Suicide Trends and Care Management
In the United States, one veteran commits suicide every 65 minutes1. In addition to the large number of veterans that have already taken their lives in 2018, this year has had many notable celebrity suicides (e.g., Kate Spade and Anthony Bourdain) that have propelled the topic of mental health and suicide to the forefront of many conversations.
Historically, suicide rates in the U.S. have been steadily increasing since the late 1990’s, roughly 30% (citation) from 1999 to 2016. Per the CDC map below, suicide completions have increased between 6% (in Delaware) to up to 57% (North Dakota) in the United States.
In addition to increasing suicide completion rates, there has also been a steady increase in the utilization of prescription drugs for depression. The National Center for Health Statistics reported that between 1999 and 2014, antidepressant utilization rate increased from 7.7% to to 12.7% for males and females respectively (link).
But despite these alarming increases in suicide completion and increased antidepressant prescriptions, the rates of major depressive disorder diagnoses (that are associated with increased suicide completion) has not increased. The same governmental organizations (CDC/NCHS) that reported increased rates of suicide completion and antidepressant use since the 1990s, report that the prevalence of depression among adults over the age of 20 has not changed. From 2007 to to 2016, there has been no significant change in depression prevalence rate (image to right, link). So from a care management perspective (preventing our current members from committing suicide), why has suicide and antidepressant prescription steadily increased, while the prevalence of major depressive disorders have not?
Is it because depressive disorders, like major depressive disorder, are being underreported because of the social and cultural stigma associated with having a psychological condition? Is it because the makeup of U.S. society emphasizes the individual more than the collective - such as the family, leading to more suicides? Or is it because suicide is not always positively correlated with depressive disorders?
More than likely it is a combination of all of these factors. Clinical research has provided us well-established evidence to support the social and cultural stigma associated with depression and other psychological disorders in the U.S. that may lead to underreporting (Quin et al., 2009), the increase in suicide completions within cultures that emphasize individuals over collectives (Zambrano & White, 2009), and conflicting evidence of the correlation between depression and suicide completion (American Society of Suicidality).
So as care management and healthcare professionals, we must remind ourselves that just because one of our members is not diagnosed with major depressive disorder, or another depressive disorder, does not mean that member is not at risk for suicidal ideation, a suicide attempt, or suicide completion. We must utilize our clinical training and understanding of best practice (evidence-based) behavioral health management protocols to properly assess, and more importantly reassess our members mental health with each engagement.
New care management technology can also help assist a care managers ability to screen, identify, and outreach to more high-risk members who may be experiencing suicidal ideations, or at higher risk for experiencing a mental health episode that requires treatment. At Virtual Health, our goal is to significantly reduce the number of suicide completions per year by implementing our intelligent risk tool screenings, assessments, and automated workflows to ensure that all members who may be suffering from a mental illness receive the treatment that they deserve in a timely manner.
- VA Suicide Prevention Program Facts about Veteran Suicide. Veterans Affairs. Retrieved May 14, 2018, from https://www.va.gov/opa/publications/factsheets/Suicide_Prevention_FactSheet_New_VA_Stats_070616_1400.pdf (no longer available)
- Suicide rates rising across the U.S. Centers for Disease Control. Retrieved May 14, 2018, from https://www.cdc.gov/media/releases/2018/p0607-suicide-prevention.html
- Antidepressant Use Among Persons Aged 12 and Over: United States, 2011–2014. Centers for Disease Control. Retrieved May 14, 2018, from https://www.cdc.gov/nchs/products/databriefs/db283.htm
- Prevalence of Depression Among Adults Aged 20 and Over: United States, 2013–2016 NCHS Data Brief. Retrieved May 14, 2018, from https://www.cdc.gov/nchs/products/databriefs/db283.htm
- Quinn, D. M., & Chaudoir, S. R. (2009). Living With a Concealable Stigmatized Identity: The Impact of Anticipated Stigma, Centrality, Salience, and Cultural Stigma on Psychological Distress and Health. Journal of Personality and Social Psychology, 97(4), 634–651. http://doi.org/10.1037/a0015815
- Zambrano, Z., & White, L. T. (2009). Estimating suicide rates in nations that do not report suicide statistics. Undergraduate Research Journal for the Human Sciences, 8. Published on-line at http://www.kon.org/urc/v8/zambrano.html.