National Suicide Prevention (or Awareness) Month is commonly known to be from 1 to 30 September. The month of September is used to bring awareness and to shed light on a highly taboo and stigmatized subject. Suicide not only affects the one who dies by it, but it also affects those surrounding that person. According to the National Alliance on Mental Illness (NAMI), one person dies by suicide every 16.2 minutes, and two-thirds of those suffer from depression. Suicide can affect anyone regardless of their age, gender, or background. Those who are affected mostly have feelings of shame and are afraid of stigma which prevents them from talking openly. It is important to ensure that individuals, families, and friends have access to resources that they may need to discuss suicide prevention.
It is important to know some of the warning signs and risk factors of suicide. NAMI lists a few, but please bear in mind that these are not all inclusive – excessive worrying or fear, feeling sad or low, thinking about suicide, changes in sleeping habits, overusing drugs or alcohol, extreme mood changes, or avoiding friends or social activities. As much as we hate to admit it, children suffer from suicide as well. Here are some warning signs and risk factors that NAMI lists for children – excessive worry or anxiety, disobedience, aggression, changes in school performance, frequent nightmares, or hyperactive behavior.
In order to promote awareness, we must all have honest conversations about mental health and suicide. ONE conversation CAN change a life! Now, let us get to the statistics of mental health and suicide. This first set comes from NAMI –
- Suicide in the 2nd leading cause of death among people ages 10-34 in the US.
- In 2017, suicide was the 2nd leading cause of death for African Americans, ages 15-24.
- In 2017, suicide was the 2nd leading cause of death for American Indians and Alaskan Natives, ages 10-34.
- American Indians and Alaskan Natives die by suicide at a rate 20% higher than non-Hispanic, white adults.
- In 2017, suicide was the 2nd leading cause of death in the United States for Hispanics, ages 15-34.
- In 2017, suicide was THE leading cause of death for Asian Americans, ages 15-24.
- Research has found that 46% of people who die by suicide had a known mental health condition.
- Risk factors who those who are suicidal or have suicidal ideations are
- Age – those between the ages of 10-34 are at a higher risk
- Family history – those with a family history of mental illness or suicide are at a higher risk
- Gender – men are four times more likely to die by suicide than women
- Those with serious or chronic medical conditions are at a higher risk.
- Other risk factors to consider are those under prolonged stress, have experienced a recent tragedy or loss, have access to firearms, overuse or misuse substances (more than 1:3 people who die by suicide are found to have been under the influence of alcohol).
Other statistics from NAMI include: 1 in 5 US adults experience mental illness each year; 1 in 25 US adults experience severe mental illness each year; and 1 in 6 US youth, ages 6-17, experience a mental health disorder. Half of all lifetime mental illness begins by age 14, and 75% by age 24.
Now let us discuss some statistics from the US Department of Defense (DOD) – 541 service members, both active and reserve, died by suicide in 2018. That means 24.8 out of every 100,00 active personnel, 22.9 out of every 100,00 reserve personnel, and 30.6 out of every 100,000 national guard personnel. Over the past five years there has been an increase in active duty suicides, and over the past two years the pace has remained steady for the reserves and the national guard. According to the 2018 DOD report, the military suicide rate is higher than that of the US overall civilian population. Service members who die by suicide are primarily enlisted, E1-E4, less than 30 years old, and died by firearm. According to the DOD, there was a 6.6% attempted suicide rate in 2018. In 2017, the reported suicide rates for family members of military and veterans, were comparable to that of the US civilian population, with 186 reported death by suicide – that is 11.5 per 100,000 family members.
During times of crisis in the US, we cannot forget our first responders and healthcare workers as well. These statistics will come in part from the Substance Abuse and Mental Health Services Administration (SAMHSA) and in part from the American Foundation for Suicide Prevention (AFSP). According to a 2018 report by SAMHSA, 28% of EMS and paramedics feel like life is not worth living, 10.4% have had serious suicidal ideations, and 3.1% have had a past suicide attempt. Those who have both EMS and firefighting duties have an increased likelihood of reporting a suicide attempt. The 2018 SAMHSA report noted that 46.8% of firefighters reported having suicidal ideals, 19.2% had made plans for suicide, and 3.9% had attempted suicide. This same report noted that when it came to police officers, 25% of female police officers reported suicidal ideations while 23.1% of males reported suicidal ideations. Police officers with burnout showed a 117% greater likelihood of suicidal thoughts than those without burnout.
Reports on physicians are not as current as first responders, but in 2004 the AFSP reported that physicians have higher rates of burnout, depressive symptoms, and suicide risk than the general population. Physicians reported that there are several barriers they experience when seeking mental health care, including time constraints, hesitancy to draw attention, self-perceived weakness, and their reputation. This same 2004 report noted that male physicians have a 1.41 times higher likelihood of suicide than the general male population, and female physicians have a 2.22 times higher likelihood than the general female population. Moving on to nurses! Unfortunately, data on nurses is extremely outdated. There is no evidence that hospitals measure nurse loss due to suicide. Nurses face several risk factors including, but not limited to: ethical conflicts, shift work, social disruption, team conflict, and home stress. There has been minimal attention given to prevent suicide among nurses compared to physicians.
So, we have talked about risk factors and statistics, what about the warning signs? A few warning signs are phrases, such as, “I wish I wasn’t here,” or “goodbye,” or “nothing matters”, increased alcohol or drug use, dramatic mood swings, giving away possessions, impulsive or reckless behaviors, or withdrawing from family and friends.
How do we support someone who we believe is thinking about suicide? First, talk openly and honestly with them – calmly ask simple and direct questions, express support and concern, do not argue with them, do not threaten them, and do not debate with them if suicide is right or wrong. Secondly, remove all things that the person could use to harm themselves – pills, knives, guns. And lastly, be patient. It is ok to talk about suicide! It is time to change the stigma around suicide and start talking about it.
THE TIME FOR CULTURE CHANGE IS NOW!
FIGHT ON, WARRIORS!
National Academy of Medicine
Davidson, J., Mendis, J., Stuck, A., DeMichele, G. and Zisook, S., 2020. Nurse Suicide: Breaking The Silence. [online] National Academy of Medicine. Available at: <https://nam.edu/nurse-suicide-breaking-the-silence/> [Accessed 9 September 2020].
National Alliance on Mental Illness
Nami.org. 2020. Home | NAMI: National Alliance On Mental Illness. [online] Available at: <https://www.nami.org/Home> [Accessed 9 September 2020].
Department of Defense
Lopez, C., 2020. DOD Releases Report On Suicide Among Troops, Military Family Members. [online] U.S. DEPARTMENT OF DEFENSE. Available at: <https://www.defense.gov/Explore/News/Article/Article/1972793/dod-releases-report-on-suicide-among-troops-military-family-members/> [Accessed 9 September 2020].
National Library of Medicine
Dutheil, F., 2019. Suicide Among Physicians And Health-Care Workers: A Systematic Review And Meta-Analysis. [online] National Library of Medicine. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6907772/> [Accessed 9 September 2020].
Substance Abuse and Mental Health Services Administration
Samhsa.gov. 2018. Disaster Technical Assistance Center Supplemental Research Bulletin. [online] Available at: <https://www.samhsa.gov/sites/default/files/dtac/supplementalresearchbulletin-firstresponders-may2018.pdf> [Accessed 9 September 2020].