Sudhakar Madakasira, MD, DLFAPA
Suicide is a terrible human tragedy and potentially preventable. As suicide rates have steadily increased over the past few decades, the National Suicide Prevention Lifeline was established in 2004 to provide 24/7 suicide crisis intervention and support via a toll-free telephonic hotline. The US Surgeon General in 2012 announced a National Strategy for Prevention of Suicides (1). Suicide prevention is becoming recognized as a public health responsibility rather than that of the clinical settings (2). A previous study reported that suicide was the tenth most common cause of death in Mississippi (MS) in 1996 and the suicide rates were unchanged at about 14 per 100,000 population for 1996 and 2006 (3). The purpose of this article is to provide a brief overview of recent suicide statistics in MS as compared to the national data so as to discern trends and differences, from a public health, not a clinical management perspective. Data from the National Center for Health Statistics of the US Centers for Disease Control (CDC), and the MS Department of Health Division of Vital Statistics was reviewed to provide a 10-year comparison from 2008, the year in which the US economy crashed from a mortgage-lending crisis, to 2018, the latest year for which national and MS statistics were available. Comparisons of age factors and suicide methods were not done as such data was not available for MS for 2018.
There were 36,035 suicides in the US in 2008 and increased by 34% to 48,344 in 2018 (4). The national suicide rate was 11.8 in 2008 and increased to 14.8 in 2018, a substantial 25% rise. Suicide remained the 10th leading cause of death for both years. Table 1 compares suicide statistics for 2008 and 2018 between US and MS. There were 398 suicides in MS in 2008 and increased to 422 in 2018, a 6% rise; the MS suicide rate was higher than that of the US in 2008 at 13.9 and marginally increased to 14.1 in 2018. Suicide was ranked as number 13 of all causes of death in MS in 2008 and ranked slightly higher at 12 in 2018.
The data also revealed huge racial and gender differences for both US and MS. Whites comprised 87-90% of the suicides in 2008 and 2018 in the US as well as MS. More than three-fourths of the suicides in 2008 in the US were by men (79%) and even more in MS (83%). This gender difference was evident ten years later in the US but gender data for 2018 was not available for MS. White males accounted for over 70% of the total suicides in the US for both years while they accounted for 69% of total suicides in MS in 2008. Suicide rate in the US for males increased from 19 in 2008 to 23.4 in 2018, a 23% rise. The increase between the two years was much bigger in females at 51% (4.9 vs. 6.4).
Table 2 reveals interesting trends in suicides in the most populous counties in MS between 2008 and 2018. The number of suicides increased in the ten-year period in all counties except Madison.
Suicide rates significantly increased in the ten-year period in Desoto, Hinds, Jackson and Rankin counties but fell in Harrison and Madison counties.
Suicides and suicide rates have shown increasing and disturbing trends from 2008 to 2018 in the nation as well as MS although the increases in MS pale in comparison to the nation. Suicide continued to be the tenth most common cause of death in US for these years, ahead of homicide. Although the number of suicides steadily increased in MS (from 310 in 1996 (3) to 398 in 2008 to 422 in 2018; in line with population increases), suicide as a cause of death fell from #10 in both 1996 and 2006 to #13 in 2008 and #12 in 2018. This suggests medical diseases took more lives in recent years rather than suicides.
“White males accounted for about 70% of total suicides in the US and in Mississippi.”
White males consistently and increasingly account for over two thirds of the suicides in the nation and in MS, but equally alarming is the increased suicide rate in females in the ten-year period. With the economic crash in 2008, poverty, foreclosures and unemployment were expected to increase the suicide rates (4) but the rates did not increase significantly as compared to 2005 when the suicide rate was 11 in the US and 12.5 in MS (3). The poverty rate decreased in the US from 2008 to 2018 (13.2% vs. 11.8%) and in MS (21.2% vs. 19.7%) (5).The unemployment rate also decreased in the US (5.8% vs. 3.9%) and in MS (6.1% vs. 5%) during the 10-year period (6). In spite of these socioeconomic improvements, suicide rates rose in 2018 suggesting other factors were at play. Insurance companies raising deductibles, limiting coverage and denying claims for mental health care may be a factor (7).
Within MS, the most populous counties (Desoto, Harrison, Hinds, Jackson and Rankin) recorded increased number of suicides in 2018 as compared to 2008. The coastal counties of Harrison and Jackson continued to record the highest suicide rates (over 20) in the 10-year period. Perhaps this is because of higher substance abuse along the Interstate 10 corridor. In the metropolitan Jackson area, Hinds and Rankin Counties saw a significant increase in suicides from 2008 to 2018, while Madison County saw a significant decrease. These metropolitan trends cannot be explained by racial or socioeconomic disparities.
The rising trends in suicides in MS behoove healthcare professionals and policy makers alike to consider suicide a public health priority and implement more aggressive crisis intervention, public awareness and other prevention strategies. The US Federal Communications Commission (FCC) recently approved the number 9-8-8 for mobile telecom carriers to adopt as National Suicide Hotline effective July 2021.The MS department of Mental Health released its first state plan for suicide prevention four years ago for 2017-2019 that includes innovative approaches such as Mobile Crisis Response Teams, Shatter the Silence Campaign for Youth and Older Adults, IGotU! Healthy Life Choices for Teens, Suicide Prevention Training for Educators, Question, Persuade, Refer (QPR) Trainings, At-Risk on Campus and SAFETalk (Suicide Alertness for Everyone). These national and state suicide prevention strategies, if utilized widely, should have a positive impact in the long run.
- National Strategy for Suicide Prevention: Goals and Actions: A Report of the US Surgeon General and the National Action Alliance for Suicide Prevention, 2012.
- “Suicide Prevention: A Public Health Issue”, a Project of Applying Science. Advancing Practice. CDC National Center for Injury Prevention and Control, 2019.
- Sudhakar Madakasira, “Suicides in Mississippi: Recent Trends”, Journal MSMA 49 (10), 2008.
- Kerr WC, Kaplan MS, et al., “Economic Recession, Alcohol Abuse and Suicide Rates: Comparative Effects of Poverty, Foreclosure and Job Loss”, Am J Prev Med, 52(4), 2017.
- Retrieved from Statistics.com and the US Bureau of Labor Statistics, October 4, 2020.
- Retrieved from the US Census Bureau, October 4, 2020.
- Koons C and Tozzi J, ”As Suicides Rise, Insurers Find Ways to Deny Mental Health Coverage”, Bloomberg May 16, 2019.
Sudhakar Madakasira, MD is a Distinguished Life Fellow of American Psychiatric Association and President of Psycamore Psychiatric Programs.