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Tuesday, 9 August 2011

Suicide and the crash of stock market.

From the days of Durkheim in 1897, there has been a fascination in exploring what prompts individuals to tragically take their own life.  Scores of publications have explored descriptions of risk factors from several types of mental illness, alcohol dependency, history of abuse, family history, certain major physical illnesses, job or financial loss, relationship loss, lack of social support, amongst other.  Studies have described protective factors such as religious and cultural beliefs, female gender, good formal and informal support networks, reduced access to lethal methods (gun control), improved skills in conflict resolution and problem solving. 
With such great information, how well are we doing?   Canadian Suicide rates 1980-2005  shows a significant but subtle reduction of about 15% over the 25 year period of time in both males and  females.  Improvements in fatal health outcomes  for many other issues have improved substantively more, posing the question why have we not been as successful in preventing suicide?
Males complete suicide 4-5 times more often than females.   While male suicide rates are similar across all adult age groups in Canada, female rates tend to peak in the 35-65 age range.  In the US, male suicide rates increase dramatically over the age of 75 – one has to wonder about the impact of a less universal medicare structure. In Canada,  Aboriginal populations have historically had suicide rates 3-5 times the non-Aboriginal population.
Suicide attempts are about 4-5 times more common in females, and at a younger age range.  Hospitalization for suicide attempts is about 5 times more common than completed suicide. Only about 1 in 3 attempters is actually admitted to hospital.  The discouraging statistics is that in some studies less than half of attempters are referred for any follow-up despite their pleas for help.
60% of suicides occur amongst unmarried persons.  60% of suicides occur within the home. Among high school students, one in 5 has considered suicide in the previous year, 8% have taken some action on a plan, only 2-3% come to the attention of the formal support systems. 
As I said, we are great at describing suicide.  But how good are we at preventing it? There are innumerable programs that have been implemented in the name of preventing suicide ranging from school intervention programs through to assisting doctors in identifying depression in the elderly.  There are emergency room crisis teams and standardized follow-up protocols, case management of chronic mentally ill persons and bereavement crisis teams.  Most sound good on paper but have not been adequately evaluated for their impact on suicide rates.  There are only a couple of interventions that have shown benefit.  Suicide prevention training has been effective in military settings and long term follow-up (over one month) of attempters from the emergency room.
With all the good efforts and diversity of programs, you might think that only seeing a reduction in suicide rates of 15% during a time of economic prosperity seems inadequate.  Most other illnesses have improved dramatically more. The proof may be in seeing how the repression starting in 2009 has impacted suicide rates.  Yesterdays tumultuous freefall of the stock markets in the wake of the downgrading of US debt, will place more indivdiuals in financial trouble than the impact on financing the debt.  
Of course, there is very little glamour and glory to addressing a topic that has religious and cultural taboos associated with it. And in times of economic desperation, somehow watching out for the average citizens hit hardest by fiscal policies is not high on the agenda.  Seems the only time money flows for improved programming, is when suicide touches the families of a politician.  That in itself is a tragedy.

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