Suicide: Number One Killer of College Students

Suicide recently ranked as the leading cause of death among the university population, topping alcohol-related traffic deaths.

According to University of Virginia researchers, the leading cause of student deaths is suicide. James C. Turner, director of the Department of Student Health at the University of Virginia, asked more than 1,150 schools to share their student mortality rates.

Given this information, what does this say about the way major universities handle depression and mental illness?

According to the article:

It is becoming very difficult for colleges to push mental illness awareness and prevention to the forefront as economic times are getting tougher and endowments are taking hits, some schools don’t have the luxury to keep up with counseling and psychological services.
It claims that counseling and psychological services are a luxury. If the topic was concerning preventing alcohol-related traffic deaths, nobody would call traffic-safety education a luxury. Mental health services are not a luxury, but indispensable necessities and the responsibility of the university. Luxuries are the Universities' sports programs, new projectors, and remodeled buildings. The complacent tone the article's author conveys concerning the status quo is outrageous. For every suicide, there are twenty attempts, and 10% of America's college students have diagnosed depression. Does nobody care about the suffering going on before our eyes? 



Milestones In Mental Health

1932: Suicide rate reached 22 per 100000 people -- an all-time high in U.S. history. Thought to be the outcome of the Great Depression.
1946: The National Institute of Mental Health (NIMH) established within the National Institutes of Health. There, it launches a first-of-a-kind, comprehensive research program on mental illness and health.
1996: The Mental Health Parity Act (MHPA), a legislation signed into law by President Clinton, requires parity of mental health benefits with medical and surgical benefits, however, with limited scope and poor enforcement.
1999: The first White House Conference on Mental Health and the first Secretarial Initiative on Mental Health prepared under the aegis of the Department of Health and Human Services.
2004: globally, suicide tall exceeds lives taken by murder and war put together (WHO), expected to reach 1.5 million in 2020.

2009: U.S. military suicide deaths exceed combat fatalities in Iraq and Afghanistan
2009: Drugs exceeded motor vehicle accidents as a cause of death for the first time since the government started tracking drug-induced deaths in 1979, killing at least 37,485 people nationwide (U.S. Centers for Disease Control and Prevention). This is the first time that drugs have accounted for more fatalities than traffic accidents
2009: Suicides exceeded motor vehicle accidents as the cause of death for the first time since 1924 (16.4 suicides and 16.1 traffic deaths per 100k) killing 36,547 people nationwide in 2009, which is also the highest rate of suicide since 1993, 12.0 per 100,000. While car accidents had the lowest rate since 1920, 11.1 per 100k in 2009 vs. 11.4 in 1920.
2010: The Patient Protection and Affordable Care Act signed into law by President Obama, The biggest Civil Right legislature since the 1964 CRA. Expands insurance coverage to 30 million Americans.
2010: Army suicides hit all time high and continue to rise.
2010: Depression is the #1 cause of disability in the United States.
2020: Depression expected to reach #1 cause of disability in the world.

Suicide statistics grossly underestimate the actual rate of suicide. Many suicides are hidden among other causes of death, such as single car, single driver road traffic accidents, unwitnessed drownings, accidents, and other undetermined deaths. In addition, suicide is thought to be underreported for multiple reasons including stigma, religious concerns, and social attitudes. The psychological and social impact of suicide on the family and community is enormous.

Drugs Outnumber Traffic Deaths For The First Time Ever

Drugs exceeded motor vehicle accidents as a cause of death in 2009, killing at least 37,485 people nationwide (U.S. Centers for Disease Control and Prevention).
There were 33,808 traffic-related deaths in 2009.
This is the first time that drugs have accounted for more fatalities than traffic accidents since the government started tracking drug-induced deaths in 1979.

Fueling the surge in deaths are prescription painkiller and anti-anxiety drugs that are potent, highly addictive and especially dangerous when combined with one another or with other drugs or alcohol. Among the most commonly abused are OxyContin, Vicodin, Xanax and Soma, and Fentanyl.
  • There is a dramatic rise in prescription drug deaths in recent years, which now cause more deaths than heroin and cocaine combined.
"It's a wonderful medical advancement that we can treat pain," Bohnert said. "But we haven't figured out the safety belt yet."
Drug-induced deaths are mostly accidental overdoses but also include suicides and fatal diseases caused by drugs.
This is the only place the article mentions suicides. With depression affecting 6.7% of the population yearly (30% of these cases are severe), suicide is the obvious answer to the cause in the majority of overdose deaths.

Deaths from suicide outnumber traffic deaths as well.
  • Suicide vs. car accidents 
    • In the United States, suicide accounted for 36,547 deaths in 2009 (3/4 of them by males), while there were 33,808 automobile accident fatalities in 2009.
    • In Australia, 40 % more people lost their lives to suicide than car accidents. 
    • In the U.K., 100% more people die from suicide than road traffic accidents.
  • Suicide vs. homicide 
    • There were more than twice as many suicides (36,547) as homicides (16,591) in the United States in 2009. 
  • Suicide was the 10th leading cause of death in 2009.
    • 4th among 18-65 years (2007) 
  • Note: Mortality statistics are based on information from death certificates, and most suicides go unreported. 
    • The actual figure is 3 to 5 times higher (109,641 - 182,735), according to the book "Why Suicide". 
    • That puts suicide at 3rd to 6th cause of death in the U.S.
Other Suicide facts:
  • Men:
    • Die by suicide 4x more often then women (27,269 vs. 7,329 in 2009)
    • Chose more fatal methods, such as firearms.
  • Women:
    • Attempt suicide 4x more often then men. 
    • Choose less deforming methods, such as drug overdose.

Antidepressants: Most Prescribed Drug in the U.S.

About 11% of Americans aged 12 or older take antidepressant medications. The rate of antidepressant use in the U.S. has increased nearly 400% since 1988 (CDC: "NCHS Data Brief, No. 76," October 2011).

Antidepressants were the top most commonly prescribed drugs in America for all ages in the years 2006-2008, and (a very close) second in 2009 and 2010, with 253.6 million prescriptions in 2010 (Table 1). 

Two out of the top 10 most prescribed drugs are antipsychotics.
Appendix notes:
Therapy classes defined using ATC defined product groups and synthesized based on proprietary IMS Health definitions. Report reflects Prescription-bound products including Insulins (and excludes other products such as OTC). Includes all prescriptions dispensed through retail pharmacies - including independent and chain drug stores, food store pharmacies and mail order as well as long-term care facilities. Prescription counts are not adjusted for length of therapy. 90-day and 30-day prescriptions are both counted as one prescription. Updated April 7, 2011

Other findings:
  • 14% of non-Hispanic white persons take antidepressants compared with 4% of non-Hispanic black and 3% of Mexican-American persons.
  • Antidepressants were most frequently used from 2005 to 2008 by people between 18 and 44. 
  • Most people who take antidepressants do so to treat depression, but the drugs also are used for other disorders, such as anxiety (about 8% of people aged 12 and over who had no current depressive symptoms took antidepressant drugs). 
  • Females are 2.5 times more likely to take antidepressants than are males. 40% of females and 21% of males with severe depressive symptoms take antidepressants. 
  • 34% of severe, 28% of moderate, 19% of mild, and 7% of persons with no symptoms of depression take antidepressants.
  • More than 60% of Americans on antidepressants have taken the drugs for two or more years, with about 14% taking the medication for a decade or more. 
  • Less than 1/3 of people taking one antidepressant drug and less than 1/2 of those taking multiple antidepressant medications have seen a mental health professional in the past year. 
  • 23% of women between 40 and 59 take antidepressants, more than in any other age-sex group.
The Use of Medicines in the United States: Review of 2010: Report by the IMS Institute for Healthcare Informatics.
CDC: "NCHS Data Brief, No. 76," October 2011.


Are People With Mental Illness Violent?

"The vast majority of the American public believes that persons suffering from depression, schizophrenia, alcohol dependence, and drug dependence pose a threat for violence toward self and others. (NMHA, 1999)"

According to Mental Health: A Report of the Surgeon General (1999), the discrimination and stigma associated with mental illnesses largely stem from the link between mental illness and violence in the minds of the general public. “For instance, 61 percent of Americans think that people with schizophrenia are likely to be dangerous to others,” notes the report of the President’s New Freedom Commission on Mental Health, Achieving the Promise: Transforming Mental Health Care in America (2003).

Many believe that education is the key to reducing the stigma associated with mental illness. Education does not reduce stigma. According to the paper Americans’ Views of Mental Health and Illness at Century’s End: Continuity and Change, "Between 1950 and 1996, the proportion of Americans who describe mental illness in terms consistent with violent or dangerous behavior nearly doubled." 

Why is this hurtful to society?
  • As a result of the fear of violence, preference for social distance in most social settings between the public and those with mental health problems remains distressingly high. 
  • Americans are hesitant to interact with people who have mental illnesses (Pescosolido, et.al., 1996): 
    • 38 percent are unwilling to be friends with someone having mental health difficulties
    • 64 percent do not want someone who has schizophrenia as a close coworker
    • 68 percent are unwilling to have someone with depression marry into their family
  • "The public is least willing to accept persons suffering from psychological problems as family members or coworkers."
“Most people who suffer from a mental disorder are not violent — there is no need to fear them. Embrace them for who they are — normal human beings experiencing a difficult time, who need your open mind, caring attitude, and helpful support.” (Grohol, 1998)

In fact, people with psychiatric disabilities are far more likely to be victims than perpetrators of violent crime. (Appleby, et.al., 2001)

On functionality:
  • "Majority of Americans believe that persons suffering from a mental health problem (sans depression) are unable to manage finances or make treatment decisions."
  • "When asked to characterize the severity of the problem encountered by persons experiencing depression, schizophrenia, alcohol dependence, and drug dependence, the vast majority of the public views these conditions as representing “very serious” problems."
Most people with mental illness are high-functioning. 12-month incidence of mental illness in U.S. is 26.2% of adult population. Severe mental illness (resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities) is concentrated in only 1/5 of these cases (5.8% of adult population).
Women constituting twice as many severe cases as men. However, paradoxically, women with mental disorders are seen as significantly less likely to pose a threat for dangerous or violent behavior

Lifetime and 12-month incidence of mental illness in the U.S. adult population.1

The cases of mental illness in which violence does exist, the violence is not the result of inherent deviancy or a diabolical nature of those with mental illness, but because of severe distress. We, the public, are to blame for this, because we do not provide anywhere near the sufficient treatment to treat mental health problems.

Violence and Mental Illness — How Strong is the Link? 
Much can be done to diminish the risk of violence among the mentally ill. A study that compared the prevalence of violence in a group of psychiatric patients during the year after hospital discharge with the rate in the community in which the patients lived showed no difference in the risk of violence between treated patients and people without a psychiatric disorder.5 Thus, symptoms of psychiatric illness, rather than the diagnosis itself, appear to confer the risk of violent behavior. So patients with schizophrenia who are free of the acute psychotic symptoms that increase this risk, such as having paranoid thoughts or hearing voices that command them to hurt others (called command auditory hallucinations), may be no more likely to be violent than people without a mental disorder. The study did not specifically monitor the treatments, but it seems possible that treating psychiatric illness does not just make patients feel better; it may also drastically reduce the risk of violent behavior.
Of course, because serious mental illness is quite rare, it actually contributes very little to the overall rate of violence in the general population; the attributable risk has been estimated to be 3 to 5% — much lower than that associated with substance abuse, for example. One study involving 802 adults with a psychotic or major mood disorder showed that violence was independently correlated with several risk factors, including substance abuse, a history of having been a victim of violence, homelessness, and poor medical health.4 The 1-year rate of violent behavior for subjects with none or only one of these risk factors was 2% — a prevalence close to the ECA study's estimate for the general population. Thus, violence in people with serious mental illness probably results from multiple risk factors in several domains.
"Large numbers of the American public assign primary responsibility for the costs of mental health treatment to the affected individual and private insurance companies. If necessary, these individuals assign secondary responsibility to the families of those with mental health problems."
  • "Between 1957 and 1996 the percentage of the American public who indicated that they would seek informal support to deal with an anticipated nervous breakdown increased over 400 percent."
  • "Americans see the utility of a wide variety of potential sources of help for those suffering from mental health problems, but when asked to indicate whom they would turn to first, the majority indicated they would seek help from family and friends."
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