Why suicide is more than a mental health issue

New numbers from the U.S. Centers for Disease Control and Prevention show suicide is on the rise.

Suicide prevention efforts shift towards improving mental health of everyone

Renowned chef Anthony Bourdain has been found dead in France while working on CNN program. He's part of an age cohort with rising suicide rates in the U.S. (Frank Gunn/Canadian Press)

The deaths this week of celebrity chef Anthony Bourdain and designer Kate Spade come at a time when new numbers from the U.S. Centers for Disease Control and Prevention show suicide is on the rise. 

The CDC said suicide rates in the U.S. increased more than 30 per cent between 1999 and 2016. The reasons for the rise are complicated and multidimensional.

"Suicide is more than a mental health issue," Dr. Anne Schuchat, principal deputy director of the CDC, told reporters on Thursday. 

"We don't think we can just leave this to the mental health system to manage."

Multiple circumstances

Bourdain took his own life, CNN said Friday. New York City's chief medical examiner ruled that Spade's death earlier this week was also a suicide.

Spade's husband and business partner, Andy Spade, said she suffered from depression and anxiety for many years, but was seeing a doctor regularly and taking medication.

In its Vital Signs report, the CDC said that nearly 45,000 Americans died by their own hand in 2016. The latest U.S. data suggests in 54 per cent of completed suicides, there were no known mental health conditions.

In a sampling of 27 states, relationship problems were considered a contributing factor in 42 per cent of all suicides in 2015. "Problematic substance use" was listed in 28 per cent of cases.

Even so, the CDC acknowledges that poor mental health isn't always easy to detect. The agency said there could be a number of reasons why the reported level of mental illness could underestimate its actual effect, including:

  • Not all illnesses are formally diagnosed. 
  • Stigma still surrounds a diagnosis.
  • Loved ones might not have been aware of a mental health condition.

'Disturbing' age findings

Bourdain and Spade died at 61 and 55, respectively — an age cohort with strikingly high suicide rates in the U.S., according to the CDC.

New York City's chief medical examiner ruled that designer Kate Spade's death earlier this week was a suicide. (Bebeto Matthews/Associated Press)

"Middle-aged adults had the largest number of suicides and a particularly high increase in suicide rates. These findings are disturbing," said Schuchat.

Patrick Smith, CEO of the Canadian Mental Health Association in Toronto, said he isn't aware of a similar increase among that age group in Canada. But he said Bourdain and Spade's deaths show that high-profile status is no bulwark against depression and other mental illnesses.

"Someone doesn't say, 'Wow, they had everything. I can't believe they got cancer.' But we still say that about suicide or depression," said Smith.

"That's really the societal challenge — to try to understand that depression and other mental illnesses can be found in every postal code and every income bracket."

In the U.S., middle-aged adults also have higher rates of drug overdoses, Schuchat said. She pointed to emerging social science research suggesting increases in suicide correlate with "deaths of despair" among middle-age populations who may be harder hit by economic downturns. 

The need for intervention

Suicide ranked as the ninth-leading cause of death in Canada in 2009, the last year for which numbers are available, and is the 10th-leading cause of death overall in the U.S. 

In both countries, suicide prevention efforts are shifting toward meeting people's needs before they reach crisis. Just as doctors don't wait until cancer reaches stage 4 to intervene, Smith said experience in the U.K. shows that after community-based programs to provide support to people in workplaces and schools were introduced, prison populations were reduced and there was a dramatic drop in emergency room visits.

In countries with more community support, rates of feeling suicidal will be similar, Smith said, but there's a better chance of having lower suicide rates.

Everyone has to take care of their mental health and the goal is to normalize conversations to improve and enhance it, Smith said.

Bourdain spoke to CBC last year about some of the psychological challenges he faced separating from his second wife and missing his daughter while travelling the globe for his show Parts Unknown. He'd also talked about his struggles with mental health and a history of drug use.

The CDC recommends teaching children, teens and adults coping and problem-solving skills, building social connections and maintaining dialogue. The agency also encourages safe storage of pills and guns.


Where to get help:

Canada Suicide Prevention Service

Toll-free 1-833-456-4566

Text: 45645

Chat: crisisservicescanada.ca

In French: Association québécoise de prévention du suicide: 1-866-APPELLE (1-866-277-3553)

Kids Help Phone:  1-800-668-6868 (Phone), Live Chat counselling at www.kidshelpphone.ca

Canadian Association for Suicide Prevention: Find a 24-hour crisis centre

If you're worried someone you know may be at risk of suicide, you should talk to them about it, says the Canadian Association for Suicide Prevention. 

Here are some warning signs: 

  • Suicidal thoughts.
  • Substance abuse.
  • Purposelessness.
  • Anxiety.
  • Feeling trapped.
  • Hopelessness and helplessness.
  • Withdrawal.
  • Anger.
  • Recklessness.
  • Mood changes.

With files from CBC's Amina Zafar and Associated Press