Tag Archives: suicide

Does declining marriage explain rising suicide rates for old men, too? (Trick question.)

The reason it’s a trick question is that, for older men suicide rates aren’t rising—even though their marriage rates are falling. This doesn’t fit the religious conservative story spun by Brad Wilcox here at The Atlantic and broadcast by Ross Douthat in the New York Times.

The government reported this month that the suicide rate for adults ages 35 to 64 increased 28 percent from 1999 to 2010. That’s a serious problem. Oddly, though, the report didn’t include data on those over age 64 or under 35. Why? Because the rates didn’t change significantly for those groups. That’s a fine reason for the report to focus on the other groups, but the pontificators shouldn’t let that blind them to the overall story (and longer trends).

The suicide rate for people age 65-plus dropped 5.9 percent during that period, but that was significant only at the 9 percent confidence level. In the longer run, though, the drop in suicide rates for older people is certainly significant. Here is the trend from 1991 to 2009 for men, by age:

cohen_suicide1.gif

From 1991 to 2009, the suicide rate among older men dropped more than 25 percent, from 40 to 29 per 100,000 people. During that time, suicide for middle-aged men dropped and then rose again, ending up within a point of where it started the period. So the two-decade story is not one of increasing middle-aged male suicide (at least not yet). And, of course, during that time marriage dropped for all three groups.

cohen_suicide2.jpg

Source: Current Population Surveydata from IPUMS.

So who would tell a story of declining marriage causing increasing suicide? Christian conservatives promoting marriage and religion (among others). Douthat quoted Wilcox’s story and summarized:

That’s exactly what we’ve seen happen lately among the middle-aged male population, whose suicide rates have climbed the fastest: a retreat from family obligations, from civic and religious participation, and from full-time paying work.

If he’d looked at the larger trend by age, maybe he wouldn’t have written his next paragraph:

The hard question facing 21st-century America is whether this retreat from community can reverse itself, or whether an aging society dealing with structural unemployment and declining birth and marriage rates is simply destined to leave more people disconnected, anxious and alone.

For some reason our seniors just aren’t getting the pro-suicide message, so they’re not part of the story. In fact, neither are the 31 out of 35 wealthy countries that have seen falling suicide rates in the last several decades, even though every one has had falling marriage rates for decades.

Why not? Let me look more closely at that older age group of men, breaking them down into the younger-old (65-74) and the older-old (75-plus). The trend is clear for this group that has seen falling suicide rates: less marriage, more employment.

cohen_suicide3.jpg

Douthat and Wilcox could have said, “We love marriage, but in this case it looks like declining marriage isn’t causing a big problem.” But why should they? They have their story and they’re sticking to it.

Of course, no sociologist is going to deny that married men usually have lower suicide rates—and I’ve written about it myself. But for older men, at least, that doesn’t seem to be driving the trend for the last several decades. Rising employment rates are a good place to start for explaining declining suicide. And falling marriage—if it has been had an opposing effect—hasn’t been as important.

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Gun Google searches and suicide

A quick addition to the post the other day about gun searches and their association with Mitt Romney, accidental deaths of young people, and divorce rates: suicide.

The Centers for Disease Control has a tool for mapping fatal injuries. It allows mapping down to the county level, with nice options. Here’s their national map for suicide rates:

If you take the list of state suicide rates over to Google Correlate, the answer is, mostly: Guns. I entered the male and female suicide rates separately, and the total rates combined, and guns searches dominate. That is, the searches that are most common where there are more suicides (age adjusted), and least common where there are fewer suicides, are almost all about guns. Again, I’m not expert on the types of guns and paraphernalia, but this is not (just) about hunting: it includes assault weapons, ak-47s, “armor piercing,” “tactical sling,” etc. The correlations between suicide rates and search frequencies across states are high: between .82 and.90. (The full list is below).

I used age-adjusted rates for all ages and race/ethnic groups from the years 2000-2006.

Off the gun subject, there were some interesting other patterns. Both men’s and women’s suicide rates (which are highly correlated, about .90 across states) were strongly associated with searches for the artist Luis Royo, a Spanish artist who specializes in dark, violent and apocalyptic art. Here’s his homepage:

For women’s suicide rates, there was also a strong correlation with searches for “divorce help” and “divorce paperwork.” That’s interesting because suicide is more common among divorced people:

Further, both men’s and women’s suicide rates were correlated with searches for “war footage.” That’s interesting because of the high rate of suicide among soldiers and veterans:

Given how similar the male and female suicide pattnern is, the difference between searches on the male list and those on the female list is interesting, and reveals how sensitive the Google search data are, with millions of searches to sift through. Anyway, maybe someday search patterns can help with identifying risks or contribute to suicide prevention. (Here are my past posts on suicide.)

Here are the complete lists of search terms correlated with suicide rates for men and women across states, in no particular order (all the correlations are similar), condensed a little with the use of asterisks for repeated terms and plurals:

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Income inequality in mental illness

In South Korea, rising inequality, mental illness — and inequality in mental illness.

South Korea has a high and rising suicide rate, which doubled from 1997 to 2008, becoming the worse of any country in the Organization for Economic Cooperation and Development (OECD). During that time, income inequality also increased.

A new paper in the journal World Psychiatry (the source of those figures) shows that the concentration of mental illness among poorer people in South Korea also increased during that period. That is, the income inequality in mental illness grew worse. Using a large survey of self-reported mental health and income, the authors, Jihyung Hong and colleagues, calculated he distribution of illness along the income distribution, like a Lorenz curve and its related Gini coefficient.

I have rescaled their numbers, so that zero equals equality (same rates of illness at all income levels) and 1 equals complete inequality (all illness among the poor), and plotted the trends here:

South Korea had a major economic crisis at the end of the 1990s, the shocks from which reverberated in many social aspects of the society. For example, that high rate of economic inequality in suicide attempts in 1998 took place in a year that saw a big jump in suicide attempts nationwide.

Inequality has not increase continuously for all three measures during this period, but they are all substantially higher in 2007 than they were 10 years earlier — and they all show considerable economic inequality in major mental illness.

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State v. family care for elders in China

As China’s population ages, its social safety net appears increasingly inadequate.

The New York Times reports: “Under a proposal submitted last Monday by the Civil Affairs Ministry to China’s State Council, adult children would be required by law to regularly visit their elderly parents. If they do not, parents can sue them.”

Enforcing a return to filial piety is unlikely to fill the gap in care for China’s growing older population. With no national social security system, the pressure on families to care for their own elders is brutal, resulting in families splitting apart, and suicides among care givers and receivers alike.

My photo from Beijing, 2002

Suicide

Although China’s suicide rate has fallen in recent decades, researcher Jun Jing believes, it is higher among old people than young people, an unusual pattern which he attributes to “social factors such as aging, lack of medical security and conflicts caused by large-scale demolitions,” especially the destruction of historic neighborhoods in China’s big cities — which causes family conflicts and crises of elder care.

In rural areas, higher suicide rates for women than for men also set China apart from most countries — although researchers believe the displacement of rural populations for factory jobs in the cities has actually eased the stress on many rural families (and reduced the access of many poor women to pesticides, the most common method of suicide).

A few years ago Jun Jing (a sociologist at Tsinghua University) published a fascinating, in-depth account of one family’s tragic history, including the suicide of its grandmother. They were a poor, multigenerational, multihousehold family – given the pseudonym Hao – that was displaced by the construction of the Three Gorges Dam in 1996. The grandparents were reluctant to move up to the mountains with the younger households. Jun Jing tells the story better than I can:

The elderly couple had no money to repair their house, and even less to build a new one on another location, so the younger generations of the Hao family decided to draw lots for which household should look after them and set aside a place for them to live. The lot fell to the third daughter-in-law, who although unwilling to be drawn, had to join in as representative of the third household (the third son had died some time before). So the two elderly people moved into the third house and were looked after by their third daughter-in-law with support from the other households. … Soon, Lü Quanxiu started saying that her daughterin-law’s place was not as comfortable as her old home and that she was not used to living high up on the mountain slopes, so endlessly urged her sons to repair her own house by the river because she said she wanted to return. The younger generations of the Hao family discussed the matter and decided that the expenses for the repair of their house should be shouldered by the third household, since the government’s compensation money given to the elderly couple had already been used up by the third daughter-in-law’s boy. …

Once again, the Hao family got together and decided that each house would look after the old couple in turn, and the household where they die would take responsibility for the burial. The places in the mountains where houses could be built were extremely scattered and far apart, so when the six households of the Hao family moved uphill they found that they could not live in the same place. They were allocated places by the authorities, and the two closest houses were several tens of metres apart. Every five days, the elderly couple would have to travel along a stone path in the new village to move between the households supporting them. Each stone step was about 40 centimetres high, so climbing up them was a physical torment for the elderly couple. Lü Quanxiu became extremely unhappy, and felt that to live in this way she might as well be a beggar, so she decided to go to her daughter’s house to live. After she had been living there for some time, people in the village started gossiping that, in fact, the households of the younger generations of the Hao family had been unable to make proper arrangements to look after the elderly couple. As soon as they heard this, the Hao family sent people to bring the old lady back on a bamboo pole, but they kept to the rotating method of supporting her and her husband. The elderly couple still had no real place of their own to live.

The old woman eventually committed suicide by jumping off a precipice, and her husband died of a brain hemorrhage four days after her funeral. A little while later, a grandson died after a truck accident left him seriously injured — and the family could not afford the $500 deposit required by the hospital to perform surgery. A granddaughter, born “outside the government’s family planning limit,” was sent to a remote mountain village to live out of sight of local inspectors; she died of hepatitis before she could be brought to the nearest doctor.

How did the villagers interpret her suicide?

Some people said that she was unwilling to continue being a burden to her children. Some said that when she realized that the issue of her care was creating conflict between the different generations, and particularly between the brothers’ wives, she completely lost heart and all interest in living. Others said that once the issue of the Hao family’s care of the two elderly people became a topic of public opinion in the village, the old lady felt that she had lost face and was unwilling to go on being the target of ridicule in the villagers’ criticisms of the Hao family.

China may be an economic powerhouse that has the whole world worried, but with its family house this out of order, the only certainty in its future is continued suffering and the risk of growing social instability. Efforts by the state to pressure families into caring for their elders merely illustrate the shallowness of its economic miracle.

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Latina teen suicide

A small story about a young young woman, Cecilia Casas, apparently committing suicide on a Los Angeles freeway the other day led me to refresh myself on gender, ethnicity and suicide.

CNN did a story in October about Latinas in particular, with some statistics and interviews. More generally, a recent review in the journal Aggression and Violent Behavior showed that among young adults in all race-ethnic groups, women are more likely to attempt suicide than men:

One-year percentages of suicide attempts among 10–24 year olds. Gender ratios (males:females) are presented below each group.

…but men are much more likely to succeed.

One-year rates of suicide deaths per 100,000 among 10–24 year olds from 1999 to 2005. Note. Gender ratios (males:females) are presented below each group.

Suicide attempts are going to be counted much less accurately than completed suicides, so reconciling these is not simple. However, mental health data on teenagers shows that girls are much more likely than boys to have major depressive episodes:

PERCENTAGE OF YOUTH AGES 12–17 WHO EXPERIENCED A MAJOR DEPRESSIVE EPISODE IN THE PAST YEAR BY AGE AND GENDER, 2004–2007

On consequence of the attempt/completion ratio difference between men and women is that mental health practitioners are better able to intervene with women, since they’re more likely to have an unsuccessful attempt as a trigger for treatment. It’s not as effective to rely on self-reported suicidal thoughts, which is more often necessary with men. In any case, access to regular medical care – a usual doctor or other provider, not an emergency room – seems like a necessary condition for identifying and preventing suicide.

Coincidentally, Dr. Perri Klass has a post today – with good links to resources – about how to handle depression and suicidal thoughts in a discussion with students.

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Who needs marriage?

When it comes to suicide, at least, the answer is: “men.”

Jessie Bernard famously argued that every marriage is really two marriages, his and hers – and his was more beneficial than hers. We know, for example, that both men and women have more family income when they’re married, but that’s mostly because men earn more than women, and married men earn more than single men. We know that women often depend on marriage for their health insurance, because men’s jobs are much more likely to provide coverage. The recent debate about women’s reportedly-declining happiness highlights the slipperiness of subjective indicators of wellbeing.

Sociologists have always considered suicide to be the gold standard measure of psychological wellbeing. And marriage has historically been a key indicator of social integration, the source of belongingness that makes suicide less likely. Although Bernard believed that, with regard to suicide, marriage is more protective of men than of women, recent research has been more equivocal. Now, however, we have a good long-term study with a large U.S. sample that tests this, and finds that, as suspected, marriage protects men more than women from themselves.

Suicide Risk by Marital Status

Source: My figure from Table 2 in Richard Rogers, Patrick Krueger and Tim Wadsworth, “Adult Suicide Mortality in the United States: Marital Status, Family Size, Socioeconomic Status, and Differences by Sex,” Social Science Quarterly, 2009 (90[5]:1167-85).

Controlling for race, age and the number of people in the family, those in marriage relationships have the lowest risk of suicide from 1986 through 2002 (these are called hazard ratios). But the pattern is only statistically significant for men, and it’s much more pronounced. The authors offer reasonable explanations for this:

Marital status—particularly widowhood—is significantly associated with the risk of suicide among males but not among females. These findings are compatible with prior research that suggests that marriage confers greater health benefits for men than for women, potentially because women invest more time and energy than other household members caring for the health and well-being of children, husbands, and older family members. In turn, men are especially vulnerable to the risk of suicide when they lose that social support due to widowhood.

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