April 10, 2006

Who Died?

Here is a suicide statistic:

"Suicide is the eighth leading cause of death in men."

That's useless, because there is no context. Other useless statements are: the risk is higher in psychiatric illness; the risk is higher the more previous attempts; men have higher rates of sucide than women, etc.

Here are some statistics (1999, 2001 and 2003-- they're all the same) which may help you.

In the US in 2001, 30,622 people died from suicide.   Yes.  That few.

24,672 were men. 5950 were women. (That's 80/20). In the whole world (WHO 2000), it was about 815,000.

5395 were over 65. (85/15 males to females)
3971 were 15-24. (85/15 males to females)

So 70% of all suicides are adults.
73% of all suicides are white males (20,000+). To put it in perspective, in 2003, the number of black women who suicided was 358.
Guns were involved in 55% of all suicides; 60% of the men's, and 73% of the elderly's, and 54% of youth's.

In other words, mostly white adult males die.

White men over 85 have the highest rate given their popualtion (54/100,000), vs. an overall rate of 10.7/100,000 (.01%) But this number of suicides is so small that the statistic doesn't help you.

So the real risk factors are white males with a gun.

I should also point out that 30,622 is a really small number of people-- even though it is almost as many as homicides (20k) and AIDS deaths (14k) combined.

How about suicide attempts that don't result in death?

Well, there are a lot: in 2002, 132,353 were hospitalized for a suicide attempt, and 116,639 were seen in an ER and released. But here's the thing: they didn't die.

The problem with our suicide assessment is that it screens for attempts, not death. And while non-psychiatrists might be surprised to hear this, a whole lot of people commit impulsive suicidal acts with no or little interest in actually dying. Psychiatry cannot do much to stop these acts, nor should it be responsible to do so. A psychiatrist should be no more responsible to prevent these parasuicidal acts than an endocrinologist is to guarantee that the patient takes their insulin. If psychiatric illness-- that's major Axis I-- so impairs their reason that they don't know what they're doing, can't stop, etc-- then it's our responsibility, just like, given that same patient, it's the endocrinologist's.  Otherwise, it is not.

We spend a lot, a lot, of money and time hospitalizing people who are not going to die. A not insignificant portion are outright malingerers, and everyone knows it. The rest may be at risk, but they may not be best served in a hospital.

So we can either spend our time and resources on preventing suicide attempts, or on preventing the 30k actual suicide deaths. It's not the same thing.