Suicide is contagious; in fact a recent British study revealed that experiencing the suicide of a close friend or family member increases your risk of attempting suicide yourself. Of course such a painful event can also make you more sensitive to another’s suffering and put you more in a position to help prevent a suicide.
I vividly recall many years ago when one of my closest friends, a fellow physician, came to see me for lunch and when he said goodbye I had the uncomfortable feeling that he was saying goodbye for good. I talked myself out of the feeling and two weeks later he drove his car into a wall at high speed, devastating his family and friends. Ever since I have been more on the lookout for the signs of desperation and a suicidal plan in others. The next time someone tried to say goodbye to me for good I called 911 just in time.
Suicide rates are rising across the United States and the numbers are not subtle. According to a recent report from the Centers for Disease Control and Prevention (CDC), between 1999 and 2016 suicide rates increased in almost all states, with a greater than 30 percent increase in 25 states. And before you blame depression alone for this or a faltering economy earlier in the century, consider that in 27 states in 2015, for example, 54 percent of those who committed suicide were found not to have prior mental health conditions at all.
And since 2005, at a time of two wars and plenty of societal strife and stress that might indirectly increase your risk for heart disease or even cancer, suicide is literally the only leading cause of death in the U.S. that is on the rise. Deaths from heart disease, cancer and stroke are all on the way down, thanks to an increased emphasis on prevention and early intervention.
So why suicide? The answer is a combination of factors.
Deb Houry the CDC’s director of the National Center for Injury Prevention and Control wrote to me that “we know that suicide is not caused by one factor and our research demonstrates that many factors contribute to suicide beyond mental health conditions alone.” Houry cited substance misuse as an established risk factor for suicide and added that “overdose misuse associated with the opioid overdose epidemic could be driving the suicide rate higher.”
Another factor under consideration by CDC is the impact of social media. “Social media can exacerbate bullying, romanticize suicide and provide harmful content on suicide methods.”
What to do?
Dr. Houry pointed out to me that social media could also be used in a positive way to “enhance connections between people, correct myths about suicide and facilitate access to help.”
Much research has shown that talking about suicide not only doesn’t cause it to occur, but can also help prevent it, by breaking through an individual’s isolation and decreasing associated stigma. “Talking breaks the secrecy that surrounds suicidal behavior and lets people know that help is available,” Houry wrote to me.
As a practicing internist, I have always monitored my patients for escalating depression or isolation. This is my job. I believe the U.S. Preventive Services Task force was quite right to suggest we screen all our patients for depression.
But it is also an important role for friends and family and even for employers or schoolteachers. And concerned parties must follow u and not ask the question only once. The National Suicide Prevention lifeline phone number saves lives and the National Action Alliance for Suicide Prevention is an effective private/public partnership but most important is a friend or family member or doctor who continues to make sure you are okay.
The rising suicide rate is yet another wake up call to physicians to stop overprescribing opioids for chronic pain. These drugs create a false sense of euphoria and when they are withdrawn or abruptly stopped, an escalating stigmatizing suicidal depression can result.
As a society we also must come to grips with the alienating effects of texting and the infectious meanness of social media that attacks self esteem.
We need to listen to Houry’s wise suggestion that we learn to use social media to provide useful information on suicide prevention and on a larger scale that it becomes a platform to build alliances between people rather than one to tear them down.
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