Summary: Researchers examine why suicide rates may be rising in the United States, arguing that suicidality often involves more than a narrow mental health diagnosis and is tied to broader social and substance-use factors.
Source: The Conversation
Suicide rates in the U.S. have increased by nearly 30 percent in less than two decades, according to the Centers for Disease Control and Prevention. Those stark statistics emerged the same week two highly visible, accomplished figures—Kate Spade, a fashion entrepreneur, and Anthony Bourdain, a celebrated chef and travel-documentary host—died by suicide.
The highly publicized losses helped focus national attention on a growing public health crisis. Suicide is the 10th leading cause of death for Americans overall and the third leading cause of death for youth and young adults. These facts demand a broader conversation about why rates are rising so rapidly and what factors beyond individual psychiatric illness might be contributing.
Suicide: More than a mental health issue
Prevention efforts typically frame suicide as an outcome of depression, anxiety and other mental illnesses. Those conditions are serious, often disabling, and they deserve effective treatment. If you or someone you know is in immediate crisis, contact the National Suicide Prevention Lifeline at 1-800-273-8255.
Still, focusing only on individual mental illness is a limited approach. Approximately one in six Americans takes a psychiatric medication, most commonly antidepressants, anti-anxiety medicines and antipsychotics. More than one in three adults in the United States are also prescribed pain relievers for physical pain, and physical pain itself substantially increases suicide risk.
We must address shortcomings in the mental health system, stigma around diagnosis and treatment, and barriers that create a treatment gap between those who need care and those who can access it. Those are important issues, but they do not fully explain the rise in suicide. The CDC reported that more than half of people who died by suicide did not have a known diagnosed mental health condition. To understand rising suicide rates, it is necessary to examine broader contextual factors including substance use, social stressors and changing patterns of daily life.
Suicide and substance use
Substance involvement is a prominent factor in many suicide deaths. Among suicides that underwent toxicology testing, nearly 80 percent had at least one substance detected, with alcohol the most common, followed by opioids, benzodiazepines, cocaine, amphetamines, marijuana and antidepressants. Separate analyses have noted that mortality from drug poisoning, alcohol poisoning and suicide rose by more than 50 percent between 2000 and 2014.
Increasing use of psychoactive substances—whether prescribed, illicit, legal or illegal—may be an important piece of the puzzle. Illicit drug use has grown overall, and marijuana use in particular has expanded rapidly, doubling in the past decade. At present, nearly 10 percent of U.S. adults report using marijuana, and about one-third of those users meet criteria for a substance use disorder. This expansion of access and use has coincided with changes in state laws that allow legal access in many jurisdictions.
Opioid misuse and overdose deaths have also surged. In 2016, more than 42,000 people in the U.S. died from an opioid overdose, a number roughly comparable to the annual suicide toll. The opioid crisis includes both prescription pain medications and illicit opioids such as heroin and synthetic drugs like fentanyl, and it has become a recognized public health emergency.
Alcohol remains widespread: roughly 70 percent of U.S. adults drink alcohol and more than one in four report binge drinking. Alcohol and substance misuse are well-established risk factors for suicide, and overdose is itself a common mechanism of death in many suicide cases.
Why are so many people turning to psychoactive substances? Surveys and research on prescription misuse reveal pragmatic motives: people report misusing tranquilizers to relax or reduce tension, stimulants to stay alert, and sedatives to sleep. These coping strategies suggest a population coping with chronic stress, sleep problems and competing demands.
Stress, quality of life and social context
High levels of stress and low well-being appear widespread in the U.S. Recent surveys indicate that a large majority of adults report daily stress, and many say their stress has increased in recent years. Common sources include financial concerns, work pressures, uncertainty about the future, political climate and worry about violence and crime. Only about one in three Americans report feeling generally happy.
At the same time, measures of U.S. performance on social and health indicators—life expectancy, working conditions, maternal well-being, student outcomes and certain violent death rates—lag behind those of many other developed countries. These declines in quality-of-life markers may feed a sense of instability, strain social supports, and increase the use of substances as a coping mechanism.
American culture’s emphasis on individualism, personal achievement and self-reliance may also shape how people respond to stress. Expectations to succeed through individual effort, combined with limited social safety nets or accessible supports, can make chronic stress feel overwhelming. For some people, substances and, tragically, suicide may become perceived options when other supports are lacking.
Conclusion
Rising suicide rates cannot be explained solely by individual psychiatric diagnoses. Substance use, widespread stress, declining indicators of well-being and societal expectations all likely interact to influence risk. Preventing suicide requires a multifaceted approach that expands access to mental health care, addresses substance misuse and its drivers, and builds stronger social and economic supports to reduce the chronic stress that leads people to self-medicate or see suicide as their only escape.
Funding: The author previously received funding from the Centers for Disease Control and Prevention, the National Institutes of Health and the American Foundation for Suicide Prevention.
Source: Monica H. Swahn – The Conversation
Publisher: Organized by NeuroscienceNews.com
Image source: Image in the public domain.