While Rome Burns: Addressing Rising Suicide Rates

Jeffrey A. Lieberman, MD


May 13, 2016

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Hello. This is Dr Jeffrey Lieberman from Columbia University, speaking to you today for Medscape. The title of this post is "While Rome Burns," a reference to the Roman emperor Nero, who fiddled while the city was being destroyed.

A report was released today, Friday, April 22, 2016, from the National Center for Health Statistics, titled, "Increase in Suicide in the United States, 1999-2014."[1] This report documents a sobering set of statistics that indicate that the suicide rate has increased during that time period, particularly in selected demographic groups. I'd like to read some of the highlights from the report to you.

There has been an overall 24% higher suicide rate from 1999 to 2014 since previously. The average percent increase in the age-adjusted suicide rate was about 1% per year from 1999 through 2006, which increased to 2% from 2006 to 2014, indicating that the rate is increasing. In 2014, the age-adjusted rate for males was 20.7%, more than 3 times the rate for females, which was 5.8%. From 1999 through 2014, the percent increase in age-adjusted suicide was greater for females (a 45% increase) than males, who had a 16% increase. This means that although there was a greater increase in the population overall, the rate of increase, which occurred in both genders, was higher for females than males, thus lowering the historical gap in which males committed suicide more often than females.

For females, the highest increase in suicide rate was for those aged 45-64 years. This age group also had the second-largest percent increase in suicide since 1999, a 63% increase. The suicide rate for females aged 10-14 years had the largest percent increase, a 200% increase. It was a 200% increase on a relatively small base rate, but nevertheless, it was a 200% rise, tripling from 0.5 cases/100,000 in 1999 to 1.5 cases/100,000 in 2014. The percent increases in suicide for females aged 15-24 years, 25-44 years, and 65-74 years ranged between 31% and 54%.

In both 1999 and 2014, suicide rates were highest among men 75 years of age and older. However, there was a slight decrease in the time period up to 2014 compared with prior to 1999.

Men aged 45-64 years had the second highest suicide rate for males in 2014 and the largest percent increase, from 20.8% in 1999 to 29.7% in 2014. Although males aged 10-14 years had the lowest suicide rate of all age groups, this group experienced the second-largest percent increase of 37% from 1999 through 2014, going from 1.9 to 2.6 cases/100,000. What this reflects is the fact that although females had a higher increase than males, both 10-14 age groups increased, suggesting that the particular demographic of young early adolescents has now become vulnerable.

Of the methods of suicide, poisoning was the most common method of suicide for females, accounting for a third of all female suicides, while males tended to take their lives by firearms most commonly (55%).

The conclusion of the report was that since 1999, suicide has been increasing against a backdrop of generally declining mortality in this country. Suicide is currently one of the 10 leading causes of death overall within each age group between 10 and 64 years.

This report is chilling, and it resonates with an earlier report that came out in November in the Proceedings of the National Academy of Sciences of the United States of America and was authored by Angus Deaton and Anne Case, both of whom are professors of economics at Princeton.[2] Their study reported that although human survival in every demographic—age, minority, ethnic group, racial group—was improving over the last half century, they had detected a decline in the longevity of white men and women in the middle-aged group. Why this is so concerning is that for people aged 45-54 years who are white, their survival had decreased from 1999 to 2013 in contrast to every other demographic group and in contrast to the prior 40 years. Moreover, the causes of death were largely related to suicide and drug abuse—prescription and recreational.

The way I put these together is that the death rate by suicide and by other forms of passive self-destructive behavior are all related to mental disorders. We know that 90% of individuals who take their life by suicide have pre-existing mental disorders and that major causes or antecedents are mood disorders, psychosis, posttraumatic stress disorder, or substance abuse. This is a problem that has long been known and has suffered from inadequate attention, stigma, and underfunding (both in terms of clinical care services as well as biomedical research). And this problem continues to worsen, as reflected by the shocking statistics, with continued inactivity on the part of government policies, legislation, and funding priorities.

Professors Deaton and Case stated that "half a million people are dead who should not be dead," according to their calculation in terms of this change in the trajectory of longevity in this age group, which is about 40 times the Ebola statistics and approaching comparable levels to that of HIV and AIDS. Yet, if you look at the response in terms of any type of action being taken from a policy or healthcare initiative standpoint, nothing is being done. To put this into context economically, these are major public health problems, the most egregious manifestations of which are these recent statistics on suicide and declining longevity in that age group due to self-harming behaviors related to mental disorders. Yet, the amount of money that is being spent on studying them has not changed, and it is an inadequate amount in terms of the overall federal budget.

The overall federal budget in 2015 was $4 trillion. The total budget of the National Institutes of Health (NIH) was $32 billion—0.8% of the total federal budget. The combined budgets of the NIH institutes that pertain to mental illness and substance abuse—the National Institutes of Mental Health, National Institute on Drug Abuse, and National Institute on Alcohol Abuse and Alcoholism—is $3 billion if you round up, which is 0.07% of the total federal budget.

In viewing these statistics, which are unimpeachably accurate, it's hard to understand the disconnect between the amount of resources that we have and those that are being allocated to studying them and providing care. Of course, we live in a time when the economy is of paramount concern. Federal spending is being limited, understandably, and we have a government that is frozen in terms of partisan politics. So, if taxes aren't raised, it becomes a zero sum game.

However, this is not what I would consider to be rational thinking or leadership. It's hard to understand why these rates, which are really the tips of the iceberg of an overall chronically failed mental healthcare policy in this country, have not risen to the level of a national emergency, like Zika virus, Ebola, or AIDS years before.

I can only think that the reason is that there is a stigma attached to mental illness. It relates to drug abuse and the conflation of things that are not medical conditions and may relate to failings in moral character or behaviors that are sinful. I'm speculating egregiously, but I just can't understand the basis for viewing these statistics with dismay, shock, and concern and then having inaction. We've seen this with other cases before. We've seen it with civilian massacres and mass violent incidents, which usually result in cries of rage and indignation and a rush to do something to not let this happen again, and then devolve into partisan political arguments and parochial concerns, finally leading to nothing being done.

The legislation proposed by Congressman Timothy Murphy in the wake of the Sandy Hook massacre of children in Newtown, Connecticut, is still mired in partisan politics more than 3.5 years later. It does seem that we have a government that is not taking this seriously enough or acting in a responsible way that is going to change the trajectory of these shocking statistics.

I urge you to not just read up on these latest developments but to express your concern in a way that might be influential, either through the media, to your governmental representatives, or in any way that you can, so that services and funding priorities are brought in line with these public health concerns.

Thank you for listening. This is Dr Jeffrey Lieberman of Columbia University, speaking to you today from Medscape.


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