CDC report shows challenge facing public health campaign goals to prevent suicide

Thomas V. Delaney, Ph.D., assistant professor in the department of pediatrics at the University of Vermont Larner College of Medicine and a long-time suicide prevention advocate.

The World Health Organization wants to reduce the suicide rate by 10 percent by 2020.

The American Foundation for Suicide Prevention’s Project 2025 wants to reduce it 20 percent by 2025.

The Zero Suicide movement aims to prevent 100 percent of suicides in the first 30 days after a patient is discharged from inpatient or day treatment.

Are these goals realistic when new federal data show the reverse has actually been happening?

Twenty-five states saw their suicide rates rise by more than 30 percent between 1999 and 2016, including four of the six New England states.

That’s according to a study the U.S. Centers for Disease Control and Prevention published in the Morbidity and Mortality Weekly Report on June 8, the same day celebrity chef Anthony Bourdain died by suicide in France and three days after fashion designer Kate Spade took her own life at her home in New York.

“It shows we’re not winning, we’re not as a society yet reducing the rate but part of that is because the data is better,” said Robert W. Turner, the private sector chair of the National Action Alliance for Suicide Prevention.

The alliance embraced the goal of Project 2025. Count Turner among the optimists who believe it is within reach. That’s partly because he thinks what happened to him when he recently ended up in a hospital emergency room with a serious skin infection on his hand would not have happened just five or six years ago.

“It’s 1:30 in the a.m. and the admitting nurse in my room is asking me mental health suicide questions: Have I ever thought about suicide? Have I been depressed?” said Turner, a Massachusetts native and a retired senior vice president of Union Pacific Corporation.

The CDC report’s findings reinforced the need to address suicide prevention through a comprehensive and coordinated approach that combines health care system efforts with community efforts.

The study examined suicide rates using data from the National Vital statistics System for 50 states and the District of Columbia. Additionally, data from 27 states covered in the National Violent Death Reporting System – including all six New England states – showed that 54 percent of suicide victims had no known mental health condition.

Relationship, substance use, physical health problems and job, money, legal or housing stress were all identified as contributing factors.

Vermont’s rate jumped 48.6 percent, the second highest increase after North Dakota at 57.6 percent. New Hampshire was close behind with the third highest increase at 48.3 percent.

The suicide rate in Massachusetts rose 35.3 percent while Rhode Island’s rate increased 34.1 percent and Maine’s rate increase was 27.4 percent. Connecticut saw a 19.2 percent rise.

The data came as no surprise to Thomas V. Delaney, Ph.D., assistant professor in the department of pediatrics at the University of Vermont Larner College of Medicine and a long-time suicide prevention advocate. Delaney holds a doctorate in research psychology.

“How I describe it is that not only are Vermont suicide rates higher over time than the U.S. and higher than most of the other New England states, it’s that we’re actually getting worse faster,” Delaney said.

Vermont’s rural character and the higher percentages of whites and military veterans among its nearly 624,000 residents compared to other states are driving the trend. So is the fact that until this year, the state had few gun control laws.

Vermont only recently passed laws requiring background checks for private gun sales, raising the minimum age to purchase firearms to 21 and allowing courts to issue extreme protection orders so that police can seize guns from people considered at risk of harming themselves or others.

States with higher suicide death rates in the West and in the Northeast tend to have fewer restrictions of firearm purchases, Delaney said.

In contrast, Massachusetts has a low suicide rate (ranking 48th in the U.S.) and among the strictest gun control laws in the country.

‘We have this subpopulation of older white males and they tend to be rural and they tend to own firearms,” Delaney said.

“I kind of think of it as like a perfect storm situation where you have these individual factors that seem to be correlated with higher rates of suicide and they all converge over northern New England and then really over Vermont. These are trends that have been holding for 20 years at least which was what the CDC report was really focusing on.”

Delaney believes the trend of increasing suicide rates will eventually be reversed. Vermont is working to expand its Zero Suicide pilot project initiative beyond the three community mental health centers where it is now being implemented.

The data-driven initiative aims to better train health care staff to identify persons at risk for suicide and get them into treatment.

An April 2016 case study in the New England Journal of Medicine outlined how Zero Suicide depression care efforts in a primary care and the general hospital setting reduced suicides by 80 percent between 1999 and 2009 and even by 100 percent in the year 2009.

New models of care included drop-in visits, same-day evaluations by a psychiatrist and department-wide certification in cognitive behavioral therapy. The initiative also included partnering with patients and families to remove access to weapons.

“In general, we’re going to bend the curve,” Delaney said. “It may be the case that it happens because Vermont at one point becomes younger or we become more diverse or maybe we’re able to fully transform our mental health care system to be better at prevention, be more responsive and provide better treatment.”

Turner noted that suicide is an everyday occurrence in the rail industry where he spent the last 15 years of his career. Suicide not only disrupts the flow of goods at great cost to business, it also traumatizes the employees who witness it, he said.

He believes the private sector will come to view committing resources to preventing suicides the same way it did so for smoking cessation programs over the last three decades.

“Theoretically, zero is the goal, but let’s get a goal we can rally around and work towards and measure against,” Turner said.

“When we reduce the rate by 20 percent by 2025, we won’t be done. We’ll set another aspirational goal and we’ll go after that.”