Why is suicide increasing in midlife?

Photo: Tasman Sea on an overcast day.

What leads a middle-aged person to contemplate suicide? A failed relationship? Financial devastation? Drug abuse? All of these explanations have been suggested for an unexpected increase in suicides in persons 45 to 54 years old. According to the Center for Disease Control and Prevention (CDC-P), this age group had a 20 percent increase in suicides between 1999 and 2004. And while the end of an important relationship, financial ruin, and a history of drug abuse all correlate with suicide, none of these explanations really grapple with why ending one’s life would be perceived as an appropriate response to suffering.

We often expect the correct explanation to be the most direct one. Like billiard balls, one event is thought to directly impact another, leading to the observed outcome. But humans aren’t like billiard balls, and the forces governing the physical universe cannot always explain our behavior. Our beliefs about success and failure and what makes our lives worthwhile are determined by a lifetime of events, and our earliest (and often forgotten) experiences often hold sway over all others. This is especially true of the choice to attempt suicide.

Childhood trauma increases the likelihood that a person will attempt suicide later in life. Quite a few experiences can be traumatizing for a child: physical, emotional and sexual abuse; neglect; witnessing a parent being battered; as well as having a family member who is mentally ill, abuses drugs, or is incarcerated. Even divorce can leave a lasting emotional wound. According to the Adverse Childhood Experience study conducted by Kaiser Permanente and the CDC-P, a history of just one of these adverse experiences results in a 2- to 5-fold increase in the likelihood of attempting suicide. When 7 or more adverse events are endured in childhood, a person is 50 times more likely to attempt suicide as an adolescent and 30 times more likely to do so as an adult.

Childhood trauma in particular shatters basic assumptions about what it means to be a person and a member of society. Lost are youthful feelings of invincibility and the sense that the world is meaningful and just. Rather than being curious and ready to explore the world, fear and defensiveness become the norm. Perhaps most importantly, the child comes to question if she is worthy of being loved, and thus whether she matters at all.

In 2010, suicide was the 10th leading cause of death in America for all age groups. According to the National Center for Health Statistics, more people died from suicide than homicide in 2002 by a wide margin — 31,655 versus 17,638, respectively. This number is small compared to the number of attempted suicides. In 2002, over half a million people visited the nation’s emergency departments as a result of suicide attempts. Many were depressed or suffering from other mental disorders — conditions that also correlate with histories of childhood trauma. (Visit the CDC for an informative fact sheet on suicide statistics.)

One major trend in psychiatry over the past 40 years has been the widespread use of psychotropic drugs to treat mental illness. People in the 45- to 54-age range have been particularly impacted by the shift from talk therapy to drug therapy. They have access to the psychotropic drugs increasingly prescribed for mental illness, and some use these very medications to attempt suicide. According to the CDC-P, during the same 5-year period that suicides increased in this age group, drug overdoses significantly increased.

What can be done? Psychiatrist Colin Ross pushes for a paradigm shift in psychiatry in which healing from trauma becomes the primary focus of treatment. Epidemiologist Robert F. Anda advocates ending the disease-oriented, biomedical explanation of mental illness, replacing it with the World Health Organization’s definition of health: “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Perhaps with this broader definition of health, we can begin to challenge the conditions that lead so many to choose to end their lives.

© 2009 Laura K Kerr, PhD. All rights reserved (applies to writing and photography).