Suicide kings

One commonly hears about suicide among the young, and the elderly. But the CDC suggests that midlife suicide is becoming the bigger problem:

A new five-year analysis of the nation’s death rates recently released by the federal Centers for Disease Control and Prevention found that the suicide rate among 45-to-54-year-olds increased nearly 20 percent from 1999 to 2004, the latest year studied, far outpacing changes in nearly every other age group. (All figures are adjusted for population.)

For women 45 to 54, the rate leapt 31 percent. “That is certainly a break from trends of the past,” said Ann Haas, the research director of the American Foundation for Suicide Prevention.

By contrast, the suicide rate for 15-to-19-year-olds increased less than 2 percent during that five-year period — and decreased among people 65 and older.

The question is why. What happened in 1999 that caused the suicide rate to suddenly rise primarily for those in midlife? For health experts, it is like discovering the wreckage of a plane crash without finding the black box that recorded flight data just before the aircraft went down.

Experts say that the poignancy of a young death and higher suicide rates among the very old in the past have drawn the vast majority of news attention and prevention resources. For example, $82 million was devoted to youth suicide prevention programs in 2004, after the 21-year-old son of Senator Gordon H. Smith, Republican of Oregon, killed himself. Suicide in middle age, by comparison, is often seen as coming at the end of a long downhill slide, a problem of alcoholics and addicts, society’s losers.

“There’s a social-bias issue here,” said Dr. Eric C. Caine, co-director at the Center for the Study of Prevention of Suicide at the University of Rochester Medical Center, explaining why suicide in the middle years of life had not been extensively studied before.

There is a “national support system for those under 19, and those 65 and older,” Dr. Caine added, but not for people in between, even though “the bulk of the burden from suicide is in the middle years of life.”

Of the more than 32,000 people who committed suicide in 2004, 14,607 were 40 to 64 years old (6,906 of those were 45 to 54); 5,198 were over 65; 2,434 were under 21 years old.

By itself, that last is not necessarily particularly worrisome; the Boomers are so much bigger than any other generation (didn't somebody around here just write an article on this?) that it's not surprising that they account for so many of the nation's suicides. This initially made me skeptical of the rest of the results, but with caveats that the data changeover in 1999 makes the study period unhappily short, they seem surprisingly robust. The middle aged really are killing themselves more than they used to.

Why would that be? Fractured social networks or better reporting (there's less stigma than their used to be--so medical examiners may be more willing to call a death a suicide.) Or are we just witnessing the collective despair of a generation that thought that they would be forever young with the world all before them? One odd possibility that occurs to me is that fewer children, and better social safety nets, may make suicide less costly--perhaps previous generations were only held here by the fear that they'd be leaving their children to starve. But to be sure, this probably doesn't match up very well with any time period we can study, so we'll probably never know whether it was a factor.

The article suggests that more widely available prescription drugs are the culprit, but this seems most unlikely. Most completed suicides are not by overdose, which is why women, who favor pills, commit suicide so much less frequently¹. Nor do I know of any evidence that suggests that Viagra causes suicidal ideation--unless it somehow triggers the realization that no pill will make you seventeen again.

¹This is not, as is commonly believed, because women don't "mean it"; the female preference for poison is global, and in places where very effective poisons are commonly available, such as most of the developing world, the suicide rates are often much closer. Rather, it probably has a lot to do with female fear of disfigurement--yes, even in death, though it's irrational.