org355: Suicide in the USA

From the New York Times

The practice of epidemiology is often dominated by the "determinants" aspect, with less priority/prestige on the "distribution" side. I appreciate this article because of how a very simple descriptive (distribution) statement sparks a lengthy discussion of potential determinants.

"In data released in 2017, the rate for white Americans was around 19 per 100,000, and it was about 7.1 for both Hispanics and Asian-Americans/Pacific Islanders, and 6.6 for Black Americans, according to the Centers for Disease Control and Prevention."

"Suicide rates are highest among Native American and Alaska Native populations: 21.8 per 100,000 people"

1. Let's say you are in charge of a funding agency. What hypothesis mentioned here is the one for which you would prioritise funding for a study? Why?

1b. What are the modifiable risk factors mentioned in the article?

2. At the end of this article (and indeed any article concerning suicide in reputable, mainstream print media), editors have appended a statement for self-referral. I've included the statement used for articles published in The Guardian, below. You won't see statements like this with articles about other health conditions. Why?

In the UK and Ireland, Samaritans can be contacted on 116 123 or email jo@samaritans.org or jo@samaritans.ie. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at www.befrienders.org.

Re: Suicide in the USA

by | ARDELE MAUREEN MANDIRIRI - Tuesday, 5 January 2021, 6:51 AM

1)Hypothesis- Suicidal rates in native American and Alaska are higher compared to rates in other ethnics groups in America.
1.1) Why - If the hypothesis is proven to be true, several underlying factors for this inequitable rates distribution as cultural/racial discrimination might need to be addressed.
1b) Modifiable factors-mechanism of death/access to firearms, poverty and unemployment(economic indicators/determinants).
2) Could it be that people with suicidal ideation are likely to read on suicide
before the act?. This is interesting, I await to hear from the discussion other thoughts.

Re: Suicide in the USA

by | JUDITH MARGARET BURCHARDT - Tuesday, 5 January 2021, 11:03 AM

Thanks Sujit for posting on this distressing and important topic.

I agree with all your points Ardele. It would be interesting to see if the association between racial group and suicide was confounded by poverty, alcoholism, drug use, gun ownership and unemployment.

It is intriguing that Black and Latino populations are at lower risk. As the article mentions, closer family and community ties, religious faith and and a less individualistic mindset are possible reasons. These are more difficult to quantify than the other possible confounders.

I listened to a podcast from the Tavistock clinic about suicide and was struck by the psychiatrists saying that this was often an impulsive act, committed within less than an hour of the idea. Also, that when people are stopped, they are usually glad about this afterwards. I suppose this may be related to the article by saying what a very lonely thing suicide is and that people with more social connection may be more protected. As a GP it is notable how women with children almost always say they wouldn't commit suicide as they couldn't do that to their children. Having a feeling of meaning, purpose and responsibility in life is a strong protective factor.

Some psychoanalysts think that suicide can be interpreted as an aggressive act towards those left behind. I think this is an intriguing hypothesis, but am not aware of any evidence for it, except that of course suicide causes great pain to grieving families, friends and colleagues.

There is also a "contagious" element to it - people are more likely to commit suicide if they learn that others have done so. I guess this is one reason for the information about sources of help at the end of newspaper articles. I imagine that researchers reading papers are thought to be less impressionable than members of the public, but I don't know if this is actually the case?

Judith

Re: Suicide in the USA

by | Katherine Carr - Wednesday, 6 January 2021, 8:54 AM

1. There are two hypotheses that I would prioritise for funding a study:

To what extent are deaths of Black Americans being misclassified as accidents or other rather than suicide?

Are suicide rates for indigenous peoples higher than non-indigenous peoples across other countries? -

( I did a quick check and in Canada the rate for indigenous people is 3x higher than for non-indigenous people. The rate for female First Nations people in Canada was 35 per 100,000 - even worse than the rate for indigenous people in US)

1b. Modifiable Risk Factors: unemployment, stress, threat to wellbeing, alcohol or drug use,

2. I was aware of the phenomena but not the name of it. Apparently there is a risk of 'suicide contagion' - exposure to media reports or suicide in your peer group or family increases suicidal behaviours. (https://www.hhs.gov/answers/mental-health-and-substance-abuse/what-does-suicide-contagion-mean/index.html) I believe this is also the case for anorexia and eating disorders - that reading about it online can increase likelihood of engaging in these behaviours.

Finally - an interesting fact that was in the article I found quite amazing: "most gun deaths in America are suicides not murder". !

Re: Suicide in the USA

by | FATHIMA MINISHA - Thursday, 7 January 2021, 4:03 AM

Hi Sujit and everybody...
It's good to be back here after the break!
Thank you for your posts guys- very interesting. Frankly, the results are a bit shocking for me. I was expecting quite the opposite, with suicide rates higher in the minority ethnic groups due to the various confounding factors mentioned in the article. Of course, this also depends on how a case of death by suicide has been defined since there is always a possibility of misclassification, as mentioned by the others. It could be that accurate identification of death by suicide is more in white Americans- but then again, that is speculation. The factors mentioned in the article, like larger family groups, religion, more single parents, gives a new perspective to the possible better mental health of the minority groups. It makes me think that the numbers mentioned in the article are closer to reality...
The modifiable risk factors mentioned in the article include alcohol/ drug abuse, lack or incomplete education, lack of a sense of purpose (unemployment or no family ties), and perception and awareness about mental health issues.
I was intrigued by the suicide contagion mentioned by Judith and Katherine. This statement is usually mentioned not only for suicide but also for other social problems like domestic violence or mental health (not only after articles but also after any media coverage on these topics). The contagion concept is one thing, but I think one of the other reasons is to increase awareness about what help is available- these problems require active involvement from the public (either the victim or anybody who knows them). The majority of the time, they are not aware of what is available or whom to contact.. This is not the same for other health conditions.

Fathima