Making Sense of Suicide Statistics

I just read some disturbing news the other day. According to the Centers for Disease Control and Prevention (CDC), the suicide rate in the United States is at a 50-year high. If that weren’t concerning enough, I’m also seeing multiple news outlets reporting that more than half of the people who died by suicide in 2016 had no known mental health problems. The trend in reporting is attributing the dramatic rise in the suicide rate mainly to opioid addiction and overdose.

Let me preface this by saying I’m not a health care professional, so I’m not an expert. Nevertheless, as someone who struggles with mental illness, I keep asking myself the same questions. Why are so many people getting hooked on opioids? Why are so many of the people dying by suicide not known to have mental health problems? Why is the discussion around substance abuse disconnected from the discussion around mental health? Are we missing some key information here? It’s possible many of these people who died by suicide just had never been diagnosed with mental illness.

There is a serious lack of funding for mental health care in this country. There’s also no doubt that opioid addiction is a national health crisis. So many Americans live in difficult environments brought on by income inequality, sexism, racism, domestic violence and so on. Many people don’t have access to the health insurance needed to get diagnosed with mental illness. They may be ashamed to ask for help because of the stigma and discrimination surrounding mental illness. But if they can either get opioids from a doctor, or elsewhere, and they feel better temporarily, they can also become addicted and die by suicide. They may very well be uncounted in the recent suicide statistics.

The National Institute of Mental Health (NIMH) states that addiction to alcohol or drugs is a mental illness in and of itself. By that token, wouldn’t that mean some people addicted to opioids, and dying from opioid overdoses, fall into the category of those with mental health problems?

There are plenty of people who visit a doctor for pain—for instance from a car accident—are prescribed opioids and then accidentally become dependent on them. However, according to both Psychology Today and the National Institutes of Health (NIH), depression can actually cause physical pain. So what about those who visit the doctor for unexplained pain, but it’s due to depression? Instead of being evaluated by a mental health professional and receiving a diagnosis, those people may just be given opioids or potentially addictive benzodiazepines like Xanax by a primary care physician. Sure, the patient will feel better, but the doctor has just slapped a Band-Aid on an underlying issue. Doctors may not be looking for the root cause of the pain. Patients may not know to ask. Think about how many people in this country suffer due to inequality. They could experience pain and not know that it’s a symptom of depression, which is a completely normal reaction to living in tough surroundings.

There are also those who self-medicate, using drugs or alcohol as coping mechanisms for either mental illness or situational stress or depression. There’s a known link between mental illness and substance abuse, according to the National Institute on Drug Abuse (NIDA). The NIH states that “Self-medication of negative affective states with opioids was quite common – with 94.9% of individuals sampled reporting self-medication behaviors. In adjusted analyses, individuals engaging in more frequent opioid use tended to self-medicate negative emotions with opioids more often.”

This all leaves me with more questions than answers. I wanted to get another opinion, so I asked a friend of mine, who also happens to be a psychotherapist. She’s been practicing for decades, so I think she might have some insight that I don’t. Here’s what she said:

“Primary care physicians (PCPs) have traditionally not screened well/or at all for depression, and especially for bipolar disorder. They are quick to give addictive medicine for anxiety and panic (benzodiazepines like Xanax) and often they’re not able to distinguish between panic disorder, and panic symptoms that are not a real panic disorder. If a PCP does medicate for depression, often they don’t closely follow the patient, and typically under-dose, so the patient may feel somewhat better but not get the depression into remission. Sometimes when a PCP under-medicates someone who was previously too depressed to attempt suicide, that person gets just enough emotional energy with their low dose of antidepressants to end up dying by suicide. Bipolar patients primarily present to PCPs when they are depressed, not manic. A PCP who gives antidepressants to this population could trigger a manic episode. PCPs in large practices are now including mood disorder screening questionnaires in their patient paperwork; however, that doesn’t mean the doctor responds to or even reads the answers given by the patient.”

There you have it. It may be just one opinion, but it’s one from someone who knows better than I. It is possible that many of the people counted in the recent suicide statistics could have had mental illness, but were undiagnosed, diagnosed incorrectly, treated incorrectly or just not treated at all. I’m not saying the NIH or the CDC is trying to mislead us. I think they’re doing their best to make use of the data they have. They do us all a great service by quantifying overwhelming numbers to help us make sense of the world, earmark funding, and enact legislation. All I’m asking is, how accurate are all these statistics really? Humans are not statistics, and mental illness can be a huge gray area.

I wonder how many of the people counted in these recent suicide statistics had ever visited a mental health professional? I wonder if the CDC study (or others) checked for crossover between drug or alcohol addiction and propensity to self-medicate due to depression, for instance? I wonder if we’re missing some data here. Are we not seeing that many of these people who died by suicide could have had undiagnosed mental illness?

It’s so sad that these people are gone. They died by suicide and they’re never coming back. We can’t ask them to get a psychological evaluation. What we can do is try to train primary care doctors to better identify and screen for both mental illness and situational depression, so that going forward, we can help save people from debilitating and often fatal addictions.

I took a hiatus from the news right after the 2016 election. It was just too stressful for me to watch it. Now, though, I watch the news while wearing my critical thinking cap, and I remind myself that I’m not a statistic.

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