Loss of hope fueling suicides

We seldom fully know the reasons for a suicide, but we do know that the number of suicides is increasing at an alarming rate. The United States is the only developed nation with increasing mortality rates. The causes of this recent reversal are “deaths of despair” ‒ preventable deaths due to suicide, drug or alcohol abuse.

Arkansas ranks 14 in the nation in suicide deaths with 547 lives lost in 2018. That’s more than double the number of homicides in Arkansas in 2018. On average, one Arkansan dies by suicide every 16 hours.

The Brookings Institution researchers tell us that deaths of despair occur among people who “lack hope for the future, have high levels of stress and worry, very limited social ties, and poor health due to diabetes, obesity or heart disease.” Of all the markers, though, lack of hope for the future stands out as the most important sign of vulnerability to “deaths of despair.”

They explain that suicides occur more often among people who are not optimistic about their future. Suicide is about a loss of hope and the least hopeful Americans are middle-aged men, without a college education. Deaths of despair are claiming these Americans in alarming numbers. The U.S. male life expectancy has fallen for the past three years.

The highest levels of opioid abuse are occurring in places where jobs are scarce and people are moving away. Losing a job means losing the social ties and sense of community or belonging that a job can provide.

Optimistic people often live longer because they are more likely to engage in healthy behaviors that promote longevity. They’re more likely to avoid risky behaviors that could jeopardize their future. Optimistic people are willing to invest in their future.

The key message for all of us is: Suicide is preventable.

Each of us can help prevent deaths of despair. One obvious way is to get medical attention. This is more likely if patients and their doctors integrate mental health care into the patient’s overall wellness plan. Mental health checkups or screenings should be part of every doctor visit, like checking blood pressure or a blood draw.

A well-publicized study found that suicide victims often visited their doctor in the month prior to their death. For most Arkansans, their primary care or “family” doctor is the only setting in which they are likely to receive mental health care. For a person at risk of suicide, this may be their only chance to get care.

Suicide survivors say that being asked about suicide in a concerned manner often provides some relief. Contrary to a common myth, asking someone about suicide does not “plant the idea” in their head. A person with suicidal thoughts needs to be acknowledged. In her suicide research, Ursula Whiteside, PhD, states, “Many described feeling that they weren’t listened to or understood and this, in itself, was driving their suicidal thoughts.”

About half of us go through at least one mental health crisis during our lifetime. Unfortunately, most people who experience these crises do not receive mental health treatment. Our doctors, sometimes even our closest family or friends, are unaware of the extent of our mental anguish. For some, the outcome is suicide.

Those most at risk for suicide may have a history of bipolar disorder, long-term depression, alcohol or drug abuse, severe concussion or other traumatic brain injury, and serious physical health conditions including acute pain or previous suicide attempts. Drastic personal upheaval due to changes in marital status, job loss, grief or other stressors dramatically increases the risk of suicide and substance abuse.

Not every person with suicidal thoughts requires psychiatric hospitalization, but prompt action is needed. Action can include, but is not limited to, securing a safety plan and removing or reducing lethal means for each care setting. Be sure the person’s doctor knows the extent of their risk by sharing changes in behavior described below. Encourage follow-up appointments with mental health providers. Discuss the person’s safety plan with their family and friends (with patient permission).

Suicide prevention is everyone’s business. Be aware of the warning signs and take action to save lives.

Editor’s note: Dr. Edwards is an AFMC associate medical director. The opinions expressed are those of the author.