Reducing Suicide A National Imperative (2002) / Chapter Skim
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2 Magnitude of the Problem
2 Magnitude of the Problem
Pages 33-68
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From page 33... ...
White males over 85 have the highest rate of suicide, about 65 per 100,000. Suicide rates are also elevated in some ethnic groups.
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From page 34... ...
GEOGRAPHIC TRENDS Suicide rates are generally higher in northern European nations than in southern European nations (see Table 2-1~. For example, Hungary's suicide rate was over 33 per 100,000 as of 1999 (WHO, 2001a)
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From page 35... ...
35 Country Total Male Female Year Armenia 1.8 2.7 0.9 1999 Austria 19.2 28.7 10.3 1999 Azerbaijan 0.7 1.1 0.2 1999 Belarus 34.0 61.1 10.0 1999 Brazil 4.1 6.6 1.8 1995 Canada 12.3 19.6 5.1 1997 China 14.1 13.4 14.8 1998 Rural Areas 23.3 21.9 24.8 1998 Urban Areas 6.8 6.8 6.8 1998 Finland 23.8 38.3 10.1 1998 Georgia 4.3 6.6 2.1 1992 Greece 3.8 6.1 1.7 1998 Hungary 33.1 53.1 14.8 1999 India 10.7 12.2 9.1 1998 Italy 8.2 12.7 3.9 1997 Japan 18.8 26.0 11.9 1997 Kuwait 2.2 2.7 1.6 1999 Lithuania 41.9 73.8 13.6 1999 Mexico 3.1 5.4 1.0 1995 Norway 12.1 17.8 6.6 1997 Philippines 2.1 2.5 1.7 1993 Poland 14.3 24.1 4.6 1996 Republic of Korea 13.0 17.8 8.0 1997 Russian Federation 35.5 62.6 11.6 1998 Singapore 11.7 13.9 9.5 1998 Sri Lanka 31.0 44.6 16.8 1991a Sweden 14.2 20.0 8.5 1996 Tajikistan 3.5 5.1 1.8 1995 Thailand 4.0 5.6 2.4 1994 Ukraine 29.1 51.2 10.0 1999 United Kingdom of 7.4 11.7 3.3 1998 Great Britain & Northern Ireland United States 10.7 17.6 4.1 1999 aThe more recent total suicide rate for 1996 was 21.6, but rates by sex were not available. Overall, suicide rates are lower in other Asian nations compared to China, including Singapore (11.7 per 100,000)
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From page 36... ...
. Suicide rates vary greatly across the United States, with higher rates generally in the western states.
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From page 37... ...
_ r lo....... 1 , 14.9 | 1 20.6 FIGURE 2-2 Annual Suicide Rates per 100,000 (1996-1998~.
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From page 38... ...
The analysis also reveals that there are spatial anomalies; in the western United States and Alaska, where suicide rates are typically high, there are a few counties that have calculated estimates that are consistent with the national average. Similarly, in the central United States, where
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From page 39... ...
there is a high concentration of counties with the lowest suicide rates, there are a few counties that exhibit the highest suicide rates. What are the protective factors that have produced these spatial anomalies?
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From page 40... ...
Since 1990, the overall suicide rate for this age group has stabilized at approximately 11 deaths per 100,000. One national school-based study of youth found high oneyear prevalence rates for suicide attempts (7.7 percent)
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From page 41... ...
The rate of psychopathology among younger adolescent suicide victims is much lower than among older adolescents, so that the availability of guns becomes the paramount risk factor for younger, impulsive individuals (Brent et al., 1999; Shaffer et al., 1996~. Elderly In almost all industrialized countries, men 75 years of age and older have the highest suicide rate among all age groups (Pearson et al., 1997~.
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From page 42... ...
There is greater likelihood of death in or following a suicide attempt in the elderly. While in younger age groups suicide attempts are more often impulsive and communicative acts, in later life most attempts can be considered "failed suicides." Older individuals make fewer suicide attempts per completed suicide.
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From page 43... ...
In the 60-90 year old age group, the rates of suicide attempts associated with untreated mood disorders increase with each subsequent decade (Bostwick and Pankratz, 2000~. Psychological autopsy studies have found depression to be the most common psychiatric diagnosis in elderly suicide victims, while alcoholism is the most common diagnosis in younger adults (Conwell and Brent, 1996; Dorpat and Ripley, 1960~.
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From page 44... ...
Below we discuss the differences in suicide rates for African Americans and Native Americans in greater detail. African-Americans The rate of suicide among African Americans has historically been lower than that of whites, but in young black males the gap has been gradually closing (see Table 2-2; Griffith and Bell, 1989~.
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From page 45... ...
The suicide rates among black women have held steady at about 2/100,000 for the past two decades (Griffith and Bell, 1989~. The difference between black and white women is diminished when suicide attempts, rather than completed suicides are considered.
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From page 46... ...
can be applied to the question of the rise in rate of suicides in young black males. Comparing suicide rates in young white and black males, ages 15-24, from 1989-1998 reveals that the overall suicide rates have been decreasing over the past ten years and that, in 1989, the suicide rate in white males was significantly larger than the suicide rate in black males.
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From page 47... ...
For further discussion of these issues, see Chapter 6, and the sections in Chapter 7 on faith-based interventions, and Chapter 9 on barriers to treatment. Native Americans3 and Alaska Natives The rate of suicide among Indians and Alaska Natives of the United States is about 1.7 times the rate of the nation as a whole (Indian Health Service, 1999~.
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From page 48... ...
American Indian women 75 years of age and older do not complete suicide with any measurable frequency. Therefore, while Indian and Alaska Native females have substantially lower rates than Indian and Alaska Native males, their rates are higher than other women in the country until age 44, and then they are approximately the same until age 75, when suicides no longer occur (Indian Health Service, 1999~.
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From page 49... ...
Social and familial disruption, cultural conflict, and social disorganization are often cited as major influences on American Indian suicide rates. Suicide rates among American Indians vary with the degree of social and cultural change and acculturation pressure (Garro, 1988; Levy, 1965; VanWinkle and May, 1986; 1993~.
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From page 50... ...
Aspects of acculturative stress include disrupted social support and family support networks, low education and income, lack of knowledge of the language and culture of the new country, motives for immigrating, spiritual beliefs, tolerance of the host country toward immigrants, and positive or negative views of the acculturative process itself. Studies of various Hispanic and Asian immigrant groups demonstrate that lack of English skills predicts distress, depression, and suicidal ideation among immigrants, sometimes over and above the effects of pre-arrival trauma (Hinton et al., 1997; Hovey, 2000a; Hovey,2000b)
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From page 51... ...
While various studies show Mexican-born and overall numbers of Asian-born immigrants attempt and complete suicide less frequently than their American-born peers (Shiang et al., 1997; Sorenson and Golding, 1988; Sorenson and Shen, 1996) , studies have not differentiated between suicide rates of Central American versus other Hispanic or Southeast Asian versus other Asian immigrants.
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From page 52... ...
Mentally ill in correctional facilities are more likely than other offenders to have a higher prevalence of homelessness, unemployment, alcohol and drug abuse, and physical and sexual abuse before their current incarceration (US DHHS, 2001~. These risk factors are likely to contribute to the prevalence of suicide among those incarcerated.
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From page 53... ...
When compared to other working-age men, as opposed to the general population, however, police appear to have only a slightly increased suicide risk (Burnett et al., 1992; Hem et al., 2001; Stack and Kelly, 1994~. Sexual Orientation Fewer than 5 percent of adults in the United States identify themselves as homosexual or bisexual (Michaels, 1996~.
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From page 54... ...
A recent review of these studies determined that firm conclusions were unwarranted (McDaniel et al., 2001~. For suicide attempts, several recent population- and school-based studies provide strong support for a relationship between sexual orientation and suicidal behavior in males.
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From page 55... ...
LIMITATIONS OF DATA Official suicide rates capture completed suicides only. They have been used to chart trends in suicide, monitor the impact of change in legislation, treatment policies, and social change, and to compare suicides across regions, both within and across countries.
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From page 56... ...
Lost productivity was defined as the discounted present value of expected future age-, sex- and race-specific earnings. The average annual earnings by age, race/origin, and sex were estimated from the March 1998 supplement to the Current Population Survey (Bureau of Labor Statistics, 1998~.
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From page 57... ...
FINDINGS · Suicide rates vary widely across demographic groups. African Americans have had significantly lower rates historically than whites despite higher incidence of major risk factors.
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From page 58... ...
· The differences in suicide rates among ethnic groups in the United States, among immigrant populations, and among countries throughout the world point to the influence of social and cultural factors. Risk factors vary in their importance for different groups.
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From page 59... ...
American Indian and Alaska Native Mental Health Research Monograph Series, 4: 71-80. Bedeian AG.
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From page 60... ...
American Journal of Public Health, 88~2~: 262-266.
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From page 61... ...
American Indian and Alaska Native Mental Health Research, 1~3~: 36-55. Fortney J
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From page 62... ...
1994. Comparative analysis of violent deaths in American Indians and Alaska Natives.
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From page 63... ...
1989. Motor vehicle crashes and alcohol among American Indians and Alaska Natives.
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From page 64... ...
National Vital Statistics Reports, 48~11~: 1-105. National Commission on Correctional Health Care.
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American Indian and Alaska Native Mental Health Research Monograph Series, 4: 81-94; discussion 94-6. Sartorius N
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1985-1986. Recent suicide rates among ten Ojibwa Indian bands in northwestern Ontario.
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From page 67... ...
2001. Evaluation of the National Model Adolescent Suicide Prevention Project: A Comparison of Suicide Rates Among New Mexico American Indian Tribes, 1980-1998.
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From page 68... ...
They also persecute me by way of unwavering commentary and riJicule to Jeceive, derange, and force me into a world of crippling paranoia. Their commands are abrasive and allencompassing and have resulted in periods of suicidal behavior and self-mutilation.
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