In 2014, the suicide rate in the United States was 13 per 100,000 people, the highest recorded rate in 28 years. Over that year, 43,000 Americans killed themselves. The U.S. suicide rate also rose 24% over the 15 previous years (1999-2014), with the rise correlated to the period’s severe economic slump.
I am getting ready to enter a five day stretch of work, during which time I will spend fifteen hours in mental health clinics, up to seven hours in probate court related evaluations, and thirty seven hours doing telepsychiatry consults in emergency rooms around South Carolina. If past history is any predictor of future trends, which it always is, then many of those hours in clinic and ED will be spent assessing suicide risk.
Threatening to commit suicide can be a cry for help, a manipulation to control an estranged spouse, a last ditch effort to control debilitating anxiety, the only perceived way out of a drug addiction, or a gamble that one might be admitted to a secure hospital when one has no where else to go. It may also be, unfortunately, the successful ending of one’s life by one’s own hand.
We see various forms of threats. Let’s me say right off the bat that ALL threats should be taken seriously. ALL.
There are teens who cut themselves. Although some folks do indeed cut themselves seriously enough to to die, most of these self-identified cutters do so to control anger, stem impulsive and destructive urges, or to “just feel something”.
There are others who have suicidal ideation, real thoughts about dying, without any specific plan or intent or mean to carry out the threat.
Other groups have suicidal ideation, specific plans, and means to carry out those plans. These are often considered gestures if they involve non-lethal methods such as swallowing a small amount of household cleaner, burning oneself, or trying to drown oneself in the bathtub. Again, some of these gestures can be inadvertently lethal, such as when a preteen decides to take a whole bottle of a “safe” household drug like Tylenol, shuts down her liver and dies.
Then there are the more serious attempts, such as overdose with a lethal amount of an antidepressant (one week’s worth of some such pills is enough to cause death), hanging (still one of the most common methods used in jails), and self inflicted gunshot wounds. I have seen patients who tried to hang themselves and succeeded only in causing anoxia severe enough to cause permanent brain damage. I have also seen a police officer, well trained in the use of guns, attempt to kill himself by pulling the trigger of a shotgun with his toe, only to have miscalculated the kick of the weapon, blowing his face off but leaving him very much alive.
The most serious of suicide attempts, the ones who succeed, often give you clues to the act before they carry it out, but manage to succeed anyway. They are often middle aged to elderly men, divorced or widowed, with medical problems, a history of depression, substance abuse, taking antidepressants and who have made some contact with a healthcare provider within days of killing themselves. These men are disconcerting, because they are often resigned to the fact that they are going to die, are relieved and even happy about it, are firm in their convictions and plans, and are very likely to be successful. I have seen some of them leave all the bills paid, the financial and other documents neatly organized on desk or disk drive, and have a letter, will, and other documents laid out for easy discovery by their grieving families.
Who kills themselves the most?
For every one completed suicide, there are about twenty five attempts. Often, these are women using overdoses, cutting or other attempts. Men tend to use guns, although women are catching up to them in that department. Firearms account for almost fifty per cent of all suicides. White males accounted for seven of ten completed suicides in 2014, and middle aged to elderly men are still the most at risk group of them all.
Women attempt suicide three times more often than men.
Men die of suicide 3.5 times more often then women.
Obviously, suicide attempts and completions are still a huge problem in the United States.
Suicide is the tenth leading cause of death in South Carolina, where I practice psychiatry. On average, one person dies by suicide in this state every 11.5 hours. Our telepsychiatry shifts cover eighteen hours per day.
The rate of 15.13 suicides per 100,000 people is higher than the national rate of 12.93.
I will go into this long working stretch knowing that the odds are stacked against us, but that we can make a difference if we listen, intervene, and try to catch those who feel that suicide is the only way out.
If you or someone you know is suicidal, please seek help through your local emergency room, through your doctor, or by calling the National Suicide Prevention Lifeline at 1-800-273-8255.