone is in crisis, you want to make it as easy as possible to get help. For the same reasons, means reductions matters when it comes to preventing suicide.

Second is the cultural statement: Suicide prevention matters. We all know 911 and understand the importance behind needing to call for help as soon as possible. With suicide numbers continuing to rise unabated, having a three digit number is a statement of priorities. It’s our way of saying, “Yes, this is important – really important. So important that we’re going to elevate the ease of getting help.”

But, that’s not to say that issues may not emerge as a result of this very significant and important change. As noted by this article from Pew Trusts, the new number will likely lead to a surge in calls. That’s good if it helps more people get help, but it can only help people get more help if the hotlines are prepared.

As noted by the article, there is not one massive hotline, per se, but a series of local hotlines, and many of them are “woefully underfunded.” Waiting periods and being bounced to a less local line are already occurrences which occur, and this surge in calls may make things worse. Furthermore, some states are in better shape then others. Six states (Georgia, Arizona, Colorado, New Mexico, New York and Utah) have made substantial investments and improvements in their suicide prevention hotlines, centralizing and standardizing systems while also expanding them. These states will be better prepared for the change over, but others may not.

What’s the solution here? The shift to 988 is great – but only if these lines are adequately funded. State and national governments have to expand funding, and they have to do it now. Pennsylvania and the rest of the nation have been utterly devastated by the opioid crisis which has taken more than 70,000 from us in 2017. As a result, we invested tens of millions of dollars in prevention and treatment. Suicide took 47,000 from us in the same time period, and hasn’t seen anywhere near the same levels of investment.

We need to invest the money here, too.

How Gun Control Can Help Stop Suicides

When people who oppose gun control don’t want to say, “Hey, yeah, I think that we should allow ordinary citizens to own ballistic weapons without so much as a background check,” they don’t do that. Instead, they say, “We shouldn’t focus on gun control – we should focus on mental health.” It’s a lovely political pivot from a group of people who don’t want to actually focus on things which will stop gun deaths.

Related: They then do less than nothing to help people with mental illness.

I’ve attacked that argument before, but now I’d like to add to it: Gun control measures – and specifically Red Flag laws – can help stop suicides.

What is a “Red Flag Law”?

A “Red Flag Law” – also known as an Emergency Risk Protective Order – is a formal court proceeding. They vary from state to state but have the same characteristics: If a person is making threats or found to be a danger to themselves or others, someone (such as a family member or police officer) can petition the Court to have an individual’s guns temporarily removed from their possession. They’ve been promulgated as an effort to stop mass shootings, but the data thus far shows that they are more beneficial in the fight against suicide.

Limiting Access To Deadly Means Stops Suicide

Multiple studies and historical experience have proved it – if you limit someone’s access to the means of suicide, you can reduce suicides. And that is precisely why Red Flag laws are so important for reducing suicides. If crafted appropriately, a red flag law can result in the removal of a gun from someone who may hurt themselves with it.

So, yes. Here’s an area where we can help mental illness – but it’s via sane gun control measures.

Red flag laws are relatively new, so the research on them is somewhat limited. But, from what’s available, they work. For example, take a look at the experience of states like Indiana and Connecticut, which enacted red flag laws relatively recently:

“In Indiana, after the enactment of the law [in 2005], we saw a 7.5 percent decrease in firearms suicides in the 10 years that followed,” Kivisto said. “We didn’t see any notable increase or decrease in non-firearms suicide.”

“And so when we looked at it from 2007 and beyond [in Connecticut], [gun suicides] decreased by 13.7 percent,” Kivisto said.

This furthers the idea that access to deadly means can help control for suicide.

Suicide is a massive societal problem, one which belies simple solutions, involves multiple areas of public policy and will require significant investment to truly tackle. That being said, some small laws can make a big difference, and reducing access to suicidal means can do just that.