The Mystery Around Middle-Age Suicides
The death rate is climbing for those between 45 and 64, new CDC data show
The recent suicides of two well-known figures—celebrity chef Anthony Bourdain and fashion designer Kate Spade —underscore a sobering reality: Suicide rates for people in middle age are higher than almost any other age group in the U.S. and rising quickly.
A report released today from the Centers for Disease Control and Prevention showed that suicide rates for women 45 to 64 increased nearly 60% between 2000 and 2016. For men of the same age the suicide rate increased almost 37% over that time.
No group of women saw a higher suicide rate. Among men, only those 75 and over had higher rates than the 45-to-64 group.
Overall, suicide rates in the U.S. increased 30% between 2000 and 2016. A separate CDC analysis released this month found that suicides have risen in almost every state.
Experts say mental illness, substance abuse, loneliness and financial and relationship problems all have contributed to suicide rates increasing. But it’s unclear why suicide appears to peak in middle-aged people.
“Life satisfaction hits an all-time low in middle age. This dip in happiness is known as the U curve,” says Samantha Boardman, a clinical instructor in medicine and psychiatry at Weill Cornell Medical College in New York City.
“Depression and stress are particularly high in this age group. Juggling responsibilities and managing multiple roles takes a toll and can lead to feeling overwhelmed, a loss of control and despair.”
Tragic Toll Suicide rates have risen 60% for middle-aged women and 37% for middle-aged men over 16 years.
Factors such as a decline in physical health and chronic pain can also contribute to suicide, Dr. Boardman says. Those stresses can feel particularly difficult for longtime sufferers of depression.
The five most common stressors linked to suicide among middle-age adults were problems with intimate partners, job/finances, health, family and criminal/legal problems, according to a 2016 study in the American Journal of Preventive Medicine.
The CDC found the suicide rate for women 45 to 64 climbed to 9.9 deaths per 100,000 people in 2016, up from 6.2 in 2000. For men in that age group over that time, the suicide rate rose to 29.1 deaths per 100,000 in 2016, up from 21.3.
Catherine Burnette, an assistant professor at Tulane University School of Social Work in New Orleans, says if people have lived with untreated depression over time, it can implode in their 40s, 50s or 60s.
“If people have been drinking or using substances as a coping mechanism, the cost of that might peak at those ages, too,” Dr. Burnette says.
For accomplished or well-known people, isolation can be a risk factor, she says. “Social connection is one of the biggest antidotes to suicide,” she says. “I think it can be pretty isolating to be a celebrity, where outside people may seek social opportunities rather than social connection.”
Anne Case, a professor of economics and public affairs at Princeton University, says the demographic group really driving middle-age suicide rates is white people without a four-year college education. African-Americans have lower suicide rates that haven’t increased, she says.
“We think whites without a B.A. find that they don’t have the same promising future that the generation before them had,” Dr. Case says. “It’s much harder to find a good job, a job with a ladder up.”
Increasing reports of patients experiencing physical pain may also play a role, she says. “We know that pain is a trigger for suicide,” she says.
Jeffrey Lieberman, chairman of psychiatry at Columbia University, says 90% of people who die by suicide have pre-existing mental disorders, whether they have been diagnosed and treated or not. The top four conditions associated with an increased risk for suicide are depression, bipolar disorder, schizophrenia and post-traumatic stress disorder.
Another major risk factor for suicide is substance abuse, he says. Heavy drug or alcohol abuse alters the connectivity of neural pathways involved in reward and the emotional and cognitive processing of normal experiences. “It produces chemical changes and ultimately structural changes in a way that becomes permanent,” Dr. Lieberman says.
Mr. Bourdain had spoken openly about past problems with substance abuse.
For women, hormonal changes that come with menopause may play a role. Menopause results in a drop in estrogen, which can cause changes in brain function, which not everyone is able to adapt to, he says.
Inger Burnett-Zeigler, a clinical psychologist and assistant professor in the department of psychiatry and behavioral sciences at Northwestern Medicine, says job-related concerns can play a role for men in particular, who have higher rates of suicide overall.
Men are also less likely to identify that they have a mental-health problem or may need treatment. “So there’s less support connecting them to treatment,” he says.
“People of all levels of success and those who have achieved great success are still at significant risk for having emotional and mental difficulties,” Dr. Burnett-Zeigler says. “Sometimes people who are highly successful also have an increased level of anxiety around maintaining that level of success, or fear of loss of all that they’ve achieved. So I think we should be mindful that even those who to the outside world are quite successful can still have a lot of emotional difficulties that are not obvious to others.”
Where to Find Help
The CDC says warning signs for suicide include when people talk about feeling like a burden, feeling hopeless or wanting to die. An increase in anxiety, extreme mood swings and increased anger are also signs that someone may be at risk. Increased substance use, sleeping too much or too little and looking to obtain a firearm or poison are also warning signs.
The CDC recommends that those in need call the National Suicide Prevention Lifeline: 1-800-273-TALK (8255). Another option is to chat online with someone at www.suicidepreventionlifeline.org. Both are free and confidential and will connect people to a counselor in their area.
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