Suicide rates rise sharply across the United States, new report shows

Suicide rates rise sharply across the United States, new report shows

  •  Health Blog •

This article was originally published by The Washington Post.

This post has been updated.

Suicide rates rose in all but one state between 1999 and 2016, with increases seen across age, gender, race and ethnicity, according to a reportreleased Thursday by the Centers for Disease Control and Prevention. In more than half of all deaths in 27 states, the people had no known mental health condition when they ended their lives.

In North Dakota, the rate jumped more than 57 percent. In the most recent period studied (2014 to 2016), the rate was highest in Montana, at 29.2 per 100,000 residents, compared with the national average of 13.4 per 100,000.

Only Nevada recorded a decline — of 1 percent — for the overall period, although its rate remained higher than the national average.

Increasingly, suicide is being viewed not only as a mental health problem but a public health one. Nearly 45,000 suicides occurred in the United States in 2016 — more than twice the number of homicides — making it the 10th-leading cause of death. Among people ages 15 to 34, suicide is the second-leading cause of death.

The most common method used across all groups was firearms.

“The data are disturbing,” said Anne Schuchat, the CDC’s principal deputy director. “The widespread nature of the increase, in every state but one, really suggests that this is a national problem hitting most communities.”

It is hitting many places especially hard. In half of the states, suicide among people age 10 and older increased more than 30 percent.

Percent change in annual suicide rate* by state, from 1999-2001 to 2014-2016 (Centers for Disease Control and Prevention)

“At what point is it a crisis?” asked Nadine Kaslow, a past president of the American Psychological Association. “Suicide is a public health crisis when you look at the numbers, and they keep going up. It’s up everywhere. And we know that the rates are actually higher than what’s reported. But homicides still get more attention.”

One factor in the rising rate, say mental health professionals as well as economists, sociologists and epidemiologists, is the Great Recession that hit 10 years ago. A 2017 study in the journal Social Science and Medicine showed evidence that a rise in the foreclosure rate during that concussive downturn was associated with an overall, though marginal, increase in suicide rates. The increase was higher for white males than any other race or gender group, however.

“Research for many years and across social and health science fields has demonstrated a strong relationship between economic downturns and an increase in deaths due to suicide,” Sarah Burgard an associate professor of sociology at the University of Michigan, explained in an email on Thursday.

The dramatic rise in opioid addiction also can’t be overlooked, experts say, though untangling accidental from intentional deaths by overdose can be difficult. The CDC has calculated that suicides from opioid overdoses nearly doubled between 1999 and 2014, and data from a 2014 national survey showed that individuals addicted to prescription opioids had a 40 percent to 60 percent higher risk of suicidal ideation. Habitual users of opioids were twice as likely to attempt suicide as people who did not use them.

High suicide numbers in the United States are not a new phenomenon. In 1999, then-Surgeon General David Satcher issued a report on the state of mental health in the country and called suicide “a significant public health problem.” The latest data at that time showed about 30,000 suicides a year.

Kaslow is particularly concerned about what has emerged with suicide among women. The report’s findings came just two days after 55-year-old fashion designer Kate Spade took her own life in New York — action her husband attributed to the severe depression she had been battling.

“Historically, men had higher death rates than women,” Kaslow noted. “That’s equalizing not because men are [committing suicide] less but women are doing it more. That is very, very troublesome.”

Among the stark numbers in the CDC report was the one signaling a high number of suicides among people with no diagnosed  mental health condition. In the 27 states that use the National Violent Death Reporting System, 54 percent of suicides fell into this category.

But Joshua Gordon, director of the National Institute of Mental Health, said that statistic must be viewed in context.

“When you do a psychological autopsy and go and look carefully at medical records and talk to family members of the victims,” he said, “90 percent will have evidence of a mental health condition.” That indicates a large portion weren’t diagnosed, “which suggests to me that they’re not getting the help they need,” he said.

Cultural attitudes may play a part. Those without a known mental health condition, according to the report, were more likely to be male and belong to a racial or ethnic minority.

“The data supports what we know about that notion,” Gordon said. “Men and Hispanics especially are less likely to seek help.”

The problems most frequently associated with suicide, according to the study, are strained relationships; life stressors, often involving work or finances; substance use problems; physical health conditions; and recent or impending crises. The most important takeaway, mental health professionals say, is that suicide is an issue not only for the mentally ill but for anyone struggling with serious lifestyle problems.

“I think this gets back to what do we need to be teaching people — how to manage breakups, job stresses,” said Christine Moutier, medical director of the American Foundation for Suicide Prevention. “What are we doing as a nation to help people to manage these things? Because anybody can experience those stresses. Anybody.”

The rates of suicide for all states and the District of Columbia were calculated using data from the National Vital Statistics System. Information about contributing circumstances for those who died by suicide was obtained via the National Violent Death Reporting System, which is relatively new and in place in only 27 states.

“If you think of [suicide] as other leading causes of death, like AIDS and cancer, with the public health approach, mortality rates decline,” Moutier said. “We know that same approach can work with suicide.”

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Get to Know the In It Together Health Literacy Project

 

Event Date: Thursday, June 14, 2018 – 2:00pm to 3:00pm EDT

Event Type: Webinar / Teleconference

ACE TA Center

Register for the Webinar

Better health starts with health literacy!

Register and join(link is external) this webinar to learn about:

  • How limited health literacy impacts the health of people living with HIV
  • How to identify when a client is struggling with health literacy
  • Approaches and resources you can use to promote health literacy for your clients
  • The cultural, social, and environmental factors that can impact the health literacy of racially, ethnically, culturally, and linguistically diverse people
  • How In It Togetherresources could benefit your organization or community

In this webinar, two In It Together trainers will also share their experience providing the community health literacy training in their own communities. Join the webinar to learn how you or someone at your organization can to become a health literacy community trainer.

Intended Audience954627 954627

This training webinar will be especially useful to program managers, clinical staff, health educators, case managers, staff that conduct outreach, as well as other staff that provide HIV care or supportive services.

 

HRSA Awards $2.8 Million in Grants to Community-based Organizations to Help Americans Get HIV/AIDS Care and Support Services

Congress is hyperfocused on opioids. Is it focusing enough on addiction?

Controversy over one bill that could fragment care for people with substance use disorder raises serious questions.

Still life. Oxycodone. Oxycodone is a narcotic pain reliever. Oxycodone has a high abuse potential and is prescribed for moderate to high pain relief associated with injuries, bursitis, dislocation, fractures, neuralgia, arthritis, and lower back and cancer pain. OxyContin, Percocet, Percodan, and Tylox are trade name oxycodone products. (Photo by: Education Images/UIG via Getty Images)
STILL LIFE. OXYCODONE. OXYCODONE IS A NARCOTIC PAIN RELIEVER. OXYCODONE HAS A HIGH ABUSE POTENTIAL AND IS PRESCRIBED FOR MODERATE TO HIGH PAIN RELIEF ASSOCIATED WITH INJURIES, BURSITIS, DISLOCATION, FRACTURES, NEURALGIA, ARTHRITIS, AND LOWER BACK AND CANCER PAIN. OXYCONTIN, PERCOCET, PERCODAN, AND TYLOX ARE TRADE NAME OXYCODONE PRODUCTS. (PHOTO BY: EDUCATION IMAGES/UIG VIA GETTY IMAGES)

Congress is trying to pass legislation that addresses the opioid crisis in an election year, so they’re moving fast, passing a bill through committee Thursday that would free up Medicaid dollars for opioid addiction treatment in institutionalized care. But it could be more harmful than lawmakers realize.

Rep. Greg Walden (R-OR) is aiming for the House to take up legislation in June. So to keep with schedule, the House Committee on Energy and Commerce — on which Walden serves as chairman — advanced 32 bills on Thursday, after unanimously advancing another 25 bills last week. The Senate health committee passed its legislative package in April

While lawmakers agree it’s critical to address an epidemic where more people died of a drug overdose in 2016 than the aggregate of the Vietnam War, they don’t always jibe on how.

A question some lawmakers and journalists often ask is whether Congress is too closely targeting opioids, as the epidemic is a problem of polydrug misuse. Bloomberg’s editorial board warned “lawmakers need to take benzodiazepines seriously, before it’s too late.” (Overdose deaths associated with benzodiazepines are fewer than opioids, but still eight times what it was in 1999.)

“I’m concerned that here in Congress we’re so focused on opiates as the drug de jure, if you will, and that in five years or so when this crisis ends or abates or tapers that we’re going to have a bunch of federal programs that are specifically aimed at a problem that may not be as significant,” said Sen. Lisa Murkowski (R-AK) in April.

This point was raised again on Thursday when House members debated, largely along partisan lines, whether to advance the bill to allow Medicaid dollars to be used for opioid addiction treatment in certain treatment facilities.

“With 115 Americans dying each day, we have to focus on the opioid crisis,” said Rep. Mimi Walters (R-CA), the bill’s sponsor. “While we agree that all substance use disorders are important, we’re prioritizing our resources to address the opioid crisis.”

Walters was immediately met with resistance from Democrats.

“I’m troubled that this bill would expand treatment only to people with opioid use disorder as opposed to those with other substance use disorders like alcohol, crack-cocaine, methamphetamine,” said Rep. Jan Schakowsky (D-IL). “This bill is not only blind to the reality faced by people suffering from substance use disorder but it’s also discriminatory.”

Given that the bill exclusively helps those struggling with opioid use disorder, lawmakers are making it clear they only care when white constituents are dying, said Rep. Bobby Rush (D-IL).

“Too often, Mr. Chairmen, this committee and this House have paid attention to issues only when they affect the majority — the majority of the white population,” said Rush. “This leaves too many Black Americans behind.”

The measure would partially and temporarily repeal Medicaid’s Institutions for Mental Disease (IMD) exclusion, meaning it would allow federal Medicaid dollars to pay for opioid use disorder treatment up to 30 days in facilities with more than 16 beds. It would only repeal the ban until December 2023.

Currently states seek federal permission, by waiver, to relax the IMD exclusion for substance use disorder (SUD) treatment. Ten states have these waivers, with California being the first in 2015 to get the okay from the Obama administration.

“We don’t yet know what the utilization of this service looks like, as the program is so new, but it’s worth noting that the IMD exclusion exemption in California’s program is just one piece of a larger system,” said senior program officer at the California Health Care Foundation Catherine Teare, who worked extensively on the state’s waiver. “It’s not specific to opioids or any other particular substance, and it’s embedded within a system that provides access to a full continuum of evidence-based SUD services — based on the American Society of Addiction Medicine criteria.”

Sometimes that care is residential, and sometimes it’s not. People might start their recovery process in inpatient rehab, but then need community-based services to maintain sobriety. In 11 California counties, Medicaid not only pays for residential treatment but a host of other services:

Screenshot of The Drug Medi-Cal Organized Delivery System Pilot Program
SCREENSHOT OF THE DRUG MEDI-CAL ORGANIZED DELIVERY SYSTEM PILOT PROGRAM

It also forced relationship-building between primary care, mental health, and substance use treatment providers.

This is another reason why health experts are wary of Walters’ bill.

“I’m fine with paying for the residential component of care, but only if linked to an enduring care plan, such that a person would get more than that,” said Keith Humphreys, a drug policy expert at Stanford University. “Otherwise I think we’ll just spend a lot of money on expensive inpatient stays that don’t have any follow-ups, and the history of that is it’s actually worse than nothing because a person loses their tolerance and they’re even at a higher risk for overdosing than they were when they started.”

It just doesn’t work to build a system where people cycle in and out of institutions, Humphreys added.

Various Republican lawmakers pointed out during the hearing on Thursday that it took months for states to get the federal government to approve their waivers — which is concerning given how many people die a day on average from drug overdoses. For example, West Virginia applied in December 2016, but didn’t get approved until October 2017. For that, Republicans reasoned it just makes sense to lift the ban altogether.

But it’s also important to remember that Congress only has a limited amount of money dedicated to this drug crisis, and IMD repeal could be expensive.

“The cost of inpatient care typically ranges from $6,000 for a 30-day program to $60,000 for 90-day programs, while community-based outpatient services cost around $5,000 for three months of services. That means that any repeal of the IMD would require significant offsets,” according an analysis by the Center on Budget and Policy Priorities (CBPP). Experts at CBPP don’t support a repeal.

Hannah thank you for saying like it is.

Hannah Katch@hannahkatch

Repealing ‘s restriction against payment for institutional care, known as the “IMD exclusion,” would not solve the epidemic — it would risk worsening care for people who need treatment. @JudyCBPP and I explain: https://www.cbpp.org/research/health/repealing-medicaid-exclusion-for-institutional-care-risks-worsening-services-for 

Repealing Medicaid Exclusion for Institutional Care Risks Worsening Services for People With…

Opioid use caused over 42,000 deaths in 2016, and drug overdose deaths rose by statistically significant amounts in 27 states that year, according to the Centers for Disease Control and Prevention….

cbpp.org

The Congressional Budget Office is reportedly working on a score for the bill, but a GOP committee aide told Modern Healthcare that the agency has said repeal is in the “low single digit billions.” IMD exclusion for both mental health and SUD services without day limits would cost up to $60 billion over 10 years.

The worry is money will go to measures that further fragment care for people with substance use disorder, rather than investing in the continuum of care model. Alternatively, for states to secure a SUD waiver, they need to show how inpatient and residential care will supplement community-based services. This can work really well, just look at Virginia.

The House Committee on Energy and Commerce did pass several measures that seem small, but could do a lot of good. Some even addressed fentanyl, which is now the dominant cause for drug overdoses, with fentanyl-laced cocaine potentially becoming the next wave of the opioid crisis. For example the STOP Fentanyl Deaths Act of 2018 authorizes grants for federal, state, and local agencies to create or operate public health laboratories to detect the illicit, synthetic opioid.

Humphreys’ advice: Congress should pass targeted bills addressing the supply side of opioids — but aim for more comprehensive bills when it comes to treatment.

After a Big Buildup, the Trump Administration’s Drug Pricing Plan Doesn’t Deliver

 

Last Friday, President Trump and Secretary of the Department of Health and Human Services Alex Azar unveiled the administration’s plan to lower prescription drug prices, but health policy experts are warning that the proposals fall short of the promises he made on the campaign trail and will do little to address the root causes of the issue. The plan received criticism for being too easy on pharmaceutical companies for their role in the seemingly exponential recent rise in drug prices. President Trump, who once accused the pharmaceutical industries of “getting away with murder” sang a more sympathetic tune last week. Several central tenets of his plan actually support the industry by aiming to increase competition and negotiating power – though not, however, directly for Medicare Part D, as then-candidate Trump touted as his plan during his campaign.

Secretary Azar further clarified the President’s plans in a speech Monday, focusing mostly on the role of Pharmacy Benefits Managers (PBMs), companies that act as middlemen in drug negotiations between insurers and manufacturers. Azar will seek to restrict how much and from where PBMs can collect revenue during their negotiations. The lack of action regarding pharmaceutical manufacturers comes as no surprise to most, considering Secretary Azar’s history as a former industry leader himself.

Also as a part of the administration’s overall efforts to decrease drug prices, the Food and Drug Administration released new data on Thursday about which pharmaceutical companies were potentially “gaming” the drug pricing system by blocking access for other corporations to develop generic (and cheaper) versions of their products.

This national conversation about drug pricing is one that has been ongoing in the HIV community for years, from the creation of the AIDS Drug Assistance Program to subsidize exorbitant HIV medication costs in the 1980s to the prohibitively high cost of one of the only FDA-approved PrEP drugs, Truvada. Most people living with and at risk for HIV are able to get the medications they need thanks to what HIV activist Tim Horn terms the “patchwork of coverage” in place to pay for HIV-related treatments; however, AIDS United will continue to monitor any legislative or regulatory changes proposed by this administration regarding drug pricing and will work to ensure access to these lifesaving drugs is only increased.

Elevating Trans Voices

I am Joi-Elle White, and I work at Positive Impact Health Centers (PIHC). I am an HIV Educator and soon will become a Prevention Specialist. I’ve been at PIHC for a year but have been in this field for 16 years. I started out as an outreach volunteer for Hudson Pride Connections in New Jersey when I was going to their transgender group called G.L.I.T.Z. (Girls Living in the Trans Zone).

My lived experiences got me involved in this work. I faced rejection, discrimination, sexual and physical assault, homelessness, and other bumps in my journey. And some of my experiences I would not wish on anyone, let alone the younger generation. I can’t stop any of that from happening and we all will have to come across them. So my plan was to learn a way to help the youth through whatever life can throw at us.

I was so excited to be put on the Transgender Leadership Initiative project at PIHC, where I was part of creating applications, policies, and curriculums, as well as facilitating an eleven-session leadership program called TRANSitioning to Leaders Academy (T2L). I was part of recruiting twelve transgender ladies to compete the academy.

T2L’s goal was to help bring the leadership skills out in these ladies so the transgender community can have a voice on the HIV planning council and anywhere else their voices can be heard. T2L was unique because it was “for us, by us.” Three transgender women and a cisgender woman created the curriculums and facilitated the sessions.

We need as many voices and people as possible to help us get rid of the stigma, myths, discrimination, lack of Medicaid coverage, and, last but not least, lack of education. Those are a few of the barriers we face. It’s important for us to keep talking about HIV to educate society. I would like people to get tested and learn their status. Knowing your status is the first step towards reducing the risk of spreading HIV. G.I. Joe said it best: “Knowing is half the battle.”

Additionally, we need to create our own platforms, forums, and panels all over on TV screens, radios, and magazines. It’s also important for organizations to hire transgender people. Not only will it give the transgender community a friendly face of someone who has walked in their shoes, it also gives us an opportunity to be part of the change we want to see.

I believe what keeps me motivated is every time I hear or see a law that has changed to benefit the transgender community and seeing more transgender people joining the fight. Hearing a transgender male or female say to me, “I am working,” or “I got my keys to my apartment,” knowing that they reached their goal – that motivates me.

Joi-Elle White is an HIV Health Educator in Atlanta, Georgia. Through Positive Impact Health Centers, a grantee of AIDS United’s Transgender Leadership Initiative, Joi-Elle and her colleagues created a leadership course for transgender individuals to increase participants’ HIV knowledge and to improve HIV service delivery, health and social justice outcomes for their peers. Joi-Elle has been doing HIV work for over fifteen years. 

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Why Are Older Adults with HIV at Increased Risk for Multimorbidity

NMAC

 

 

Advocacy and Education Webinar Series
Please join us for our next webinar!
Why Are Older Adults with HIV at Increased Risk for Multimorbidity?
By Dr. Stephen Karpiak
Friday, April 6th, 2018 – 3:00 PM to 4:00 PM EST
Registration URL: https://attendee.gototraining.com/r/1280203559206296322
(After registering you’ll receive a confirmation email with information about joining the training.)
As people living with HIV experience longer lives, healthcare providers are spending less
time managing HIV-related issues and more time managing age-associated illnesses.
Multimorbidity refers to several serious health conditions that cannot be cured to any
great extent, occurring in an older person and engendering functional and/or cognitive
debility. Join us as we explore this topic with national expert on HIV and aging, Dr.
Stephen Karpiak from ACRIA.
Stephen Karpiak PhD is the Senior Director for Research at the ACRIA Center on HIV &
Aging at GMHC, where he launched ROAH, the seminal Research on Older Adults with HIV,
and supervised clinical trials for HIV drugs. He is a member of the Einstein-Rockefeller-Hunter
Center for AIDS Research, Editorial Board HIV-AGE (www.HIV-AGE.org) American Academy of
HIV Medicine, the American Geriatrics Society, and, the UN Aging Committee. Dr. Stephen is on
faculty at NYU and has published over 150 peer reviewed scientific papers.
Website: http://www.SEKPhD.com