Inside the Public Health Crisis of Rising Suicide Rates in the United States

A new report by the Centers for Disease Control and Prevention has found the US suicide rate rose by 25 percent over the past two decades. Topping the list was North Dakota, where suicides have risen by 57 percent from 1999 levels. Suicide is the 10th leading cause of death in the United States. For more, we speak with Dr. J. John Mann about this public health crisis. He is a psychiatry professor at Columbia University, a division director at the New York State Psychiatric Institute and a past president of the International Academy of Suicide Research and the American Foundation for Suicide Prevention.

AMY GOODMAN: A new report by the Centers for Disease Control and Prevention has found the US suicide rate rose by 25 percent over the past two decades. Topping the list was North Dakota, where suicides have risen by 57 percent from 1999 levels. Suicide is the 10th leading cause of death in the United States. The report found nearly 45,000 suicides occurred in the United States in 2016, more than twice the number of homicides. Firearms accounted for 51 percent of all suicides in the same year. Among people ages 15 to 34, suicide was the second leading cause of death. While suicide rates have risen in all but one state, researchers have found states with strict gun laws have some of the lowest suicide rates. This includes New Jersey, New York, Massachusetts, Maryland and Connecticut.

The findings come as two high-profile suicides occurred within days of each other last week. Celebrity chef and television host Anthony Bourdain died by suicide Friday. The 61-year-old was found dead in his hotel room near Strasbourg, France, where he was filming an episode of his CNN program Parts Unknown. He was found hanging to death. Bourdain’s death came just days after fashion designer Kate Spade was found dead in her Manhattan apartment in an apparent suicide, as well, again, hung to death in the bathroom.

Meanwhile, media reports have revealed that a Honduran asylum seeker, who was separated from his wife and 3-year-old child after crossing the border, died by suicide in mid-May after strangling himself in a jail in Starr County, Texas. A Border Patrol agent told The Washington Post Marco Antonio Muñoz “lost it” after agents told him he’d be separated from his child, and the agents then, quote, “use[d] physical force to take the child out of his hands.”

To talk more about this public health crisis, we’re joined by Dr. John Mann, professor of psychiatry at Columbia University and a division director at the New York State Psychiatric Institute. He’s past president of the International Academy of Suicide Research and the American Foundation for Suicide Prevention.

Dr. John Mann, welcome to Democracy Now!

DR. J. JOHN MANN: Thank you. Good morning.

AMY GOODMAN: It’s good to have you with us. Can you talk about this rising rate of suicide?

DR. J. JOHN MANN: Well, it’s, of course, extremely alarming, especially because suicide is such a major cause of death particularly in young people. So people are cut short in the prime of their lives. The context of this is not that the United States is sharing this problem with the rest of the world. It’s quite different. The United States has had a steadily rising suicide rate for two decades. Much of the rest of the world has had a declining suicide rate. So we are going very much in the wrong direction.

AMY GOODMAN: And what do you think accounts for this?

DR. J. JOHN MANN: Well, several things. First of all, you mentioned North Dakota. Now, there’s a clue there. North Dakota has very few psychiatrists, very little psychiatric services. It’s a fairly rural state without much medical—as much medical infrastructure, for example, as the other states that you mentioned, like on the East Coast—New York, Connecticut, etc., Massachusetts. And so, people don’t have access to healthcare. Why does that matter for suicide? It matters because suicide, in the majority of cases, is a complication of an untreated psychiatric illness. That means nobody made the diagnosis. And most of these people, meaning over 70 percent of them, die untreated.

AMY GOODMAN: You talked about there being fewer psychiatric and psychological services in these places, also stricter gun control laws.

DR. J. JOHN MANN: Well, there are a number of factors that contribute to suicide. First of all, if you don’t have a diagnosable psychiatric illness, your chances of dying by suicide are very tiny. So, first of all, you have to have a diagnosable psychiatric illness. When you have that, all kinds of social factors become much more important. Even within individuals who have a psychiatric illness, it is only a subgroup that are at particular risk. So we try to focus on who that subgroup is, in order to focus our main prevention efforts on the people who need the most help. It’s not that easy to find that subgroup, and that’s what our research is all about.

AMY GOODMAN: So, white males account for seven of 10 suicides. That was in 2016. Why is this demographic the greatest risk, white young men?

DR. J. JOHN MANN: So, male suicide rates are three-and-a-half times higher than females in the United States. But it’s not quite that simple. The pattern is different. And we don’t really understand why males commit suicide so much more frequently than females. And the pattern is different in the sense that male suicide rates are pretty constant after late teenagehood through into the sixties. And then, once males enter their sixties, seventies and eighties, the suicide rate begins to climb again quite dramatically. But it’s quite different in women. Women have a gradual rise to middle—in suicide rates to midlife, and then it begins to decline. So it’s actually going in a very different direction.

We’ve tried understand the differences. There are biological differences in the brain in women compared to men, and they’re reflected in behavioral differences. Men are more prone to violence against others and as well as against themselves. But another big factor, we think, is help seeking. Women are more prepared to seek help, more prepared to say, “I have a problem, and I need help with this.” Men, culturally, socially, find that a more difficult step to take, and men are poorer at getting help for themselves.

AMY GOODMAN: We have seen, for years now, this phenomenon in the United States that is unusual in the world, and this is mass killings, most usually perpetrated by young white men, young white men who, by the way, before that, have, more often than not, inflicted pain on a woman in their life, maybe their mother or a girlfriend or, in these high school shootings, stalking a girlfriend or someone that they perceive, they want her to be their partner. Do you see a connection between suicides and these mass shootings?

DR. J. JOHN MANN: Yes, there’s definitely an important connection. For many years, there was a phenomenon that was pretty uncommon called homicide-suicide, where individuals would die by suicide, but before they died, they killed other people, usually multiple people, usually people they had some connection with or knew, meaning family, girlfriend, fellow employees. But there’s been a new phenomenon that’s emerged, strikingly, which are these mass killings, using automatic weapons and high-capacity cartridges which allow people to kill a lot of others in a very short period of time. So this has now become a kind of a copycat thing. Many, but not all, of these individuals end up dying by suicide, by their own hand. Now, this is now what you might regard as an extreme form of homicide-suicide. These are individuals who are filled with a lot of anger and depression. So, the first thing that they do is express their anger by killing other innocent people around them. And the second step is killing themselves. It’s a rare form of suicide. Unfortunately, a lot of innocent people die, as well, so it garners a lot of attention. That’s appropriate, of course. But in the bigger picture of preventing suicide, if one prevented all of these events from happening, one would only prevent a tiny, tiny, tiny fraction of the 45,000 or so people in the U.S. who die every year.

AMY GOODMAN: I mean, this is an absolutely shocking number: 45,000 people die a year, more than twice the number of homicides.

DR. J. JOHN MANN: Yes. This is true worldwide. Worldwide, it’s estimated that about 600,000 people die by—in wars, of all sorts. But it’s estimated somewhere between 800,000 and a million people die every year, worldwide, due to suicide. Those of us who have been working in this field have been a kind of a voice in the wilderness trying to help the public understand that suicide is such a terrible threat and causes such loss of life.

AMY GOODMAN: And what about the racial disparities? We’re talking about mainly young white men die by suicide. I also, in a moment, want to ask why the language has changed and why you don’t say “commit suicide,” but “die by suicide.” But what about racial disparities?

DR. J. JOHN MANN: So, race seems to make a difference. We’re not entirely sure, again, what the reasons are. For example, the community that’s most imperiled are North American Indians in the United States. In Canada, our allies to the north, the community that’s most imperiled are the Inuits; in Australia, Australian Aborigines. So, somehow these groups are particularly at risk. Now, it’s true that they also have greater problems with things like substance use and alcohol use disorders, etc., etc. But they’re definitely at greater risk.

AMY GOODMAN: And does poverty weigh in?

DR. J. JOHN MANN: Poverty has an effect, for sure. We know that one of the reasons why there is such—there are big differences across United States when you look at suicide by ZIP code or county level. Part of the reason for those differences are the quality of medical care and the availability of medical care. But even if you have medical care available, part of the reason for the difference in suicide rates is related to per capita income. If people can’t afford to pay for healthcare, then you can have the best healthcare in your neighborhood, but it doesn’t do you any good. The United States is distinguished from much of the Western world by not having universal healthcare coverage.

AMY GOODMAN: The words “die by suicide,” “committing suicide”—why do people now refrain from saying “committing”?

DR. J. JOHN MANN: Well, this is part of the stigma associated with suicide. For many, many years, until relatively recently in our history, suicide was regarded as a crime. It was listed as a crime on the statutes. So you commit murder, and you commit suicide. Suicide was regarded as self-murder. There’s a long theological background to this kind of thinking. And so, this was a terrible problem in terms of reaching out to these people and offering them help. We know now, in many religions, that the theological view of suicide has changed. It’s now regarded as the act of an ill person, and therefore not a sin, and thus people and their families should be treated just the same as people who have died of any other cause.

AMY GOODMAN: Opioid addiction?

DR. J. JOHN MANN: Yes. This is a huge problem in the U.S., probably has contributed to the rise in suicide rates more recently. Our rise in suicide rates has been going on for two decades, steadily. So, opioid addiction is not the explanation of what’s happened. It is one contributing factor, just as the economic recession in 2008, which occurred after the suicide rate was clearly rising, is one potential factor, but not the explanation. The opioid epidemic is a medical disaster. It contributes to suicide rates, but it is not the sole driver.

AMY GOODMAN: Dr. Mann, I wanted to ask you about suicide prevention, the most important question: What are the most effective ways to prevent suicide?

DR. J. JOHN MANN: So, the critical thing to know is that suicide is highly preventable, that when we have organized, targeted programs, we can produce a significant decrease in suicide rates. We’ve shown this in a number of ways in different communities and countries, depending on the causal factors. The causal factors vary from place to place. For example, we’ve now shown in—at county levels and even at city levels, that if you improve physicians’ capacity for diagnosing and treating major depression, which is the psychiatric causal factor in 60 percent of the suicides with psychiatric disorders, and 90 percent of all suicides occur in the context of a psychiatric disorder—if you just train physicians to better recognize depression and treat it more effectively, you will lower the suicide rate. We know this for a fact. It’s been demonstrated in multiple studies, in multiple countries.

It’s not a matter of training the psychiatrists. Most adults are treated by their GPs, their internists or their OB/GYNs, specialists. We need to train nonpsychiatrist physicians to diagnose and treat suicidal people better. We have to remember that about 40 percent of all suicides see their doctor within 30 days of dying by suicide, and about 80 percent see their doctor within 12 months. So what does a—what is the suicidal patient saying to their doctor? They’re probably talking about physical symptoms, when those physical symptoms actually represent a depression with physical symptoms. They don’t mention they’re depressed. If the doctor doesn’t ask, the patient doesn’t think to tell him. So that’s one very important thing.

But what else can we do in the United States? Well, the obvious thing are guns. People need to know that the more available the gun is, the more likely it is to be used in a suicide. Homes with more guns have more firearm suicides. Homes with guns have more firearm suicides than homes without guns. Your chance of getting killed with a gun or a family member dying with a gun in a suicide is much greater than any chance of an intruder getting killed with that gun. So, guns don’t make people safe. They actually are a two-edged sword. They place everybody in the household at risk.

AMY GOODMAN: So you compare attempted suicide with suicide. We don’t usually see those numbers. And you’d be less likely to die if you attempted it another way.

DR. J. JOHN MANN: If you attempt suicide and survive, more than 80 percent of those individuals never die by suicide, which makes it very important to, if you like, shift people from the most lethal methods to the least lethal methods, because you can save a lot of lives that way. Guns are an extremely lethal method of suicide. The chance of surviving a self-inflicted gunshot wound is very low, so that these people don’t get a second chance. In countries, which is most of the Western world, where guns are much less available, they are much safer. Their commonest method of suicide is hanging or overdose, and the chances of survival are much better.

AMY GOODMAN: For family members, friends, teachers, what is recommended when you see someone in pain?

DR. J. JOHN MANN: So, we don’t expect families and schoolmates and fellow employees and students to be able to diagnose who is going to be at risk for suicide. That’s unrealistic. However, expression of suicidal thoughts or life isn’t worth living, or giving away valued possessions, or examining their will or their insurance, these are signs that people are thinking of closure in their life, which is a bad thing. And it’s like a fever. A person has a bit of a fever. You don’t know, as their family member or best friend: Is that a pneumonia? Is that an overwhelming infection? Or is that just an upper respiratory tract viral infection, which is of no consequence? So what do people do in those circumstances? They go and ask somebody who does know: go and see the nurse, go and see the doctor, nurse practitioner, somebody, and get checked out. It’s the same. If somebody says that they’ve got suicidal thoughts, this could be lethal. It mightn’t be, but you don’t know. It’s hard to tell. They should go and talk to somebody who knows. We have hotlines, phone lines, suicide helplines, available throughout the United States 24/7. We have emergency rooms with experts who can tell the difference, with a reasonable degree of certainty, 24/7. People should go and ask and get help.

AMY GOODMAN: Is there suicide hotline that you give out?

DR. J. JOHN MANN: The suicide hotline, you can find that everywhere. It’s on, to their credit, on Google, on Facebook. When you do have a search—use a search engine to look about, to ask about suicide, it’s everywhere.

AMY GOODMAN: And finally, we’re talking about 123 suicides a day in the United States, the average, from 45,000 a year. We talked about Anthony Bourdain, Kate Spade. These make it high-profile, so suicide gets more attention. And then you have the case of this migrant father who has his child ripped from his arms, doesn’t know if he’ll see his child again, and he takes his own life in a Texas jail.

DR. J. JOHN MANN: Yes. So, the pattern with these kinds of suicides is that, at first, they seem inexplicable or due to social causes. But in reality, when we begin to learn more about these individuals, we find that these kinds of social stressors affect vulnerable people particularly. Suicide is a very extreme response to stress. It doesn’t occur in well-integrated, healthy people. People are resilient. And so, the individuals, like Kate Spade, now we know—her husband issued a press release—that she suffered from depression and anxiety and was seeking treatment, but we also know that she was living alone, separated from her spouse. We know that Anthony Bourdain, from the news reports and the statements of his friends, had a serious problem with substance use disorder when he was younger, and more—and had been suffering from depression. We don’t know much more than that. And we know nothing about this individual who was treated in this horrible way. Of course people shouldn’t be treated like that. That goes without question. It doesn’t matter whether you’re resilient or vulnerable. But you’re going to have—a segment of the population is vulnerable. They’re suffering—already suffering from a depression. We know that life events, bad life events, happen more frequently to people who have a psychiatric illness. If we ignore the psychiatric illness piece, we are colluding with the stigma that has harmed and prevented help coming to people who are suicidal. We have to recognize they often have an illness, and they’re mostly untreated. That is a terrible state of affairs and, in this country, with all its wealth and resources, shouldn’t continue.

AMY GOODMAN: Marco Antonio Muñoz was the name of the Texas man who took his own life, and of course we know Anthony Bourdain and Kate Spade, just in the space of a few days. And yet, every day between them—well, between these people, altogether hundreds of people took their own lives. And the National Suicide Prevention Lifeline says calls have spiked since the apparent suicides of—that became so public last week. Final words, Dr. Mann?

DR. J. JOHN MANN: I’m glad calls have spiked. I hope that means that people who need help are reaching out for it. That would be good news.

AMY GOODMAN: I want to thank you for being with us. Dr. John Mann, psychiatry professor at Columbia University and a division director at the New York State Psychiatric Institute, past president of the International Academy of Suicide Research and the American Foundation for Suicide Prevention.

This is Democracy Now! When we come back, we’ll be joined by Michael Eric Dyson. He has a new book out, What Truth Sounds Like: RFK, James Baldwin, and Our Unfinished Conversation About Race in America. This is Democracy Now! Back in a minute.

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AMY GOODMAN: Students from Stoneman Douglas High School performing last night during the Tony Awards “Seasons of Love” from the hit Broadway musical Rent. Their teacher also won an award, one of the teachers at Stoneman Douglas, Melody Herzfeld, the drama and art teacher who protected so many students as a gunman rampaged through their school on Valentine’s Day.