It’s an unpleasant question, and it doesn’t usually come up in casual conversation, but if you were to ask who was the group in the U.S. most likely to suicide, you’d get a variety of answers. Had you asked my brother two weeks after the birth of his first child, he would have told you anyone with children.
Leaving aside his unique spin on parenting, most people will tell you it’s adolescent boys. Many will bet that young Hispanic adults, both men and women, are the most likely. There’s been a belief for years–it seems unshakable–that (I’m not making this up; ask around) dentists are the most likely to kill themselves, so someone’s bound to offer that as their final answer. (Perhaps wish fulfillment dreams on the part of the dental patient?)
These answers are all losers on today’s quiz show. It’s a case of the truth being more shocking than fiction.
The group with the highest suicide rate–by far–in this country is white males over 65.
I know, it’s probably the last group of people you’d think of. I didn’t have my grandfather that long, but my memory of him is of one extremely chilled individual. He’d been long retired, and he spent half the year in Florida, mainly, as far as I could tell, playing cards and smoking a cigar. Occasionally he went to the race track. He didn’t particularly strike me as a high risk. (I’m purposely ignoring for the moment the ugly fact that my father is now in this age group. If we’re forced to assume that I age at the same rate as he does, it says unpleasant things about how old I might be–and we really don’t want to go there.)
But my Papa Ben aside, we’ve got a very serious situation on our hands.
According to the Population Reference Bureau (or PRB), suicide is the 11th leading cause of the death in America, with 11 deaths by suicide for every 100,000 Americans. That doesn’t sound too good to start off with, really.
But–and this is truly upsetting–white men over the age of 65 suicide at a rate of approximately 31.1 suicides per 100,000 per year, according to the American Association of Suicidology, which, using my advanced mathematics skills, I calculate to be over three times the national average (I’m not sure what to do about that tenth of a person, and what his issues might be, so I just ignore him).
And what’s even more shocking is that it just keeps getting worse. As of 2007, white men over the age of 85–called (and I wonder if anyone every asked this group of they like this term?) the “old-old”–committed suicide at a rate of 45.42 per 100,000. The American Association of Suicidology pointed out that that’s actually 2.5 times the rate for men of all ages.
It’s not ‘simply’ a factor of age–it has to do with the interplay between age and gender. Is it surprising that in this country, more males suicide than women? Suicide.org has it at a 4 to 1 ratio.
Go back for a moment to the–what do you call them?–the ‘regular’ old? These men are eight times more likely to suicide than are women of the same age (PRB).
Oh–and ethnicity is a factor in there, too, for, if you take out gender again, and just look at age and ethnicity, white men are still tops in statistics, in a way that, honestly, is pretty surprising.
Looking at men of different ethnicities, 65 and older, and recalling that white men 65+ have a suicide rate of 31.1 suicides per 100,000, which ethnicity would you hazard would approach that percentage–and how close will it come? (Remember: Old as you are, there’s always credit for class participation.)
Well, if you opted out or just wouldn’t play, in a way you’re a winner, because no one comes close. The highest rate is among Asian or Pacific Islander males (17.5), followed closely by Hispanic or Latino males (15.6), and, bringing up the rear are African American males who don’t have the best rates of longevity, but, apparently, once they make it old age, do not, as a group, act out en masse in the painfully violent, self-destructive act that is suicide.
The data is indisputable. But the question is as obvious as it is brief: WHY? What is it that occurs within the life cycle–not of women, only of men, and not of ethnic men, but only white men?
Well, there have been a number of theories. In fact, so many theories have been put out there that it seems more like a sign that we really don’t know the reason for the staggering number of suicides. And sometimes you’ll find doctors and researchers admitting that behind all the “maybes,” we don’t know for sure. plain and simple. Journalists will go out to get the scoop, and wind up writing things like, “Experts are divided over how to explain the elevated risk of suicide for older white men,” or “Analysts are divided over how to explain the elevated risk of suicide for older white men.” It fails to inspire confidence.
That, of course, does not account for the paper of record–the New York Times, the paper that somehow manages to get the story while Chicago’s papers–Chicago, second city, with its creative theater and its world-class museums–and don’t’ forget the cows!–believe that details about our governors in jail (did you know that Blagojevich learned to play guitar while behind bars?) counts as news.
So the Times spoke to some big shots, and got some news–which, while well-covered and innovative, isn’t, in the end, all that shocking, and really is what you might be saying already. You just don’t speak with the authority the Times does.
So, for example, widowers are high-risk, because today’s older men, as a general rule, depend on their wives for social contacts. (In my experience, with my father and my step-father, this statement couldn’t be more true. In fact, my step-father doesn’t even answer the phone, says he doesn’t know how to work it.). So–you can see this coming–when their wives die, they lose social interaction.
Social isolation puts them at risk for suicide. In fact, the California Mental Health Planning Council 2011 paper, “Gender and Ethnic Differences in Older Adult Suicide” estimated that 50 percent of the elderly people who commit suicide live alone.
It isn’t enough on its own–but it’s a piece of the puzzle. The Times interviewed Martha Bruce, a professor of sociology and psychiatry at the Weill Medical College of Cornell University in White Plains, New York, who believes men simply aren’t prepared for retirement. That’s a double whammy, she claims, in that they both don’t know how to fill their time and don’t know how to maintain a sense of purpose.
Global Action on Aging points out that suicide is almost never caused by one single occurrence or reason. It’s usually a number of factors which, over time and in combination, cause a sense of overwhelm and hopelessness.
We really don’t need the Times, do we? If we think about it, risk factors are fairly obvious and include:
- death of a spouse,
- deteriorating health,
- socioeconomic decline,
- family history of suicide,
- a baby boomer site points out that stressful events that can occur at any point in life (divorce, bankruptcy, etc.), in combination with other factors can push a person over the edge,
- and then there’s really what we should have started with–psychiatric illness. Depression features strongly in suicide among the elderly, with the majority of studies finding that depression or another mood disorder might have been present in somewhere between 60-90% of successful suicides.
I’d love to end this piece with three great preventative strategies, ways to put an end to the staggeringly high numbers of white elderly suicide. But the first strategy I have for you–to make sure older men, especially if they seem emotionally fragile–see their primary care physicians– is more bad news.
The New York Times (yes, them again, what can I say? It’s a love affair.) writes, “Primary care practitioners [PCPs] are also crucial to suicide prevention among the elderly because older people, and especially older men, are unlikely to seek out and accept mental health services but are often seen by family doctors and nurses within days or weeks of a suicide.”
Good enough.
But then we find out the following:
Of those 55 and older who successfully suicide, 58% saw a PCP in the month before the suicide. And, as if that’s not bad enough, 40% saw their PCP within one week of the suicide–and (this gets really ugly) 20% saw the doctor the same day. I’m thinking the PCP avenue isn’t ‘happening’ when it comes to prevention.
Strategy 2: Ok, here we’ve got more happening, from Spring et al (2007)–but, truthfully, it doesn’t have a lot to do with you and me. They note that certain physical illnesses greatly increase the chances of suicide–but that all efforts have shown that using a medical diagnosis on its own to predict suicide risk is fairly useless.
So they recommend–and you wouldn’t think this would be ground-breaking research, but you never can tell in the world of publication–that the PCP or psychiatrist establish whether a psychiatric condition–one that could, potentially, lead to suicide– is present and then focus on the medical illness and whether it is causing emotional difficulties which add to the suicide risk. Thus their preventative plan was the doctor treating the depression (or other illness) that was further exacerbating suicidal tendencies. [Apparently you have to tell some people everything.]
So what does that leave for you and me, if faced with an older suicidal man? The best we can manage. Remove anything the person might use to kill himself. Find a good psychiatrist who’s worked with suicidal patients and make sure your friend/father/grandfather gets to his appointment with him or her. If the crisis is acute, do not hesitate to have the person hospitalized. You think you can watch over them 24-hours–a-day, but you can’t.
The best you can do is visit them, both in the hospital and when they get out; work with them to find a hobby or volunteer commitment that they like and they can handle; encourage them to be medically compliant, and if–God forbid–you lose your friend to suicide, know that suicide is the 8th leading cause of death among elderly white males, and you’ve done all you can do.
Now it’s society’s turn.
