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SUICIDE, THE KILLER WITHIN

In the recent years, suicide has reached public health crisis proportions. The rates of suicide in the developed world continue to climb. Geography, access to healthcare, unique stressors and many other factors are contributing to the disparity in numbers when quantifying how suicide affects different communities.   Healthcare facilities and providers alike are at the front lines of this war. However, the ones we trust to combat suicide are not immune from its effects. Here are a few facts to help us understand and hopefully prevent suicide.

More suicides than homicides
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In the United States, more than forty thousand people die annually by suicide. To put this number in perspective, 58,000 service people lost their lives during the Vietnam War (1968-1973); during the same period, 220,000 U.S. citizens lost their lives to suicide [i].
Suicide is the 10th Leading cause of death overall[ii] and according to the CDC, from 1999 through 2014; the age-adjusted suicide rate in the United States increased 24%[iii]. Lastly, suicide surpasses homicide as the leading cause of death for all age groups after the age of 10 years old. For persons aged 25–44 years, the rate of suicide was nearly twice the rate of homicide, whereas for those aged ≥65 years, the rate of suicide was nearly seven times the homicide rate[iv].

Rural Suicide

Rural communities suffer a greater rate of suicide than the urban environments. The age-adjusted suicide rate among persons aged 15 years and older who lived in nonmetropolitan counties was 37% higher than the rate among suburban residents. Most of this discrepancy was attributed to the greater difference in suicide rates among men. The suicide rate among men who lived in the most rural counties was 47% higher than the rate among men who lived in suburban counties[v].

Vulnerable Populations

Despite the strengths of American Indian and Alaska Native (AI/AN) families and communities, suicide remains a devastating and all too frequent event.

Native American/Alaska Native (AI/AN) population has the highest rate of death by suicide of all cultural groups[vi].t.
The suicide rate among AI/AN has been increasing since 2003, and in 2015, AI/AN suicide rates in the 18 states participating in the National Violent Death Reporting System (NVDRS) were 21.5 per 100,000, more than 3.5 times higher than those among racial/ethnic groups with the lowest rates[vii]

Medical Providers and Departments at the front lines

On average, 45% of suicide victims had contact with primary care providers within 1 month of suicide[viii]. Given these statistics, primary care has enormous potential to prevent suicides and connect people to needed specialty care — especially when they collaborate or formally partner with behavioral healthcare providers[ix].
Emergency Departments have a pivotal role in preventing suicide. In results published April 29, 2017 in JAMA Psychiatry, the largest ED-based suicide intervention trial ever conducted in the United States examined how screening in emergency departments, followed by safety planning guidance and periodic phone check-ins led to a 30 percent decrease in suicide attempts over the 52 weeks of follow-up, compared to standard emergency department care[x].
Nurses practice on the front-lines and have the greatest number of opportunities to identify and intervene with suicidal patients.  Most registered nurses (RNs) have little or no training in how to assess, evaluate, treat, or refer a suicidal patient.  Because of this lack of training, RNs feel ill-prepared and afraid to talk to patients about suicide. Research suggests that once RNs are trained in suicide assessment, they realize it is no different than assessing for any other type of illness and are then able to help those with suicidal tendencies[xi].

Suicide of the Caregivers

An estimated 300–400 physicians die by suicide in the U.S. per year[xii]., this is on average, one doctor per day. The suicide rate among male physicians is 1.41 times higher than the general male population. And among female physicians, the relative risk is even more pronounced — 2.27 times greater than the general female population[xiii].
The available US data on nurse suicide are outdated, yet provide clues that suicide may be a risk of the nursing profession. Research is needed to assess the magnitude of nurse suicide and associated work stressors[xiv].

Prevent Suicide

Suicide is preventable. We need to re-examine how we equip our healthcare professionals to deal with this epidemic. We also need to re-examine our priorities as a society and address the stressors we put in our members. We need more research and we need to be kinder to one another.

Tools and Resources

We Care

It is not a cliché, AB Med cares about the communities and the facilities we are called to serve.

If you or someone you know is having thoughts of suicide, contact the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) or visit National Suicide Prevention Lifeline.
For our Veterans, call 1-800-273-8255 and Press 1, chat online or send a text message to 838255

Prevention Programs

2012 National Strategy for Suicide Prevention
2012 National Strategy for Suicide Prevention
Interactive Screening Program (ISP)
National Institute of Mental Health

Tools

Complete APA Practice Guidelines here

REFERENCES / RESOURCES

  1. World Health Organization. (2014). Preventing suicide: A global imperative. Retrieved from http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/
  1. https://www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_by_age_group_2013-a.gif
  1. https://www.cdc.gov/nchs/products/databriefs/db241.htm#ref1
  1. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6128a8.htm
  1. https://ajph.aphapublications.org/doi/full/10.2105/AJPH.94.10.1682#
  1. https://www.ihs.gov/suicideprevention/populations/youth/
  1. https://www.cdc.gov/mmwr/volumes/67/wr/mm6708a1.htm
  1. https://www.ncbi.nlm.nih.gov/pubmed/12042175
  1. https://www.integration.samhsa.gov/about-us/esolutions-newsletter/suicide-prevention-in-primary-care
  1. https://www.nimh.nih.gov/news/science-news/2017/emergency-departments-could-play-significant-role-in-reducing-suicide-attempts.shtml
  1. http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-20-2015/No1-Jan-2015/Suicide-Assessment-and-Nurses.html#WHO14
  1. https://jamanetwork.com/journals/jama/article-abstract/196774
  1. http://mwia.net/wp-content/uploads/2012/07/SuicideRatesAmongPhysicians.pdf
  1. https://nam.edu/nurse-suicide-breaking-the-silence/

By: Erik McLaughlin MD, MPH and Aikaterini Papadopoulou, B.Arch

 

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Erik McLaughlin MD, MPH
Chief Medical Officer
E.McLaughlin@myABMed.com
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