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.

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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.

 

IHAP Webinars Upcoming Webinars

https://careacttarget.org/library/ihap-webinars?eType=EmailBlastContent&eId=c1b5bd96-8517-4513-b52b-bc10dea856c1

08 Harvard Study puts Puerto Rico Hurricane Maria Death Toll in the Thousands

 

Last week, a Harvard T.H. Chan School of Public Health study made headlines by estimating the actual number of deaths in Puerto Rico associated with Hurricane Maria as 4,645. While the official government count, which only includes deaths directly attributable to the storm itself, is just 64 the Harvard study estimated that anywhere between 793 and 8,498 deaths (4,645 is the median between these two figures) were likely caused by the storm, mostly due to delayed medical care stemming from the slow recovery response.

 

While the potential range may be wide, there is additional evidence that the botched response to Maria did lead to large numbers of potentially avoidable deaths, and these other estimates do fall within the range identified by the Harvard researchers. University of Puerto Rico statistician Roberto Rivera, along with colleague Wolfgang Rolke published an analysis in February concluding that in the first six weeks after Hurricane Maria, the death count was between 605 and 1,039. Other researchers have also estimated a death toll in the ballpark of 1,000, including the New York Times. Months ago, the government in Puerto Rico commissioned a study to examine the death toll by the George Washington University Milken Institute School of Public Health. That study is ongoing.

 

Either way, one thing is certain. Hundreds, and potentially thousands of Puerto Ricans died — many unnecessarily — because of a lack of preparedness and a lack of urgency in our nation’s response to the island’s crisis. And while we don’t have specific figures on the number of these deaths related to delayed care involve HIV, we know that Puerto Rico was already struggling to keep up with the need for HIV services before the hurricane. The island has over 20,000 people living with HIV, placing it squarely in the top 10 U.S. states and territories for total HIV cases.  Puerto Rico fares even worse in health outcomes, with the highest HIV death rate in the country. In that environment, it’s hard to imagine a scenario in which major interruptions to medical supply chains and service provision wouldn’t devastate residents living with HIV.

 

We reached out to AIDS United partners working on the island, Anselmo Fonseca and Rosaura López-Fontánez to get their take on these new figures and to give us an update on what they’re seeing on the ground.  Here’s what we heard back:
Recognizing that [Hurricane] Maria was an unprecedented natural disaster, the local, state, and federal governments all share equal negligence for the loss of human life and perpetuated devastation. This was criminal!

– Anselmo Fonseca, President, Pacientes de SIDA pro Política Sana; Chair, Cero VIH Puerto Rico; Ryan White Part-B Community Co-Chair (San Juan, PR)

Hurricane Maria not only devastated our country, she demonstrated to the world and ourselves that our island is a territory controlled by the United States, that has always looked at us with indifferences, with disrespect and consideration at every level.  The survey accomplished by [Harvard]  University…demonstrates a reality that the government of Puerto Rico at 9 months of the passing of Maria continues avoiding.  Hurricane season began on June 1st, and with it, families continue without electricity and a roof over their heads, people living in their vehicles, unattended by the local and federal agencies called to ensure their social welfare… finally they have left us with no hope.

I ask myself: Where are the people that govern my country?  To whose interest do they respond? Why and what are the reasons for their continued indifferences? Puerto Rico continues in national mourning.

– Rosaura López-Fontánez, MSW/LCSW, Executive Director Puerto Rico CoNCRA

Anthony Bourdain’s death is one in a growing public health tragedy

Suicide rates have risen in almost every state in the US in the past two decades.

Between 1999 and 2016, suicide rates rose in nearly every state in the union, with 25 states showing increases of more than 30 percent.
 Slaven Vlasic/Getty Images

The suicide deaths of chef, author, and TV host Anthony Bourdain and fashion designer Kate Spade this week are stories of lives cut short for reasons we’ll never fully understand. But these anecdotes are also a reminder of a serious public health issue in America that needs far more attention.

According to data from the Centers for Disease Control and Prevention, released on June 7, suicide rates have increased significantly across the US. Between 1999 and 2016, suicide rates rose in nearly every state in the union, with 25 states showing increases of more than 30 percent.

The central and northern parts of the US — North Dakota, Wyoming, Montana, Minnesota — saw some of the greatest rises in suicide rates.

Percentage change in annual suicide rate, by state. United States between 1999 to 2001 and 2014 to 2016.
 CDC

In North Dakota, for example, the suicide death rate increased by nearly 60 percent since 1999. Nevada was the one state that saw no increase — but the rate there remained “consistently high throughout the study period.” The suicide rate in Nevada is currently 21 per 100,000 deaths, greater than the national average of 13 deaths per 100,000. (You can see other state-specific rates here.)

In 2016, nearly 45,000 Americans died by suicide — making it the 10th most common cause of death in the US, and one of only three leading causes that are increasing, according to the CDC.

One of the most disturbing aspects of the report: More than half of the people who died by suicide had no known mental health problems. Instead, the CDC said, “Relationship, substance use, health, and job or financial problems are among the other circumstances contributing to suicide.” Also disturbing: 48 percent of the suicides occurred by firearms — another reminder that while the homicides in America’s gun crisis get a lot of public attention, suicides by gun are far more common.

“At what point is it a crisis?” Nadine Kaslow, a past president of the American Psychological Association, asked the Washington Post. “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.”

The majority of the suicide deaths not linked to mental health problems involved midlife white males

The vast majority of suicides that weren’t linked to a known mental health problem in the CDC study involved middle-aged white males — yet another reflection of a growing tragedy in the US.

Life expectancy keeps dropping in the US, and researchers have explained the decline, in part, by an increase in “deaths of despair”: suicides, alcoholism, and drug overdoses, particularly from opioid painkillers, are a rising problem for midlife white people.

Along with worsening job prospects over the past several decades, this group has seen their chances of a stable marriage and family decline, as well as their overall health. To manage their despair about the gap between their hopes and what’s come of their lives, they’ve often turned to drugs, alcohol, and self-harm.

Meanwhile, gains in fighting heart disease have stalled as rates of obesity and diabetes have ploddingly climbed.

So the rise in mortality for white middle age people in America since the late 1990s is actually the final stage of a decades-long process. “It’s about the collapse of white middle class,” Princeton University’s Anne Case told Vox. But the deaths of Spade and Bourdain should remind us that people on even the highest rungs of the socioeconomic ladder are not immune.

Sometimes when we hear a trend is “on the rise,” our brains translate that to “everyone is doing it.” Because we are very sensitive to information about what’s normal, it’s important to note: While suicide is the tenth leading cause of death, it’s still rare, and it ought to be rarer, as I reported with my colleague Brian Resnick.

To prevent suicide deaths, a couple of things are clear: Countries that have made it more difficult to access firearms have seen their suicide rates decline. So the evidence suggests that addressing America’s gun problem would certainly help. The CDC report also calls for a comprehensive approach to prevention, including “strengthening economic supports” through housing and financial policies, and “promoting social connectedness.”

“Suicidologists regularly state that suicide is not caused by a single factor,” the CDC said. And as this new report clearly shows, the causes of suicide are much broader than just mental health conditions. We need suicide prevention policies and strategies that reflect that.


After 37 Years We Can Finally End the HIV Epidemic. The Question Is, Will We?

SLOGAN 1

With one now very big exception, nothing really notable happened on June 5, 1981. The then little-noticed exception was found in the publication of the CDC’s Morbidity and Mortality Weekly Report which noted that a rare form of pneumonia had been diagnosed among five “active homosexuals” in Los Angeles. The report said that the men were treated at 3 different hospitals and that two of the men had died. Three of the men had been previously healthy according to the report.

There was little immediate reaction in the public to the MMWR report here in the United States or around the world. The Associated Press and the Los Angeles Times filed stories about the report on June 5th and the San Francisco Chronicle ran an article on June 6th. This may seem strange today, when “Breaking News” is a daily feature of our lives and social media can make even the smallest news item known worldwide instantly. The New York Times, the “paper of record,” did not do an article following up on the report until a month later, in its July 3rd issue. The Times article reported on what by then were 41 cases of a rare form of cancer among homosexual men in New York and California. Reading the article that day on the eve of the July 4th holiday as a gay man living in New York City, I thought it was a strange story, but had no idea that my world, and indeed the whole world, was about to change drastically. I certainly had no idea that I was witnessing the beginning of what would become one of the worst pandemics in history.

The immediate reaction to the June 5threport was slow but the pace of varied responses and reactions built up quickly. By mid-August Larry Kramer pulled together a group of gay men that raised immediate funds and led to the formation of Gay Men’s Health Crisis (GMHC) in January 1982, the nation’s first community-based AIDS service provider. Along with that activist response, there was fast-growing fear among many gay men, increased stigmatization of gay men and of gay sex (including internalized stigma) and stigmatization of injection drug users and of drug use in general, increased discrimination, and blindness to the impact of the emerging epidemic on women who did not have a history of drug use, gay and bisexual men of color, and other men who have sex with men.

There was also much hope and optimism in those early years that a cure for AIDS would be found quickly. However, the more dominant reaction among the general public and most levels of government was the willful and shameful ignorance of the emerging AIDS epidemic and neglect of, animosity towards, and abhorrence of people living with and dying of the newly recognized disease. The stigma, discrimination, and neglect all but extinguished the hope of a cure inspired by the active and activist response to AIDS. When I was 41 years old and diagnosed with HIV infection in 1989, I was convinced that I would be dead before my 50th birthday.

Hope and optimism in the fight against AIDS and HIV infection was rebounding by the 15th anniversary of the AIDS and HIV pandemic on June 5, 1996. The growing proof of the effectiveness of highly active antiretroviral therapy (HAART) in saving lives of people living with AIDS heralded a new era of HIV treatment. The theme of that year’s International AIDS Conference, “One World, One Hope,” articulated the resurgent optimism.

The revival of hope and optimism was soon challenged by the clear inequities and gaps in access to the new, effective drug therapies and gaps in access to HIV prevention education and services. The themes of the 1998 and 2000 international conferences were “Bridging the Gaps” and “Breaking the Silence.” The June 5th anniversaries of the HIV pandemic were grim reminders of the toll that HIV disease had taken on our lives and on our communities. The light at the end of the tunnel provided by effective treatments was eclipsed by continued stigma, discrimination, and the blatant lack of sufficient political will to conquer HIV infection and disease within governments here in the United States and around the world. Progress and the ensuing hope and optimism were being kept alive by the magnificent courage and determination of people living with and affected by HIV, health care and service providers, HIV-focused researchers, and HIV advocates.

June 5, 2018, the 37th anniversary of the HIV pandemic is now here. We are still counting the years of HIV disease. We have at least two generations of people who have never known a world without AIDS. But we do have the proven and effective treatment and prevention tools to end the HIV epidemic here in the U.S. and globally. We have powerful messages such as “Treatment is Prevention” and “U=U.” I recently celebrated my 70th birthday and I’m more worried about my back than I am about being HIV positive. And I am certainly not the only long-term survivor; there are many thousands of us.

But there is also far too many multiple thousands of people who remain vulnerable to HIV infection or whose HIV infection is undiagnosed or not successfully treated. Yes, there are numerous factors that account for those realities. For me, the salient factor is the continued lack of sufficient political will to end the HIV epidemic. We have a president and an administration that have made little public effort to highlight the priority of ending the HIV epidemic. We have an administration and a congressional majority that work to undermine health care and the various safety nets and entitlement programs that are crucial to Americans, including those of us living with HIV. Thankfully, there are tenacious federal leaders and workers who are moving forward to maintain a strong federal response to HIV. Thankfully, the courage and determination of people living with and affected by HIV, providers, and advocates that have kept hope and optimism alive in the past continue their efforts. But the challenges and barriers posed by the lack of sufficient political will is daunting.

We enter the 38th year of AIDS and HIV still counting. We can end the epidemic, but will we? If the political landscape does not support our efforts, then we must work together to change it; to elect leaders that have the political will to move us forward and not backward. The June 5, 2019 anniversary can be a marker on the countdown to ending the HIV epidemic. Yes, we can. More importantly, we must.

Posted By: Ronald Johnson, Policy Fellow, AIDS United – Monday, June 04, 2018

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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