WASHINGTON (Circa) — The deaths of fashion designer Kate Spade and celebrity chef and author Anthony Bourdain put a spotlight on suicide in a week when new official statistics showing the rate of suicides in the United States is increasing were released.
Behind the deaths of two cultural figures is the fact that more than 120 Americans commits suicide every day, according to new data from the Centers for Disease Control and Prevention. In 2016, approximately 45,000 people took their own lives, more than twice the number of homicides.
Across the entire country, the suicide rate increased by 25 percent from 1999 through 2016. In 25 states, the increase was greater than 30 percent.
Every year since 2005, the total number of suicide deaths has consistently gone up. It is the tenth leading cause of death in the United States and is one of only three leading causes that continues to increase each year.
CDC found the increase impacted men and women, Americans of all ages, racial and ethnic groups.
The issue itself begs the question, why? For experts, public health officials and suicide survivors, the answer is complex.
In its new report, CDC highlighted one factor that could change the approach to that question, asserting that suicide is "more than a mental health concern."
The agency studied 27 states in detail as part of an effort to understand the issue and reduce the annual suicide rate 20 percent by 2025. What researchers found was more than half (54 percent) of people who committed suicide had no known mental health disorder.
Among CDC's conclusions, was that suicide prevention strategies need to have an "additional focus on nonmental health factors further upstream." In other words, focusing on life stressors that, in some cases, may contribute more to suicide risk than depression.
The report specifically highlighted relationship problems, personal crises, substance abuse, physical health problems, and financial, housing and legal problems as leading factors in suicides among individuals with and without prior mental health conditions.
Shifting that focus in the direction of life stressors and other problems may help more people get the support they need, according to Dr. John Draper, the director of the National Suicide Prevention Lifeline.
It's easier to recognize when someone is struggling with a divorce or financial problems, he told Circa. "Because those are much more recognizable than 'mental health symptoms, it gives us the opportunity to say...'can you tell me how you're doing?... Are you thinking about suicide?'"
Those kinds of questions "save lives," Draper asserted because it gives a person who may be reluctant to ask for help "permission to connect" and talk about what is going on. "That's the first step, not only of getting them help, but helping them feel better now."
Experts also advised that the CDC's statistics about mental health and suicide does not necessarily mean individuals did not have an underlying mental issue.
According to Dr. Michael Anestis, professor of psychology at the University of Southern Mississippi and author of "Guns and Suicide: An American Epidemic," the number suggests that a lot of people are not engaging with the mental healthcare system.
"Part of the problem is that we have a system that is built entirely on preventing suicide by having someone come in and say, 'I'm in despair,'" he said. "If that's all we focus on, we don't help any of these people who don't engage with the system or who do and don't tell us their thoughts."
Underreporting suicidal thoughts or plans and not accessing support are related problems, related to inadequate resources and the stigma of suicide, according to experts.
"We need to change what we're doing," said Dr. Julie Cerel, president of the American Association of Suicidology (AAS) and professor at the University of Kentucky. "Like mental health treatment in general, it's stigmatized. We don't talk about it, so therefore, we have fewer resources devoted to figuring it all out."
There are a number of effective, evidence-based treatments for people struggling with suicidal thoughts and actions, she explained, but they aren't widely disseminated. Moreover, only a handful of states require mental health clinicians and psychologists to be trained in suicide risk assessment and intervention. California became the seventh state to require suicide prevention training in 2017.
Despite being the tenth leading cause of death, there is less money and attention paid to suicide prevention than other causes, Cerel added.
In 2017, the National Institutes of Health spent $35 million on suicide prevention research. That same year it spent $301 million on research for the flu, the seventh leading cause of death.
Overcoming the stigma of suicide is another challenge made even more difficult by the lack of public discussion about the issue. Though high-profile deaths, like Anthony Bourdain, Kate Spade or Robin Williams typically drive a public conversation, some worry that those discussions can encourage people to consider suicide as an option.
Among the myths some experts have tried to dispel is that talking about suicide increases the risk of a person killing themselves.
The so-called suicide "contagion" effect was widely discussed after Netflix released "13 Reasons Why" in 2017, a show about a high school girl who commits suicide. Some studies have suggested that an increased exposure to suicide in the media or on the internet can make a person more susceptible to viewing it as a viable option.
"It's definitely a double-edged sword," Cerel said. "We want to talk about it. We don't need the stigma anymore...but we don't need to glamorize it." She added that the risks of talking about suicide are outweighed by the benefits of having the discussion.
Anestis agreed that exposing vulnerable people to "unnecessarily explicit details" is not helpful, "but we aren't going to solve suicide by not talking about it."
That includes a national discussion about suicide as a public health crisis as well as individually talking to family, friends and loved ones.
"We are not going to cause suicide by talking about it. We prevent it by talking about it," he stressed. "We as a nation have to decide we're going to talk about this more, find out what science has taught us about it and we're going to make a concerted effort to keep this in the news."
Accurately discussing suicide means challenging assumptions about why an individual decides to take his or her life. Those reasons can often be different from the causes of suicidal ideation or a suicide attempt. Studies over the years have shown that the vast majority of individuals who think about suicide never attempt it. And 90 percent of those who attempt suicide and survive do not go on commit suicide at a later time.
Predicting suicide based on suicidal ideation, a previous attempt or mental illness has proven to be inaccurate, Anestis said. He pointed to recent research by Dr. Joseph Franklin showing that in the past fifty years, professionals have not improved their ability to predict whether or not a person will take his or her life.
Ultimately, the underlying reality of suicide is that it is preventable.
"In spite of not knowing all of the reasons, we do know how to prevent it," Draper told Circa. "How to prevent it doesn't change."
Draper stressed that every person has a role to play in suicide prevention, even it's just asking someone how they are doing and piercing through the isolation that can often contribute to a person feeling hopeless.
"Most of the time suicidal moments pass. [In the moment] they feel like the pain is never going to stop," he said. That is why the National Suicide Prevention Lifeline is available at any hour, Draper said, "to be there for people so they have access to care in the moment they need it."
There are a number of effective programs and resources available. The National Suicide Prevention Lifeline is available 24 hours a day, 7 days a week to provide crisis support and recommend local resources. The AAS also has a list of accredited crisis centers around the country.