Tuesday, February 19, 2008

Mid-life Suicide Rate Increases

The New York Times has a story today about the increasing rate of suicides in the 45-64 age set. It's worth reading to I thought I'd post it here for readers to surf to. Thanks to Patricia Cohen, who wrote the story.

It refers to a recent CDC report, which I could not find on the cdc.gov site (if someone finds it, please put a link in the comments). Here is a link to a .pdf CDC Fact Sheet on suicide.


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[Edit... added 2/20/2008, from additional info in comments]

Kudos to Bee! Thank you for finding the link to the Dec 14 2007 MMWR article.

Table 2 makes the point quite clearly.
From 1999 to 2004, the rate of identified suicides per 100,000 population in the 20-29 age group went from 12.3 to 12.4, a 1% increase.

The rate in the 45-54 age group went from 13.9 to 16.6, a 19% increase.

From the article: Among persons aged 45--54 years, the total injury mortality rate increased 24.5%, including an 87.0% increase in the mortality rate from unintentional poisoning (most commonly drug poisoning) and a 48.0% increase in suicide by hanging/suffocation...

[For the entire US population, i]ncreases in poisoning mortality accounted for 61.9% of the increase in unintentional injury, 28.0% of the increase in suicide, 81.2% of the increase in deaths from injury of undetermined intent, and 55.7% of the increase in total injury mortality.


The authors suggest that the increase in poisoning is mostly due to an increase in substance abuse. 6% of the poisonings were due to "psychoterapeutic drugs", while 47% were due to narcotics and hallucinogens [Table 2].

I note that Maryland is one of the 4 states that actually recorded a decrease in overall population poisoning deaths for this time period (hmm, despite Baltimore being the Heroin Capital?).

26 comments:

Anonymous said...

Article blames the use and abuse of presciption drugs which ties in so ummm well with your podcast. I suppose that i could use my benzos to OD but I wonder rather whether the fact that all the other supposed wonder drugs have failed is the impetus to make me want to do it.At least in part.
For what it is worth, I am glad to see Shrink Rap gradually resurfacing in the blogosphere. The TV guide blog was very cheap. Cheaper even than the ads. Hope you will behandle the situation better from here on or I will be forced to surf on over to Denmark to chill for a spell.

Anonymous said...

Oh shoot, I am not old enough to be in mid life according to the article. WT__? I'm booking that trip to Denmark now.

dinah said...

Roy, wait, aren't you going to comment on this? Are there Roy theories of why?

Anon: 1) it's hard to od on benzos alone, one of their pros is that they don't kill you.
2) our visits are way up since we started our In Treatment Series and I'm enjoying it...it's my blog and I'll cry if I want to.

KBAB said...

Interesting read.

I like the In Treatment sub-blog, even more now that I can't watch it online. Please continue to follow it, especially as a springboard for topics. That seems most useful. I watched the 2-min recaps for this week and I'll be interested to hear what you have to say after Friday's episode!

Anonymous said...

Really, you can't od on benzos that you have been hoarding when you mix with alcohol and maybe some ambien and gravol to keep from puking it all up? News to me.

KBAB said...

anonymous, are you cooking up a plan?

Health Psych said...

Thanks for drawing attention to this interesting article.
HP

jcat said...

If you have long-term depression, it makes perfect sense. When you are younger there is still the hope that things will change - by middle age, you know that nothing's going to get better and that if it does it's only temporary anyway. And the prospect of doing it all for another 20 or 30 years is just too much.

Anonymous said...

My immediate thought was that the increase in suicide rate is due to increased use of SSRI Anti-depressants. I am in the midst of reading "Let Them Eat Prozac" by David Healy which in chapter 7 outlines a study he did giving Zoloft and reboxetine to healthy, normal volunteers. Two of 20 of these carefully selected volunteers came very close to killing themselves during the 2 week trial of Zoloft and they WERE NOT DEPRESSED before they started the drug!

When I started with a psychotherapy with a psychiatrist (who is not a fan of using drugs as a first line treatmentand only uses them if absolutely necessary) several of my firends were adamant to me that I should be taking anti-depressants. I have 4 friends who are on SSRI's without talking therapy. We are all middle-aged. To me this shows a strong cultural bias towards taking SSRI Anti-depressants.

Roy said...

This blip seems to be happening at a time of *decreased* SSRIs use. But, a quick look at some of the 145+ NYT comments suggests numerous other causes, incl 9/11, Bush, economy, excessive expectations, internet, music, ageism, and lack of sex or intimate relationships.

Take your pick.

(and, yes, benzo overdose *can* be lethal)

The Shrink said...

In ther UK we've had the opposite end of the spectrum, with 17 school children in one town hanging themselves over the last 13 months.

Grim.

Anonymous said...

and the survey says...anti convulsants can cause depression. who knew? add up all the people taking those and gettign depressed and all the people having bad reactions to antidepressants or good response followed by poop out, interpret that how you will, all the people dependent on benzos and sleep aids which do help with anxiety but do also cause depression and all the people self medicating with alcohol, add in the people who have gained too much weight on atypicals and who have devoloped metabolic changes and i don't think you even have to ask what the presentign problem was in the first place. where's the rope?
yeah and walmart gets a lot of visitors too.meaning what?

Bee said...

Have no subscription, so can't read the article. Was there a breakdown into social classes or living circumstances (urban/suburban/cities) etc. What does the data past '04 look like or hasn't there been data? Can anybody give me a journal reference or have the results not yet been published?

Roy said...

Anon-exactly (re Walmart). One can't make much inference using associations, though it is tempting. For example, look at the incidence of suicide attempts PRIOR TO going on antidepressants versus AFTER ... but what does it really mean? (see graph in this post)

Bee-I don't have a NYT subscription either. Maybe you have to register (not sure). The original report that the NYT article refers to is supposedly on the CDC website, but I could not find it. KUDOS to the first reader who puts a link to it in the comments here.

Bee said...

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5649a1.htm

Anonymous said...

Ahhh Walmart...how did that make you feel? I play the oboe too.

Roy said...

Kudos to Bee! Thank you for finding the link to the Dec 14 2007 MMWR article.

Table 2 makes the point quite clearly.
From 1999 to 2004, the rate of identified suicides per 100,000 population in the 20-29 age group went from 12.3 to 12.4, a 1% increase.

The rate in the 45-54 age group went from 13.9 to 16.6, a 19% increase.

From the article: Among persons aged 45--54 years, the total injury mortality rate increased 24.5%, including an 87.0% increase in the mortality rate from unintentional poisoning (most commonly drug poisoning) and a 48.0% increase in suicide by hanging/suffocation...

[For the entire US population, i]ncreases in poisoning mortality accounted for 61.9% of the increase in unintentional injury, 28.0% of the increase in suicide, 81.2% of the increase in deaths from injury of undetermined intent, and 55.7% of the increase in total injury mortality.


The authors suggest that the increase in poisoning is mostly due to an increase in substance abuse. 6% of the poisonings were due to "psychoterapeutic drugs", while 47% were due to narcotics and hallucinogens [Table 2].

I note that Maryland is one of the 4 states that actually recorded a decrease in overall population poisoning deaths for this time period (hmm, despite Baltimore being the Heroin Capital?).

Bee said...

you're welcome. you have a very interesting and lively blog, keep up the good work :-)

Anonymous said...

the decrease in maryland was due to dinah's refusal to prescribe xanax which as we have agreed can be lethal in combination with...

Bee said...

Hi Again,

Since there seems to be no good explanation so far and most mentioned causes are speculative, let me give you my `theory'. I don't know much about psychology, so I apologize in advance if it doesn't make much sense. I'd be grateful for any references on related matters that come into your mind. Most of all, I'd be interested to hear your opinion.

First, I want to acknowledge that depression followed by suicide can have lots of causes and every story is individually different. Also, it might indeed turn out to be just a statistical fluctuation, though I personally don't think so. I actually believe this trend will continue and the increase in suicide rates will somewhat extend towards younger ages. Here is why:

Evolution doesn't only support behavior that is beneficial for the individual but traits that are beneficial for the whole group the individual lives in, possibly on the expenses of the individual. In most cases, individuals share genes that encode certain types of behaviours. They might however not share other genes so their personal development will be different, and they certainly don't share experiences, skills, etc. Without having followed the progress on research too closely, I think studies support that causes of depression are shared between genetic predispositions and personal trauma, roughly speaking.

Evolution favors survival of the fittest. Favored are individuals that 'fit best' into their environment. The human race is in an exceptional situation in that we have been modifying the environment we live in ourselves, and we have done so extremely rapidly, within only few generations, much faster than our brains can possibly adapt to it.

I am always stunned about the capabilities of the human mind (think about something as 'simple' as driving a car! our brain was never meant to deal with that - and still after some practice we come to consider driving as something almost 'natural' ). But there are limits to what even the human mind can adapt to, limits that are simply set by the time it takes for us to learn and reproduce. We were not meant to live in large cities, we were not meant to sit in front of a computer all day long. Many people have problems coping with an abundance of food, lack exercise, suffer stress from information overflow, noise, time pressure, lacking social networks, you all know these 'civilization drawbacks'.

Now to come back to the depression. People who don't 'fit' into their environment feel misplaced, inadequate, insecure. They will notice a tension between what they are capable of doing (capable to do happily, without lasting stress) and what type of skills flourish in the world they live in. They will undergo an increasing amount of self-reflection, and if they don't see no way to adapt (either by changing themselves or changing the environment), they will commit suicide. I know it sounds quite cynical, but for the society as a whole it improves the 'fitness' if those who are inadequate remove themselves.

This reaction I would expect to become increasingly important around an age where people realize they are aging physically and mentally, are are never going to be 'fitter' than what they already are. It would expect this conclusion to become relevant if people have tried to 'fit in', but they have to face that whatever they do and have tried it doesn't make them happy (i.e. their reward mechanism is inappropriate to what behavior their environment requires). They have to notice that whatever they can realistically envision for their future (or even that of others), they see no way to make peace with the life they are being offered. This tension is significantly enhanced by the pace of change in the world they live in. (Suicide among younger people can have related reasons but with some support it is easier to convince them their future can look bright if they only try the right way. Contrary to conventional wisdom, hope does not spring eternally. ) I would expect this trend to move towards younger ages, because the change on our environment seems to become faster every year, so people will come to draw a line earlier. Also, though I hope very much I am wrong, the USA has in in many instances been a precursor for change in other parts of the world, and I wouldn't be surprised if parts of Europe and Asia will see similar trends.

To summarize: I think this increasing suicide rate reflects that our 'civilizations' are creating a change in environment that we ourselves (on the average) do no longer 'fit in', and we leave behind an increasing part of mankind. The problem is, these people do not only feel inadequate, they ARE inadequate. Though it would be better to put it the other way round: the environment we have created is inadequate for increasingly many of us.

This is not an issue that can be resolved with SSRI or psychotherapy, this is a major sociological and political problem.

Best,

B.

FooFoo5 said...

You might be interested in this, and the particular point that whenever a significant publication publishes regarding suicide, the post-publishing rate of suicides is known to rise.

Anonymous said...

FYI - You can register for free to read the NYT online.

KBAB said...

bee, i like your idea. I know that a lot of my depression stems from the feeling of "not fitting." I'm discussing this with my shrink, whether or not I need to be on meds the rest of my life (as I previously thought) or if I can just change my attitude. Of course there are different causes of different people's depression, but I also that suicide is becoming more socially acceptable. And I have to say that although there are suicidal people who are mentally ill, I think there are also people in fine mental health who might contemplate suicide. ??

Bee said...

Hey Foofoo,

That's an interesting read, though not exactly related to the topic. Just a remark to that writing: the German word 'Geisel' does not mean 'an instrument of torture', it means 'hostage'. He must have confused it with 'Geißel'. Best,

B.

Bee said...

Hi Kbab,

Thanks for the feedback. As I said previously, there are of course many other reasons for suicidal tendencies - some people are indeed mentally ill, some have suffered severe trauma, or maybe they just have a good reason for suicide. Probably more. So what I wrote above I believe to apply only for a fraction that does not fall into these categories, and it is only a speculation that I believe the increase in suicide rates to be in that fraction:

I know quite a number of people who are depressive up to being suicidal, and who are in my (not very professional) perception mentally perfectly healthy. They just think 'too much', care 'too much', worry 'too much' - 'too much' measured on the average person (if there is such a person). Most of them share the desperate wish to just 'function' normally and keep wondering why they can't just live their life as everybody else, why they can't be 'normal' and 'happy'.

The human brain has a wide range in which it can adapt, but this range of adaption has its limitiations (as everything has), and we are pushing these limits with the changes in our society, environment, work requirements etc. We are pushing these limits pretty hard, think of how much our lifes have changed within only two decades. Some people can just 'change their attitude' - but others can't, they just simply can't. It's not a matter of being mentally ill. Some people can sleep peacefully through noise and in every possible position, others can't. Some people start crying if their friends cry, others don't. Some people can eat food with artifical colors, others can't. There is nothing 'wrong' with that that has to be fixed. These people don't need medication or a shrink, they need a place in this world. Our world used to have nishes for all of them, for all this diversity in people's personalities, but these nishes are vanishing.

Those people who are suffering now from this tension, I believe they play much the same role as the canary in the coal mine: it is a warning that we are changing our world into something that we ourselves with our 'last century needs' don't fit in any more. Those that I know (this is most likely not a very representative sample) are very sensitive, empathic, thoughtful and intelligent. It's people we need for our future, and besides the personal suffering that I believe is avoidable our society can't afford to lose them.

I believe that we can change our world such that everybody can find a place where he or she belongs.

Best,

B.

Anonymous said...

Dr Theodore Seuss Geisel's first wife committed suicide. He was sneetching on her or something.