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Up Show is dedicated to the reality of depression. Our
hosts will talk with some of the world's top experts on depression, as
well as people who have been impacted by this illness. The reality
of depression is that it is a debilitating and potentially deadly
medical condition that affects more than 15 million Americans every
year. The other reality of depression is that there is hope.
Down & Up Show #45: Suicide Rates and Depression in the U.S.
DR. REEF KARIM:
Welcome to the Down and Up Show on depressionisreal.org. I'm your
host, Dr. Reef Karim, psychiatrist, addiction specialist and relationship
(inaud.). My guess today is Dr. Eric Caine, co-Director at the Center
for the Study of Prevention of Suicide at the University of Rochester
Medical School.
Dr. Caine is from the Research Center for Disease Control and Prevention
Study which worked with suicide rates in different groups from the
U.S. from 1999 to 2004. And the study has some definitive findings-definitively
interesting findings on suicide and some demographics in regards
to suicide (unint.). Thanks for being here today, Dr. Caine.
DR. ERIC CAINE:
Thank you.
DR. REEF KARIM:
Okay, so let's start on the study. Could you-could you provide a
little background on the CDC's findings for our listeners (inaud.)...
Yeah.
DR. ERIC CAINE:
As you know, the Center for Disease Control-Centers for Disease
Control in Atlanta are the-sort of the major statistical reporting
site in the United States for health statistics. And there is...
Within the centers there's the National Center for Injury Prevention
and Control, and they report on things like homicide and suicide
and accidental death.
And they come out with regular reports over periods of time and
they look at the death data as well and come out with special reports.
In December there was a special report, mid-December, on suicide
and homicide and accidental death and changes that occurred between
1999 and 2004.
In a similar way there had been a report in September on changes
with youth. This one was-in December, though, was focused on people
above the age of 18. And what it showed was that there had been
a rather startling increase in suicide and also in accidental poisoning
in particularly, as well as falls, but in suicide in people in the
middle years of life with a-sort of a particular emphasis on people
over 40 and under 65.
And this... It was very interesting because it... Some of us saw
it when it came out because we get it through the web, and I saw
it and thought, gee, this is really DR. REEF KARIM:uite striking,
and yet there was very little public attention for several months
until there was a news report in the New York Times which I had
been contacted about, and then there was this flurry of attention.
So the report showed that there was this increase in suicide, that
it was mostly related to poisoning-self-inflicted poisoning or hanging
and suffocation, but not to firearm use.
DR. REEF KARIM:
Let's look at the numbers with the CDC study. There's-there's-there's
two questions that I had right up front. The date says from 1979
to 1999 the total (unint.) mortality rate declined but were increases
in suicide rates in the late Ô80s and (inaud.) Ô90s. And then you
go to 1999 to 2004 and at that point everything went up.
Injury mortality went up, unintentional injury mortality rates,
suicide rates, (inaud.) injury of undetermined...
DR. ERIC CAINE:
Actually, the homicide tickled (ph.) down over most of that period
of time, although it's picked (ph.) up dramatically in 2005, 2006
and 2007.
DR. REEF KARIM:
So what's your take on that? What happened in 1999?
DR. ERIC CAINE:
I think what we have to understand is there's things that go on
outside that affect people's lives in ways that we at least have
to be mindful of. We can't be 100% saying, "Oh, this caused this
increase".
But in 1997 and 1998 in Asia there was a tremendous economic downturn.
And in the... You know, there was the Asian fiscal crisis, not much
different from what we have now in some ways. You had places like
Hong Kong where the housing values just plummeted. Japan same thing.
And what they saw was this rapid and, you know, I think, pretty
frightening increase in suicide, particularly in people in the middle
years of life. Between '97, '98 and 2004 it just went right up.
And-and in-and in fact, people have been looking at that and saying,
"Oh, it's-it's-it's come principally from people in the middle years
of life".
People were laid off. There was just tremendous social distress.
And that social distress, you know, when we think about it in the
broad sense... You know, you sort of think about, "Yeah, you know,
there's a housing crisis and stuff but how does that play out in
an individual's life"?
Well, that may play out in ways that-that-that, you know, sometimes
lead to death. And so, you know, I think in the United States it's
very clear, and I don't know if this is the explanation but it's
very clear that starting in 2000/2001 there was a lot of economic
dislocation that began.
And while the economy grew through-in all grew through much of the-of-of
the first, you know, decade of the new century, it didn't grow in
a uniform way. And so I think that, you know, people who want to
do research on this and want to find out about it, are gonna have
to dig in and start asking, "Well, who were these people? You know,
can we get some sense of relationships between socio-economic status
and other things"?
Now in the United States our hands are tied some because we don't
get the kind of data, we don't collect the kind of data from coroners
or medical examiners that they do in other countries. And so we
may never know exactly what was going on. But if I had my hunch,
I would think that there were both-there are broad social forces
and then how this affected people's lives right at the-at the-at
the workplace, right in the house, right in the home, right in wherever
they live.
DR. REEF KARIM:
What's the relationship between depression and suicide? What do
you think can be done to lower the rates of suicide and what are
some of the warning signs?
DR. ERIC CAINE:
Well, it's very clear that at the time that someone dies, especially
in people under the age of 65, there's a very, very high rate of
psychiatric distress. Now a lot of studies show over 90% of a diagnosable
psychiatric disorder.
It changes across the life course between, you know, kids when there's
more psychosis and substance use and in the middle years of life
when there's more depression and alcohol and in the later years
of life when there's more depression in sort of co-morbid medical
disease and pain meds and other things.
I think that the efforts to reduce suicide (and the-probably the
largest scale effort was done by the U.S. Air Force) was to work
at multiple levels all at the same time. And in the Air Force they
said, "You know, strong men can ask for help". And they started
saying, "It's okay when you've got a problem not to feel stigma,
not to feel that you're weak by asking for help, but that, in fact,
it's okay to ask for help".
And so they pushed that, but then they also said in the workplace
we-we... You know, they had workplace-oriented programs which said,
"If you see that your colleague or your subordinate, you know, is
having a hard time, it's okay to talk to that person about that
they're having a hard time and not to just gloss it over, and to
help that person get care".
DR. REEF KARIM:
You said-you said that high rate of psychiatric distress in a suicide
attempt, you said some data showed 90%.
DR. ERIC CAINE:
Right.
DR. REEF KARIM:
Does that include substance use...
DR. ERIC CAINE:
Yes.
DR. REEF KARIM:
... being altered at the time?
DR. ERIC CAINE:
Well, remember the substance use that's both acute and substance
abuse or use that's chronic. And...
DR. REEF KARIM:
Are either of those included in that or is there a number for people
that...
DR. ERIC CAINE:
It changes across the life course. So substances...
DR. REEF KARIM:
So somebody... If somebody commits suicide, are there numbers or
is there data somewhere of the number of those people or the percentage
of those people that were acutely intoxicated with some drugs or
alcohol?
DR. ERIC CAINE:
Oh, it's very high. For... You know, I can't quote you a specific
study now but, yes, there have been plenty of series of post-mortem
studies where, you know, the medical examiners reported how many-what
percent of people were intoxicated at the time of death. And that...
DR. REEF KARIM:
And what are some warning signs of suicide?
DR. ERIC CAINE:
Well, it's very hard to see warning signs of suicide. What you're
really looking for are signs of person's distress. Again, it changes
at different points of the life course. So in a kid, you're looking
for kids who start to withdraw, drop out, lose-you know, sort of
become less social, less interactive, their grades go down.
They may be using drugs a lot more. You know, they're dropping out
and-and-and disappearing. A lot of the problems though for us as
professionals is that a lot of us kids actually drop out of school.
You know, they get to age 16, 17, 18, they don't have to be in school
anymore and so they're on the streets.
And a lot of the kids who are killed by homicide are also kids who
are in the same population who kill themselves by suicide. In the-in
the 20s, you know, one of the things that's really clear... The
number one cause of death in the 20s is accidental death.
Accident motor vehicle, accidental poisoning, but accidental motor
vehicle... And lo and behold, same sorts of problems Ð family turmoil,
drug use, excessive drinking, excessive drugs. But, again, those
kids are often on the margins. They're not... You know, they're-they're-they're
kids who are-who-who've broken from their families, they're kids
who are on the streets in alternative settings.
Kids shelters have-are places you'd go and look for kids who would
be the-would be the ones at most risk. So it isn't just the warning
signs, it's... You might also think of where are the places where
I would find more people. Jails, detention centers. I mean, they're
huge for finding people who are at-more at risk.
In a-in-in-in adulthood you're talking about co-existing substance
use. It changes from sort of, you know, more street drugs, recreational
drugs to alcohol as people get older (you know, it sort of shifts),
and depression. Depression's a big deal, and depression in both
men and women.
And then in elders, you know, you're looking for people who have
become... And this is what makes it almost harder. The elders who
are depressed have medical problems, they have pain problems, but
they're [sic] also tend to be more socially isolated.
And when they go to the doc, you know, you can imagine the older
guy, more often white, and you go to the doc and they say, "How
are ya"? "Fine." They're not really open with their problems. They're
sort of... The stiff upper-stiff upper lip that got em through life,
that one foot in front of the other quality that was so actually
useful earlier, may be less useful later.
DR. REEF KARIM:
They get... Yeah, as they get older. Yeah. Depression is Real Coalition
seeks to diminish the stigma around depression. How do you feel
the stigma around depression relates to higher suicide rates?
DR. ERIC CAINE:
Well, I think it's the stigma of asking for help. You know, depression
is still viewed as a weakness. Depression is still viewed as a flaw
or a fault or something that you should take care of or something
you should, you know, make your way through. You know?
And, of course, the irony is depression causes more disability than
anything else in our society. It costs more money to employers.
You know, it's the second most common thing to back pain but it
certainly causes a lot more cost to employers than back pain. Depression
is a very-you know, very, very vexing problem when you look at world
health organization statistics.
You know, the global burden of diseases it's caused are called-is
much higher from depression than-than-than virtually any other kind
of condition in certainly middle life. I mean, you know, you say
heart disease; well, that's more later life. It's really in the
middle years of life depression has a much higher burden of disease
in our-in our society.
We're not just talking about death but because people won't reach
out for help because they think they can muddle their way through
it. Then it, in fact, gets worse. And that's where it then contributes
to death by suicide.
DR. REEF KARIM:
Yeah.
DR. ERIC CAINE:
I'm gonna have to sign off so...
DR. REEF KARIM:
Yeah. Just a question. You know, what can somebody do if they think
they know someone who might be considering suicide? What would you
suggest?
DR. ERIC CAINE:
Talk to em about it and drag em in to get some care. Don't be-don't
be afraid of bringing it up, though, because, you know, a lot of
people say, "Well, if I bring it up, that'll put it in their mind",
and that's mythology. And I'm-and, by the way, that's a mythology
that I've seen in mental health professionals as much as I've seen
in lay people.
People are worried that if they say something about suicide, they
might cause the thought. But it's very clear that if someone's in
great pain and in great distress, you know, it-it-you know, it's-it's-it's
very reasonable to go up to them and say, "You know, you look in
such distress, I wanna do something for you".
"Oh, I'm fine." "I'm so worried about you. I'm worried that you've
come to the point where you think you'd be better off dead or that
this pain would only be relieved if you're not alive anymore. And-and-and
let's go talk to somebody." The last thing that someone should do
is think that they should be the professional that's gonna carry
their friend or carry their loved one over the-over that hurdle.
Rather, they should reach out and... Some people won't go to-to-to
mental health professionals, so you say, "Well, let's go to your
primary care doc" or "Let's go to the clergy person who you trust
or something. But"...
DR. REEF KARIM:
Right.
DR. ERIC CAINE:
"...but-but let's go reach out to someone else." And-and-and, you
know, my view about the stigma around the depression and the reaching
out is to sort of try to slide around it. You know, if someone's
really resistant to seeking mental professionals, then I just try
to sort of slide around and say, "Let's reach out to somebody who's
outside to get you to start at least acknowledging that this is
something we can talk about together".
DR. REEF KARIM:
Well, this has been great. I mean, thank you so much, Dr. (Unint.),
for speaking with us today.
DR. ERIC CAINE:
Have a good day.
DR. REEF KARIM:
Okay, join us next week for another (inaud.) of the Down and Up
Show on Depressionisreal.org. I'm Dr. Reef Karim.
