Economic Deprivation and Social Fragmentation Drive Suicide Rates in US

Major study finds that economic deprivation and a lack of social capital are driving increasing rates of suicide in the U.S.

Micah Ingle, MA
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A recent study published in JAMA Network Open analyzes different factors associated with suicide rates in the U.S. The results of the analysis point to economic deprivation in rural areas, access to guns, lack of health insurance, and the breakdown of social bonds as factors that are driving increasing rates in the United States.

The authors analyzed data from January 1, 1999, to December 31, 2016, including all individuals aged 25 to 64 in the study. Variables analyzed included age, gender, geographic location (rural-urban), amount of gun shops, social capital, economic deprivation, social fragmentation, and veteran status.

“Suicide is a major public health problem in the United States and the tenth leading cause of death, with more than 47,000 individuals dying by suicide in 2017. Despite a national prevention effort initiated in 2015 with the goal of reducing suicide rates 20% by 2025, rates are trending higher,” the researchers,” led by Daniella Steelesmith, write.

“Analyses from 2018 found that suicide rates increased by more than 30% in 25 states from 1999 to 2016 and nearly 90% of US counties had an increase greater than 20% from 2005 to 2015. Rural counties consistently have the highest rates and demonstrate the greatest increases over time.”

Photo Credit: Pixabay

Suicide is currently in the top 12 leading causes of death in the United States. Rates have increased dramatically over the past several decades. Some researchers have noted a correlational rise in antidepressant usage with this increase in suicide. Others have suggested that income inequality may play a part in the epidemic.

“Although a few studies suggest that isolation, limited socioeconomic opportunity, and limited access to mental health care in rural communities may contribute to higher suicide rates, further research is needed to explore the association of contextual factors with county-level suicide rates. Understanding geographical and community-level differences in suicide rates has the potential to inform targeted prevention efforts.”

Whatever the exact cause or causes, it has also been suggested that the current mental health system is not adequately addressing the problem.

The current study seeks to clarify the relationship between suicide and many of these social and individual variables, to better inform efforts to curb the epidemic. The authors focus on individuals aged 25-64 because these are the statistically significant years within which many suicides are committed. All individuals analyzed were assigned an ICD-10 (International Statistical Classification of Diseases and Related Health Problems) code of suicide.

Various databases were consulted for individual variables such as sex, age, county of residence, rural-urban location, the ratio of psychiatrists to community members, veteran status, socioeconomic status, patterns of social interaction, and other factors. Both cross-sectional and longitudinal methods of study were employed to discover trends between communities and trajectories within communities.

A total of 453, 577 suicides were accounted for in the data, from 1999 to 2016. The majority of these were male (77%), with the 45-54 age range having the most at 30.1%. Suicide rates increased during the study, with the last three years showing the highest rates.

Large metropolitan areas had the highest number of suicides (48%), although rural counties had higher percentages per population. Counties with the highest rates tended to be in the Western U.S. states such as Colorado, New Mexico, Utah, Wyoming, Kentucky, Virginia, West Virginia, Arkansas, and Missouri. These rural counties also had the highest rates of increase in suicide.

At the outset of the study, rates in economically deprived rural counties were higher than that of rates in more affluent rural counties, but over time these affluent rural counties had an increase in risk compared to affluent metropolitan areas. Still, the highest rates were found in economically deprived rural counties.

“Our study’s findings of a significant interaction between RUCC and deprivation suggest that individuals living in rural counties may be especially susceptible to the effects of deprivation, such as lower levels of education, employment, and household income. Long-term and persistent poverty appears to be more entrenched and economic opportunities more constrained in rural areas.”

Predictably, counties with the highest levels of social capital—or engagement between individuals—had the lowest rates, while counties with the highest levels of social fragmentation demonstrated the highest rates. People without health insurance were at a higher risk, as were veterans, which may explain some of the dramatic rates in rural areas, as a higher proportion of veterans reside in rural America.

“Consistent with prior research, these findings indicate that greater opportunities for social engagement and connection within a county are associated with lower suicide rates,” the researchers write.

“Programs establishing connectedness and social support within a community are a potential strategy for reducing suicide. Several programs that include components for building connectedness, such as peer support programs and community engagement activities, have been shown to be effective within bounded settings and could be practically applied to test the effect of enhancing social capital as a means of reducing suicide risk.”

Gun shops were associated with increased firearm suicide risk, but mainly in metropolitan areas rather than rural areas. The authors suggest that this may be related to gun saturation in rural areas, versus increasing gun availability in urban areas.

The strengths of the study include an analysis of all 50 states, a longitudinal design covering the rural-urban continuum, and a wealth of data from different sources allowing for a sophisticated understanding of suicide rates and trajectories over time.

The study did have some limitations. These limitations include difficulty applying analyses at the individual level rather than the ecological level, problems with the constructs (i.e., presence of gun shops may not fully represent gun availability), and the possibility that national mortality rates may underestimate the actual number of suicides.

The authors conclude:

“An increase in suicide rates was associated with rural residence, higher deprivation, higher social fragmentation, a higher density of gun shops, and a higher percentage of county residents who were veterans and who were uninsured.”

“Study findings suggest that increasing social connectedness, civic opportunities, health insurance coverage, and limiting access to lethal means within communities have the potential to reduce suicide rates across the rural-urban continuum. Suicide rates in rural counties are especially susceptible to deprivation, suggesting that rural counties present special challenges and deserve targeted suicide prevention efforts.”

 

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Steelesmith, D. L., Fontanella, C. A., Campo, J. V., Bridge, J. A., Warren, K. L., & Root, E. D. (2019). Contextual factors associated with county-level suicide rates in the United States, 1999 to 2016. Jama Network Open, 2(9). (Link)

2 COMMENTS

  1. “Economic Deprivation and Social Fragmentation Drive Suicide Rates in US.” No, it can’t be!

    Because our “mental health professionals” have been swearing up, down, left, right, and backwards for decades that “all distress,” especially that which causes suicides, “is caused by ‘chemical imbalances’ in people’s brains,” which can only be cured with a lifetime of their neurotoxic psych drugs.

    Pardon my sarcasm, and disgust, at our insane “mental health professionals'” systemic crimes against the innocent, decent, and ethical within our society. “Mental heath professionals,” whose entire lives’ goals have been about their worship of the fraud based money of the never ending war mongering and profiteering, bailout needing, fiscally irresponsible, “banks steal $trillions worth of houses” globalist banksters’ worthless paper money.

    Of course the societal injustice of fiscally irresponsible globalist banks being given bailouts, then being allowed to steal “$trillions worth of houses” is distressing for many within our society, and has nothing to do with “chemical imbalances” in people’s brains. Of course the mainstream “fake news” and their “divide and conquer” the American populous with their satanic propaganda, is frustrating for the majority of Americans.

    How embarrassing that our highly DSM deluded “mental health” workers have been on the wrong side – on the side of the fiscally irresponsible, never ending war mongering and profiteering, home stealing, globalist banksters – for so many decades. Our scientific fraud based, DSM deluded “mental health” workers truly are among the “enemies within” America today.

  2. “..Whatever the exact cause or causes, it has also been suggested that the current Mental Health System is NOT adequately addressing the problem…”

    https://www.bmj.com/content/358/bmj.j3697/rr-4

    “…Antidepressants Increase The Risk of Suicide, Violence and Homicide At All Ages

    The FDA admitted in 2007 that SSRIs can cause madness at all ages and that the drugs are very dangerous; otherwise daily monitoring wouldn’t be needed: “Families and caregivers of patients should be advised to look for the emergence of such symptoms on a day-to-day basis, since changes may be abrupt” … “All patients being treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases. The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants” (1).

    Such daily monitoring is, however, a fake fix. People cannot be monitored every minute and many have committed SSRI-induced suicide or homicide within a few hours after everyone thought they were perfectly okay.

    As the published trial literature related to suicidality and aggression on antidepressants is unreliable, we looked at 64,381 pages of clinical study reports (70 trials) we got from the European Medicines Agency. We showed for the first time that SSRIs in comparison with placebo increase aggression in children and adolescents, odds ratio 2.79 (95% CI 1.62 to 4.81) (2). This is an important finding considering the many school shootings where the killers were on SSRIs.

    In a systematic review of placebo-controlled trials in adult healthy volunteers, we showed that antidepressants double the occurrence of events that the FDA has defined as possible precursors to suicide and violence, odds ratio 1.85 (95% CI 1.11 to 3.08)(3). The number needed to treat to harm one healthy adult person was only 16 (95% CI 8 to 100).

    Based on the clinical study reports, we showed that adverse effects that increase the risk of suicide and violence were 4-5 times more common with duloxetine than with placebo in trials in middle-aged women with stress urinary incontinence (4). There were also more women on duloxetine who experienced a core or potential psychotic event, relative risk RR 2.25 (95% CI 1.06 to 4.81). The number needed to harm was only seven. It would have been quite impossible to demonstrate how dangerous duloxetine is, if we had only had access to published research. In accordance with our findings, the FDA has previously announced that women who were treated with duloxetine for incontinence in the open-label extension phase of the clinical studies had 2.6 times more suicide attempts than other women of the same age (5).

    Looking at precursor events to suicide and violence is just like looking at prognostic factors for heart disease. We say that increased cholesterol, smoking and inactivity increase the risk of heart attacks and heart deaths and therefore recommend people to do something about it. Psychiatric leaders, however, routinely try to get away with untenable arguments. Many say, for example, that antidepressants can be given safely to children arguing that there were no more suicides in the trials, only more suicidal events, as if there was no relation between the two, although we all know that a suicide starts with suicidal thoughts, followed by preparations and one or more attempts. The same can be said about homicide. It can no longer be doubted that antidepressants are dangerous and can cause suicide and homicide at any age (5-7). It is absurd to use drugs for depression that increase the risk of suicide and homicide when we know that cognitive behavioural therapy can halve the risk of suicide in patients who have been admitted after a suicide attempt (8) and when psychotherapy does not increase the risk of murder…”