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Much of my work and much of the public’s attention in the last several years has been focused on the opioid crisis, and properly so.  But addiction (or substance use disorders) are the result of a complex mix of genetics, environment and exposure to the substance.

The environment includes the stability of the household and exposure to emotional traumas (like the loss of a parent, witnessing domestic violence, suffering emotional, physical or sexual abuse, etc.) but also the larger environment, or what has been termed the social determinants of health.  These include issues like poverty, education, housing, and a sense of community and belonging.  To the extent that we fail to meet our ideals in all of these areas we place people at risk for the “diseases of despair”, like addiction.  Another disease of despair is suicide, and the news on that front is not good.  The CDC reported recently that 45,000 Americans age 10 and older took their own lives in 2016.  More alarmingly, across the nation suicide rates have risen by nearly 30% in the last 18 years.  Some additional findings:

  • Between 1999 and 2016 suicide rates increases significantly in 44 states.
  • 25 states experienced an increase of over 30% (Maine’s increase is 27%).
  • The range of increases were 5.9% (Delaware) to 57.6% (North Dakota).
  • 54% of people who took their own life did not have a known mental health condition, like depression.
  • Circumstances more likely among those who did not have a known mental health condition included relationship problems, life stressors, and recent or impending crisis.
  • Suicide rates increased among all age groups under age 75, and people age 45 to 64 had the steepest increase in suicide rates.
  • Men still are more likely than women to take their own life, but the increase in suicide rates in women is twice that in men.
  • Firearms are the most common method for suicide.

So what can be done?  We need to work to raise awareness, and to work to improve human connection (belonging) in all of our communities.  In primary care we need to reliably screen for depression and offer appropriate treatment when it is identified.  Working to expand people’s access to healthcare is fundamental to this work, and we must study gun violence and its role in suicide so that effective interventions can be developed.  There are important resources available including:

  • BeTheOneTo.com where you can learn about the warning signs for suicide.
  • 1-800-273-TALK (8255) – the National Suicide Prevention Hotline
  • 741741 – the Crisis Text Line
Noah Nesin, MD

Dr. Nesin, Vice President of Medical Affairs for PCHC, is a family doctor with 30 years of experience.

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