Studying the statistics

I know that statistics provide a way of viewing the past and that they rarely have much value as a way of predicting the future, but there are patterns that can be detected. Recently, when trying to gain understanding suicide in our community, I turned to the statistics. I began to compare our state to its neighbors looking for similarities and differences. Whenever I do this, I keep in mind that statewide averages don’t tell us what we need to know about South Dakota because the two ends of our state are radically different. In Eastern South Dakota, suicide rates run very close to national averages. Those numbers, while not good, are significantly lower than the Western part of our state. Here in Pennington County, our suicide rate has been as high as 2 1/2 times the national average.

Every suicide is a tragedy with wide-ranging consequences. Those who have lost loved ones to suicide themselves live with an increased chance of dying by suicide. Suicide grief is unique. The stigma attached to mental illness extends to suicide. People don’t want to talk about it and those who suffer the pain of loss feel that they don’t have support in the community. I don’t want a discussion of statistics to cloud this simple fact: one death by suicide is too many. However, the numbers do tell a story.

If you look at statewide averages, every year in the past decade when our rate has equaled or exceeded the rate in Colorado, South Dakota has experienced a drop in the rate the following year. In 2006, our statewide rate was higher than Colorado’s. 2007 was the lowest number of suicides in South Dakota since I’ve been following the numbers. We exceeded Colorado again in 2010, and had a dip in 2011, though not as dramatic as was the case in 2007. In 2013, the rate was virtually the same in the two states, and again, in 2014, South Dakota experienced a dip. We don’t have the numbers in for 2016 yet, but it appears that we will be very similar as a state to Colorado. How I wish the numbers were predictive and we might experience a drop in 2017.

One more thing about statistics before I proceed. The rate of death by suicide continues to increase. If you think you’ve heard more about suicide in recent years one of the reasons is that the number of suicides is increasing. Nationally, we will probably top 13 suicides per 100,000 people this year. South Dakota’s rate will likely be in the range of 18 per 100,000. Here in Pennington County, we could see numbers as high as 29 per 100,000.

Suicide is a phenomenon that we only partly understand. Its causes and the dynamics in individual cases are varied. And it is hard to study the act of suicide because much of the evidence is lost with the death. There is a lot that we simply don’t know about what leads up to death by suicide. So we look for commonalities. We search for other factors that might explain what is going on. There are some things we can observe. Suicide rates are higher in areas where access to psychiatric treatment is limited. In rural areas there are fewer psychiatrists and the wait for an appointment can be long. Here in our county a person experiencing suicidal ideation might wait for up to three weeks to be seen by a psychiatrist.

The use of medications to treat psychological symptoms continues to rise at a rapid rate. Because people don’t have access to psychiatrists, nearly 80% of mood-altering drugs are prescribed by doctors who are not psychiatrists. Doctors often give these powerful medications to persons who have no psychiatric diagnosis. Let me be clear. I am not suggesting that these medications are the cause of the increase in suicide. Research into the field is challenging because people who take the medications are more likely to suffer from depression and depression is one of the leading causes of suicide. We simply don’t have the evidence to suggest that there is a cause/effect relationship. What I do believe, however, is that we have come to believe that medications can provide a cure to our problems and when they fail to do so, a spiral of hopelessness begins. I routinely encounter people who are taking more than three psychotropic medicines. The person doesn’t respond to the first medicine, so another is added. The process continues. Multiple powerful mood-altering drugs at the same time is, for most people sub-optimal treatment.

Because there are multiple causes for depression, we shouldn’t expect there to be a one-size-fits-all treatment for the condition. I have read that antidepressant medication alone works in only about half of the situations where it is prescribed.

When people don’t receive treatment that works for their illnesses, the risk of death by suicide increases.

There is something else that has been going on over the past decade. While suicide remains more common among men than women, the rate of death by suicide among middle-aged women in our community has been increasing steadily since at least 2007. The women who are dying seem to be mostly white and tend to have jobs that are physically demanding.While labels such as blue collar and white collar don’t fully describe the individuals in our community, those dying by suicide tend not to be working in offices, but rather in service jobs such as housekeeping and janitorial, as well as retail trades. They often are working at multiple jobs at the time of their deaths.

Women who die by suicide are likely to be taking medicine for psychological illnesses. Nearly 1 in 4 women aged 50 to 64 in our community are taking an antidepressant according to federal health statistics. That means that they and at least a physician are aware that illness exists and that there is an attempt to find a solution.

I don’t have the answers. And I doubt that studying the statistics will provide the insights that are needed to prevent suicide in our community. But neither will ignoring the problem. So we continue to study and to respond and to build awareness in our community. It is that third part - building awareness - that I see as critical. This blog is one more attempt at that task.

Copyright (c) 2016 by Ted E. Huffman. I wrote this. If you would like to share it, please direct your friends to my web site. If you'd like permission to copy, please send me an email. Thanks!