September 24, 2019

Suicide, The Numbers

September is Suicide Prevention Month, and at JKBF we believe both facts and perspective are important in understanding the complex and devastating condition we are working to prevent. The pain of suicide touches all of us, and losses of high-profile celebrities and mental health advocates have shown that suicide can affect anyone.

Suicide is a distressing phenomenon, consistently ranking among the top 10 causes of death in the United States, where more than 47,000 people die by suicide each year. Due to perceived stigma and the challenges of identifying a deceased person’s intent (e.g. accidental or intended overdose?), it is likely that suicide is still under-reported. The 47,000 lives lost to suicide in the US represent twice the population lost to homicide.

In the most recent data available, the CDC reported the US suicide rate to be 14 per 100,000 in 2017, up 33% since 1999. While women are far more likely to attempt suicide, men die by suicide at a much higher rate (22.4 for men, 6.1 for women). There is considerable variation across race, as well as geographically within the US, with higher rates in rural areas. Suicide takes a higher number of lives in the elderly, but it ranks as the second leading cause of death in 10-34 year olds, with rates in adolescents, and even children, on the rise.

Reporting and research usually covers Suicide Behavior, a term that encompasses both thoughts and actions. Suicidal ideation is defined by the National Institute of Mental Health as thinking about, considering, or planning suicide. A suicide attempt is a non-fatal, self-directed, potentially injurious behavior with intent to die as a result of the behavior. Suicide is defined as death caused by self-directed injurious behavior with intent to die as a result of the behavior. In an effort to reduce stigma, the phrase died by suicide is preferred to committed suicide.

Suicide is generally regarded as a process, with most suicide believed to begin with ideation. Ideation can be fleeting, recurrent, or persistent, and is believed to occur in up to 10% of people at some point in their lifetime. Risk increases as ideation becomes a plan (e.g. when, where, how) and as steps are taken to obtain means and to move the plan into action. These stages can occur over the course of weeks or years, or even days, hours, or minutes. While many survivors of an attempt report having had a plan, some suicides are considered spontaneous and seem to occur in response to a catastrophic event, or without an obvious trigger. Half of suicide deaths occur as a result of an initial attempt.

While the loss of life statistics are alarming, it is important to note that the suffering caused by suicide behavior is monumental—for every suicide there are 10-30 attempts, with as many as 25 million attempts worldwide each year.

Suicide is also preventable. A recent article in the Wall Street Journal highlights that 9 out of 10 people who make a suicide attempt and survive will not ultimately die by suicide. For these individuals, the urge to die is temporary, and blocking their access to lethal means in the moment can make all the difference. Efforts to restrict access to pesticides, a common means in third world countries, has contributed to a recent decrease in suicide rates world-wide (800,000 deaths per year, down from 1 million).

However, as online community reactions to the WSJ article have reflected, for many others, the preventive measures currently employed are not enough. For those with a certain kind of suffering, there is persistence of pain or thought processes that continue to drive them to this end. Indeed, the greatest risk factor for death by suicide is a previous attempt.

One important statistic highlighted by Zero Suicide, which is driving plans to improve screening in primary care, is that most affected individuals (83%) visited a doctor in the year before dying. Only half had a mental health diagnosis and even fewer were receiving mental health treatment. Zero Suicide and other efforts are hoping increased attention to screening will pick up mental illness and suicide ideation in primary care, but we see additional opportunities for learning. For example, chronic disease, traumatic brain injury, and other physical health matters are known risk factors for suicide, so a better understanding of the nature of those medical visits might reveal relevant risk and treatment information as well.

Which leads us to the topic of research–what JKBF champions. Despite its lethality and impact on society, funding for scientific research in suicide is dismally low. The most recent numbers on suicide research spending by the National Institute of Health is $96 million in 2018, the lowest by far of any of the top ten causes of death in the US. Since it is a matter of special concern to the military and veterans, the Department of Defense spends about $100 million, and additional research happening at the Department of Veteran’s Affairs. The largest private funder of suicide research is the American Foundation for Suicide Prevention.

With statistics of this magnitude, numerous risk factors known and unknown, and the likelihood that multiple factors combine to increase risk, it will take a significant effort to turn the tide on these statistics. However, dedicated resources can make a difference in outcomes—the scary and deadly HIV/AIDS has now become a manageable disease through research initiatives and billions of dollars in funding.

At JKBF we believe that it will take a multi-pronged approach and investigation of mind and body processes, and how these interact, to understand suicide and save more lives. Cognitive and psychosocial elements are the best characterized risk factors (coming in a future eNEws), but these are generally non-specific and not always helpful in knowing who needs what and when. Half of suicide deaths occur in “low-risk” populations, and the vast majority of those considered high risk will not die by suicide.

What else do we need to know about what drives suicide behavior? At JKBF, we believe there are additional clues in the statistics, in the physiology, and in the reports from those who experience suicidal behavior. Join us in working to support the researchers who are following those clues and investigating the biological influences on suicide. Connect us to others who will want to be part of this conversation and contribute your experiences and insights, so that together we can create additional approaches to preventing suicide.