The disproportionally high levels of suicide among (some) minority groups

It’s been written repeatedly, and it’s true: One of the most likely demographic to die by suicide are middle aged, white men. But, as a recent report in USA Today helps illuminate, we shouldn’t confuse this reality with the notion that white men are the most at risk – or that other groups don’t need very real assistance.

USA Today’s story, which was published earlier in the week, came with this stark headline: Suicide Rate for Native American Women is up 139%. Native American and Alaska Natives have a suicide rate 3.5 times higher than the lowest group – an astonishingly high number.

The story highlights a very, very ugly truth: In mental health – just like in health care generally speaking, unfortunately – minority communities have it worse. But, in the case of suicides, not every minority community is this way. For example, suicide rates among African Americans and Pacific Islanders have increased, but remain roughly half the rate of suicides as whites, according to the American Foundation for Suicide Prevention:

suicideRatesByEthnicity.png

Meanwhile, according to the Suicide Prevention Resource Center, rates of suicides among Hispanics also remain far below the United States average, with Hispanics dying by suicide at a rate of slightly more than half of the rest of the United States population.

This is good news, of course, and a very rare bit of good news when it comes to health care for black and Hispanic communities. What drives these rates lower? There are many theories, primarily the idea that strong family and community support provide a degree of resilience not available in other cultures, as well as the idea that self esteem and religiosity rates are higher among African Americans.

All of these factors may tie into why other minority groups have higher rates of suicide. LGBT community members are three times more likely to die by suicide. On average, LGBT members as well as Native Americans, have lower levels of self esteem, community support and family bonds.

In total: The minority suicide rates are not what they would reflexively seem to be. That’s something for all of us to keep in mind as we deal with public policy and suicide.

Yes, people really are this stupid about mental illness and suicide

Sometimes, I find myself falling victim to the availability heuristic, and if you read this blog on a regular basis, I bet you do too.

For those of you unaware, the availability heuristic is defined as: “A mental shortcut that relies on immediate examples that come to a given person’s mind when evaluating a specific topic, concept, method or decision. The availability heuristic operates on the notion that if something can be recalled, it must be important, or at least more important than alternative solutions which are not as readily recalled.”

Why am I mentioning this now? Well, if you read this blog, I’m guessing you have an interest in mental health and mental illness. It’s probably a subject you follow closely and in which you are are well educated. I bet you have more evolved views on the causes and symptoms of mental illness and understand it’s complexities. And, I’d bet that the vast majority of people you interact with feel the same way.

Ahhhh, dear reader, allow me to share portions of an Email I just received. Among it’s gems:

  • “People commit suicide because they lack hope. True hope comes from putting your trust in the Lord Jesus Christ.”
  • “A troubled person who believes in evolution and does not know anything about the Bible, may turn to suicide as an escape.”
  • “If you want to reduce suicide, introduce the Bible back into school and stop teaching the fairy tale of evolution.”

First, a disclaimer, and let me make it crystal clear: The purpose of this entry is not to mock anyone’s faith or sincerely held beliefs. Rather, it’s to point out an absolutely ridiculous example of thinking. Faith absolutely assists some in the fight against depression and hopelessness. That’s wonderful. If that’s something which may work for an individual, I highly, highly encourage them to find a method of counseling which fits their views on religion, God and spirituality.

But the notion that prayer, Jesus or teaching creationism will cure depression and suicide for everyone is absurd.

Mental illness is highly complex. It often requires time, resources and multiple, simultaneous methods of treatment and lifestyle changes in order to fully address and treat. There is no one size fits all bullet. But what absolutely will not help is judgmental statements like the above, or the adherence to a one-sized fits all approach.

I’d also challenge anyone who makes a statement about reducing depression, mental illness and suicide to make sure that their comments are backed up by research. As I’ve noted in previous entries, there is a complex relationship between religion and mental illness, but as best I could find, there is ZERO relationship between teaching evolution and mental illness. Someone correct me if I’m wrong.

We’ve made great strides in the area of mental illness of late, but we still have a long long way to go. And absolute statements like the ones made above will do nothing but drive people further into the shadows.

There are people this uneducated out there, and I hope this is something we can all remember.

Five horrifying statistics about suicide today

As I wrote earlier this week, we’re in a bad way when it comes to suicide as a nation. Suicide rates are rising – badly – and we need to do more to address this ongoing crisis.

We need to have a better understanding about where we are at when it comes to suicide as a country. To that end, here are five things you should know about suicide in America, 2019.

Suicide rates are at near fifty year highs. After hitting lows in the late 1990s, suicide rates began to climb again. They are now at rates which haven’t been seen in fifty years, and have increased 33% since they hit their lowest point in 1999. More than 47,000 Americans died by suicide in 2017, making suicide the 11th leading cause of death in the United States. The number is so high that it has actually begun to drag down the average life expectancy of Americans.

Gun ownership and suicide rates are directly related. This isn’t to say that gun owners are more likely to kill themselves, but it does show a direct relation between the means of suicide and actual suicides. One study revealed that suicide rates are higher in states with high rates of gun ownership, and lower in states with lower rates. Another showed that firearms account for roughly half of all suicide deaths.

For every completed suicide, there are twenty-five attempts.

Women are more likely to attempt suicide, but men are more likely to complete it. This is, in part, due to the method by which each gender typically attempts suicide. Women are more likely to attempt suicide by drug overdoses and other less violent means, giving rescuers a greater opportunity to reverse suicide attempts. Men are more likely to use firearms and asphyxiation related methods, which are typically harder to reverse.

Suicide rates are highest in the Mountain West states, and lowest in the Mid Atlantic. According to the CDC, the states with the highest suicide rates are Montana, Alaska, Wyoming, New Mexico and Idaho. States with the lowest rates are New York, New Jersey, Massachusetts, Maryland and California.

If you are looking for more information about suicide, I highly recommend you visit the American Foundation for Suicide Prevention’s website. After all, the only way to stop a problem is to fully understand it.

Suicide rates are rising in girls – with the highest rise among ages 10-14

I guess I should warn you ahead of time, but this entry has some absolutely brutal statistics. For those who may be disturbed by such content, please note that the following blog entry will review information on suicide, including methods.

A new study which appeared in JAMA examined whether or not the gap between suicide in boys and girls was narrowing. Broadly speaking, while women are more likely to attempt suicide, men are more likely to complete it. This is for a variety of reasons, but the most obvious one is that men typically use more violent means to commit suicide, and are thus less likely to be saved by medical professionals.

The results of the JAMA study were disturbing. It examined 85,051 suicides of children and teenagers, ages 10-19, between 1975 and 2016. The most painful result:

Following a downward trend until 2007, suicide rates for female youth showed the largest significant percentage increase compared with male youth (12.7% vs 7.1% for individuals aged 10-14 years

From the conclusion of the study:

A significant reduction in the historically large gap in youth suicide rates between male and female individuals underscores the importance of interventions that consider unique differences by sex. Future research examining sex-specific factors associated with youth suicide is warranted.

Further examination of the data reveals that the rate at which women were using hanging and suffocation for suicide were approaching the same rates as men. In other words, girls are starting to use more lethal means to kill themselves, a highly disturbing trend, and one that will lead to additional deaths.

A key and tragic consideration to keep in mind when it comes to suicides is that, for every death by suicide, there are an estimated 25 attempts. A rise in use of more lethal means of suicides means that more suicide attempts will result in death.

To put the above statistic another way: If every suicide attempt led to a death, we’d lose approximately 1,175,000 people every year.

Unfortunately, none of this information is all that surprising, though it is deeply disturbing to know that more 10 year olds are killing themselves at accelerating rates. A study which came out last months showed that the number of children going to the emergency room doubled between 2007-2015. Suicide is the 2nd leading cause of death of 15-34 year olds in America, and rates of mental illness are rising among young adults faster than any other age group.

Clearly, our young people are under more pressure than ever before, and clearly, we are failing them if we don’t do a better of job of addressing this crisis.

Back to the study above. One of the things I’d like to focus on – at least when it comes to trying to reduce this gap – is means reduction. If young girls are starting to use more violent means for suicide, we must do a better job of determining why, and what, if anything, we can do about it. There are public policy options when it comes to guns, but I’m not sure what you can do, if anything, when it comes to suffocation or hanging.

We have to do something. The only way to guarantee failure is not try anything.

Report: Netflix’s 13 Reasons Why tied to rise in suicides

13 Reasons Why started as a book and then made it’s way to a Netflix series. From the summary:

Clay Jensen returns home from school to find a strange package with his name on it lying on his porch. Inside he discovers several cassette tapes recorded by Hannah Baker—his classmate and crush—who committed suicide two weeks earlier. Hannah’s voice tells him that there are thirteen reasons why she decided to end her life. Clay is one of them. If he listens, he’ll find out why.

Clay spends the night crisscrossing his town with Hannah as his guide. He becomes a firsthand witness to Hannah’s pain, and as he follows Hannah’s recorded words throughout his town, what he discovers changes his life forever.

The series on Netflix generated no shortage of controversy when it graphically depicted the suicide of Hannah. At the time, there was concern that the depiction of suicide may encourage other vulnerable young adults to do the same.

A new report suggests those fears were well founded.

The brutal findings, courtesy of a study conducted by the Journal of the American Academy of Child and Adolescent Psychiatry:

The Netflix show “13 Reasons Why” was associated with a 28.9% increase in suicide rates among U.S. youth ages 10-17 in the month (April 2017) following the shows release, after accounting for ongoing trends in suicide rates, according to a study published today in Journal of the American Academy of Child and Adolescent Psychiatry…The number of deaths by suicide recorded in April 2017 was greater than the number seen in any single month during the five-year period examined by the researchers.

The study notes that suicide rates spiked during the promotion for 13 Reasons Why and in the aftermath of its immediate release, and spiked particularly among young males. Homicide rates – which are influenced by similar cultural and sociological factors – did not show a spike during the same time.

As this Vox article notes, this increase is likely tied to the concept of suicide contagion – the idea that one suicide will encourage more. At least one suicide expert advised Netflix not to release the show:

His fears sprang from the problem of suicide contagion, which is what it’s called when media attention focused on one prominent suicide leads other people who are struggling with suicidal ideation to try to kill themselves. It’s a danger that young people are especially vulnerable to.

To be fair, there are certain concerns with the conclusion of this study. This includes the it’s design (which makes it impossible to rule out other sources) and the fact that boys drove the rise in suicide (girls would have been more expected, given the fact that the lead character is a girl).

This tragic result reiterates an important point: The media and entertainment industries have a moral obligation to be careful with how they discuss and depict suicide.  ReportingOnSuicde.org gives some helpful advice. These include:

  • Avoid glamorizing the death, sensational headlines and showing pictures of grieving and weeping families.
  • Describing the suicide as sudden or “without warning.”
  • Treating suicide as any other crime.
  • Showing or describing the method of death in graphic detail.
  • Using appropriate language, including “died by suicide,” “completed” or “killed himself” INSTEAD of “successful/unsuccessful.”

I never watched 13 Reasons Why, but from what I have read, the show’s depiction of Hannah’s suicide violates all of these rules.

Between the research already done and the study which came out last week, it’s clear that 13 Reasons Why is contributing to an ongoing massive spike in suicide rates – and one that is particularly acute among young adults.

The show should be pulled off the air.

Religion and suicide

About two weeks ago, I was able to participate in a Jewish Federation event on mental health and stigma. The participants included myself, a psychologist, the head of our local NAMI Chapter and a Rabbi. Much of the information I heard during this presentation was things that I had heard before, but the newest perspective actually came from the Rabbi, who discussed what happens with Jews who do die by suicide.

Apparently, in Judaism (like many other religions), a strict interpretation of suicide views the action as a major sin, and those Jews should not be buried in a Jewish cemetery. Thankfully, this Rabbi believes (like many others) that those who do die by suicide are clearly ill at the time of their death; thus, they should not be “punished” for that action and should be allowed to be buried in a Jewish cemetery.

This entire conversation had me thinking about suicide and religion. Are there differences in suicide rates by religion? What about those with no religion – do they have higher or lower suicide rates? How can religion help or hurt someone’s mental health?

The relationship, as best I can tell, is complicated. According to a 2016 study on the subject:

We found that past suicide attempts were more common among depressed patients with a religious affiliation (OR 2.25, p=.007). Suicide ideation was greater among depressed patients who considered religion more important (Coeff. 1.18, p=.026), and those who attended services more frequently (Coeff. 1.99, p=.001). We conclude that the relationship between religion and suicide risk factors is complex, and can vary among different patient populations.

This study would obviously suggest that religion and suicide are positively correlated. But, as a 2017 article from the American Sociological Association notes, the real relationship is more complicated – and that largely depends on where in the world you are discussing:

A Michigan State University sociologist reports in The Journal of Health and Social Behavior that religious participation affects suicide rates differently around the world, and in Latin America particularly, high religious involvement is associated with low suicide rates.

In contrast, in East Asia, where residents are reportedly more secular, higher levels of religious involvement are connected to higher suicide rates. A one percent increase in religious participation is associated with a one percent increase in suicide rates in East Asia.

Statistics for the United States generally follow with the statistics for Latin America, although the link between religious participation and low suicide rates is not as pronounced in the United States.

An interesting 2017 article from the Huffington Post makes a similar argument but from a reverse perspective: That it is atheists, not religiously affiliated people, who have a “suicide problem.”

When I started this entry, I was curious to see what religions have higher or lower rates of suicide. I now see that it’s not that simple. Religion and suicide are related, and that makes sense, of course. On one hand, religion can give people additional joy, purpose and value. Fear of divine punishment can also serve as a powerful motivator to keep people from killing themselves. However, religion can also alter perspectives and force negative value judgments.

My conclusion: The relationship between religion and suicide is complicated and depends on a variety of factors.

As always, let us know what you have to say in the comments below!

No, you cannot “implant” the idea of suicide

One of the great myths of suicide is that you shouldn’t talk about it with someone (particularly younger people) because doing so may somehow “implant” the idea of killing oneself into someone’s head. That’s categorically, unquestionably not true, and I wanted to take a moment to discuss the idea.

The idea that we can unintentionally encourage suicide by discussing it is a frightening prospect because it leaves us powerless. One of the things that many mental health advocates say (and this certainly includes me!) is that we must discuss suicide and mental health. However, there is a persistent fear that discussing suicide may cause someone to consider attempting the act.

There’s good news though: It’s just not true.

There is ample evidence to back up the notion that discussion of suicide doesn’t increase suicidal ideation or attempts; indeed, thankfully, the opposite is true. According to a 2014 review on just this subject:

None [of the studies reviewed] found a statistically significant increase in suicidal ideation among participants asked about suicidal thoughts. Our findings suggest acknowledging and talking about suicide may in fact reduce, rather than increase suicidal ideation, and may lead to improvements in mental health in treatment-seeking populations. Recurring ethical concerns about asking about suicidality could be relaxed to encourage and improve research into suicidal ideation and related behaviours without negatively affecting the well-being of participants.

This is great news, particularly for anti-suicide and mental health programs, as it means that you can talk about suicide without supposedly putting the idea of suicide into someone’s head.

That doesn’t mean, of course, that suicide and mental health can just be discussed in a willy-nilly sort of way; there must be specific guidelines to these conversations.

According to this article from Psychology Today, these conversations can range from casual to serious. Addressing the issue is important, but it doesn’t have to be done in an ultra-serious way. Asking your child about high-profile suicides in the news, asking their thoughts, inquiring about their feelings and state of mind – these are all positive ways of addressing the subject.

The article also does a good job of explaining what to do if someone you know or love says that they have had thoughts of suicide. It notes that many of us have had those thoughts at some point, and that isn’t inherently dangerous. What is dangerous is if these thoughts are persistent, overwhelming or come with specific plans. That’s when more action may be needed.

So, the summary is this: Talk about suicide with your children or others you care about. Do so in a way that is factual and avoids glamourizing the issue, but in a caring and supportive way. This will not encourage the idea of suicide – indeed, it will help prevent it.

It’s important that we have these conversations with people we love, and do so without fear of “implanting” the idea of suicide. This goes for schools, parents – really, all of us.

The Parkland tragedy continues, as two survivors kill themselves

Originally, this entry focused on Sydney Aiello’s tragic suicide. I finished it early Sunday morning. And by Sunday afternoon, came to the tragic realization that it needed to be updated.

First: Parkland survivor Sydney Aiello died by suicide last week. The young teenager had survived the massacre at Stoneman Douglass High School, which claimed 17 lives.

According to Sydney’s mother, Sydney “struggled with survivor’s guilt and was diagnosed with post-traumatic stress disorder in the year following the tragedy. And while she reportedly never asked for help, she struggled to attend college classes because she was scared of being in a classroom.”

Like all Stoneman students, Sydney was affected by the tragedy. Like far too many, she lost a friend:

Sydney Aiello & Meadow Pollack

Sydney lost her “longtime friend,” Meadow Pollack, in the shooting.

Next: The second victim. On Sunday afternoon, news broke that a second Parkland survivor had killed themselves. It was a sophomore male, and he, like Sydney, shot himself. As I type this entry, much is unknown about this student, including his name. Unfortunately, the notion of a suicide contagion effect is very, very real – and it is highly possible that this is what we are witnessing here.

The ugly truth is that a trauma never ends when the bullets stop firing. There are always long-term after effects. According to a 2018 survey:

  • Nearly 22% of people who had been raped had also attempted suicide at some point in their life.

  • Approximately 23% of people who had experienced a physical assault had also attempted suicide at some point in their life.

  • These rates of suicide attempts increased considerably among people who had experienced multiple incidents of sexual (42.9%) or physical assault (73.5%). They also found that a history of sexual molestation, physical abuse as a child, and neglect as a child were associated with high rates of suicide attempts (17.4% to 23.9%)

  • People with a diagnosis of PTSD are also at greater risk to attempt suicide. Among people who have had a diagnosis of PTSD at some point in their lifetime, approximately 27% have also attempted suicide.

There is no easy, glib solutions here, but there are ways to mitigate suicide risk after a traumatic event. The American Psychiatric Association lists a few helpful ways to deal with a traumatic event, including:

  1. Keeping informed but avoiding over-saturation with an event.
  2. Learning about local resources and sharing that information.
  3. Remembering that you are not alone and talking with family and friends about your experiences.
  4. Remembering that anxiety and depression after an event are normal, and seeking help if this continue or if you become overwhelmed.

There is, as always, a relatively standard thread here: If you endure a traumatic event, seek help. You are not alone, you are not weak or foolish, and you didn’t deserve whatever happened to you. Therapy – or even just talking to someone – can make a powerful difference.

I have a tendency with these blog entries to take smaller events and turn them into larger points. That’s a conscious decision informed by my experience with mental illness. But I want to conclude this entry by making sure we don’t lose sight of Sydney Aiello or the second student, name currently unknown.

It goes without saying: Sydney and others affected by Parkland didn’t deserve what happened to them. It’s a human tragedy. But Sydney and her classmates spent much of their time after the shooting advocating for a better world. I hope that some good comes of this tragedy, and I hope it is done, at least in part, in memory of Sydney, this second student, and all those affected by this tragedy.

Access to guns means higher rates of suicide. What we can do about it is a harder question.

I recently shared this article on my Facebook page. The crux of the article is this: States with higher gun ownership have higher rates of youth suicide, and the gun ownership leads directly to more suicide. According to the article, “For each 10 percentage-point increase in household gun ownership, the youth suicide rate increased by 26.9 percent.”

This study comes in addition to the overwhelming evidence which shows that access to guns leads directly to higher rates of suicide. This isn’t just in terms of youth suicide, but for individuals across the country, regardless of age.

Why is this? While suicidal thoughts and ideation can be a long standing problem, the impulse to actually kill oneself is often a fleeting impulse. That’s why so many advocates – including me – have concentrated on means reduction when it comes to suicide: If we can get someone through that terribly difficult moment, we may be able to get them the help that they need.

Unfortunately, guns are one of the deadliest methods of suicide. If someone attempts suicide with a gun, that method will tragically “work” more than four out of five times. Gun use also explains some of the gender differences of suicide attempts vs. suicide completions: “…women are roughly three times more likely to attempt suicide, though men are around three times more likely to die from suicide.” This is, at least in part, because men are more likely to use a firearm.

While the evidence is overwhelmingly clear that there is a problem, how we address that issue is something else entirely. Like it or not, guns are overwhelmingly pervasive in America, and basic gun ownership is legally protected. Furthermore, it can be difficult for someone who favors gun control methods to advocate for reducing gun-related suicides without seeming like you are actually advocating for more gun control and to take away guns from law abiding citizens (trust me on this – I’ve run into the issue many times!). Any effort to reduce the access of suicidal people to guns has to be balanced with already existing legal protections.

So, what can we do? Many states have enacted so-called “red flag laws” which create a process by which guns can be temporarily removed from someone’s home if there is evidence which shows they can be a danger to themselves or others. Such laws can be effective in reducing suicide: According to a 2016 study of such laws in Connecticut and Indiana, “Indiana’s firearm seizure law was associated with a 7.5% reduction in firearm suicides in the ten years following its enactment, an effect specific to suicides with firearms and larger than that seen in any comparison state by chance alone. Enactment of Connecticut’s law was associated with a 1.6% reduction in firearm suicides immediately after its passage and a 13.7% reduction in firearm suicides in the post–Virginia Tech period, when enforcement of the law substantially increased.”

That’s an amazing number. And that’s a real difference.

But it doesn’t just take a law or official government action to make an impact in this regards. Take New Hampshire, where the Gun Shop Project has encouraged New Hampshire firearms instructors to “show a video about suicide prevention in their classes.” That information, coming from peers, can be powerful. I hope that research is conducted on these efforts in the future.

We have to find a way of respecting the rights of gun owners while protecting those with mental health challenges, but I do have to think there is common ground here. It is my hope we can find that space.

My most-read blog entries of the year

I have to say, I really enjoyed the blog this year. After letting it go for months, I picked it up again and have consistently tried to create useful and interesting content. It’s also helped me expand my horizons and think about mental health in a different way.

This year also saw the publication of Redemptionan experience which has given me more joy than I ever could have realized – and an experience which was borne of my own depression. Take note, reader: You can get immeasurable joy out of sadness.

That being said, most importantly, I hope what I wrote has helped you.

So, here’s a look at the five blog entries I wrote which seemed to be the most popular. My year in review, if you will.

5) Ties That Bind: Liberals, Conservatives & Mental Health: This is the only “top five” entry which dealt specifically with public policy. It dealt with the challenges facing Democrats/Republicans, urban/rural areas and how mental health remains a huge challenge in all of these sections of the country.

4) Redemption, by Mike Schlossberg, is Almost Available: Alright, this one was blatantly self-promotional 🙂

3) The Tragic Suicides of Kate Spade & Anthony Bourdain: Within a few days, Kate Spade and Anthony Bourdain killed themselves. I wrote this blog entry just after the news broke about Bourdain, largely motivated by a very real fear about the contingent effect when someone does kill themselves. It was my immediate thoughts on what to do and how to help those who are suffering.

2) How To Stay Hopeful in a World Filled With Darkness: This entry was one of the most painful ones I have ever done, and like the one above, it was in the immediate aftermath of a tragedy – specifically the Tree of Life shooting in Pittsburgh. The crux of this entry was how anyone can stay hopeful and optimistic in a world where gloom and doom have become so powerful.

1) How Vacation Can Make You Depressed, and What You Can Do About It: This entry was inspired by my own upcoming vacation – and the depression which often accompanied it. What was most interesting about this one to me is that this one has seen a slow and steady increase in hits after the entry was posted back in late July. It did okay at first, but then the views just grew and grew. I suppose it’s good to know that I’m not the only one who sometimes feels this way.

It has been a wonderful year, and thank you for giving me the opportunity to talk to you. I wish you a happy, peaceful and restorative New Year. See you in 2019!