Suicide rates for middle-aged American men and women have been climbing for more than a decade. But efforts to change the trend hinge in part on figuring out what's happening — and on that question, there's more speculation than consensus, experts agree.
A report released this month by the Centers for Disease Control and Prevention (CDC) found that the annual age-adjusted suicide rate for those 35 to 64 rose from 13.8 per 100,000 in 1999 to 16.7 in 2010. That's a 28.6 percent increase.
Broken down by race, the numbers show a 65.2 percent increase among American Indian/Alaska natives and 40.4 percent among whites. By age, the greatest increases for men were during their 50s; for women, numbers rose most in their early to mid-60s. Geographically, suicide rates among the middle-aged climbed in all four regions and in 39 states.
Men have been and remain more likely to kill themselves than women. The CDC analysis said the three most common methods — firearm, suffocation and poisoning, usually by drug overdose — all increased.
What the numbers don't explain is the why, without which effective prevention is more challenging, experts agree. It's also easy to forget when faced with stark numbers that suicide is not common, though it occurs too often.
"There is no suicide epidemic," said Dan Reidenberg, executive director of Suicide Awareness Voices of Education (Save.org) and managing director of the National Council for Suicide Prevention. However, suicide increases among middle-aged Americans "clearly is a trend, and it's a disturbing trend."
The most important thing someone struggling needs to know, he added, is that both help and hope are available. People recover. "We are making progress. There are more suicide prevention programs. We have a national strategy for prevention, and research prioritization is almost finished."
There are a number of theories on what's driving the increase in suicide among the middle-aged. Reidenberg cites convergence of ongoing wars and the number of both active-duty soldiers and veterans who have post-traumatic stress disorder with life in uncertain economic times as possible factors. "Though recessions themselves don't necessarily significantly impact suicide, unemployment does." High numbers of unemployed and others struggling financially are reason for concern, he said.
W. Bradford Wilcox wrote in The Atlantic that the increase may be owed, at least in part, to an erosion of traditional support systems. Wilcox directs the National Marriage Project at the University of Virginia and co-authored "Gender and Parenthood: Biological and Social Scientific Perspectives." He cited French sociologist Emile Durkeim's theories that men are more apt to kill themselves when they are "disconnected from society's core institutions," like marriage and religion, both now in decline in America.
Men are also vulnerable when their economic prospects falter, such as when unemployed. "So men are more likely to thrive and survive when they have a job, a wife and a community connection to a church or some other group that grounds their lives," Wilcox wrote.
College-educated men, he said, are more apt to lead socially supported, traditional lives, with jobs and wives, intact families and a church. They are less likely to kill themselves, compared to men who struggle in those areas.
Suicide rates for the young have been stable and among the elderly they have declined somewhat. That it is rising among the middle-aged may reflect the group itself — the baby boomers, said Jill Harkavy-Friedman, senior director of research for the American Foundation for Suicide Prevention. "This group had more anxiety and depression in the past and a lot of substance abuse in both the past and in the present. Those things, mental health, mental illness in general, substance abuse, they all contribute to suicide."
The likelihood of dying by suicide is also greater with some medications that are now available," said Harkavy-Friedman. Plus, some middle-aged people may be less likely to take medications prescribed to treat mental illness because of warnings of side effects and complications.
"The point is there are many factors that come together. For each individual, those factors may be different. ... Then there's likely to be a recent stressor that triggers an already-at-risk person," she said, from depression to a job loss or a broken relationship. Many people endure and survive those stressors, but someone struggling with mental health may be more affected. That's why having outsiders who will help and creating a plan to cope with stresses can save a life for those who are vulnerable.
Reidenberg hopes American businesses will tackle prevention by turning work sites into places to get helpful information, from suicide and mental health to coping with different stressors and a tough economy. He believes employers could do much more to make work a safe place to discuss struggles.
Experts urged reducing access to lethal means of suicide, noting the "impulsive nature of the act. Research shows that when you put barriers across a bridge that has become a popular place to jump, people don't usually go to another bridge. If you take car keys away from someone who is in an acute, high-risk phase for suicide, lives can be saved. The ultimate form of reducing access to lethal means is putting someone in a hospital," Reidenberg said. Although it can happen, fewer suicides occur there.
Experts note some age-based differences, said Reidenberg. It is known that youths with depressive disorder tend to be more irritable than adults with such a disorder. Adults tend to more noticeable sleep disturbances, in part because adolescence is a time of sleep disruption. There are fewer warning signs for senior citizens than other groups; they tend to employ very lethal means. What is consistent across ages is communicating intent in some way and looking for a way to do it, which creates opportunities for intervention.
Among specialized interventions designed to prevent suicide are cognitive behavior therapy, problem-solving therapy and dialectical behavior therapy.
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