September 24, 2009

Will The Suicide Rate Change As The Population Ages?

jonas brothers.jpgThe correct question would be: what will they do?



I.

Part 1 here.



The point of the editorial in AJP is that since everybody knows the elderly kill themselves at higher rates, we should go Orange Alert and mobilize America in preparation. Ok.


suicide rates by age and race 2004.jpg



There are a total of 30000 suicides a year.  As you can see, the only group who commit suicide at higher rates as they age are white males. Granted, I don't want white people to die any more than George Bush does, but this increase applies only to them.

Now reread that quote in AJP:

In most countries of the world, older adults kill themselves at higher rates than any other age group. Given that the leading edge of the large post-World War II "baby boom" cohort will reach the age of 65 in 2011, demographers predict a rapid rise in the number of seniors taking their own lives in subsequent decades. The need for effective approaches to late-life suicide prevention is pressing.


There's your sleight of hand.  If the elderly kill themselves at a given rate, the fact that there are more of them coming shouldn't change the rate, only the number.  The trick is that "the suicide rate in the elderly is four times higher" is the only thing dramatic enough to get you NIH grants. If it was reported as an increase in the number of suicides-- a number that in the most apocalyptic scenario would be in the hundreds-- no one would care, and certainly no one would pay for it.


II.

Q: Why do the elderly kill themselves at higher rates?

A: "Ummm.... because they are old and there is nothing left to live for?"  That culture-bound moronity exemplifies my point.  The old must be more depressed and pessimistic, after all they're too old to enjoy life... or something... (God knows the young are enjoying it all so much.)

And maybe many do feel that way, but maybe they aren't any more intent on dying than the young (who have more non-lethal attempts) but are simply physically weaker and thus more susceptible to dying- even during what they hoped would be a non-lethal attempt?


Q: Why do we expect an increase in the number of elderly people to suicide?  Is it a stable suicide rate coupled with an increasing population? 



suicide rates since 1900.jpg

from andrewgbiggs.blogspot.com

Well, the suicide rate has mostly fallen.   Also note that the greatest change in rates occurred before the psychopharmacology era.  The gazillions spent everywhere post 1960 have done nothing. But as anyone with experience using technical analysis will tell you, we don't know what the hell direction those lines are going next.  The above blog discussed the opinion that the rate declined with the creation of Social Security.  Or was it the war?  Or...

It's hard enough to understand what happened in the past.  How is AJP so confident about the future? 


III.


First, the suicide rates from different decades are not even comparable.  An elderly person today will probably have little resemblance to an elderly person of 2030.  Consider:


  • will economic pressures push the elderly to live longer with their kids/extended families (or vise versa)
or
  • will family units continue their trajectories towards looser, smaller, and more disjointed (e.g. divorces) affiliations?



  • will better physical health/sex/financial security lead to more satisfaction in later life
or
  • will promised better health/sex/financial security not materialize, leading to great pessimism?



  • will narcissists cling to their lives/youth no matter what; Sex In The City VIII begins filming

or

  • will narcissists suffer the ultimate of narcissistic injuries?


etc.


IV.

The chief reason that suicide rate predictions fail is that they are based, primarily, on absolutely nothing.  Psychological autopsy is a biased interview occurring in a specific historical and cultural moment (e.g. the three generations before the current 40 year olds)  not generalizable to the next one.  Look at 1930 vs. 1960.

Psychiatric illness is a changing construct.  What was MDD in 1930 may in some ways be similar to 2009, but in others it is not.  If it is madness to conclude a 2009 suicide must have been mentally ill, it is complete and utter madness to take this conclusion and apply it to 1930, let alone 2030.

Instead of asking how the the hypothetical elderly might act in 30 years, you'd be better to ask how we will act in 30 years.


II.

Q: Assuming that there is actually a suicide epidemic on the edge of the horizon, what can be done about it?

A: Nothing.  As with all complex behaviors, nothing works reliably across a given population.   No drug (I'll leave aside lithium for a moment) or therapy has been reliably shown to reduce the suicide rate across the population.  "But I've saved so many of my patients..."  You can only change the rates of a complex behavior such as suicide, violence, styles, opinions, at an individual level, or through society-- the culture.  If you want to lower the suicide rate, you can't target "at risk" populations, you have to make suicide less of an option for all of society.

Two examples:

  • if you want to reduce terrorism, you cannot round up all terrorists and change their thinking.  You must either a) kill individual terrorists; b) make terrorism less viable/interesting/acceptable/easy for all of society.
  • if you want to reduce teen drinking, you can't target the population of at risk teens and make them drink less.  You must either target a) individual teens, one at a time; b) make teen drinking less viable/interesting/acceptable/easy for all of society.
  • if you want to reduce the suicide rate, you can't find the depressed people and create a population based treatment.  You must either a) target each individual suicider; b) make suicide less viable/interesting/acceptable/easy for all of society.

Simply: you will reduce the suicide rate much more if you take all guns off the earth than if you "improve access to healthcare."  (There may be other reasons why taking away all guns is not a good idea, that's not the immediate point.)


Q: Why is there so much focus on the coming suicide epidemic, if there isn't any logical reason to assume one is coming?

A:  Please understand I am not dismissing suicide, I am fully aware of its devastation.  But this is the creation of a hysteria that will generate a lot of activity (and money), and this-- not the reduction of suicide per se-- is the hysteria's chief purpose.  The mobilization of the mental health army will ultimately have no demonstrable effect on the suicide rate. 

The future revenue streams in psychiatry won't be from billing for the treatment (Pharma) but from billing for the evaluation (insurance.)

You would do better-- and I mean this in complete earnestness; not that this should be done, but that it would be more effective-- to take all the money devoted to this problem, and giving the money to the "at-risk" patients as a pension.  


----

http://twitter.com/thelastpsych






Comments

RE:War on suicide.Bu... (Below threshold)

September 24, 2009 11:24 AM | Posted by Anonymous: | Reply

RE:War on suicide.
But Last Psychiatrist people LOVE to make war. The planning , the execution, the press, getting to be a hero.

RE :Buying out the enemy
Same thing for the Vietnam war.
From the straight dope
straightdope.com/columns/read/717/would-vietnam-war-money-have-been-better-spent-bribing-the-enemy-to-stop-fighting
"The combined population of North and South Vietnam in 1969, the midpoint of substantial U.S. involvement, was somewhere around 39 million. That means that over 10 years we spent about $3,600 for every Vietnamese man, woman, and child."

Who would we be without war?

People have to have a reason to get up in the morning besides paying for their shiny car.

Vote up Vote down Report this comment Score: 1 (1 votes cast)
Good article!... (Below threshold)

September 24, 2009 3:51 PM | Posted by Lela: | Reply

Good article!

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The point of this study is ... (Below threshold)

September 24, 2009 5:13 PM | Posted by medsvstherapy: | Reply

The point of this study is the point of the lame Robinson 2008 JAMA post-stroke SSRI study, and the SADHART study: to sell meds to the masses of healthy older adults.

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I'm really not sure that th... (Below threshold)

September 24, 2009 8:14 PM | Posted, in reply to Anonymous's comment, by caeia: | Reply

I'm really not sure that this is about a war on suicide. There are some provisions in the UHC proposal to the effect of trying to not give the elderly certain types of care -- things like hip replacements and chemo. Now if you can make the case that old people are suicidal, you make that idea a bit more platable -- I mean, they might commit suicide after we spend $XX,000 to get them a new hip, so rather than do that, we'll just let them lie in bed and have almost no quality of life. That WILL make them depressed, if they weren't before, especially if pain isn't treated properly.

I don't believe that it's death panels, but I do think there is a sense that the sick elderly don't deserve the care as much as a younger person does. You know, because they're gonna die soon anyway, and they won't be productive.

I find such a view of human life to be disgusting -- human life is valuable in its own right, not just because they can make money.

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"You would do better-- and ... (Below threshold)

September 25, 2009 5:12 AM | Posted by Anonymous: | Reply

"You would do better-- and I mean this in complete earnestness; not that this should be done, but that it would be more effective-- to take all the money devoted to this problem, and giving the money to the "at-risk" patients as a pension."

No, no. That may decrease risk in the already-at-risk population, but will probably will make insurers kill themselves.

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Good comments about statist... (Below threshold)

September 26, 2009 1:19 AM | Posted by Meat Robot: | Reply

Good comments about statistical sleight of hand and the quest for grant-dollars.

I have often wondered why completed suicides are more common in the elderly and yet good gerontological research suggests that the elderly report fewer negative affects and greater contentment. I think there may be some merit in your notion that the elderly suicide attempter might simply have less physiological reserve to withstand the attempt.

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Yes, more people will kill ... (Below threshold)

September 26, 2009 2:57 PM | Posted by Claudius: | Reply

Yes, more people will kill themselves because the Jonas Brothers will continue to clog the airways with their poison music

BAAYYYYYYYYYBAAAYYYYYYYY!

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I'm confused.In th... (Below threshold)

September 28, 2009 9:01 PM | Posted by Jack Coupal: | Reply

I'm confused.

In the 3 examples of countering terrorism, teen drinking, and suiciders, Alone implies that either a) or b) is the correct approach. In all those examples given, both a) and b) are actually employed to achieve the desired goal.

It's more expensive to use that shotgun strategy, but the either/or strategy has no chance of success.

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i like the guns part, makes... (Below threshold)

October 27, 2009 1:29 AM | Posted by fry: | Reply

i like the guns part, makes me laugh. this article has no value.A gun kills people like my pc MKAES me mis typr ro maybe its the keyboards fualt dik or is that idk

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Hasan is a typical shrink. ... (Below threshold)

November 15, 2009 5:43 PM | Posted by navel comtemplator: | Reply

Hasan is a typical shrink. They are drawn to the field because they initially want to figure out why they are so screwed up. They never discover the reason and then fabricate all sorts of illogical crap for the masses. Herre's a prediction for you...white senior over 60 sucicide rate(not numbers) will be a record high in 2010. Come back in a year and Ill explain why. You will never understand unless your white and over 60. Go find something productive to do in the meantime.

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Yes, the federal estate tax... (Below threshold)

June 28, 2010 11:09 PM | Posted, in reply to navel comtemplator's comment, by jon: | Reply

Yes, the federal estate tax is suspended for the year. It does provide a decent incentive for those, with sizable fortunes, to kill themselves before the end of the year. Of course this assumes they hate taxes more than their kids, and don't mind dying early.

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I had got a dream to begin ... (Below threshold)

March 31, 2012 2:01 AM | Posted by JuneStrickland: | Reply

I had got a dream to begin my own organization, however I didn't earn enough of money to do it. Thank heaven my colleague recommended to utilize the business loans. Thence I used the collateral loan and made real my dream.

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It'd be nice to read an art... (Below threshold)

July 7, 2014 1:05 PM | Posted by Joe: | Reply

It'd be nice to read an article on your impression of how you think the future will be like. Curious.

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