With suicide rates the highest they’ve been in three decades, according to the latest Centers for Disease Control and Prevention data released last year, efforts to prevent people from taking their own lives are expanding.
Those involve better determining who might be at risk in order to provide critical, timely help. But while the link between mental health disorders — like depression — and higher suicide rates is well-established, research finds less than half who die by suicide have a mental health diagnosis. That means intervening only after psychological concerns arise may miss saving many whose lives are ultimately cut short.
Meanwhile, there’s growing evidence that physical health conditions could be a factor in predicting whether a person may be a higher risk for taking their own life. “Poor health increases suicide risk overall,” says Brian Ahmedani, director of psychiatry research at Henry Ford Health System in Detroit.
Ahmedani led research that found 17 different physical health conditions — from traumatic brain injury to migraine, cancer, congestive heart failure and stroke — were associated with a higher rate of suicide after adjusting for age and sex. The study of U.S. patients from the general population, published last month in the American Journal of Preventive Medicine, reflects findings from prior studies in other countries and in U.S. military and veteran patients. Those studies have likewise shown that physical health conditions, from chronic obstructive pulmonary disease, or COPD, to asthma (conditions also covered in the AJPM research), are associated with raised suicide risk.
[See: 9 Things to Do or Say When a Loved One Talks About Taking Their Life.]
The research follows a 2014 Journal of General Internal Medicine study Ahmedani led finding that the vast majority who die by suicide are seen by a health provider in the 12 months prior. “Our previous research found that over 80 percent of people had some sort of health care visit in the year before they die by suicide,” he notes. Most saw primary care providers or specialists. However, only about 45 percent had a mental health diagnosis, according to that research.
It’s well-established that people with chronic conditions suffer higher rates of depression, says Dr. Gregory Simon, a psychiatrist and an investigator at Kaiser Permanente Washington Health Research Institute, who was a co-author on both studies with Ahmedani; and depression increases one’s risk for suicide. That’s one way that suffering a major physical health condition may raise suicide risk — by contributing to mental illness, including issues that may go undiagnosed.
In addition, the research published in AJPM suggests that the burden of the disease or condition alone — without any compounding mental illness — may increase the odds that a person takes his or her own life. In fact, the study found that even after adjusting for mental health and substance use diagnoses, nine conditions were still associated with increased odds of suicide. Among these, three conditions were linked to a more than two-fold increase in suicide risk: sleep disorders, HIV/AIDS and most notably, traumatic brain injury, which was associated with a nearly nine-fold increase in suicide risk (it was linked with a 15-fold increased risk for suicide overall, when not adjusting for mental health or substance use diagnoses). Having multiple physical health conditions also increased suicide risk substantially, the researchers noted.
[See: Top Reasons Children End Up in the Hospital.]
That’s not totally surprising, according to Jordan Grafman, director of brain injury research for the Shirley Ryan AbilityLab in Chicago. TBI can be caused by anything from a car accident to a hard hit in football. Many with a mild TBI recover fully. However, others suffer more serious, lasting injuries. “If they have a moderate to severe traumatic brain injury, while they may recover, they rarely recover completely,” Grafman says. “They’re left with certain cognitive, social and emotional deficits — impairments due to their areas of the brain that were damaged.”
That damage can profoundly disrupt a person’s life. It may hamper work performance or alter a person’s demeanor, straining personal relationships. For some, the resulting effects can snowball and lead to thoughts of ending it all. “If somebody, for example, is less — in some way — resilient and emotionally competent after their brain injury, they may not be able to cope well with the effects of the brain injury, which could potentially increase the likelihood, if not for suicide, at least for suicidal ideation,” Grafman says.
To be sure, the absolute risk for suicide is still low — even as rates are historically higher — at nearly 13 per 100,000 for the general population in a given year, according to the CDC. That’s led some to question broad suicide prevention efforts in health care.
The U.S. Preventive Services Task Force, an independent group of experts that makes recommendations on preventive care, previously found there wasn’t sufficient evidence to make recommendations on suicide screening and prevention in primary care settings. However, the Joint Commission, which accredits hospitals and other health care organizations, last year urged that patients be screened for suicide risk in outpatient, inpatient and emergency settings, as noted in the AJPM research. Given that nearly every physical health condition studied was associated with suicide, the researchers wrote, “widespread suicide prevention efforts in all healthcare settings seems warranted.”
Simon highlights the particularly strong association between neurological conditions studied and suicide risk. “It’s clear that multiple sclerosis, Parkinson’s disease, stroke and traumatic brain injury have a strong and specific association with depression, and now we see they have a stronger and specific association with suicide,” he says. “It’s no doubt a complex relationship involving both the psychological impact of those conditions, but also their physiologic impact. When parts of people’s brains are damaged, that can affect their mood and their reasoning.”
That makes it all the more important that individuals and their family members or other advocates focus not only on treating the conditions themselves, but potential mental health concerns that arise as well. Experts emphasize the profound burden a serious health issue or chronic condition — including those that aren’t neurological — can place on a person. They say it’s important for clinicians to ask probing questions that might reveal mental health issues, particularly in those with physical health conditions most associated with a higher rate of suicide as well as individuals with multiple chronic conditions.
[See: How to Find the Best Mental Health Professional for You.]
People with chronic conditions and their loved ones are also urged to keep lines of communication open. Talk openly with health providers about psychological concerns and seek help from a mental health professional to address those as needed. Don’t succumb to what mental health researcher David Goldberg described as the fallacy of good reasons, Simon says. Just because there seems to be an obvious reason for emotional difficulties, doesn’t mean those should be ignored. Namely in this case, don’t give into the thinking that people who suffer from chronic health conditions have “so-called ‘good’ reason to feel depressed, to feel discouraged, to feel hopeless, therefore it’s OK, and we don’t need to pay attention to it. We know that depression, discouragement, hopelessness and suicidal thoughts in people who have chronic medical conditions should not be written off to, ‘Oh well of course they feel that way,'” he says. “We would see this as an important thing that needs to be attended to and certainly can be addressed by appropriate treatment.”
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Combating Suicide Risk Associated With Physical Health Conditions originally appeared on usnews.com
