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Impulsivity And Access To Means Drive Rising U.S. Suicide Rate


Over the past couple of years, we've reported on the alarming rate of suicide in the armed forces. As we've heard, it's mostly at home, not on deployment; and a prior study found that the incidence of suicide in the military isn't related to being deployed several times, or even once. I wondered how the suicide rate in the military, which has led to the initiative that Blake Farmer just reported on, compares to the rate in society at large. I asked Dr. Alex Crosby, who's a medical epidemiologist at the Centers for Disease Control and Prevention. He says men between the ages of 17 and 60 are about as likely to die by suicide in civilian life, as they are in the military.

DR. ALEX CROSBY: One of the things that we have been looking at is, the suicide rate in the United States has been increasing. And as the rates in the military had been going up, it actually - for a long time, it had been lower than the civilian rate - but actually equaled the civilian rate, matched for that age and sex group, just last year.

SIEGEL: So now, they're about the same. But as you say, there's been a rise in recent years. Why?

CROSBY: I can't comment on what's been going on in the military, as to why they think the increase is occurring. But within the civilian population, we think that there are multiple factors that play a role. There are factors at the individual level - things like substance abuse, like mental illness; at the family level - like family dysfunction or exposure to violence within the family, like intimate partner violence or child maltreatment; or in the society - things like social isolation.

SIEGEL: How much of a factor is the recession?

CROSBY: There had - definitely - been some studies that have shown a - association between the economy and suicide rates. You know, some of the early studies had just looked at the Great Depression, and found that those were where we had the highest suicide rates, historically - ever - in the United States.

There was a recent study done by several of - scientists at CDC, in which we looked at what are called business cycles - the economy goes up, or the economy goes down; these business cycles - over about a 70-year period, from the late 1920s up to the early 2000s; and found that there was a consistent pattern, especially among working-age adults - those 25 to 64; that when the economy went down, suicide rates went up. Now, we know that there are multiple factors but definitely, that can be one of the influences on suicide rates in the United States.

SIEGEL: The current discussion of gun control, and the talk of mental health professionals identifying people who pose a danger to themselves - or others - so that they might be barred from gun ownership, has been nearly all about preventing homicide. But among gun deaths, how many are suicides as opposed to homicides?

CROSBY: Well, in the year 2010, there were slightly over 38,000 suicide deaths in the United States; and just over half of them, the firearm was a mechanism.

SIEGEL: I've heard one figure - that that accounts for over 60 percent of deaths by firearms, generally.

CROSBY: Yes, the overall deaths that are firearm-related, the majority of them are actually due to suicide deaths.

SIEGEL: In Britain, where - I gather - a common means of suicide was a particular drug, a rather simple step lowered the rate of suicide.

CROSBY: A leading mechanism for suicide attempts there was paracetamol; which, in the United States, is acetaminophen. And what they did is, they changed the packaging. So instead of someone being able to go to a store and buy a bottle of - you know, a hundred pills, in which all you have to do is open the top of the bottle and try to ingest them; what they did is, they started having them packaged in blister packs, which are the ones where you have to push out a pill. And what they found was a dramatic decrease in the number of suicide attempts that were due to that paracetamol. And so what they found is that that method decreased; other methods did not go up concurrently - at the same time.

One study that we did that confirms that, is we had looked at - in Harris County, Texas, we looked at near-lethal suicide attempts for which had there not been a medical intervention, they would have died. What we found is in this age group - especially those adolescents and young adults, 15 to 34 - is that a little over 20 percent said less than five minutes had transpired between when they thought about suicide, and when they did the act. We call that impulsive suicide. If you're talking about over a fifth - almost a quarter - of people making an impulsive suicide attempt, if you can remove that means from that group, it may be that they'd never go back to attempting suicide.

SIEGEL: Dr. Crosby, thank you very much for talking with us about it.

CROSBY: You're quite welcome.

SIEGEL: That's Dr. Alex Crosby, medical epidemiologist with the Centers for Disease Control and Prevention. Transcript provided by NPR, Copyright NPR.

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