Earlier this month, the Center for Disease Control and Prevention (CDC) released a report stating the suicide rate among teenage girls rose to its highest level in a decade. Overall, suicide rates are highest in young people and those over age 65. Carolyn Turvey, PhD, psychiatrist with UI Hospitals and Clinic, talks about suicide and prevention:

Why is suicide considered a public health problem?

Suicide has consistently been between the 10th and 11th leading cause of death in the United States. Obviously it leads to the death of the person who commits suicide, but it also devastates family members, loved ones, and acquaintances in the community. In Iowa, there is a higher suicide rate than gunshot mortality rate, meaning that there are more suicides than homicides. So it’s the leading cause of violent death in Iowa.

Suicide by definition is fatal, but not all who attempt succeed. What injuries result from attempted suicide?

There can be quite a range. Some of the more common injuries are things like cuts to the wrist, or cuts to different parts of the body. People who get in single-driver car accidents but then who live can have enormous injuries. They can do enormous bodily musculoskeletal damage. People who try to hang themselves, but for whatever reason don’t do so to death, can have difficulty speaking. They can do permanent damage to their voice box. Drug overdose is another common type of attempted suicide, and there, I haven’t seen much kind of permanent brain damage due to that. But there is the recovery period after the drug overdose.

Why are adults over 65 just as likely as teenagers to commit suicide?

I think that was an interesting question. There is a lot more press about teen suicide; it might be because people are concerned about what children do anyway. And another reason why it gets more press is that it’s on the rise: teen suicide rates are increasing. But actually, adults over age 65, and in particular, white men, are much more likely or much more at risk to commit suicide than teenagers. The demographic group most at risk to commit suicide are men over age 65 who are white, and that’s been so since the statistics for suicide have been kept.

We see teenager suicides rising. Do we know why or do we see other things that put teenagers at risk for suicide?

I don’t think people have a definite reason for why that is. And I think often suicide people often think of these larger global issues; they’re uncertain about the future. When I was in graduate school, people talked about the possibility of nuclear holocaust. I think a lot of people who study teen suicide think it might have to do with the actual greater increase in substance abuse. And that explanation makes more sense to me, because really the main risk factors for suicide are closely tied to psychiatric disorders. They’re not as often due to existential angst. I think there’s this kind of romanticized view of suicide that it’s due to some sort of existential angst. Usually, it’s due to having a very severe psychiatric disorder. Many professionals believe that the increase in teen suicides is related to increased use of substances.

What are some of the warning signs of suicide?

One of the main psychiatric risk factors for suicide is major depression, so if someone is down or depressed, withdrawn. Hopelessness is a very strong predictor of eventual suicide. If people feel hopeless, things aren’t going to get better, and they have difficulty eating, sleeping, chronic low self-esteem, or feelings of guilt or worthlessness, that might be a warning sign. Other warning signs might be tied to the two other psychiatric risk factors for suicide: substance abuse and also major psychotic disorder. If you see that someone’s abusing substances and possibly feeling low, or if they have a major psychotic disorder, certainly for those disorders you really need to get a psychiatrist or psychologist on board and try to help them with those problems.

If we feel we know someone who is considering suicide, what steps should we take?

I would ask them about it. There’s this myth that if you ask people about suicide, it’s going to put the thought in their head, and I don’t think that that’s true. That’s not been borne out in any research. Let them know that you’re very concerned about them, what the impact of the suicide would be on you; let them know that they’re not out there on their own, that it does actually have an impact. But then first thing is to get them to a mental health professional. And if you’re really concerned about that and really concerned that they’re going to hurt themselves, you may need to get them to see help against their will—what we call commitment. But if you’re really concerned then that might be what it takes.

Is the University of Iowa currently involved in any research or studies with regard to suicide rates in Iowa?

I’m not aware of any with teens. I’m currently conducting a study looking at a community sample of people who report suicidal thinking, and what I’m trying to determine is whether or not they get treatment and how they get treatment. And if they are suicidal and they don’t get treatment, why is that?

I’m looking at if they have some of the risk factors, what predicts whether or not they get the help that they need versus kind of go it on their own and possibly put them at more risk for suicide. A colleague of mine is doing a study looking at suicide in people with manic depression. Manic depression is a serious mood disorder where people have periods of great highs and great lows. He’s looking to see, amongst people with manic depression, what predicts suicide outcome.

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