Suicide rates climbing, especially in rural America
"US life expectancy drops again as opioid deaths and suicide rates rise "The Real Governments of Blue America""
County-by-county analysis offers clues about elevated risk
Date: September 9, 2019
Source: Ohio State University
Summary: Suicide is becoming more common in America, an increase most pronounced in rural areas, new research has found. The study also highlights a cluster of factors, including lack of insurance and the prevalence of gun shops, that are associated with high suicide rates.
FULL STORY
Suicide is becoming more common in America, an increase most pronounced in rural areas, new research has found.
The study, which appears online today (Sept. 6, 2019) in the journal JAMA Network Open, also highlights a cluster of factors, including lack of insurance and the prevalence of gun shops, that are associated with high suicide rates.
Researchers at The Ohio State University evaluated national suicide data from 1999 to 2016, and provided a county-by-county national picture of the suicide toll among adults. Suicide rates jumped 41 percent, from a median of 15 per 100,000 county residents in the first part of the study to 21.2 per 100,000 in the last three years of the analysis.
Suicide rates were highest in less-populous counties and in areas where people have lower incomes and fewer resources. From 2014 through 2016, suicide rates were 17.6 per 100,000 in large metropolitan counties compared with 22 per 100,000 in rural counties.
In urban areas, counties with more gun shops tended to have higher suicide rates. Counties with the highest suicide rates were mostly in Western states, including Colorado, New Mexico, Utah and Wyoming; in Appalachian states including Kentucky, Virginia and West Virginia; and in the Ozarks, including Arkansas and Missouri.
"While our findings are disheartening, we're hopeful that they will help guide efforts to support Americans who are struggling, especially in rural areas where suicide has increased the most and the fastest," said lead researcher Danielle Steelesmith, a postdoctoral fellow at Ohio State's Wexner Medical Center.
"Suicide is so complex, and many factors contribute, but this research helps us understand the toll and some of the potential contributing influences based on geography, and that could drive better efforts to prevent these deaths."
Suicide rates are trending higher despite a national prevention effort that kicked off in 2015 with the goal of reducing suicide rates 20 percent by 2025. Another recent analysis found that suicide rates in almost 90 percent of U.S. counties increased more than 20 percent from 2005 to 2015.
The new study included 453,577 suicides by adults 25 to 64 years old from 1996 to 2016. Suicides were most common among men and those 45 to 54 years old.
Suicide prevention can be bolstered with this new information about trends and patterns of suicide, said Cynthia Fontanella, a study co-author and associate professor of psychiatry and behavioral health at Ohio State.
"For example, all communities might benefit from strategies that enhance coping and problem-solving skills, strengthen economic support and identify and support those who are at risk for suicide," Fontanella said.
"The data showing that suicides were higher in counties with more gun shops -- specifically in urban areas -- highlights the potential to reduce access to methods of suicide that can increase the chances an at-risk person will die."
Another factor related to increased suicide rates, particularly in rural areas, was "deprivation," a cluster of factors including underemployment, poverty and low educational attainment.
Long-term and persistent poverty may be more entrenched and the economic opportunities for individuals more limited in rural areas, Steelesmith said, adding that many rural Americans rely on jobs in agriculture and industries including coal mining.
"In cities, you have a core of services that are much easier to get to in many cases. You may have better access to job assistance, food banks and nonprofits that might all contribute to less desperation among residents," Steelesmith said.
High social fragmentation -- which factors in levels of single-person households, unmarried residents and the impermanence of residents -- was associated with higher suicide rates, as was low social capital, a measure of the interconnectedness of people in an area. Both of these were particularly pronounced in rural America.
Other factors associated with higher suicide rates included high percentages of veterans in a county and lower rates of insurance coverage.
Fontanella said that people who live in rural America might particularly benefit from strategies to promote social connections through community engagement activities that offer opportunities for residents to interact and to become familiar with supportive resources in their area.
Steelesmith said it's important to note that county-by-county geographical information on suicide doesn't tell the whole story. Some states, particularly in the West, have large counties with great variability in terms of resident life experiences, for instance. This work also excludes data on suicides by young and elderly Americans.
Story Source:
Materials provided by Ohio State University. Original written by Misti Crane. Note: Content may be edited for style and length.
Journal Reference:
Danielle L. Steelesmith, Cynthia A. Fontanella, John V. Campo, Jeffrey A. Bridge, Keith L. Warren, Elisabeth D. Root. Contextual Factors Associated With County-Level Suicide Rates in the United States, 1999 to 2016. JAMA Network Open, 2019; 2 (9): e1910936 DOI: 10.1001/jamanetworkopen.2019.10936
2018 - "US life expectancy drops again as opioid deaths and suicide rates rise"
A Philadelphia neighborhood is the largest open-air narcotics market for heroin on the East Coast. Addicts come from all over, and many never leave.
By Jennifer Percy Oct. 10, 2018
[...]
“We have not only people from other parts of the state,” Trainor said, “we have people from other parts of the country who come here.” Every year, “drug tourists” from all over the United States visit Kensington for the heroin. Eunice Sanchez, a local pastor, put it more succinctly: the area, she said, was the “Walmart of heroin.”
[...]
In the early 2000s, Dominican gangs started bringing in Colombian heroin that was not only purer but much cheaper than heroin imported from Asia, which historically predominated. Kensington’s decentralized market kept competition high and prices low. Most corners were run by small, unaffiliated groups of dealers, making the area difficult to police; if a dealer was arrested, there was always someone there to replace him. The Philadelphia prison system has become the largest provider of drug treatment in the city. The police have realized that they can’t arrest the problem away, and they spend many of their calls reviving drug addicts with Narcan, an overdose-reversal spray. The D.E.A. focused on the high-level drug traffickers, not the guys working the streets, but the arrests did little to curb the growing demand.
[...]
At the bottom of the station steps, I met John, a 55-year-old man who lived with his parents. John was a “guide”: He guided customers from the train to the drugs. He could help you find heroin, cocaine, PCP, marijuana, Xanax, Percocet virtually any time of day or night. He could help you shop around, compare prices and quality. His own drug of choice was heroin, which he sniffed. John carried a grocery bag filled with clean needles. He got them from Prevention Point, a nonprofit on Kensington Avenue that exchanged dirty needles for clean ones. Needle exchanges helped stop the spread of H.I.V. and hepatitis C. But John was smart and made a small business out of it. He sold clean needles for $2. “You don’t come from our world,” he told me, “and we don’t come from your world.”
[...]
When Philadelphia’s progressive mayor, Jim Kenney, took office in 2016, he soon made it a priority to tackle the city’s opioid crisis. His administration wanted to focus on getting heroin users into treatment rather than arresting them. In late 2016, Kenney created a task force of addiction experts, doctors, social workers and agents from the D.E.A. to come up with a plan to curb overdose deaths in the city. In May 2017, they offered 18 recommendations, including a media campaign about the risks of opioids, wider distribution of Narcan and support for medically assisted treatment, which uses opioid-replacement drugs like Suboxone to help users manage withdrawal.
The city offered treatment, but most of the displaced heroin addicts didn’t accept it. They moved into crumbling churches, abandoned buildings, vacant lots. They pitched tents on the grass at McPherson Square, where library staff regularly rushed outside with bottles of Narcan to save the overdosed. The police told the users to be on their way. Some of them moved to the abandoned and boarded-up Ascension of Our Lord Church, on a windswept corner of Westmoreland Street about a mile northeast of the tracks. They gathered in pews, beneath light raining through stained-glass windows. They left needles in the holy-water basin.
[...]
This January, Gov. Tom Wolf signed a statewide disaster declaration, the first of its kind for a public-health emergency in Pennsylvania. There had been more than 1,200 overdose deaths in Philadelphia in 2017 — a 34 percent rise from 2016. Wolf pushed the state to roll back regulations that might be stopping users from getting help, like ID and sobriety requirements for shelters and treatment facilities. Instead of sending overdosed people back out onto the street, the city hired recovery specialists in the E.R. to talk to them about treatment. It handed out tens of thousands of doses of Narcan. It sent a van into the neighborhood to offer recovery services. It gave residents blue light bulbs for their porches, because the light seemed to make it harder for heroin users to find a vein.
Shanta Schachter, a community development consultant who was hired by Conrail during the cleanup as a liaison between the company and neighborhood organizations, watched the new encampments grow throughout the winter.
[...]
The city was willing to try almost anything. In January, the Department of Public Health announced that the city would “encourage organizations to develop” supervised-injection sites, where people can bring their own drugs without fear of arrest and inject under the care of a medical team. There are roughly 120 of these injection sites around the world — although none in the United States — and research has shown that they reduce overdose deaths, connect addicts to long-term care and help keep neighborhoods clean of needles. There has never been a fatal overdose at an official safe-injection site. The Justice Department made it clear that it would view any such place to be in violation of federal drug laws, but Ed Rendell, the former Pennsylvania governor and Philadelphia mayor, threw his support behind a nonprofit group trying to establish one.
[INSERT: A leading voice for positive change The first ‘official’ supervised injecting facility in the world began in Switzerland in 1986. The Uniting Medically Supervised Injecting Centre (Uniting MSIC) has been operating in Kings Cross, Sydney since May 2001. For 17 years Uniting MSIC was Australia’s only supervised injecting facility. A second Australian facility opened in North Richmond, Melbourne in June 2018. P -As of 2019, there are more than 120 supervised injecting facilities operating around the world, in Switzerland, Germany, Spain, The Netherlands, Norway, Luxembourg, Denmark, Canada, Portugal, Iceland and France, amongst others. More are being planned in places like Ireland and Scotland. https://www.uniting.org/community-impact/uniting-medically-supervised-injecting-centre--msic/history-of-uniting-msic ]
[...]
A woman sleeping below the Kensington Avenue underpass. Jeffrey Stockbridge for The New York Times
.. said lead researcher Danielle Steelesmith, a postdoctoral fellow at Ohio State's Wexner Medical Center.
"Suicide is so complex, and many factors contribute, but this research helps us understand the toll and some of the potential contributing influences based on geography, and that could drive better efforts to prevent these deaths." https://investorshub.advfn.com/boards/read_msg.aspx?message_id=173583365
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