Looking the Right Way?Changing Demographic Trends in Suicide in America

Patrice Al-Shatti, LMSW, OSW-C

For Ken and ShaunBrave true souls, sons, and friends.

We are a generation in We are a generation in tremendous pain.tremendous pain.

Suzanne Gerber, columnist for pbs.org

“Surprising Hike in Suicide Rates Found Among Baby Boomers” Live Science

“Men and Suicide: An Epidemic the Must Be Confronted Aggressively”The Huffington Post

“What Is Driving the Rise in Suicide Among Middle Aged Men”The Atlantic

“More Middle-Aged Men Dying by Suicide and Experts Don’t Know Why”The National Post

“Robin Williams’ Age Group at Heightened Suicide Risk”The Wall Street Journal

The New Public Health Epidemic

Centers for Disease Control Morbidity and Mortality Weekly Report, May 3 2013

From 1999 to 2010:• Suicide up 49% among men 50-59.

• Suicide up 59% among women 60-64.

• By racial/ethic groups, the greatest increases were among AI/ANs, up 65%, and Caucasians, up 40%.

• The rate among those aged 10-24 remained stable.

• The rate for those over age 65 declined.

Percent Change from 1999 to 2010

10-24 25-34 35-39 40-44 45-49 50-54 55-59 60-64 65+

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Women

Age 10-24 25-34 35-39 40-44 45-49 50-54 55-59 60-64 65+

“What happened in 1999 that caused the suicide rate to suddenly rise primarily for those in mid-life? For health experts, it is like discovering the wreckage of a plane crash without finding the black box..”

Patricia Cohen, New York Times

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CDC, MMR, May 3, 2013

Middle Aged Caucasians: A Demographic Time Bomb

“Working age adults are most vulnerable. The baby boom generation historically had higher suicide rates than earlier generations.”

Dr. Thomas SimonCenters for Disease ControlTrends in suicide mortality in Caucasians by age group, U.S., 1981–2005 Guoqing Hu et al. Mid-Life Suicide:

An Increasing Problem in US Whites, 1999-2005. American Journal of Preventive Medicine. (2008). 35 (6). Pp 589-593.

Theories: Correlations and Causality

Men and the Struggle with Role Stress

• Caught between two generations.

• The legacy of the sexual revolution and women’s right movement.

• Silent Generation fathers modeled stoicism.

• Expected to become socially progressive by female peers.

• Sharing the breadwinner role.

• Watching sons who are now generally emotionally open, and able to seek help.

“Society has moved on but middle aged men are not as equipped as they should be to deal with changes in their role in society.”

Dr. Rory O’Connor, Glasgow University

Our Changing Society

• The fragmentation of the nuclear family.• The internet age and growing social isolation.• American car culture and longer work weeks.• Generational character.

“In an era of instant communication via cell phone and e-mail, some would argue that it doesn’t make sense that people are lonely. Nevertheless, sharing, the antidote to loneliness, is not the same thing as talking. Chattering with another person can simply be a … distraction from loneliness, similar to having the television on in the background to keep the house from seeming empty and barren, or to make it less obvious that the people inside are not interacting with each other.”

Janice Shaw Crouse. “The Loneliness of American Society.” The American Spectator.5/14/2014

The Insults of Aging

• Poorer health than previous generation.

• Growing incidence of multiple chronic health problems.

• Increasing out of pocket healthcare expenses as insurance benefits erode.

• Significant jump in prescription drug use and abuse in this generation.

• The toll of lifelong recreational drug use.

• The cost of aging to the male psyche.

• Decrease in the use of hormone replacement therapy in post-menopausal women.

"Despite their longer life expectancy over previous generations, U.S. baby boomers have higher rates of chronic disease, more disability and lower self-rated health than members of the previous generation at the same age,"

Dr. Dana E. King, West Virginia University in Morgantown.

The Finances of Pain

• The Great Recession and rising unemployment.

• The changing nature of work, less long term and more short term employment.

• This generation’s tendency to be somewhat more materialistic and forgo a financial safety net.

• Bankruptcy at later stages of life in recent years.

• Vulnerability of men with lower incomes and less education.

“When men lose their jobs, sometimes they question who they are. All too often we hear men who say my family would be better off with my life insurance.”

Tricia Marks, Dayton Suicide Prevention Center

The Gender Divide

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Women

Age 34-39 40-44 45-49 50-54 55-59 60-64

CDC, MMWR, May 3, 2013

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When compared with suicidal women, men who reach the point of suicidal action are more hopeless, more willing to carry out actions that mightleave them injured or disabled, more unconcerned with consequences, and more clearly resolved to die. Elwood Watson, The Huffington Post

Women Seek Help, Men Die

“He did not have friends. He did not feel comfortable with other men... He did not trust doctors and would not seek help even though he was aware that he needed help.” Autopsy report, male

62 year suicide decedent

As they age, men may be less successful in feeling satisfaction with their major life roles. “This leaves many lonely, socially unresourceful, and desperate for real connections, wisps of which they can get from a drink, the golf course, or the roar of a sporting gun or a race car.” Dr. Thomas Joiner

Men and women have different symptoms of depression. Men report higher rates of anger attacks/aggression,

substance abuse, and risk taking compared with women. Using this scale, analysis has found that men and

women met criteria for depression in almost equal proportions: 30.6% of men and 33.3% of women.

Dr. Jeb Diamond

Maleness and the Road to Lonely

• Biological differences in infancy and early childhood between boys and girls.

• Increasing instrumentality and desire for autonomy in grade school.

• Emergence of the ideal of “real manhood” during adolescence.

• Friendship networks stabilize in late adolescence, the last days of easy

camaraderie.

• Focus on success over relationship building with gradual erosion of friendships

as lost relationships are not replaced.

• The “it’s under control” years of early adulthood.

• Becoming lonely but oblivious.

• Marriage and subsequent reliance on one’s wife to supply socialization.

• Atrophying social skills.

• May have career successes but they are increasingly not meaningful.

• Public square relatedness. Alone in a crowd.

• The changes of middle age cause distress as independence and vitality is

threatened.

• Tendency toward self-destructive, unhelpful coping strategies.

• Risk of deep and fatal loneliness with loss of will to cope when hit by

sequential life stressors.

Putting the Puzzle Together, Maybe

Thwarted Belongingness: • I feel disconnected from other people.

• I rarely interact with people who care about me.

Perceived Burdensomeness:  • The people in my life would be better off if I were gone.

• These days I think I have failed the people

in my life.

Capacity for Suicide: • Things that scare most people do not

scare me.

• I am not at all afraid to die.

Thomas Joiner. (2005) Why People Die By Suicide

As this Cohort Faces Declining Health..

In patients over age 60, physical illness contributes to 70% of suicides

when depression or anxiety is also present.

Patients with diabetes fight feelings of hopelessness more than the general population and report the wish for a hastened death more frequently. They are 54% more vulnerable to Clinical Depression.

Patients with insomnia have a 72% increase in the likelihood of moderate to high suicide risk for every hour of reduced sleep duration.

Patients with chronic back pain and migraines are at increased risk of suicide, independent of any psychiatric condition.

Other health problems have repeatedly been found to contribute to suicide risk: Congestive heart failureChronic obstructive pulmonary diseaseSeizure disorderUrinary incontinenceMultiple SclerosisPeptic ulcerLupus

Cancer is most frequently diagnosed when people are between 65 and 74 years

old. The median age of diagnosis is 66.

One in every two men will be diagnosed with cancer at some point and one of

every three women.

People with cancer are:

• Twice as likely to die by suicide.

• Twice as likely to consider suicide.

• This risk is highest in the first three months after diagnosis.

“Research on suicide among the middle aged has been relatively rare. Indeed, major reports do not focus on this age group at all.”Dr. Julie A Phillips, Rutgers University

“Middle-aged adults got kind of left out of thinking of where to focus resources for suicide prevention.”Alex Crosby, Centers for Disease Control

“There are no comparable efforts that focus on suicide in the middle years of life and little if any coherent discussion nationally about how one would design, develop, implement, or evaluate such programs.”Eric Caine MD, University of Rochester Medical Center, Injury Control Research Center for Suicide Prevention

Working From An Old Paradigm

People try to put us down, talkin' 'bout my generation.Just because we get around, talkin' 'bout my generation.Things they do look awful cold, talkin' 'bout my generation.I hope I die before I get old, talkin’ ‘bout my generation .

Who Is at Risk?

• The coworker at the next desk.

• Your best friend.

• Your boss or employee.

• Your banker, accountant, or lawyer.

• Your plumber or mechanic.

• Your brother, your father, or your husband.