Transcript for VitalSigns Teleconference: Suicide Prevention

KATHY HARBEN: Thank you Julie. And thank you all for joining us today for the release of a new CDC Vital Signs report on Trends in Suicide Rates and contributing circumstances to suicide. We are joined by Dr. Anne Schuchat, CDC’s Principal Deputy Director and Dr. Deb Stone, lead author of the study. Following opening remarks, Drs. Schuchat and Stone will respond to questions. I’ll turn the call over now to Dr. Anne Schuchat.

ANNE SCHUCHAT: Good afternoon and thank you for joining us today. CDC works 24/7 to protect Americans against health threats. Each month in CDC’s Vital Signs report, we focus on one of these issues and what can be done about it. Today’s report contains new information about state suicide trends, the factors that contribute to suicide, and the implications for prevention. In 2016 alone, 45,000 people in the U.S. lost their lives to suicide. Unfortunately, our data show that the problem is getting worse. Suicide is one of just three leading causes of death that are on the rise. And these statistics don’t begin to reveal the emotional, social and financial toll that suicide exacts on individuals, families and communities who are left devastated. Many have lost friends, neighbors and family members to suicide or have loved ones who have considered or attempted it. Between 1999 and 2016, suicide rates increased among all age groups younger than 75 years. During that period, middle-aged adults had the largest number of suicides and particularly high increases in rates. We found that suicide rates increased in nearly every state across the nation. These findings are disturbing. Suicide is a public health problem that can be prevented. For this Vital Signs report, we first analyzed data from the National Vital Statistics System to look at trends in suicide rates for all 50 states and Washington, D.C. We then looked at data from CDC’s National Violent Death Reporting System or NVDRS, which included information for 27 states in 2015, and looked at circumstances around suicides among people with and without known mental health conditions.

As a side note, CDC is now collecting these kinds of data in 40 states, D.C. and Puerto Rico. And Congress has provided additional funding in fiscal year 2018 omnibus act so that CDC can expand the system to all 50 states. Suicide is often attributed solely to a mental health concern. But, according to our data, fewer than half of the people who died by suicide had a known mental health condition. Our research found that those people who died by suicide and did not have a mental health condition previously diagnosed were somewhat more likely than those with a mental health condition to struggle with relationship problems or loss, other life stressors, and experience recent or impending crises. But very importantly, these circumstances were likely to occur in all people who died by suicide, regardless of whether or not they had a diagnosed mental health condition. Suicide is preventable. That’s why it’s so important to understand the range of factors and circumstances that contribute to suicide risk, including relationship problems, substance misuse, physical and mental health conditions, job issues, financial troubles, and legal problems. With this information in mind, states and communities can develop a comprehensive approach to suicide prevention. One example of a successful program is The United States Air Force Suicide Prevention Program. This program, which includes 11 policy and education initiatives designed to increase social support, social skills, and help-seeking, shifted the culture of the Air Force away from viewing suicide as an individual-oriented mental health concern to a larger, service-wide problem impacting the whole community. After the program was begun, the Air Force saw a 33 percent reduction in suicide as well as reductions in other related problems. By increasing awareness of the range of circumstances contributing to suicide risk, and acting to address them through a comprehensive approach, we could reach our national goal of reducing the annual suicide rate by 20 percent by 2025.

Today’s report suggests we have a lot of important work to do to reach this goal. Nearly all states had increasing suicide rates between 1999 and 2016, and 25 states had rate increases of more than 30 percent. So how do we work together to reverse these numbers and help save lives? On the Federal level, government agencies are tracking the problem of suicide to understand trends and groups at greatest risk; developing, implementing, and evaluating what works to prevent suicide in communities; supporting local, territorial, state, tribal, and other partners to prevent suicide; and working with public and private partners to advance the National Strategy for Suicide Prevention. In states and communities, close coordination of activities between public health agencies and other sectors of society is critical for preventing suicide. Necessary partners include health and mental healthcare providers, social services, first responders, educators, faith communities, and the media. States and communities can and should take action now. To help prioritize prevention, CDC developed Preventing Suicide: A Technical Package of Policy, Programs, and Practices. It features the best available evidence for states and communities to guide their prevention activities. Some of the strategies are designed to prevent suicide risk before it emerges in the first place. These strategies include teaching coping and problem-solving skills to help people manage life challenges; promoting safe and supportive environments, including safe storage of medications and firearms among people at risk; providing temporary help for people struggling to make ends meet; and encouraging connectedness so people are less likely to feel alone or isolated. Other strategies in the technical package are designed to support people who may already be struggling, by providing effective treatment and crisis intervention strategies. Health and behavioral health care providers have an important role to play in suicide prevention as well, so that nobody in these systems falls through the cracks. Policies and protocols that prioritize patient safety and that help get people into ongoing care, especially during care transitions, can help prevent suicide. Last and very important, the technical package describes approaches to prevent future suicide risk among people who have attempted suicide or have lost a friend or loved one to suicide. You can find the link to the technical package is on our Vital Signs website. Preventing suicide takes everyone. Parents, employers, teachers, coaches, religious leaders, healthcare providers, and people affected by suicide – everyone in the community can help prevent suicide risk by learning the warning signs of suicide and how best to respond effectively. Together we can work to bring hope and save lives.

KATHY HARBEN: Thank you, Dr. Schuchat. Julie, we’re now ready for questions.

OPERATOR: Thank you. If you would like to ask a question, please press star 1 and you will be prompted to give your first and last name as well as your organization. Our first question comes from Adam Sabes with the Washington Times. Your line is open.

ADAM SABES: Hello. So, I see that Nevada is the only state where the rate of suicides have actually gone down since 1999. Why is that?

ANNE SCHUCHAT: Thank you for that question. Nevada has a high rate of suicide and the rate stayed high. They actually have the ninth highest rate in the country. We believe they’ve continued with the rest of the states to have an ongoing challenge with suicide prevention and the reason that they didn’t go up probably is that they were already at such a high level. Next question?

OPERATOR: Thank you. Our next question comes from Carla Johnson with the Associated Press. Your line is open.

CARLA JOHNSON: This is a small detail, but could you clarify whether the overall U.S. rate is 15.6 per 100,000 as in the introduction to the report or 15.4 as in the supplementary table? Thank you.

ANNE SCHUCHAT: Let us get back to you on that. It may be a question of the states included, but let us get you that later.

KATHY HARBEN: Thanks.

ANNE SCHUCHAT: Hold on a second. Okay. Go ahead.

DEB STONE: So the rate in the table is based on six consecutive three-year averages and so you’ll see a difference when you’re looking at it that way versus just the rate of the whole population in 2016.

CARLA JOHNSON: Thank you.

ANNE SCHUCHAT: So it’s a single year rate versus a three-year average.

CARLA JOHNSON: Got it.

ANNE SCHUCHAT: Any questions? Do we have a follow up?

CARLA JOHNSON: No. Thank you.

OPERATOR: Our next question comes from Ben Carey with the New York Times. Your line is open.

BEN CAREY: Thanks very much. You know, you mentioned that it’s the — one of three leading causes of death that’s on the rise. What are the other two?

ANNE SCHUCHAT: Alzheimer’s disease and drug overdoses.

BEN CAREY: Okay. And I just have another one on firearms. I’m not sure I’m looking through the report now, have you found changes in methods that are worth mentioning? For example, is — you know, is over dose on the rise or on the decline? You know, what’s some of the data say there?

ANNE SCHUCHAT: This report looks at the circumstances for 2015, so it’s a single year look-

BEN CAREY: Okay.

ANNE SCHUCHAT: -At the circumstances. That would be a different report and so we don’t have that information today. We did — the trend analysis was the state-specific rates-

BEN CAREY: Yeah.

ANNE SCHUCHAT: Going back to ’99. So, we just have 2015. Did you have a follow up?

BEN CAREY: I think so. You can’t do the trend analysis but you’re looking at a snapshot of a year on this particular report?

ANNE SCHUCHAT: That’s right. That’s right.

BEN CAREY: What about — what does the trend analysis from the previous years say? I don’t know if you have that right there in your pocket but you might in terms of the changing — you know, what’s happening in trends and using methods? For example, with guns, is it going up, down, sideways? What’s happening, do you know?

DEB STONE: We typically see that firearms make up about half of all suicides, and that tends to be pretty consistent.

BEN CAREY: Right.

ANNE SCHUCHAT: Next question, operator.

OPERATOR: Our next question comes from Brianna Ehly with Politico. Your line is open.

BRIANNA EHLY: Hi. Thanks for taking the call. I was wondering if the CDC has done any new research on suicide rates among chronic teens and then second question, I’m just wondering if there’s any concerns about the recent efforts to limit prescription opioids, if that might contribute to pain patients that do need opioids, they’ve had trouble accessing them. We’ve heard anecdotal stories that some people are led to suicide because they’re in so much pain. I’m wondering if that’s something that the CDC is researching or addressing at all?

ANNE SCHUCHAT: Our report found that physical health problems were present in about 1/5 of individuals as circumstances leading — considered to lead up to the suicide. That doesn’t differentiate whether it was, you know, intractable pain versus other conditions that might have been factors in the person’s actions. The issue of pain is very important and the U.S. government and Health and Human Services are working on comprehensive pain management strategies. The NIH, of course, is investing in innovative methods, medications and other approaches for pain management and we have issued guidance for treatment of chronic pain in terms of the opioid issue and the harm that can be done. We don’t have other studies right now, but I would say that the management of pain is a very important issue for CDC and health and human services right now.

BRIANNA EHLY: Okay. Thank you.

ANNE SCHUCHAT: Next question.

OPERATOR: Our next question comes from Kathleen Doheny covering for WebMD.

KATHLEEN DOHENY: Hi, good morning. Do you have any breakdown of suicide rates by month in the country or any trends in seasons with the highest rate that you could share?

ANNE SCHUCHAT There’s some analyses of days of week and month of year and season. I’ll let Dr.Stone expand on that.

DEB STONE: So there was a recent paper that just came out and basically showed that suicide rates are increasing between — increased between March and September tends to be the months where there’s the highest rates.

KATHLEEN DOHENY: And is there any interpretation of why?

DEB STONE: There’s a lot of different factors, of course, that contribute to suicide, and so it’s a little bit hard to say without further research why those months particularly.

KATHLEEN DOHENY: can you give us the citation for that paper?

ANNE SCHUCHAT we can get that to you after the call.

KATHLEEN DOHENY :okay.

ANNE SCHUCHAT: Remind me who you were again?

KATHLEEN DOHENY kathleendohney@gmail.com, d-o-h-e-n-y.

OPERATOR: Next question comes from Susan Scutti with CNN. Your line is open.

SUSAN SCUTTI hi. You highlighted the fact that middle-aged adults had the highest increased rates change. Can you speak to the possible reasons why this group stood out?

ANNE SCHUCHAT: You know, this is a very important population right now in terms of some of the national statistics. We’re seeing middle-aged adults have higher rates of drug overdose and we’re also seeing, you know, the so-called deaths of despair emerging in some of the social science literature. It is hard to say. I can say that increases in suicide tend to correlate with economic downturns and some of the economic downturns may have left some middle-aged populations really hard hit. But there are probably many factors that feed into the findings. Of course, importantly we saw increases in all ages except those over 75 so while the increases were most striking in the middle-aged group; they were present in all of the groups over ten. it’s a major problem that we need comprehensive approaches for. Next question?

OPERATOR: our next question comes from Andrew Siddons with Congressional Quarterly. Your line is open.

ANDREW SIDDONS: Hi. it’s Andrew from CQ do you think there is overlap between these numbers and the opioid or drug overdose death rate?

Dr. DEB STONE: Thank you for that question. Substance misuse was a factor in 28% of the suicides in the 27-state analysis, and intentionality can be complex to determine in a medical investigation at the scene of death. there is probably some overlap in terms of people who died by suicide using opioids for that purpose, but there are probably also some over doses that were not deemed suicides because insufficient information was available. so the national violent death reporting system works hard with a variety of data sources to identify both intentionality and be then the other circumstances. so these data are really the best that we have. Another question or follow-up question from you?

ANDREW SIDDONS:  Yeah, if you don’t mind. Is there anything more you can say about the methods I guess by which people took their lives? You said that firearms tend to be pretty consistent if I heard that correctly. Is there anything else you can say?

ANNE SCHUCHAT: Yeah. The leading causes, the most common method was firearm followed by, you know, hanging, suffocation followed by poisoning, which includes the opioids. Opioids were present in 31% of the individuals who died by suicide and were considered the means of death. So, you know, as Dr. Stone mentioned, firearms have shown up as nearly half fairly consistently over time. That 48% is for the 27-state analysis, the 2015 data.

ANDREW SIDDONS: Thank you.

ANNE SCHUCHAT: I would say related to that that one of our recommendations is assuring safe storage of medications and firearms as one of the approaches to prevention. very important to — you know, to have safe storage. Next question, operator?

OPERATOR: yes. Our next question comes from Liz Szavo with Kaiser Health News. your line is open.

LIZ SZAVO: Hi. I wanted to ask you about the percentage of people with mental illness. i’ve had many psychiatrists tell me that 90% of suicides are related to mental illness and you found a much lower rate. Is it possible that people are undiagnosed or is this simply more accurate data than we’ve had in the past?

ANNE SCHUCHAT: There are a couple things I’d like to say. Our data suggests that suicide is more than a mental health issue. We know we need improved access and treatment for mental health conditions and better recognition and diagnostics because there are still stigmas and still reasons that people don’t present for care. But we think that a comprehensive approach to suicide is what’s needed to ensure that we can prevent suicides and identify concerns earlier. So I do think it’s possible that we have some under recognition on mental health conditions in our data, both because conditions haven’t been formally diagnosed and because those left behind may not have been aware of the mental health diagnosis that an individual carries. But I think a very important point is that if we only look at this as a mental health condition or mental health issue we won’t make the proper diagnosis that we need. We feel that communities, institutions, families, faith-based institutions can really play a role as can state and local [health] departments as can the health care profession. We’d like people to recognize some of these circumstances and factors that led up to suicide in a number of cases and help people, you know, reach out, support those around you, look for those warning signs in people you love and care for and, you know, help with earlier support. we called out both the national suicide prevention life line as a 1-800 number people can call whether you’re considering or whether you have loved ones that may be, and we also called out a great website bethe1to.com which can help people who have colleagues or friends struggling know how to help them. So we don’t think we can just leave this to the mental health disciplines to manage. We think all think we have a role to play and that together we can prevent suicide. Next question?

OPERATOR: Thank you. Our next question comes from Ke Xu with Sing Tao Daily.

Ke Xu: Hi. I was wondering Do you have any breakdowns of suicide rates among different ethnic groups?

ANNE SCHUCHAT: Right. in the national violent death reporting system, the 27-state analysis, the population distribution we found, you know, about 84% of those in the study were white, 1200 — basically, sorry, 6% black non-Hispanic, 1.8% American Indian/Alaska native, 2.8% Asian and 5.4% Hispanic. That’s not really in comparison with the populations in those states and I think that those data are part of other analyses but not this report. You know, we think suicide can happen to anybody and we all, I think, can be on the lookout for those in our families, our friends, our loved ones, our colleagues to try to identify opportunities for prevention. Next question?

OPERATOR: Our next question comes from Deborah Brauser with Medscape Medical News. Your line is open.

DEBORAH BRAUSER: Hi. Yeah. Liz from Kaiser asked my question, but I have a follow-up about it. It was about the 54 percent rate about the people who died by suicide did not have a known mental health condition. Making sure — two quick follow-ups if you don’t mind. Number one, it’s not — like you said, it’s not saying that those with mental illness are not — that’s not a risk factor, is that correct?

ANNE SCHUCHAT: Right. And just importantly, among those with mental health conditions, preceding factors. You know, life stressors, relationship problems, imminent crisis was common. So there were preceding factors in both those with and without mental health diagnoses and we think those proceeding factors can be, you know, a reminder for us to reach out when you know somebody’s going to be going through – you know, they just lost their job, broke up with a partner, you know, that those are times to really support each other and make sure that for those who aren’t coping well that we can help — that we help them get the help that they need. So, we know that, you know, severe depression can lead to suicide, but it’s very rare among those with chronic depression. So suicide is a — kind of a special case, one that we’ve learned is preventable and where there’s several I would say strategies that can help. So that was our key message here, not to say it’s not important for people who are struggling to get help, including mental health support, but that this is a bigger issue than that. We have time for one last question, operator.

OPERATOR: Thank you. Our last question comes from Heidi Splete with Clinical Psychiatry News. Your line is open.

HEIDI SPLETE: Hi. Thank you. I was wondering whether you could expand a little bit more on what health care providers in particular should look for or what resources they might want to try and have or make available to look for some of these warning signs or people who may be at risk who don’t have the mental health condition?

ANNE SCHUCHAT: You know, one thing I’d point to is to be aware of transitions. You know, a person moving from one system to another, maybe in patient to out-patient or substance use treatment to another community service, that those transitions can be stressors, you know? Conditions from the military to out of the military. I’ve learned from pro sports to post pro sports can be an issue. We do think high quality, ongoing care focused on patient safety and suicide prevention is important for health systems to build into their approaches and to train providers in adopting proven treatments for patients at risk for suicide. It’s not necessarily something that is a big part of a primary care clinician’s training, but there are, you know, obviously warning signs to look for and then ways to help people get the care that they need. I think that that is — I’m going to turn it back over to our press office.

KATHY HARBEN: Great. Thank you. Thank you, Dr. Schuchat and Dr. Stone and also reporters for joining us today. If you have follow-up press questions, you can call us at 404-639-3286 or e-mail us at media @cdc.gov. Thank you for joining us. This concludes our call.

OPERATOR: Thank you for your participation. You may disconnect at this time.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES