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Tuesday May 24, 2016

How Can Family Physicians Turn Back the Rising Suicide Rate?

As both a physician and someone who suffers from depression and anxiety, I have been alarmed by what appears to be a dramatic rise in mental illness in our country. With this in mind, I was extremely saddened -- but not shocked -- to see that the U.S. suicide rate has reached a 30-year high, according to a recent CDC report(www.cdc.gov).

 Nearly 20 percent of Americans have a mental disorder, but 60 percent of people with mental illness do not receive treatment.

Depression and other mental illnesses have long carried a stigma of failure and weakness among Americans. We are a country of rugged individualism, self-sufficiency and economic advancement. Mental illness runs counter to these notions but is nevertheless increasing among wide swaths of the U.S. population.

It is estimated that 18 percent of Americans suffer from a mental disorder(www.samhsa.gov), a rate that appears to have increased dramatically from the 1930s to the early 1990s(www.psychologytoday.com).

You might expect suicide rates to decrease because of improved diagnosis and treatment options. But suicide rates have increased 24 percent since 1999, supporting the idea that a growing number of individuals have mental illness. (Ninety percent of people who commit suicide suffer from a psychiatric diagnosis(www.nami.org).) This trend holds in both women and men, in adolescents and the middle-aged, and among nearly all ethnic and racial groups(www.cdc.gov). And although rates of suicide among the elderly have not increased, these individuals are still at high risk for suicide.

Attempted suicide is also increasing among youth, suggesting that the increased rate of suicide is not just an increase in "successful" attempts(www.cdc.gov)." More than one-third of college students report(www.acha-ncha.org) that in the past 12 months, they experienced depression to the extent that it affected their ability to function. And although individuals in the gay, lesbian, bisexual or transgender (GLBT) community are more likely to have mental illness, they are also more likely to run into discrimination in health care(www.nami.org), thus lowering their rate of diagnosis and treatment.

Among veterans, post-traumatic stress disorder (PTSD) has caused significant morbidity since the Vietnam era. As many as 31 percent of Vietnam combat veterans have had PTSD, as has a similar percentage of those who served in the Iraq and Afghanistan wars(www.ncbi.nlm.nih.gov). In fact, according to the Department of Veterans Affairs, one veteran commits suicide nearly every hour(www.va.gov).

However, this is not just an American problem. Suicide is the third-leading cause of death in the world(www.save.org) for individuals ages 15 to 44, having increased by 60 percent since the 1970s. One person commits suicide every eight minutes(www.paho.org) the Americas. This tells us that the problem is not one of just culture, environment or health care, but a situation that crosses all of these variables.

So what is our role as family physicians? Assisting in diagnosis and treatment could make a difference because 60 percent of individuals with mental illness do not receive treatment(www2.nami.org). A broader goal should be to help individuals overcome the stigma of mental illness so those who need treatment will seek it. Working with our clinic populations, along with local health departments or other community groups, we can educate the public about the legitimacy of mental illness and the crucial need for treatment.

What about preventing suicide? Some of the suspected causes for the increase in suicide in recent years(www.washingtonpost.com) include divorce, drug addiction, economic concerns and increased social isolation that stems from Internet and social media use. These are areas we rarely cover in our anticipatory counseling, but where education can make a huge difference in our patients and communities.

Recognizing the populations at highest risk, such as adolescents, veterans and members of the GLBT community, helps us tailor our prevention efforts. According to a U.S. Preventive Services Task Force evidence review, psychotherapy can reduce suicide by nearly one-third in adults(www.ncbi.nlm.nih.gov). Considering the biggest antecedents to the recent rise in suicide, it also may be helpful to focus more on patients' personal relationships, economic stresses and even social media use. NIH has some great resources on healthy screen time and personal relationship-building(www.nhlbi.nih.gov) that can be beneficial to patients and families.

There are many CME options related to the diagnosis and treatment of mental illness. For example, the AAFP is offering a Maintenance of Certification for Family Physicians self-assessment module that focuses on improving care of depression and coincides with the Family Medicine Experience Sept. 24 in Orlando, Fla.

Social determinants of health, issues that family physicians are acutely aware of in the public health realm, are believed to be the biggest contributors to suicide. The World Health Organization offers assistance in addressing these issues with our patients(www.who.int).

Mental illness and suicide are huge problems. But as with many problems in medicine, family physicians are poised to provide meaningful solutions.

Kyle Jones, M.D., is a faculty member at the University of Utah Family Medicine Residency Program in Salt Lake City. He is the director of primary care at the Neurobehavior HOME Program, a patient-centered medical home for those with developmental disabilities. You can follow him on Twitter @kbjones11(twitter.com).

Posted at 08:11AM May 24, 2016 by Kyle Jones, M.D.

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