Suicide is difficult to talk about and impossible to ignore
by Jed Delmore, MD
This article cannot start with my usual attempt at being witty. The past few weeks have brought suicide to the forefront for me and, I suspect, all in the community.
While attending the funeral and celebration of life for the child of good friends, I couldn’t help the constriction in my chest and tears of sorrow for the loss of such a wonderful, talented person and the lasting impact that loss would have on her family and all she touched.
Just weeks ago, a front-page article in the Wichita Eagle reported that the Kansas suicide rate had risen 45 percent since 1999, exceeding the U.S. rate. Only four other states exceeded that degree of increase. Within days, news outlets were reporting the deaths of fashion designer Kate Spade and then celebrity chef and author Anthony Bourdain, both reportedly by suicide. Next came the apparent suicide in Wichita of Emily Glass, the stepmother of the little boy, Lucas Hernandez, whose body was found after going missing three months ago.
I suspect that most of us have an impression or notion of what factors would lead someone to be sufficiently desperate to end his or her own life. Those notions are likely overly simplistic.
Within the past year we have been informed, warned and educated regarding the opioid epidemic. These reports have resulted in proposed state and federal legislation, in addition to restrictions placed by third-party and government payers on prescription narcotics. The Centers for Disease Control reported 42,249 opioid-related deaths in the U.S., with an incidence of 10.4 per 100,000 population for all narcotics and 4.7 per 100,000 for prescription ones.
Allow me to put these statistics in perspective. Data from the CDC shows 44,965 suicides in 2016, making it the nation’s 10th-leading cause of death. The incidence of suicide is 13.4 per 100,000 population. For every death from suicide, there are 25 attempts. Men die by suicide 3.5 times more often than women, with males accounting for 7 in 10 suicide deaths in 2016.
In Kansas, 514 suicides were reported in 2016, an incidence of 19.9 per 100,000, placing us 15th in the nation. Suicide in Kansas is the second-leading cause of death for ages 15-44, and the fourth-leading cause of death for ages 45-54. It seems that opioid misuse is an epidemic, while an equal or bigger problem, suicide, doesn’t receive the same attention.
The factors and causes leading to death by suicide are complex. There is no single cause or etiology. A combination of emotional and physical stressors may produce hopelessness, despair and the ultimate decision to end one’s life. Although mental health conditions including depression, bipolar disorder, anxiety disorders, substance abuse and schizophrenia may be risk factors, almost 50 percent of deaths by suicide occur in those without a documented mental health disorder.
What can we do? As physicians, health care providers and members of the human race, we should be observant and caring regarding those around us. There are multiple organizations, websites and helplines with lists of actions, behavior and changes in personality that raise concern.
Perhaps of greatest help is the ability to mention the word “suicide.” Asking about suicide does not precipitate the action. If someone we know or care for appears to be barely holding it together, asking if they have considered suicide may result in a call for help and action on our part.