Why can't we do better at preventing suicide?
Over the last twenty years we’ve witnessed a stunning setback in the US. While there are multiple organizations working to reduce suicide and multiple efforts in place, we have nevertheless seen a steady rise in suicides- of about 40%. While rates decreased slightly in 2020, the drop was small, and it is unclear how we should understand this (the COVID pandemic may have played an unexpected role in risk for suicide and/or in collecting data). Additionally, many other first world countries have seen reduction in suicide rates during this same period.
What is going on?
In the past several years, the CDC has begun to take a new approach in examining the circumstances predisposing or contributing to suicide. There is a long held truism that 90% of those who die by suicide have an underlying mental health condition, while more recently the CDC has reported that 54% of those who had died by suicide in the prior year had no psychiatric diagnosis (for a discussion of this discrepancy see: https://afsp.org/story/ask-dr-jill-does-mental-illness-play-a-role-in-suicide). In any case, the CDC has begun to note other important contributors to suicide risk in their reports on suicide. They now note that relationship, employment, housing, and legal problems appear to be major contributors to suicide risk in the US.
I was reminded of this trend when I recently came across an updated report by the Princeton economists Anne Case and Angus Deaton entitled, The Great Divide: Education, Despair and Death. This is a follow-up report to the earlier work published in their 2015 book, Deaths of Despair and the Future of Capitalism. They argue that since the 1970’s, working class Americans without college degrees have been increasingly marginalized and disadvantaged-in the workplace and the political arena, have grown increasingly unhealthy and pessimistic/hopeless, and as a result have increasingly died from drug overdoses, suicide and alcohol related liver disease. These changes have escalated as income inequality has soared while the social safety net has eroded in the past 20 years.
They show how lower life expectancy in the US is a direct result of these “deaths of despair” mostly among non-college educated men in their midlife years. Surprisingly, while non-Hispanic Blacks have higher death rates than age matched non-Hispanic whites, Blacks with a BA are much closer in death rate to whites with a BA and have substantially lower death rates than whites without a college degree. College education has become the most powerful driver of death rate independent of race. (This is not happening in other first world countries). Further, since 2010, (probably as a result of the market crash and bland recovery which largely left many working-class people underemployed) death rates for those with BA’s continued to decline while for those without a BA they went up-again independent of race. The authors discuss the impact of COVID on these trends and find that these relationships held steady at least through 2020.
Where does this leave us?
I strongly recommend anyone trying to think about what we need to do from a policy and legislative perspective to reduce suicide rates and other deaths of despair to study Case and Deaton’s work carefully. The continuing erosion of our support for and access to health care, social services, livable wage employment, and affordable housing are having tragic impact on the morale, health, and safety of the nation. Case and Deaton suggest that many working class whites have shifted to supporting political positions and candidates who often are promoting legislation that actually further hurts them (largely driven by anxiety and racial animus).
In any case, until we can begin again to function as a united national community with an understanding that the health and safety of every resident of our country impacts that of everyone else, we will not make substantial progress in lowering suicide rates nationally no matter how many webinars and trainings we do. The malady is systemic, and we won’t fix it by covering it with a bandage. There need to be systemic and fundamental cultural and political shifts before we can do much better. Dare I say it, we need quite a bit more socialism in our country!
Please read and carefully consider their work.