nearly 40,000 Americans kill themselves. The majority are men, and most of them
use guns. In fact, more than half of all gun deaths in the United States are
Experts and laymen have long assumed that people who died by suicide will
ultimately do it even if temporarily deterred. “People think if you’re really
intent on dying, you’ll find a way,” said Cathy Barber, the director of the
Means Matters campaign at Harvard Injury Control Research Center.
Prevention, it follows, depends largely on identifying those likely to harm
themselves and getting them into treatment. But a growing body of evidence
challenges this view.
Suicide can be a very impulsive act, especially among the young, and therefore
difficult to predict. Its deadliness depends more upon the means than the
determination of the suicide victim.
Now many experts are calling for a reconsideration of suicide-prevention
strategies. While mental health and substance abuse treatment must always be
important components in treating suicidality, researchers like Ms. Barber are
stressing another avenue: “means restriction.”
Instead of treating individual risk, means restriction entails modifying the
environment by removing the means by which people usually die by suicide. The
world cannot be made suicide-proof, of course. But, these researchers argue, if
the walkway over a bridge is fenced off, a struggling college freshman cannot
throw herself over the side. If parents leave guns in a locked safe, a teenage
son cannot shoot himself if he suddenly decides life is hopeless.
With the focus on who dies by suicide, these experts say, not enough attention
has been paid to restricting the means to do it — particularly access to guns.
“You can reduce the rate of suicide in the United States substantially, without
attending to underlying mental health problems, if fewer people had guns in
their homes and fewer people who are at risk for suicide had access to guns in
their home,” said Dr. Matthew Miller, a director of Harvard Injury Control
About 90 percent of the people who try suicide and live ultimately never die by
suicide. If the people who died had not had easy access to lethal means,
researchers like Dr. Miller reason, most would still be alive.
The public has long held the opposite perception. In 2006, researchers at the
Harvard center published an opinion survey about people who jump from the Golden
Gate Bridge. Seventy-four percent of respondents believed that most or all
jumpers would have completed suicide some other way if they had been deterred.
“People think of suicide in this linear way, as if you get more and more
depressed and go on to create a more specific plan,” Ms. Barber said.
In fact, suicide is often a convergence of factors leading to a sudden, tragic
event. In one study of people who survived a suicide attempt, almost half
reported that the whole process, from the first suicidal thought to the final
act, took 10 minutes or less.
Among those who thought about it a little longer (say, for about an hour), more
than three-quarters acted within 10 minutes once the decision was made.
“We’re very bad at predicting who from a group of at-risk people will go on to
complete suicide,” Dr Miller said. “We can say it will be about 10 out of the
100 who are at risk. But which 10, we don’t know.”
Dr. Igor Galynker, the director of biological psychiatry at Mount Sinai Beth
Israel, noted that in one study, 60 percent of patients who were judged to be at
low risk died of suicide after their discharge from an acute care psychiatric
“The assessments are not good,” he said. So Dr. Galynker and his colleagues are
developing a novel suicide assessment to predict imminent risk, based upon new
findings about the acute suicidal state.
“What people experience before attempting suicide is a combination of panic,
agitation and franticness,” he said. “A desire to escape from unbearable pain
and feeling trapped.”
Sometimes, depression isn’t even in the picture. In one study, 60 percent of
college students who said they were thinking about ways to kill themselves
tested negative for depression.
“There are kids for whom it’s very difficult to predict suicide — there doesn’t
seem to be that much that is wrong with them,” said Dr. David Brent, an
adolescent psychiatrist who studies suicide at the University of Pittsburgh.
Dr. Brent’s research showed that 40 percent of children younger than 16 who died
by suicide did not have a clearly definable psychiatric disorder.
What they did have was a loaded gun in the home.
“If the kids are under 16, the availability of a gun is more important than
psychiatric disorder,” Dr. Brent said. “They’re not suicidal one minute, then
they are. Or they’re mad and they have a gun available.”
Availability is a consistent factor in how most people choose to attempt
suicide, said Ms. Barber, regardless of age. People trying to die by suicide
tend to choose not the most effective method, but the one most at hand.
“Some methods have a case fatality rate as low as 1 or 2 percent,” she said.
“With a gun, it’s closer to 85 or 90 percent. So it makes a difference what
you’re reaching for in these low-planned or unplanned suicide attempts.”
Statistically, having a gun in the home increases the probability of suicide for
all age groups. If the gun is unloaded and locked away, the risk is reduced. If
there is no gun in the house at all, the suicide risk goes down even further.
Findings like these are far from popular. Taxpayers resist spending public money
on infrastructure that they believe will not prevent people determined to die by
suicide, and the political tide has turned against gun control. But growing
evidence of suicide’s unpredictability, coupled with studies showing that means
restriction can work, may leave public health officials little choice if they
wish to reduce suicide rates.
Ken Baldwin, who jumped from the Golden Gate Bridge and lived, told reporters
that he knew as soon as he had jumped that he had made a terrible mistake. He
wanted to live. Mr. Baldwin was lucky.
Ms. Barber tells another story: On a friend’s very first day as an emergency
room physician, a patient was wheeled in, a young man who had shot himself in a
suicide attempt. “He was begging the doctors to save him,” she said. But they
A version of this article appears in print on March 10, 2015, on page D2 of the
New York edition with the headline: Blocking the Paths to Suicide.
rates among middle-aged Americans have risen sharply in the past decade,
prompting concern that a generation of baby boomers who have faced years of
economic worry and easy access to prescription painkillers may be particularly
vulnerable to self-inflicted harm.
More people now die of suicide than in car accidents, according to the Centers
for Disease Control and Prevention, which published the findings in Friday’s
issue of its Morbidity and Mortality Weekly Report. In 2010 there were 33,687
deaths from motor vehicle crashes and 38,364 suicides.
Suicide has typically been viewed as a problem of teenagers and the elderly, and
the surge in suicide rates among middle-aged Americans is surprising.
From 1999 to 2010, the suicide rate among Americans ages 35 to 64 rose by nearly
30 percent, to 17.6 deaths per 100,000 people, up from 13.7. Although suicide
rates are growing among both middle-aged men and women, far more men take their
own lives. The suicide rate for middle-aged men was 27.3 deaths per 100,000,
while for women it was 8.1 deaths per 100,000.
The most pronounced increases were seen among men in their 50s, a group in which
suicide rates jumped by nearly 50 percent, to about 30 per 100,000. For women,
the largest increase was seen in those ages 60 to 64, among whom rates increased
by nearly 60 percent, to 7.0 per 100,000.
Suicide rates can be difficult to interpret because of variations in the way
local officials report causes of death. But C.D.C. and academic researchers said
they were confident that the data documented an actual increase in deaths by
suicide and not a statistical anomaly. While reporting of suicides is not always
consistent around the country, the current numbers are, if anything, too low.
“It’s vastly underreported,” said Julie Phillips, an associate professor of
sociology at Rutgers University who has published research on rising suicide
rates. “We know we’re not counting all suicides.”
The reasons for suicide are often complex, and officials and researchers
acknowledge that no one can explain with certainty what is behind the rise. But
C.D.C. officials cited a number of possible explanations, including that as
adolescents people in this generation also posted higher rates of suicide
compared with other cohorts.
“It is the baby boomer group where we see the highest rates of suicide,” said
the C.D.C.’s deputy director, Ileana Arias. “There may be something about that
group, and how they think about life issues and their life choices that may make
The rise in suicides may also stem from the economic downturn over the past
decade. Historically, suicide rates rise during times of financial stress and
economic setbacks. “The increase does coincide with a decrease in financial
standing for a lot of families over the same time period,” Dr. Arias said.
Another factor may be the widespread availability of opioid drugs like OxyContin
and oxycodone, which can be particularly deadly in large doses.
Although most suicides are still committed using firearms, officials said there
was a marked increase in poisoning deaths, which include intentional overdoses
of prescription drugs, and hangings. Poisoning deaths were up 24 percent over
all during the 10-year period and hangings were up 81 percent.
Dr. Arias noted that the higher suicide rates might be due to a series of life
and financial circumstances that are unique to the baby boomer generation. Men
and women in that age group are often coping with the stress of caring for aging
parents while still providing financial and emotional support to adult children.
“Their lives are configured a little differently than it has been in the past
for that age group,” Dr. Arias said. “It may not be that they are more sensitive
or that they have a predisposition to suicide, but that they may be dealing with
Preliminary research at Rutgers suggests that the risk for suicide is unlikely
to abate for future generations. Changes in marriage, social isolation and
family roles mean many of the pressures faced by baby boomers will continue in
the next generation, Dr. Phillips said.
“The boomers had great expectations for what their life might look like, but I
think perhaps it hasn’t panned out that way,” she said. “All these conditions
the boomers are facing, future cohorts are going to be facing many of these
conditions as well.”
Nancy Berliner, a Boston historian, lost her 58-year-old husband to suicide
nearly two years ago. She said that while the reasons for his suicide were
complex, she would like to see more attention paid to prevention and support for
family members who lose someone to suicide.
“One suicide can inspire other people, unfortunately, to view suicide as an
option,” Ms. Berliner said. “It’s important that society becomes more
comfortable with discussing it. Then the people left behind will not have this
Male suicides at highest level for a decade
while rate for men aged 45-59
is at worst level since 1986
Tuesday 22 January 2013
This article was published on guardian.co.uk
at 13.38 GMT on Tuesday 22 January
It was last modified at 14.19 GMT
on Tuesday 22 January 2013.
Significant rises in the overall UK suicide rate and in the
proportion of men aged between 45 and 59 killing themselves have been reported
by the Office for National Statistics (ONS).
Male suicides are now at their highest rate for nearly a decade, although they
are still proportionally fewer than they were 30 years ago. The rate among men
aged 45-59, which has gone up sharply in recent years, is at its worst since
In Wales, the overall suicide rate for men and women rose by 30% between 2009
The Department of Health in England last year identified middle-aged men as
being at high risk of killing themselves, in its suicide prevention strategy,
while a report for the Samaritans suggested men from low socioeconomic
backgrounds living in deprived areas were 10 times more likely to die by suicide
than were men from high socioeconomic backgrounds living in the most affluent
Norman Lamb, the care services minister, said the figures caused very real
concern, and they needed to be tackled "head on".
In all, 6,045 suicides were recorded among people aged 15 and over in 2011, the
ONS said. That is up 437, or 8%, on the previous year, the rise being the same
in percentage terms for men and women. The UK suicide rate is now 11.8 deaths
per 100,000 people, up from 11.1 in 2010, and the highest since 2004.
The number of male suicides increased to 4,552, which at a rate of 18.2 per
100,000 was the highest level since 2002. The worst suicide rate remains among
men aged 30 to 44, at 23.5 per 100,000; for 45 to 59-year-old men, the figure
now stands at 22.2 per 100,000.
Female suicides rose to 1,493, a rate of 5.6 per 100,000. Although suicide among
15- to 29-year-old females is rare, the rate in this age group has also risen
significantly, from 2.9 per 100,000 in 2007 to 4.2 per 100,000 in the latest
statistics. Big gender differences have been recorded for a generation.
The ONS accepts that some of the increases could be down to changes in
statistical recording. Coroners in England and Wales are now giving more
"narrative" verdicts, where causes of death are difficult to identify. The ONS
advised them to describe the circumstances of deaths in a way that could make
clearer the intentions of those who died: for example, whether there was
deliberate self-harm rather than an accident.
In England, the overall suicide rate is 10.4 deaths per 100,000, with the rate
highest in the north-east, at 12.9, and lowest in London, at 8.9. In Wales, the
suicide rate has leaped up sharply, from 10.7 in 2009 to 13.9 in 2011.
Changes in death registration rules and the way in which deaths are recorded in
Scotland appear to have had a more dramatic effect on figures there, making
statisticians cautious about comparing previous figures. In 2011, there were 889
suicides under the new rules and 772 under the old ones. But the General
Register Office for Scotland says the "moving average" over recent years has
consistently been "around 800 or so".
In Northern Ireland, there were 289 suicides in 2011, 216 men and 73 women. That
figure is down from the 313 (240 men, 73 women) the previous year.
The New York Times
By WENDY BUTTON
A FEW years
ago, I awoke at 2:30 a.m. to more than a “rapping, rapping at my chamber door.”
It was a full-force pounding of a body trying to break into my little house in
Washington, D.C. It was the sound and scenario that, as a single woman living
alone, I feared more than spiders in the house.
Because I was writing political speeches at the time, my BlackBerry slept on the
pillow beside me. I grabbed it and looked out my bedroom window at the stoop
below. There he was: tall, dark clothes, big. He backed up and then raced to the
door, pounding his body against it. Then he kicked at it the way actors take
boots to the heads of bad guys in the movies.
I dialed 911 and ran downstairs, my 100-pound Newfoundland with me.
I gave the dispatcher my address, let her know that I lived around the corner
from a police station and said, “Please hurry.” She heard the loud noise and
remained on the line with me.
I put the BlackBerry on speaker and pushed a heavy armchair toward the door. I
watched as the wood expanded with each pound. The white paint splintered some.
The deadbolt held at the top, but the bottom half of the door popped open,
letting in the steam heat from the summer night. I took that chair and slammed
it so the side pushed the door back in line with the frame. I held that chair
with everything my 5 foot 3 inches had. My dog sat right by me on the rug,
“The police are outside,” the dispatcher said.
I let go of the chair’s arms and thanked the woman for staying on the phone with
me. I answered the questions from the police and looked at the drunk man in the
back of the patrol car, kicking at the seats. When they left, I pushed the
couch, chair, coffee table and even a lamp in front of the locked door. I did
that every night for a week until a steel-gated security door was installed.
And then, I did more.
I considered buying a gun. The threat of violence rattles you like that. What
rolled round my head after that dark morning was: what if I hadn’t heard the
noise, what if it’s different next time? While I held that chair with all of my
strength, I wished that I had had a gun because if he had gotten in, then I
could have pointed it at him, maybe deterred him and if necessary pulled the
So I looked at guns. Some had mother-of-pearl handles and looked like something
Mae West would use in a movie. Others were Glocks, shotguns and rifles. I had
gone as far as to dial the number of the Metropolitan Police Department’s
firearms registration division and begin the process. Then I stopped and put my
I remembered who I am.
I am one of the millions of people in this country who live with depression. I
knew that in the gun registration form there would be a version of this
question: Have you ever voluntarily or involuntarily been committed to a
hospital? The answer is yes — voluntarily. But because my hospitalization was
years earlier and I wasn’t in treatment at the time, I could have gotten a gun.
My depression appeared for the first time in the late ’90s, right before I began
writing for politicians. It comes and goes like fog. Medicine can help. I have
my tricks to manage and get through it. Sometimes it sticks around for a day or
a week, and sometimes it stays away for a couple of years. But it never leads me
to sleep all day, cry and wear sweat pants like the people in the commercials.
You’d look at me and never know that sometimes my fight against the urge to die
is so tough the only way I get through it is second by second; I live by the
According to the Centers for Disease Control and Prevention, 38,364 Americans
lost that fight in 2010 and committed suicide; 19,392 used a gun. No one ever
attempted to break down my door in the early morning again, but I had an episode
when my depression did come back in full force in the early winter of 2009,
after I made a career-ending decision and isolated myself too much; on a January
night in 2010; and again in May 2012, after testifying in the federal criminal
trial of John Edwards, my former boss. If I had purchased that gun and it had
been in my possession, I’m not sure I would have been able to resist and would
be here typing these words.
The other day, the president and the vice president announced their plans to
curb gun violence in the wake of the shooting in Newtown, Conn. I agree with all
of their measures. But I believe they should be bolder and stop walking on
eggshells about what to do with people like me and those not even close to being
like me but still labeled with the crazy term “mentally ill.” The executive
actions the president signed to increase access and treatment are all good,
although the experts will struggle with confidentiality and privacy issues.
But since most people like me are more likely to harm ourselves than to turn
into mass-murdering monsters, our leaders should do more to keep us safe from
Please take away my Second Amendment right. Do more to help us protect ourselves
because what’s most likely to wake me in the early hours isn’t a man’s body
slamming at my door but depression, that raven, tapping, rapping, banging for
I have a better chance of surviving if I never have the option of being able to
pull the trigger.
not as newsworthy as homicide. A person’s disaffection with his own life is less
threatening than his rage to destroy others. So it makes sense that since the
carnage in Newtown, Conn., the press has focused on the victims — the
heartbreaking, senseless deaths of children, and the terrible pain that their
parents and all the rest of us have to bear. Appropriately, we mourn Adam
Lanza’s annihilation of others more than his self-annihilation.
But to understand a murder-suicide, one has to start with the suicide, because
that is the engine of such acts. Adam Lanza committed an act of hatred, but it
seems that the person he hated the most was himself. If we want to stem
violence, we need to begin by stemming despair.
Many adolescents experience self-hatred; some express their insecurity
destructively toward others. They are needlessly sharp with their parents; they
drink and drive, regardless of the peril they may pose to others; they treat
peers with gratuitous disdain. The more profound their self-hatred, the more
likely it is to be manifest as externally focused aggression. Adam Lanza’s acts
reflect a grotesquely magnified version of normal adolescent rage.
In his classic work on suicide, the psychiatrist Karl Menninger said that it
required the coincidence of the wish to kill, the wish to be killed and the wish
to die. Adam Lanza clearly had all three of these impulses, and while the
gravest crime is that his wish to kill was so much broader than that of most
suicidal people, his first tragedy was against himself.
Blame is a great comfort, because a situation for which someone or something can
be blamed is a situation that could have been avoided — and so could be
prevented next time. Since the shootings at Newtown, we’ve heard blame heaped on
Adam Lanza’s parents and their divorce; on Adam’s supposed Asperger’s syndrome
and possible undiagnosed schizophrenia; on the school system; on gun control
policies; on violence in video games, movies and rock music; on the copycat
effect spawned by earlier school shootings; on a possible brain disorder that
better imaging will someday allow us to map.
Advocates for the mentally ill argue that those who are treated for various
mental disorders are no more violent than the general population; meanwhile an
outraged public insists that no sane person would be capable of such actions.
This is an essentially semantic argument. A Harvard study gave doctors edited
case histories of suicides and asked them for diagnoses; it found that while
doctors diagnosed mental illness in only 22 percent of the group if they were
not told that the patients had committed suicide, the figure was 90 percent when
the suicide was included in the patient profile.
The persistent implication is that, as with 9/11 or the attack in Benghazi,
Libya, greater competence from trained professionals could have ensured
tranquillity. But retrospective analysis is of limited utility, and the
supposition that we can purge our lives of such horror is an optimistic fiction.
In researching my book “Far From the Tree,” I interviewed the parents of Dylan
Klebold, one of the perpetrators of the Columbine massacre in Littleton, Colo.,
in 1999. Over a period of eight years, I spent hundreds of hours with the
Klebolds. I began convinced that if I dug deeply enough into their character, I
would understand why Columbine happened — that I would recognize damage in their
household that spilled over into catastrophe. Instead, I came to view the
Klebolds not only as inculpable, but as admirable, moral, intelligent and kind
people whom I would gladly have had as parents myself. Knowing Tom and Sue
Klebold did not make it easier to understand what had happened. It made
Columbine far more bewildering and forced me to acknowledge that people are
When people ask me why the Klebolds didn’t search Dylan’s room and find his
writings, didn’t track him to where he’d hidden his guns, I remind them that
intrusive behavior like this sometimes prompts rather than prevents tragedy and
that all parents must sail between what the British psychoanalyst Rozsika Parker
called “the Scylla of intrusiveness and the Charybdis of neglect.” Whether one
steered this course well is knowable only after the fact. We’d have wished for
intrusiveness from the Klebolds and from Nancy Lanza, but we can find other
families in which such intrusiveness has been deeply destructive.
THE perpetrators of these horrific killings fall along what one might call the
Loughner-Klebold spectrum. Everyone seems to have known that Jared Loughner, who
wounded Representative Gabrielle Giffords and killed six others at a
meet-and-greet in Tucson in 2011, had something seriously wrong with him.
In an e-mail months before the shootout, a fellow student said: “We have a
mentally unstable person in the class that scares the living crap out of me. He
is one of those whose picture you see on the news, after he has come into class
with an automatic weapon.” The problem was obvious, and no one did anything
No one saw anything wrong with Dylan Klebold. After he was arrested for theft,
Mr. Klebold was assigned to a diversion program that administered standardized
psychological tests that his mother said found no indication that he was
suicidal, homicidal or depressed. Some people who are obviously troubled receive
no treatment, and others keep their inner lives completely secret; most
murder-suicides are committed by people who fall someplace in the middle of that
spectrum, as Adam Lanza appears to.
So what are we to do? I was in Newtown last week, one of the slew of
commentators called in by the broadcast media. Driving into town, I felt as
though the air were full of gelatin; you could hardly wade through the pain. As
I hung out in the CNN and NBC trailers, eating doughnuts and exchanging
sadnesses with other guests as we waited for our five minutes on camera, I was
struck by a troubling dichotomy. People who are dealing with a loss of this
scale require the dignity of knowing that the world cares. Public attention
serves, like Victorian mourning dress, to acknowledge that nothing is normal,
and that those who are not lost in grief should defer to those who are. When I
stopped in a diner on Newtown’s main drag, I did not sense hostility between the
locals and the rest of us but I did sense a palpable gulf between us. We need to
but cannot know Adam Lanza; we wish to but cannot know his victims, either.
In a metaphoric blog post called “I Am Adam Lanza’s Mother,” a woman in Boise,
Idaho, who clearly loves her son but is afraid of him worries that he will turn
murderous. Many American families are in denial about who their children are;
others see problems they don’t know how to stanch. Some argue that increasing
mental health services for children would further burden an already bloated
government budget. But it would cost us far less, in dollars and in anguish,
than a system in which such events as Newtown take place.
Robbie Parker, the father of one of the victims, spoke out within 24 hours of
the shooting and said to Adam Lanza’s family, “I can’t imagine how hard this
experience must be for you, and I want you to know that our family and our love
and our support goes out to you as well.” His spirit of building community
instead of reciprocating hatred presents humbling evidence of a bright heart. It
also serves a pragmatic purpose.
My experiences in Littleton suggest that those who saw the tragedy as embracing
everyone, including the families of the killers, were able to move toward
healing, while those who fought grief with anger tended to be more haunted by
the events in the years that followed. Anger is a natural response, but trying
to wreak vengeance by apportioning blame to others, including the killer’s
family, is ultimately counterproductive. Those who make comprehension the
precondition of acceptance destine themselves to unremitting misery.
Nothing we could have learned from Columbine would have allowed us to prevent
Newtown. We have to acknowledge that the human brain is capable of producing
horror, and that knowing everything about the perpetrator, his family, his
social experience and the world he inhabits does not answer the question “why”
in any way that will resolve the problem. At best, these events help generate
The United States is the only country in the world where the primary means of
suicide is guns. In 2010, 19,392 Americans killed themselves with guns. That’s
twice the number of people murdered by guns that year. Historically, the states
with the weakest gun-control laws have had substantially higher suicide rates
than those with the strongest laws. Someone who has to look for a gun often has
time to think better of using it, while someone who can grab one in a moment of
passion does not.
We need to offer children better mental health screenings and to understand that
mental health service works best not on a vaccine model, in which a single
dramatic intervention eliminates a problem forever, but on a dental model, in
which constant care is required to prevent decay. Only by understanding why Adam
Lanza wished to die can we understand why he killed. We would be well advised to
look past the evil against others that most horrifies us and focus on the pathos
that engendered it.
The rate of suicide in the United States rose sharply
during the first few years since the start of the recession, a new analysis has
In the report, which appeared Sunday on the Web site of The Lancet, a medical
journal, researchers found that the rate between 2008 and 2010 increased four
times faster than it did in the eight years before the recession. The rate had
been increasing by an average of 0.12 deaths per 100,000 people from 1999
through 2007. In 2008, the rate began increasing by an average of 0.51 deaths
per 100,000 people a year. Without the increase in the rate, the total deaths
from suicide each year in the United States would have been lower by about
1,500, the study said.
The finding was not unexpected. Suicide rates often spike during economic
downturns, and recent studies of rates in Greece, Spain and Italy have found
similar trends. The new study is the first to analyze the rate of change in the
United States state by state, using suicide and unemployment data through 2010.
“The magnitude of these effects is slightly larger than for those previously
estimated in the United States,” the authors wrote. That might mean that this
economic downturn has been harder on mental health than previous ones, the
The research team linked the suicide rate to unemployment, using numbers from
the Centers for Disease Control and Prevention and from the Bureau of Labor
Every rise of 1 percent in unemployment was accompanied by an increase in the
suicide rate of roughly 1 percent, it found. A similar correlation has been
found in some European countries since the recession.
The analysis found that the link between unemployment and suicide was about the
same in all regions of the country.
The study was conducted by Aaron Reeves of the University of Cambridge and
Sanjay Basu of Stanford, and included researchers from the University of
Bristol, the London School of Hygiene and Tropical Medicine, and the University
of Hong Kong.
The New York Times
By PATRICIA COHEN
Neal can instantly tell you the best night of her life: Tuesday, Dec. 23, 2003,
the Hinsdale Academy debutante ball. Her father, Steven Neal, a 54-year-old
political columnist for The Chicago Sun-Times, was in his tux, white gloves and
tie. “My dad walked me down and took a little bow,” she said, and then the two
of them goofed it up on the dance floor as they laughed and laughed.
A few weeks later, Mr. Neal parked his car in his garage, turned on the motor
and waited until carbon monoxide filled the enclosed space and took his breath,
and his life, away.
Later, his wife, Susan, would recall that he had just finished a new book, his
seventh, and that “it took a lot out of him.” His medication was also taking a
toll, putting him in the hospital overnight with worries about his heart.
Still, those who knew him were blindsided. “If I had just 30 seconds with him
now,” Ms. Neal said of her father, “I would want all these answers.”
Mr. Neal is part of an unusually large increase in suicides among middle-aged
Americans in recent years. Just why thousands of men and women have crossed the
line between enduring life’s burdens and surrendering to them is a painful
question for their loved ones. But for officials, it is a surprising and
baffling public health mystery.
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.
Complicating any analysis is the nature of suicide itself. It cannot be
diagnosed through a simple X-ray or blood test. Official statistics include the
method of suicide — a gun, for instance, or a drug overdose — but they do not
say whether the victim was an addict or a first-time drug user. And although an
unusual event might cause the suicide rate to spike, like in Thailand after
Asia’s economic collapse in 1997, suicide much more frequently punctuates a long
series of troubles — mental illness, substance abuse, unemployment, failed
Without a “psychological autopsy” into someone’s mental health, Dr. Caine said,
“we’re kind of in the dark.”
The lack of concrete research has given rise to all kinds of theories, including
a sudden drop in the use of hormone-replacement therapy by menopausal women
after health warnings in 2002, higher rates of depression among baby boomers or
a simple statistical fluke.
At the moment, the prime suspect is the skyrocketing use — and abuse — of
prescription drugs. During the same five-year period included in the study,
there was a staggering increase in the total number of drug overdoses, both
intentional and accidental, like the one that recently killed the 28-year-old
actor Heath Ledger. Illicit drugs also increase risky behaviors, C.D.C.
officials point out, noting that users’ rates of suicide can be 15 to 25 times
as great as the general population.
Jeffrey Smith, a vigorous fisherman and hunter, began ordering prescription
drugs like Ambien and Viagra over the Internet when he was in his late 40s and
the prospect of growing older began to gnaw at him, said his daughter, Michelle
Ray Smith, who appears on the television soap “Guiding Light.” Five days before
his 50th birthday, he sat in his S.U.V. in Bloomfield Hills, Mich., letting
carbon monoxide fill his car.
Linda Cronin was 43 and working in a gym when she gulped down a lethal dose of
prescription drugs in her Denver apartment in 2006, after battling eating
disorders and depression for years.
Looking at the puzzling 28.8 percent rise in the suicide rate among women ages
50 to 54, Andrew C. Leon, a professor of biostatistics in psychiatry at Cornell,
suggested that a drop in the use of hormone replacement therapy after 2002 might
be implicated. It may be that without the therapy, more women fell into
depression, Dr. Leon said, but he cautioned this was just speculation.
Despite the sharp rise in suicide among middle-aged women, the total number who
died is still relatively small: 834 in the 50-to-54-year-old category in 2004.
Over all, four of five people who commit suicide are men. (For men 45 to 54, the
five-year rate increase was 15.6 percent.)
Veterans are another vulnerable group. Some surveys show they account for one in
five suicides, said Dr. Ira Katz, who oversees mental health programs at the
Department of Veterans Affairs. That is why the agency joined the national
toll-free suicide hot line last August.
In the last five years, Dr. Katz said, the agency has noticed that the highest
suicide rates have been among middle-aged men and women. Those most affected are
not returning from Iraq or Afghanistan, he said, but those who served in Vietnam
or right after, when the draft ended and the all-volunteer force began. “The
current generation of older people seems to be at lesser risk for depression
throughout their lifetimes” than the middle-aged, he said.
That observation seems to match what Myrna M. Weissman, the chief of the
department in Clinical-Genetic Epidemiology at New York State Psychiatric
Institute, concluded was a susceptibility to depression among the affluent and
healthy baby boom generation two decades ago, in a 1989 study published in The
Journal of the American Medical Association. One possible reason she offered was
the growing pressures of modern life, like the changing shape of families and
more frequent moves away from friends and relatives that have frayed social
More recently, reports of a study that spanned 80 countries found that around
the world, middle-aged people were unhappier than those in any other age group,
but that conclusion has been challenged by other research, which found that
among Americans, middle age is the happiest time of life.
Indeed, statistics can sometimes be as confusing as they are enlightening.
Shifts in how deaths are tallied make it difficult to compare rates before and
after 1999, C.D.C. officials said. Epidemiologists also emphasize that at least
another five years of data on suicide are needed before any firm conclusions can
be reached about a trend.
The confusion over the evidence reflects the confusion and mystery at the heart
of suicide itself.
Ms. Cronin explained in a note that she had struggled with an inexplicable gloom
that would leave her cowering tearfully in a closet as early as age 9. After
attempting suicide before, she had checked into a residential treatment program
not long before she died, but after a month, her insurance ran out. Her parents
had offered to continue the payments, but her sister, Kelly Gifford, said Ms.
Cronin did not want to burden them.
Ms. Gifford added, “I think she just got sick of trying to get better.”
Filed at 10:56 p.m. ET
The New York Times
By THE ASSOCIATED PRESS
(AP) -- The suicide rate among middle-aged Americans has reached its highest
point in at least 25 years, a new government report said Thursday.
The rate rose by about 20 percent between 1999 and 2004 for U.S. residents ages
45 through 54 -- far outpacing increases among younger adults, the U.S. Centers
for Disease Control and Prevention reported.
In 2004, there were 16.6 completed suicides per 100,000 people in that age
group. That's the highest it's been since the CDC started tracking such rates,
around 1980. The previous high was 16.5, in 1982.
Experts said they don't know why the suicide rates are rising so dramatically in
that age group, but believe it is an unrecognized tragedy.
The general public and government prevention programs tend to focus on suicide
among teenagers, and many suicide researchers concentrate on the elderly, said
Mark Kaplan, a suicide researcher at Portland State University.
''The middle-aged are often overlooked. These statistics should serve as a
wake-up call,'' Kaplan said.
Roughly 32,000 suicides occur each year -- a figure that's been holding
relatively steady, according to the Suicide Prevention Action Network, an
Experts believe suicides are under-reported. But reported rates tend to be
highest among those who are in their 40s and 50s and among those 85 and older,
according to CDC data.
The female suicide rates are highest in middle age. The rate for males -- who
account for the majority of suicides -- peak after retirement, said Dr. Alex
Crosby, a CDC epidemiologist.
Researchers looked at death certificate information for 1999 through 2004.
Overall, they found a 5.5 percent increase during that time in deaths from
homicides, suicides, traffic collisions and other injury incidents.
The largest increases occurred in the 45 to 54 age group. A large portion of the
jump in deaths in that group was attributed to unintentional drug overdoses and
poisonings -- a problem the CDC reported previously.
But suicides were another major factor, accounting for a quarter of the injury
deaths in that age group. The suicide count jumped from 5,081 to 6,906 in that
In contrast, the suicide rate for people in their 20s -- the other age group
with the most dramatic increase in injury deaths -- rose only 1 percent.
EVANSVILLE, Ind. — Julie Amos never heard a gunshot, but she did hear her
husband's labored breathing as she came up the stairs. He was dying in their
Jeffrey Amos, 50, shot himself in the head Feb. 11. The father of two, who
had lost his job, became one of a number of suicides in Vanderburgh County that
has left families grieving and county officials searching for answers.
"I didn't see it coming," Julie Amos said. "I knew he was sad."
Suicides in the southwestern Indiana county of 173,000 usually don't exceed 30 a
year. There have been 15 since Jan. 1 — nearly triple what Vanderburgh County
had experienced at this point in 2006.
If the pace continues, Vanderburgh County's annual rate per 100,000 people would
be 43. That's about three times Vanderburgh County's usual rate and four times
the state rate. The national rate, according to the Centers for Disease Control
and Prevention, is 11.1.
Two other deaths are under investigation and are likely to be ruled suicides,
said Donald Erk, Vanderburgh County coroner. At one point a few weeks ago, Erk
said, his office was responding to a suicide about every 95 hours.
"These are not statistics that you're proud of," said Annie Groves, chief deputy
No one has come up with a pattern that would link the suicides, Erk and Groves
said. There have been no large-scale layoffs, no natural disaster, no pressure
from a countywide catastrophe that, when coupled with life's normal problems,
might make living seem unbearable for some people.
The suicides include a 24-year-old man who hanged himself from a high school
flagpole, a 76-year-old man who shot himself in his front yard and a 42-year-old
woman who overdosed on drugs.
Suicide clusters occur, said Alex Crosby, a CDC epidemiologist, but they are
"relatively rare." He said research has shown that less than 5% of suicides
happen in clusters and often in those situations there is no one cause.
Erk said relationship issues played a role in seven of the deaths and health was
a factor in three.
The Vanderburgh County suicides follow some national patterns:
•All but three victims were men, and males are four times more likely to die
from suicide, according to the CDC.
•Guns were used in six of the deaths, and CDC statistics show that nearly 52% of
suicides are committed with a gun. Two of Vanderburgh County's suicides were
done by hanging and seven with drugs.
•The suicide rate nationally also has increased, from 10.8 per 100,000 people in
2003 to 11.1 in 2004, said Gail Hayes, a spokeswoman for the CDC's Injury
Center. The CDC does not have more recent statistics.
The Vanderburgh County coroner's office has begun testing each victim to see
whether drugs or alcohol are present. All have tested positive, Groves said.
Lanny Berman, head of the American Association of Suicidology in Washington,
said drugs and alcohol are often involved in suicides — either as a long-term
addiction or a method to get courage.
While Vanderburgh County officials focus on a reason for the spike, others focus
"It's a great concern," said Janie Chappell, head of the Southwestern Indiana
Suicide Prevention Coalition. "We need to look at what we can do with our
In April, coalition members — representatives from mental health agencies,
public schools, higher education and the coroner's office — will be trained in
how to talk about suicide. They will then meet with community and business
groups to educate them.
Maryann Joyce, executive director of Mental Health America in Evansville, said
the training will help expand the coalition's reach.
"Suicide has a devastating effect on families and communities," Joyce said. She
said it's vital for survivors to talk about the effects, which is often
difficult to do because of the stigma attached to mental illness and suicide.
"It's a more complicated grief," she said.
Although the cause of the increase remains a mystery, Erk does not want to rely
on chance to bring it to an end. He wants to understand why his morgue has been
so busy. "That's your goal. By simply understanding what's going on, you'll be
able to come up with a solution that's viable," he said. "The goal is to
obviously touch on some things and prevent some of this."
Halladay reports daily for The (Louisville) Courier-Journal
March 16, 2007
By THE ASSOCIATED PRESS
Filed at 1:50 a.m. ET
The New York Times
ATKINSON, N.H. (AP) -- Brad Delp, the lead singer for the band Boston who
killed himself last week, left behind a note in which he called himself ''a
lonely soul,'' according to police reports released Thursday.
The note was paper-clipped to the neck of Delp's shirt when police found his
body at his Atkinson home, on the bathroom floor, his head on a pillow. He had
sealed himself inside with two charcoal grills; toxicology tests showed he had
committed suicide by carbon monoxide poisoning.
''Mr. Brad Delp. J'ai une ame solitaire. I am a lonely soul,'' the note read.
Delp joined Boston in the mid-1970s and sang two of its biggest hits, ''More
than a Feeling'' and ''Long Time.'' He was cremated Wednesday, after a private
funeral earlier in the week.
His fiancee, Pamela Sullivan, called police March 9 after noticing a dryer vent
tube connected to the exhaust pipe of Delp's car. In the garage, police found a
note taped to the door leading into the house.
''To whoever finds this I have hopefully committed suicide. Plan B was to
asphyxiate myself in my car.''
In another note on a door at the top of the stairs, Delp cautioned that there
was carbon monoxide inside.
''I take complete and sole responsibility for my present situation. I have lost
my desire to live,'' he wrote. The note also included instructions on how to
contact his fiancee: ''Unfortunately she is totally unaware of what I have
Police later found four sealed letters in an office addressed to Sullivan, his
children, their mother, Micki Delp, and another couple whose identity was not
disclosed. Police Lt. William Baldwin said police gave the letters to family
members without reading them.
Sullivan told police that Delp ''had been depressed for some time, feeling
emotional (and) bad about himself,'' according to the reports.
He had planned to marry Sullivan this summer during a break in a tour with
Boston. A lifelong Beatles fan, Delp also played with the tribute band Beatle
BEVERLY HILLS (AP) — Nikki Bacharach, daughter of Burt Bacharach and Angie
Dickinson, committed suicide, the songwriter and actress said in a statement
Nikki Bacharach, 40, suffered from Asperger's Disorder, a form of autism. She
killed herself Thursday night at her condo, said Linda Dozoretz, a spokeswoman
for the family.
"She quietly and peacefully committed suicide to escape the ravages to her brain
brought on by Asperger's," the statement said.
Nikki Bacharach died of suffocation using a plastic bag and helium, said Mike
Feiler of the Ventura County coroner's office.
Born prematurely in 1966, Lea Nikki Bacharach studied geology at Cal Lutheran
University, but could not pursue a career in the field because of poor eyesight.
"She loved kitties, and earthquakes, glacial calving, meteor showers, science,
blue skies and sunsets, and Tahiti," the statement said.
Nikki Bacharach was the only child of Burt Bacharach, 77, and Dickinson, 75, who
were married from 1965 to 1981.
It was the second marriage for both Bacharach, the Oscar-winning composer of
Raindrops Keep Falling on My Head, and What the World Needs Now is Love, and
Dickinson, star of the film Dress to Kill and the TV show Police Woman.
Bacharach has three children from other marriages.
It looked like an ordinary family outing. A
minivan stopped at a scenic overlook, a strip of blacktopped pavement that is
little more than a wide spot on a one-lane road along the edge of a cliff. In
the distance is the Hudson River. A hundred feet below is a forest as thick as
when the Harriman family owned it a century ago.
The police say three things happened next. A man stepped out of the minivan,
maybe to take a picture. His wife, inside with their two young daughters, put
the transmission in gear. And the minivan drove off the cliff.
The woman, Hejin Han, 35, was killed on Wednesday as the minivan bounced down
the rocky hillside in Bear Mountain State Park, about 50 miles north of Midtown
Manhattan, and slammed into a tree. The two daughters, strapped into their car
seats in the back, were not seriously injured.
Yesterday, the man who climbed out of the van before its plunge — Victor K. Han,
35, an architect from Staten Island — was charged with promoting a suicide
attempt. The police maintain that Mr. Han knew that his wife was suicidal and
"afforded her an opportunity" to kill herself.
But the police also said that there was another twist in the already complicated
case. Court papers referred to a female co-worker of Mr. Han's and said the two
had a romantic relationship.
That disclosure was at odds with the way the Hans' neighbors on Staten Island
described them — a stable family, happy and religious, with a father who had
done design work for neighbors who wanted decks built on their houses.
"They'd wait outside for him to come at night, and they would all embrace,"
Pamela Cropley, who lives near the Hans on Elvin Street in Castleton Corners,
said about Mrs. Han and the girls, ages 5 and 3.
Ms. Cropley, who said the couple moved into their half of a two-family house
five or six years ago, said she never saw anything to suggest that Mrs. Han was
troubled — let alone so troubled that she would take her own life. "She was
smiling every time I saw her," Ms. Cropley said. "She would see you, and her
face would light up."
Promoting a suicide attempt is an unusual charge, law professors and prosecutors
"As a prosecutor for a lot of years in the Manhattan D.A.'s office and now over
10 years here, I've never seen it charged," said Louis E. Valvo, the chief
assistant district attorney for Rockland County, whose office is handling the
But it was not the only charge that Mr. Han faced when he appeared before
Justice William Franks in Stony Point Town Court yesterday. He was also charged
with two counts of reckless endangerment of a child, one count for each
daughter, and two counts of endangering the welfare of a child.
Like the suicide-attempt charge, the reckless endangerment charges are felonies.
The reckless endangerment charges carry tougher penalties than the
suicide-attempt charge. Mr. Valvo said that if convicted, Mr. Han could be
sentenced to as much as 14 years in prison.
Justice Franks set bail at $75,000 and scheduled another hearing for Tuesday.
Mr. Han was being held at the Rockland County jail.
In court, he was represented by the Rockland public defender, James D. Licata,
who said he had no comment on the case. As for what Mr. Han had told the police
that would have led to the suicide-attempt charge, Mr. Licata said: "I'm not
privy to the statements he made. They haven't been supplied to us."
Mr. Han was arrested early yesterday after spending much of Thursday being
questioned. The park police said Mr. Han was aware that his wife "had earlier
threatened to harm herself and their two children."
But a one-page statement from the park police outlining the charges provided few
details about Wednesday's events, about why the Hans made the afternoon drive or
Mr. Han's explanation of what transpired. Calls to the park police at Bear
Mountain were referred to a spokeswoman in Albany, who did not make police
officials available to the news media.
The overlook where the Hans parked has a view of the river and the Bear Mountain
Bridge. At the edge, in place of a guardrail, are boulders set about 10 feet
apart — just far enough, it turned out, for the Hans' Honda Odyssey to drive
The park police said that two hikers who had heard the minivan clatter down the
hillside and smash into a tree helped officers find the vehicle. The park police
also said that when they got there, Mr. Han had gone down the hillside despite
the steep drop, and was standing by the van. By early yesterday, the park police
were accusing Mr. Han of abetting his wife's suicide, and some legal experts
were saying that it would be hard to make the charge stick.
Michael T. Cahill, an assistant professor at Brooklyn Law School, said the
provision appeared to have been part of the state penal code that was enacted in
"The language of the provision is that you have to cause or aid another person's
suicide attempt," he said, "and I wouldn't think that just leaving the car would
amount to aiding another person's suicide attempt."