An alarming study
04/11/15 05:08
Because of my work in suicide prevention and my professional membership in the National Alliance on Mental Illness, I read quite a few abstracts of studies. I rarely read the entire published results of the studies, which are often technical and published in medical journals to which I don’t always have access. The abstracts, however, give an overview of contemporary research. One abstract caught my attention recently.
Researchers at Princeton University studied mortality rates of U.S. citizens aged 45 to 54, over the period of 1999 through 2013. It revealed an unexpected change. While mortality rates for black (non-hispanic) Americans continued its decline, as was also the case for Hispanic Americans, the mortality rate for Middle-aged white Americans went up. After decades of declining mortality rates, the increase was not at all expected. Furthermore, when the study was broken down into sub categories, White Americans with education levels of high school or less showed a steady increase over the research period, with their mortality rate becoming higher than all other categories in 2007.
The study, published in the Proceedings of the National Academy of Sciences, compared the results with national data from the US Centers for Disease Control and Prevention. Several factors contribute to the increased mortality rate.
We have known for several years that suicide rates are highest among white males and females and that they are highest in the South and West. We also know that rural areas suffer from higher suicide rates than urban areas. Accurate diagnosis and treatment of mental health problems is far less common in rural areas. There are fewer resources for treatment and a higher social stigma for seeking mental health care in rural America. At the same time access to the most common means of suicide, firearms and drugs, is highest in rural areas.
A second factor cited by the study is increased drug and alcohol abuse among middle aged white males. Leading the drug abuse is opioid drugs. Prescriptions for opioids have increased greatly since the 1990’s. There has been some awareness of the increase and many physicians have become more careful about writing prescriptions. The result has been an increase in heroin use among whites. The New York Times reported that 90% of people who tried heroin in the last decade were white. While not quite as dramatic, the increase in alcohol abuse among whites has also been documented.
The increase in the abuse of pain medication and alcohol is likely connected to the increase in undiagnosed and poorly treated mental illness. People will attempt self medication with inappropriate substances just to dull the pain. The result is a compounding of symptoms leading to an increased death rate. Even if the cause of death is not suicide, alcohol and drug abuse are self destructive and related.
My experience as a member of our county’s LOSS (Local Outreach to Survivors of Suicide) has paralleled the findings of the study. We are responding to more suicides of white middle aged males than was the case years ago.
Another thing about the study is that it appears that this increase in death rates is occurring only in the United States. The results among US males is not paralleled by studies in any other country.
I had been pondering the study when I read an article in this morning’s Washington Post reporting on Susan Williams’ interview with “Good Morning America” yesterday. I didn’t watch the television interview, but the widow of Robin Williams was direct in saying that the underlying cause of Williams’ death was Lewy body dementia, an often undiagnosed brain disease. Williams suffered a wide array of symptoms before his death: crippling anxiety attacks, strange delusions, and the feeling that he was loosing his mind. He knew that something was terribly wrong, but didn’t understand what it was.
Lewy bodies are accumulations of a protein called alphasynuclean, at the ends of neurons where they connect with synapses. These bodies destroy the neurons, leading to loss of function in affected areas of the brain. The presence of Lewy bodies in Williams brain was not discovered until autopsy. Lewy bodies are also responsible for Parkinson’s disease, and Williams was diagnosed with Parkinson’s based on the symptoms he displayed. The problem with a misdiagnosis, which may have been the case with Williams, is that the medications prescribed for Parkinson’s can be ineffective for Lewy body dementia symptoms.
There have been other celebrities diagnosed with Lewy body dementia (LBD) including the famous DJ Casey Kasem, who died last summer. Kasem was initially diagnosed with Parkinson’s but the diagnosis was changed as he began to deteriorate mentally as well as physically. Stan Mikita, star Chicago Black Hawks player of the 1960s and 70s, ahas also been diagnosed with LBD. He is currently living in a health care facility unable to remember his hockey career or much else about his life.
Patients with LBD usually die within five to seven years after the initial onset of symptoms, though there are cases where people have lingered for decades with dramatically decreased cognitive function.
We will never know the full story of Robin William’s death. He was scheduled for neurocognitive testing in late August, but a week before the scheduled tests he died of suicide. Even with the information gained at autopsy, there is much that is not understood about the nature of his brain disease and death.
Williams was older than the men in the Princeton University study group, but understanding his death might lead to more understanding of the increase in mortality among middle-aged US White males. Sometimes the death of a celebrity can bring attention to a phenomena that has been affecting many people, but remains unstudied because attention is focused elsewhere.
One thing is clear to me, the social stigma that blames victims of suicide is misplaced. There is much more going on than poor choices when someone dies of suicide. Only by learning to diagnose and treat illness will we be able to make a change in this alarming statistic.
I’ll keep reading the abstracts. Clearly we have much to be learned.
Researchers at Princeton University studied mortality rates of U.S. citizens aged 45 to 54, over the period of 1999 through 2013. It revealed an unexpected change. While mortality rates for black (non-hispanic) Americans continued its decline, as was also the case for Hispanic Americans, the mortality rate for Middle-aged white Americans went up. After decades of declining mortality rates, the increase was not at all expected. Furthermore, when the study was broken down into sub categories, White Americans with education levels of high school or less showed a steady increase over the research period, with their mortality rate becoming higher than all other categories in 2007.
The study, published in the Proceedings of the National Academy of Sciences, compared the results with national data from the US Centers for Disease Control and Prevention. Several factors contribute to the increased mortality rate.
We have known for several years that suicide rates are highest among white males and females and that they are highest in the South and West. We also know that rural areas suffer from higher suicide rates than urban areas. Accurate diagnosis and treatment of mental health problems is far less common in rural areas. There are fewer resources for treatment and a higher social stigma for seeking mental health care in rural America. At the same time access to the most common means of suicide, firearms and drugs, is highest in rural areas.
A second factor cited by the study is increased drug and alcohol abuse among middle aged white males. Leading the drug abuse is opioid drugs. Prescriptions for opioids have increased greatly since the 1990’s. There has been some awareness of the increase and many physicians have become more careful about writing prescriptions. The result has been an increase in heroin use among whites. The New York Times reported that 90% of people who tried heroin in the last decade were white. While not quite as dramatic, the increase in alcohol abuse among whites has also been documented.
The increase in the abuse of pain medication and alcohol is likely connected to the increase in undiagnosed and poorly treated mental illness. People will attempt self medication with inappropriate substances just to dull the pain. The result is a compounding of symptoms leading to an increased death rate. Even if the cause of death is not suicide, alcohol and drug abuse are self destructive and related.
My experience as a member of our county’s LOSS (Local Outreach to Survivors of Suicide) has paralleled the findings of the study. We are responding to more suicides of white middle aged males than was the case years ago.
Another thing about the study is that it appears that this increase in death rates is occurring only in the United States. The results among US males is not paralleled by studies in any other country.
I had been pondering the study when I read an article in this morning’s Washington Post reporting on Susan Williams’ interview with “Good Morning America” yesterday. I didn’t watch the television interview, but the widow of Robin Williams was direct in saying that the underlying cause of Williams’ death was Lewy body dementia, an often undiagnosed brain disease. Williams suffered a wide array of symptoms before his death: crippling anxiety attacks, strange delusions, and the feeling that he was loosing his mind. He knew that something was terribly wrong, but didn’t understand what it was.
Lewy bodies are accumulations of a protein called alphasynuclean, at the ends of neurons where they connect with synapses. These bodies destroy the neurons, leading to loss of function in affected areas of the brain. The presence of Lewy bodies in Williams brain was not discovered until autopsy. Lewy bodies are also responsible for Parkinson’s disease, and Williams was diagnosed with Parkinson’s based on the symptoms he displayed. The problem with a misdiagnosis, which may have been the case with Williams, is that the medications prescribed for Parkinson’s can be ineffective for Lewy body dementia symptoms.
There have been other celebrities diagnosed with Lewy body dementia (LBD) including the famous DJ Casey Kasem, who died last summer. Kasem was initially diagnosed with Parkinson’s but the diagnosis was changed as he began to deteriorate mentally as well as physically. Stan Mikita, star Chicago Black Hawks player of the 1960s and 70s, ahas also been diagnosed with LBD. He is currently living in a health care facility unable to remember his hockey career or much else about his life.
Patients with LBD usually die within five to seven years after the initial onset of symptoms, though there are cases where people have lingered for decades with dramatically decreased cognitive function.
We will never know the full story of Robin William’s death. He was scheduled for neurocognitive testing in late August, but a week before the scheduled tests he died of suicide. Even with the information gained at autopsy, there is much that is not understood about the nature of his brain disease and death.
Williams was older than the men in the Princeton University study group, but understanding his death might lead to more understanding of the increase in mortality among middle-aged US White males. Sometimes the death of a celebrity can bring attention to a phenomena that has been affecting many people, but remains unstudied because attention is focused elsewhere.
One thing is clear to me, the social stigma that blames victims of suicide is misplaced. There is much more going on than poor choices when someone dies of suicide. Only by learning to diagnose and treat illness will we be able to make a change in this alarming statistic.
I’ll keep reading the abstracts. Clearly we have much to be learned.