Suicide and Middle-Aged Men
When the news of Robin Williams’s death swept across the nation last August, it brought attention to an issue that has long concerned Richard McKeon, Ph.D.
Dr. McKeon, chief of SAMHSA’s Center for Mental Health Services Suicide Prevention Branch, leads a team that has been working to prevent suicide, but Congressional funding focuses on ages 10 to 24. But given that there has been a decades-long rise in the rate of death by suicide of middle-aged men — a trend that has been largely unnoticed by those outside of the mental health community — SAMHSA took the step to fund efforts aimed at people in their middle years.
Suicide: Warning Signs
The following signs may mean that a person is at risk for suicide. The risk is often greater if any of these behaviors are new, have increased, or are related to a painful event, loss, or change:
- Talking about wanting to die or end life by suicide
- Looking for a way (i.e., searching online or buying a gun) to die by suicide
- Talking about feeling hopeless or having no reason to live
- Talking about feeling trapped or in unbearable pain
- Talking about being a burden to others
- Increasing use of alcohol or drugs
- Acting anxious or agitated
- Withdrawing or feeling isolated
- Showing rage or talking about seeking revenge
- Displaying extreme mood swings
Although the rate of death by suicide among those between the ages of 35 and 64 increased by an alarming 28 percent between 1999 and 2010, many Americans still view it as an issue that largely affects teenagers. But while youths have the highest rates of suicide attempts, middle-aged adults have the highest number of deaths by suicide nationwide. In 2012, more than 55 percent of the suicides in the U.S. took place among adults between ages 35 and 64, and more than 87 percent of suicides were among people older than 24.*
But the tragic death of Williams — a beloved actor and comedian — brought into our living rooms the reality that suicide is increasingly affecting men in the primes of their lives.
“There’s no question that the tragedy of Robin Williams’s suicide has brought a lot of attention to the issue,” Dr. McKeon says. “And we still have a long way to go. There are significant numbers of people who are not getting the help they need, but SAMHSA and our public and private partners are working to change that.”
Turning Around a Troubling Trend
Suicide is an issue that affects all age groups. Each year, more than 40,000 people in the United States die by suicide — a figure that exceeds the rate of death from homicide and AIDS combined.* Additionally, according to SAMHSA’s 2012 National Survey on Drug Use and Health, there are an estimated 32 suicide attempts for every adult who dies by suicide.
But many in the mental health community have been concerned by the marked increase in the suicide rate among those in their middle years — especially among men in that age group. Suicide is an issue that affects men at a disproportionate rate: four of every five suicides in the U.S. are by men.*
In response to this increase in suicidal behavior, SAMHSA and its public and private partners have been working both to understand why the suicide rate for middle-aged men has risen so sharply, and to develop suicide-prevention strategies aimed specifically at this age group.
Men who have lost their jobs, for example, are much more likely to attempt suicide. Lisa Capoccia, MPH, assistant manager of provider initiatives for SAMHSA’s Suicide Prevention Resource Center, says researchers are working to determine just how much the economic downturn that occurred during the last decade contributed to the increase in the suicide rate.
In 2013, adults who were unemployed in the past year were substantially more likely than those who were employed full-time to have serious thoughts of suicide (7.0 vs. 3.0 percent) or attempt suicide (1.4 percent vs. 0.3 percent), according to SAMHSA’s 2013 National Survey on Drug Use and Health.
In addition to the recent recession, other contributing factors may have a cohort effect on the rise in suicide rates among people in the middle years, and a rise in intentional overdoses associated with the increase in availability of prescription opioids.
Because of these and other factors, Dr. McKeon says SAMHSA is leading efforts to identify and develop approaches that will help better identify middle-aged men who are at risk of suicide, and to promote protective measures and reduce risk factors. This includes strategies such as increasing connectedness to family and peers, increasing access to physical and behavioral health care, providing continuity of care upon release from emergency departments or psychiatric hospitalization, and identifying best practices within workplaces, the criminal justice system, and other settings that provide promising opportunities to engage people in their middle years.
Increasing access to behavioral health care is particularly important in light of the fact that more than one half of the 8.6 million adults aged 18 or older who had serious thoughts of suicide in the past year did not receive mental health services, according to the 2008 to 2012 National Surveys on Drug Use and Health. Almost 40 percent neither received services nor felt they needed them.
Reaching Men in New Ways
Connecting those at risk of suicide with the appropriate mental health services is crucial. SAMHSA, as well as groups such as the National Action Alliance for Suicide Prevention, are working to ensure that more middle-aged men are getting appropriate help.
How You Can Help
If you believe someone may be thinking about suicide:
- Ask them if they are thinking about killing themselves.
- Listen without judging and show you care.
- Stay with the person or make sure they are in a safe place with another caring person until additional help is in place.
- Remove any objects that could be used in a suicide attempt.
- Call SAMHSA’s National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
- Seek help if self-harm seems imminent – call 911.
SAMHSA, for instance, recently awarded four states (NM, NY, OK and TN) national strategy grants to help prevent suicide and suicide attempts among working-age adults in support of the 2012 National Strategy for Suicide Prevention.
The National Action Alliance for Suicide Prevention is a SAMHSA-supported public-private partnership of more than 200 organizations that advance the National Strategy. In 2014 the partnership explored areas that show the most promise in helping reduce the rates of suicide attempts and suicides in the next 5 to 10 years.
Dr. Doryn Chervin, executive secretary of the National Action Alliance for Suicide Prevention, stated that these efforts will focus, in part, on how to improve outcomes for middle-aged men. In March 2015, the alliance expects to release a series of recommendations that will help establish priorities for helping men in their middle years. “We’re trying to identify where men experience crisis and identify the settings and the interventions that work best for men in these settings,” Dr. Chervin remarked.
SAMHSA will soon release a mobile phone app called Suicide Safe. Suicide Safe aims to help service providers to more confidently assist patients who present with suicidal ideation, communicate effectively with patients and their families, and make referrals to treatment and community resources.
A New Focus
Dr. McKeon says all of these efforts represent important steps forward in both understanding the reasons why suicide has been on the rise — and how to reverse that trend.
“Twenty years ago, very little if anything was being done on the federal level. Today, much more is being done,” Dr. McKeon says. “We’ve needed to play catch-up, but we are now on the right track in terms of where we’re trying to go. Now, we have to take some of the encouraging research and bring it to scale so we can fill in the gaps.”
* Source: CDC WISQARS database.
- SAMHSA’s Suicide Prevention
- National Suicide Prevention Lifeline (800-273-TALK/8255)
- National Action Alliance for Suicide Prevention
- National Strategy for Suicide Prevention 2012: How You Can Play a Role in Preventing Suicide
- Learn the Warning Signs: National Suicide Prevention Lifeline Wallet Card
- Red nacional para la prevención de suicidio: Señales de Suicidio: Conozco las señales de peligro
- Stories of Hope and Recovery: A Video Guide for Suicide Attempt Survivors
- Suicide Assessment Five-Step Evaluation and Triage (SAFE-T)
- Suicide Prevention Resource Center
- TIP 50: Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment
Related SAMHSA Blogs
- Robin Williams: Raising Awareness About Depression
- Suicide Prevention: What’s Your Role?
- View from the Administrator: Preventing Suicide
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