Sunday, October 16, 2011

Trend Alert: Suicide in Later Life Women

Though suicide is the most preventable kind of death, more than 3,000 people die by suicide each day—more than all the deaths caused by accidents, wars, and homicides around the world, combined.

The largest growing number of completed suicides is occurring in later life, more specifically with women aged 50 and older. A recent study has shown a staggering 49% rise in emergency room visits for drug-related suicide attempts by females of this age population. The lethal drugs of choice are narcotic pain relievers hydrocodone and oxycodone.

This research makes the case that late-life suicide is a cause for great concern that warrants ongoing attention from researchers, health care providers, policy makers, and society at large.

Related Facts

  • Suicide is a significant risk for anyone with a mental illness, but is exponentially higher for people with depression.
  • Women attempt suicide more than men.
  • The steep rise in abuse of “narcotic pain relievers” by women is considered a public health crisis.
  • Physical pain can often mask a depressive disorder
  • Prescriptions for anti-anxiety medication and antidepressant medication have tripled over the last decade, while the seeking of psychotherapy has significantly reduced. This suggests pills are valued more-so than skills.
  • Economic stress presses heavily on baby boomers, creating a sense of vulnerability with regard to financial security.

The hard and cold truth is that not all suicides are preventable. Though many individuals plan and even leave clues regarding their objective, there are others that act on impulse, leaving no indelible imprint of their intentions. It’s crucial for family and friends of a person who has died by suicide not to blame themselves for “not knowing”.

10 Tips to Offset This trend

1) Know risks for suicide. Awareness can help identify at-risk adults :
• Previous suicide attempt(s)
• History of depression or other mental illness
• Alcohol or drug abuse
• Family history of suicide or violence
• Physical illness
• Sudden loss or significant change
• Feeling alone

2) Understand the true definition of depression. It’s essential to understand that depression is not just a disorder of mood. It is a disorder of thinking which infects the clarity of the mind like a virus attacks the body. It weakens your defenses, cripples your resolve, and leaves you vulnerable to corrosive thoughts. If you think someone is depressed, don’t rely on them reaching out to you. Instead, be proactive. Call them. Check in. Visit in person. And if you feel worried about them, don’t hesitate to call for help (Police, Fire Department, Family/Friends).

3) Perfecting Diagnosis. Primary care physicians and other health providers need to recognize that physical pain is often a symptom of depression. Better detection, diagnosis and follow up care are needed. In addition, professionals who prescribe narcotics, or any kind of medication, should monitor the frequency of requested refills. Family members should also be aware. This helps to sequester the lethality of the drugs.

4) Understand your life-cycle. The mental and physical health needs of women vary across the life span. We need to teach women what to expect when these changes occur. For example, low levels of estrogen have been linked to suicidal behavior in women. As women age, many go through the emotional process of a “life review” (measuring what they’ve done in their life as mortality approaches), which can heighten sadness. Social connections can wane with age, so isolation is a common experience in later life. It’s vital to encourage women to take an active role in monitoring their own health, so if confronted with these developmental experiences, alternatives can be explored.

5) Find balance. Interpersonal stress is a risk factor for suicide. Illness, job loss, or any kind of adversity can shake one’s feeling of hope and resolve. It’s important for women to keep a healthy diet and get plenty of sleep. Getting a good 30 minutes a day of natural sunshine boosts melatonin – and exercise releases mood pleasing endorphins. If you notice that someone you love is under stress and not tending to self-care, consider this a significant setback and risk factor.

6) Connect with others. A loss of personal control is another issue related to suicidal thinking in older females. For example, women who no longer feel important or necessary to family and/or children, or who no longer feel useful can lapse into self-destructive thoughts. A central way to combat this is to reinvest socially with others. Be it volunteering, finding a low-stress part time job, joining a book club, the goal here is to form new connections and feelings of self worth.

7) Pills are not skills. We need to return to recommending psychotherapy for skill building and problem solving when it comes to mental illness. We live in a disposable society, where medication is seen the quick fix. Medication is a tremendous tool for dealing with suicide and depression, but it’s not sufficient enough to help women navigate the challenges that present in later-life.

8) Choose life affirming experiences. Make sure to activate your senses. Touch. See. Smell. Taste. Listen. Re-engage to the world and it will refuel you. The goal here is to redirect negative thinking to more positive kinds of experiences.

9) Stay away from alcohol and drugs. This includes recreational, over the counter and prescriptive. They can blur your thinking and loosen inhibition.

10) Have a safety plan at-the-ready. Knowing what to do if suicidal thinking occurs can reduce death by suicide. Identify triggers that may lead to a suicidal crisis, such as an anniversary of a loss, stress from work, or a love relationship. Also include contact numbers for the person's doctor or therapist, as well as friends and family members who will help in an emergency. It’s also a good idea to share this safety plan with others.

Substance Abuse and Mental Health Services Administration (2011). DAWN report: Trends in emergency department visits for drug-related suicide attempts among females: 2005 and 2009. Center for Behavioral Health Statistics and Quality, May 12, 1-6.


Judy (kenju) said...

I didn't know that the incidence of suicide was rising in the older female population. For some I know, having to be the caretaker for their men, I can almost understand it.

Keltikmystique said...

With our current economy life has gotten more and more difficult... just trying to survive, as well as added stress. Morale has been on the decline and declining each day. As for the women above 50, well if add health issues to the mix, I can see why. I'm 46 and my health has been a constant frustration; I fear for my future, and would rather pass into the spirit world than be a burden to my sons. Just my 2 cents.

Dr. Deb said...

I didn't know this either until I read the studies!

There are many who feel just like you do. Life is so hard and continues to be a struggle with very little ease on the forefront. I am betting that you would never be a burden to your sons.

Anonymous said...

This is so worthy, Deb. I have been going through much anxiety pertaining to this subject as it relates to my ex-wife. She has been suffering deep depression for some years and went through a major crisis last year. It's distressing and renders me feeling helpless.

Becky Bohan Brown said...

Thanks Dr. Deb this is very insightful. I see the signs all around me with some of my very close friends. I whole-heartedly agree with the proactive approach. Stay in touch by calling, checking in or visiting in person.

Deb said...

It always baffled me when I *only* hear about teen suicides - and while that's also growing rampant, people never seem to realize how many older people, especially women are suicidal and have severe clinical depression. Thank you for bringing this up. It's important for people to know that it's not only teens - but it's happening to every type of person, age, race, gender, etc...

aek said...

I'm in that demographic & made suicide attempts after losing everything and everyone. Ostracism is never ever addressed anywhere by anyone. I was given no help at all during my month long "hospitalization" - read incarceration - in dealing with this, was humiliated, dehumanized, told to file for SSDI so I would "be able to pay the hospital bills" and was instructed to "be flexible" when I was eventually dumped out into the street at the end of a day (for those who don't know, shelter beds are assigned by a morning lottery) in the middle of a severe EPS reaction to the toxic cocktail I was prescribed. No one would speak to me about my suicidality, and so I no longer trust or communicate openly with anyone remotely associated with mental healthcare. It's a cruel and traumatic hoax from first contact to the bogus recovery concept.

Also, FYI, the 800 talk and suicide numbers are staffed by people who don't have any particular credentials or training. More than once I was hung up on when told "sorry I can't help you; I have to go now." click.

Freak? Yes, I am, and I know my place. Silent and out of sight so as to minimize being a target. There is no thanks forthcoming for not letting me end what is unbearable and unending.

Sid said...

There's some good information here to keep in mind for any age, not just women over 50.

As for the "pills are more valued than skills", I think there are bigger issues than people just wanting the pill as a quick fix.

With so many people losing their jobs and/or insurance, pills are often the only affordable option, especially with Walmart, Target & other places offering generic psychotropic meds for less than $10 a month.

Plus, while there are sliding fee scales for therapists at community mental health centers for those without insurance, but many of those centers have long waiting lists as the number of people needing services increases but the budgets of these centers are continually decimated by states dealing with deficits. Mental health is usually one of the first areas to be cut and cut and cut again.

So even if you want therapy, it's much more difficult these days to get it and if you're not well mentally, trying to navigate these hurdles just makes you even more depressed.

Continuing Education for Social Workers said...

HUGE problem and rapidly growing in correlation with declining economy/old age. Thanks for writing about it

Psych Client said...

I tell my therapist all the time when I believe I will finally make my move...he doesn't believe me though. is it normal practice for therapists to ignore suicidal comments? I told him one day it may not go his way

shrink on the couch said...

"Though many individuals plan and even leave clues regarding their objective, there are others that act on impulse, leaving no indelible imprint of their intentions."

I read something recently to this effect. I'd like to see more because I often wonder how it is datermined that the suicidal person acted impulsively. And how impulsively is operationally defined. Without any prior thought, just one day she up and decides? Maybe the person has been quietly planning, telling no one and leaving no clues.

(aka coffee yogurt)

Dr. Deb said...

Mr. Write on,
Terrible that you feel so helpless. Is she open to getting help?

Caretaking those who are depressed is ESSENTIAL for saving lives.

Yes, there is a wide range of ages that contemplate sucide. Sometimes certain groups get more media attention than others. Nice to see you here. I have to visit and catch up on how things are with you.

I am very distressed to learn that you've been hung up on, told that you can't be helped. It is true that many who answer hotlines are not professions, but the ARE supposed to be thoroughly trained and sensitive. Please consider reaching out to a mental health professional. I've been where you are and can say that there is light and hope if your depression and situation can be treated. Consider letting me know where you live and perhaps I can find a thoughtful trustworthy clinician for you.

As always, you make some great points. It is VERY difficult for many to find help, even at low fees. With less and less people going into mental health as a profession, there is a shortage of therapists too.

Social Worker,
We need to keep the subject out there and mobilize better care as well.

Psych Client,
NO! That is NOT appropriate.

Shrink on the Couch,
There *are* many who give no clues to their intentions. They are a very low percentage though. Sometimes it's impuslive other times it is quietly carefully planned.