“I just can’t do this anymore,” the woman whispers softly.  She is lying in her hospital bed, illuminated by the glaring lights of the intensive care unit.  Mrs. Jones is a woman in her late 50s.  Despite her hospital gown, she is neatly groomed and appears more ready to go out with friends than sit here in this place and have this conversation with me. She looks very much like your neighbor or someone you might see sitting at a coffee shop with a table or friends. Except for the bandage wrapped around her neck.  Underneath is a deep, self-inflicted stab wound.

“Just can’t do what?” I ask gently, moving my chair closer to hear her.  

“Life,” she offers, giving a weak smile, giving her hand a quick, dismissive wave.  She goes on to tell me of a life once filled with friends and family, two children and a handful of grandchildren, and an active circle of friends.  But then, five years ago, her husband died unexpectedly and her friends, mostly married couples, slowly drifted away. “I don’t go out much anymore. The kids are busy. . . .” Her voice fades.  “I just don’t see a reason to get out of bed in the morning. There is no reason.”

***

The story of Mrs. Jones — and those who tragically never make it to the hospital — is playing out across America as suicides increased by an alarming 24 percent between 1999 and 2014, with the greatest increase seen in girls and women, ages 10 to 14 and 45 to 64.  While the rate of suicide increased for both men and women, women saw a staggering 45 percent increase overall.  For middle-aged women, suicide remains among the top 10 leading causes of death. This marked rise, revealed in a study released by the Centers for Disease Control and Prevention this month, has left us scrambling to understand what could be driving this wave of suicides.

A look at the trends has led to a variety of ideas:

• Aging Baby Boomers: It is unclear why, but individuals identified as baby boomers have been shown to suffer from higher rates of suicide, even as early as adolescence. Some have argued it is partly cultural, with a focus on youth and abhorrence of the aging process. Others suggest it is related to growing up in the post-World War II era with advances in science and technology leading to hopes for eternal youth.
• Social Isolation: Having strong social contacts has long been shown to decrease one’s susceptibility to suicide. In a study of women, having strong social supports decreased risk of suicide threefold. As we disconnect from each other and rely on electronic forms of support, could this further influence feelings of social isolation or does it provide a greater sense of connection?  Are we more isolated now than 20 years ago?
• Finances: Studying suicide trends nationwide between 1928 and 2007, rates are seen to rise with an economic downturn. Similarly a study examining the period 2005 to 2010 found suicides to be increasingly associated with job, financial, and legal problems. As the economy begins to recover, will we see the rate of suicides begin to recede? Only time will tell.
• Access to Opioids: Some have suggested that access to and use of opiates, particularly their misuse, is associated with suicide. The rate of overdoses using opioids tripled between 2000 and 2014, as a result of both increased deaths from heroin and prescription drugs.  Opioid use has been associated with suicide in women. While many of these deaths are accidental, intentional opioid overdoses are increasingly common. The dangers of opioids is compounded by the fact that chronic pain is an independent risk factor for suicide, giving people who may already be at an increased risk the access to lethal means.

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