Every primary care doctor has had the experience of listening to a very depressed patient explain that things are hopeless, that chronic medical problems or financial setbacks or family conflicts have pushed the patient past his ability to cope, that he can't imagine how things could ever get better, that he would be better off dead.
Unfortunately, suicide in the United States is increasingly common. An article in the CDC's Morbidity and Mortality Weekly Report earlier this month reviewed the suicide statistics between 1999 and 2010. The number of suicides increased by almost a third over that decade, from 29,181 in 1999 to 38,364 in 2010. In 2009 the numbers of suicides surpassed the deaths due to motor vehicle crashes for the first time. Though previously suicide was a problem predominantly among teens and senior citizens, the increase over the last decade has been largely in middle-aged adults. This trend is worrisome to public health officials since current attempts at suicide prevention are not targeted to working age adults.
The cause of this increase in suicides isn't known. In an attached editorial CDC officials speculate about three possible causes. The recent economic downturn certainly may be contributing, as previous difficult economic times have correlated with increases in suicide rates. Another possible cause may relate to the generation of baby boomers themselves. Statisticians call this a cohort effect. Baby boomers had a higher rate of suicide in their teens than prior generations. Perhaps something unique about baby boomers and the times in which they came of age increases their risk of suicide. They certainly were disproportionately involved in the idealism (and radicalism) of the 1960s. It is certainly possible that many of them expected to build a very different world than the one they find themselves in. Finally, prescription pain medications are being prescribed and misused in unprecedented quantities. The authors speculate that the widespread addiction to opiates might be contributing to the increasing frequency of suicide.
Two years ago Freakonomics Radio, the series of podcasts inspired by the bestselling economics book, had a fascinating podcast about suicide. When you have an hour, I highly recommend listening. The podcast mentions that after media reports of suicide, especially in which the victim is famous or portrayed in a positive or sympathetic light, the frequency of suicides increases. Apparently even songs about suicide have been known to trigger "contagions" of suicide. So the media slowly learned to highlight in their stories the grief of loved ones, the disfigurement of the victim's body, the missed opportunities to get help, in an attempt to make suicide less inviting to those who are contemplating it.
So with that in mind, allow me to offer a few personal observations gleaned from caring for many depressed patients during 15 years of practice:
--Depression is treatable. I've seen many hopelessly suicidal, miserably sad patients get better.
--Hopelessness and pessimism are a symptom of the depression, not a rational assessment of the situation. I've cared for people with catastrophic health problems and terrible family and financial situations, but no depression. They didn't want to kill themselves. Depression alters judgment and makes a better future seem impossible.
--Suicide causes permanent grief to loved ones.
--All you have to do is postpone suicide for now, and get help. That doesn't limit your options later. You can always think about suicide again in the future.
So while every primary care doctor has cared for a patient at the depths of depression, we've all also seen them months later after the medications and the talk therapy have started to work. They may still be suffering, but they're glad they're alive and are relieved that they didn't do anything irreversible before. Perhaps now that we know about this trend we can focus more attention on depressed baby boomers and convince them that hope is not lost.
National Suicide Prevention Lifeline
Suicide Rates Rise Sharply in U.S. (New York Times)
Suicides Soar in Past Decade (Wall Street Journal)
Suicide Rate Climbs For Middle-Aged Americans (NPR Shots)
Economic downturn cited as suicide rate jumps for those between 35 and 64 (Daily News)
Suicide Among Adults Aged 35-64 Years--United States, 1999–2010 (Morbidity and Mortality Weekly Report)
The Suicide Paradox (Freakonomics Radio podcast)
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000. Holding privileges at Cedars-Sinai Medical Center, he is also an assistant clinical professor at UCLA's Department of Medicine. This post originally appeared at his blog.