Deaths of Despair Anthony Bourdain Suicide

Deaths of Despair – Suicide & Self Injury Crisis in US

Peter Forster Major Depression, Policy Leave a Comment

The news of Anthony Bourdain and Kate Spade’s death by suicide as well as the CDC’s report on increasing suicide rates in the US reminds us of a larger public health crisis that was given the name “deaths of despair” by researchers Case and Deaton (see below).

We have been collecting information on this topic in preparation for an effort to get the American Psychiatric Association to play a larger role in advocacy for an adequate national response to this crisis. Here is some of that information…

Suicide increased by 25% according to the CDC

Suicide rates increased by 25% in the period from 1999 to 2016 according to the CDC. The CDC report notes that half of those who committed suicide did not have a mental health diagnosis which may be misleading.

https://www.cdc.gov/media/releases/2018/p0607-suicide-prevention.html

An artificial distinction between self-injury and suicide masks the severity of the problem according to a 2015 JAMA Psychiatry article…

“To more accurately assess the magnitude of self-inflicted injury deaths in the United States, we combined estimated non-suicide DDSIs with total registered suicides to portray the trend as well as the magnitude of rates from 1999 to 2013 (Figure), using data from the Multiple Cause-of-Death public use files created by the National Center for Health Statistics. We computed 2 series of estimated self-injury mortality rates. Series 1 assumed that 70% of the drug-intoxication accident deaths and 80% of the undetermined drug-intoxication deaths, at ages 15 years and older, were DDSIs. Series 2 substituted corresponding constants of 80% and 90%. Whereas the suicide rate rose 24% over the observation period, our more conservative estimate of the self-injury mortality rate increased by 55% and our higher estimate by 58%.”Rockett  IRH, Caine  ED.  Self-injury is the eighth leading cause of death in the United States: it is time to pay attention.  JAMA Psychiatry. 2015;72(11):1069-1070.

Life expectancy in the US is declining

Death rates increased significantly between 2015 and 2016 for age groups 15–24 (7.8%), 25–34 (10.5%), 35–44 (6.7%), and 55–64 (1.0%).

This is the second year in a row life expectancy has declined (1).

The last time that life expectancy declined for two years in a row in the US was more than 50 years ago.

From 2015 to 2016, age-adjusted death rates decreased for 7 of 10 leading causes of death and increased for 3. The rate decreased 1.8% for heart disease, 1.7% for cancer, 2.4% for chronic lower respiratory diseases, 0.8% for stroke, 1.4% for diabetes, 11.2% for influenza and pneumonia, and 2.2% for kidney disease. The rate increased 9.7% for unintentional injuries, 3.1% for Alzheimer’s disease, and 1.5% for suicide.

https://www.cdc.gov/nchs/data/databriefs/db293.pdf

Deaths of despair is the term coined by Case and Deaton

Building on our earlier research (Case and Deaton 2015), we find that mortality and morbidity among white non-Hispanic Americans in midlife since the turn of the century continued to climb through 2015. Additional increases in drug overdoses, suicides, and alcohol-related liver mortality— particularly among those with a high school degree or less—are responsible for an overall increase in all-cause mortality among whites. We find marked differences in mortality by race and education, with mortality among white non-Hispanics (males and females) rising for those without a college degree, and falling for those with a college degree. In contrast, mortality rates among blacks and Hispanics have continued to fall, irrespective of educational attainment. Mortality rates in comparably rich countries have continued their premillennial fall at the rates that used to characterize the United States.

https://www.brookings.edu/wp-content/uploads/2017/08/casetextsp17bpea.pdf

The 2012 Surgeon General’s report called for action

In 2012 the Surgeon General called for a comprehensive suicide prevention strategy. The government responded with 55 million dollars in grants…

https://www.surgeongeneral.gov/library/reports/national-strategy-suicide-prevention/full-report.pdf

Funding for Suicide Prevention Remains Below Funding for Illnesses with Lower Mortality

The National Institutes of Health (NIH) provided about $35 million in 2017 to fund research into “suicide prevention,” with another $68 million devoted to the category of “suicide,” according to the agency’s statistics.

“Look at breast cancer. More people will die by suicide than breast cancer this year,” said Dan Reidenberg, executive director of the nonprofit Suicide Awareness Voices of Education.

Almost $690 million was spent on breast cancer research last year, according to NIH statistics.

https://www.reuters.com/article/us-usa-suicides/us-suicide-prevention-programs-say-more-funding-needed-idUSKCN1J42WF

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