One person dies by suicide in the United States on average every twelve minutes. The CDC estimates that 44,965 Americans died by suicide in 2016. Suicide is the number one cause of death in 15-24 year olds and in 25-34 year olds after “unintentional accidents” some of which we know are actually suicides; 51% are by firearms, 26% are by suffocation, and 14% are by self poisoning. To put this into perspective, one person will die of suicide by the time you finish reading and reflecting on this!
There are many causes of suicide. These include intrapsychic, cognitive, interpersonal, biological, neurotransmitter dysfunction, neural circuit dysfunction, environmental stressors, alcohol, drugs, family dysfunction, and in teens and young adults some would add antidepressants (though I disagree). We know, for example, that depressed patients have low levels of serotonin metabolites in their CSF and that these are even lower in those who are suicidal. We know that the hippocampus, the seat of memory in the brain, is smaller in suicide attempters. We know that beliefs contributing to suicide include “Death is a solution for my problems”, “I deserve to die”, “They’ll be better off without me”, “Death will end my pain”, and “They will be sorry” among others.
Sadly we also know that physicians, nurses, psychotherapists, and other health care professionals do an inadequate job of identifying the suicidal patient and intervening to save that person’s life. One study of 5,894 individuals who died by suicide found that 835 had received health care in the year prior to their death. Only 50% of these 835 had received a mental health diagnosis. Only 24% had received one in the past month.
We physicians, nurses, and psychotherapists must do a better job of this. And we know it. There are many obstacles including a lack of awareness, a lack of knowledge of who do we ask about suicide, how do we ask about suicide, what do we ask about suicide, and how do we apply this information to save lives. A recent study of primary care physicians revealed that 52% believe that it is difficult to maintain compassionate care with teenagers who deliberately self harm, the majority perceive communication with teenagers to be difficult and frustrating, and 75% said that they would be interested in receiving further training on assessing and managing young patients at risk of suicide.
How about you?