Last week, the American Journal of Preventive Medicine published a paper seeking to find out why the suicide rate for middle-aged American men and women has risen nearly 40 percent since 1999, with a particularly sharp increase since 2007.
The authors drew data from the Centers for Disease Control’s National Violent Death Reporting System (probably the most morbidly fascinating database in existence) for the years 2005-2010, and used as a starting point the fact that Americans ages 40-64 were the hardest-hit group in the mid-2000’s recession.
The paper found that suicides with “external circumstances” (defined as job, legal or financial circumstances) as a major factor rose from 32.9 percent to 37.5 percent of completed suicides in this age group from 2005-2010, with the chart below showing an increase corresponding with the start of the latest recession. In particular, the use of suffocation, a method that is commonly used in suicides caused by external circumstances, rose by 27.7 percent during this 5-year period among middle-aged people.
A Fading Taboo
In many parts of ancient Europe, suicide seemed to have been viewed as a routine business. According to the historian Livy, Romans could apply to the Senate for permission to commit suicide, and if granted, they would be given a free bottle of the poison hemlock. Stoicism, a school of philosophy popular in ancient Rome, viewed suicide as a dignified act if used not because of fear or weakness. Emperor Nero, Caesar’s assassins Brutus and Cassius, and the Mark Antony and Cleopatra are just a few of the famous people from this era to have committed suicide.
While the medieval Catholic Church viewed suicide as a sin, it was a topic oft discussed and debated by theologians, scholars and rulers continuing into the Enlightenment. The 19th century saw suicide become romanticized and trendy in many ways, particularly among artists and young men inspired by the protagonist of Johann von Goethe’s blockbuster novel The Sorrows of Young Werther.
Indeed, it seems only in the 20th century did suicide become a topic to be discussed only in hushed tones and rarely mentioned in print. A 1968 article in Science could only guess at the annual number of American suicides because many ended up being “disguised by the listing of another cause of death on the death certificate.”
In the 21st century, the taboo about suicide seems to be receding in favor of earnest discussions to fix the problem. The first World Suicide Prevention Day was celebrated in 2003, and issues such as the disturbing rate of suicide among American veterans are now widely covered and discussed.
With advances in neuroscience and psychology, research into the causes of suicide has shifted from abstract discussions of mental disorder to recognizing specific neural proteins and compounds associated with depression and suicide.
A 2007 article in the journal Progress in Neuro-Psychopharmacology and Biological Psychiatry found that low levels of the protein Brain-derived neurotrophic factor (BDNF) were associated with major depression and suicidal behavior. In a 2005 article published in Molecular Brain Research, abnormally low levels of BDNF were found in the brains of suicide victims, particularly those who had not taken any psychological drugs. Further research has shown that people with suicidal tendencies tend to have excess receptors for seratonin, a neurotransmitter molecule that helps regulate mood in humans.
Beyond the neurobiology of depression, science has also begun to tackle what in particular causes some people with depression to take suicidal action while others don’t. Some underlying factors are at work – men are more likely than women to commit suicide, people with a history of impulsiveness are more likely to at least attempt suicide, and as alluded to above, life circumstances or mental illness are the clearest omens of suicidal action. But a 2005 article in the Journal of Consulting and Clinical Psychology suggested that the “capability” to go through with suicide is something that must be acquired through life experience, particularly exposure to “painful and provocative events” such as fights and self harm. A 2007 study by the same team found that physical and sexual abuse during childhood was a significant predictor of a person attempting suicide in adulthood, and research has even shown that childhood abuse can cause permanent epigenetic effects on the human brain.
“People who have been abused or have abused themselves would habituate to the experiences of pain and acquire the ability to act on suicidal thoughts,” Harvard psychologist Matthew Nock said in a 2010 article in Scientific American.
Preventing the Problem
Research into actual suicide prevention has taken several paths. Some studies have looked at the effectiveness of catching depression before it becomes a problem through screening at regular doctor’s appointments, however limited data has prevented them from making firm conclusions.
Other researchers have looked into various methods for treating depression, from the effectiveness of various antidepressant drugs to whether making patients sign a suicide prevention contract actually works. Psychotherapy has been proven to work for many, but not all, people with depression.
To read more about suicide, check out these links from the American Foundation for Suicide Prevention.