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Massachusetts Medical Society's
Physician Focus

June 2010



  • More than 33,000 people die by suicide in the U.S. every year.

  • Suicide is the 11th leading cause of death among all Americans and the third leading cause for young people 15 to 24 years of age.

  • More people survive suicide attempts than die; nearly 400,000 people with self-inflicted injuries are treated in emergency rooms every year.

  • In Massachusetts, the number of suicides in the last 10 years has averaged between 400-500 annually, leaving some 24,000-30,000 survivors who have been directly affected.

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American Foundation for Suicide Prevention

American Association of Suicidology

National Alliance on Mental Illness

National Suicide Prevention Lifeline

Samaritans of Boston

In Her Wake

"Youth Suicide"
60 sec. PSA

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From left: John Fromson, M.D., Nancy Rappaport, M.D.
hi-res photo     promo slide

According to the Centers for Disease Control, the 33,000 suicides that occur every year is the equivalent of 91 per day, or one every 16 minutes. The act crosses all social, economic, and ethnic boundaries. 

Suicides among males are highest among those 75 and older, and highest for females age 45-54. Yet it is also one of the top five causes of violent deaths for those 10-24 years old. And it’s on the minds of far too many young people: a recent national survey of students in grades 9-12 discovered that one in seven said they were seriously considering taking their own lives. 

The recent suicides of Massachusetts teenagers associated with bullying have been a stark reminder of how tragic such losses can be and, in capturing worldwide headlines, have put a renewed focus on this critical public health issue. 

To further highlight the widespread nature of the issue, The Samaritans of Boston, a suicide prevention service, reported in May that calls to its hotlines are up 10 percent. And in a separate, national study, researchers have reported an increased risk of suicide for seniors who are moving into retirement and nursing homes. 

The cause of suicide, says Nancy Rappaport, M.D., often results from a “toxic combination of factors. Depression, substance abuse, impulsivity, and a profound sense of hopelessness can make one particularly vulnerable.”

Dr. Rappaport, a child and adolescent psychiatrist with Cambridge Health Alliance, an Assistant Professor of Psychiatry at Harvard Medical School, and the author of In Her Wake, A Child Psychiatrist Explores the Mystery of Her Mother’s Suicide, shares her experience and knowledge of the subject in the June edition of the Massachusetts Medical Society’s Physician Focus.

In a sensitive but frank discussion with host John Fromson, M.D., a fellow child and adolescent psychiatrist, Dr. Rappaport opens a window for viewers into the causes and warning signs of suicide, who may be at risk, preventive strategies, and the impact on family and loved ones.

Recognizing warnings signs isn’t easy, she says, but usually a combination of factors exist. “Difficulty sleeping, problems with concentration, a change in appetite, suicidal ideation [forming ideas], or long bouts of crying that last two to four weeks” can be clues.

“Do not be afraid to ask the question, ‘Are you suicidal?’,” she advises. “It is giving someone an invitation to share a burden they feel is overwhelming.” Both physicians agree that asking the question never causes someone to commit suicide, but that, in Dr. Rappaport’s words, it “may be an opportunity to provide a life-saving intervention.” 

Early treatment is critical if depression is present. Therapy could help, as could talking to a priest or minister. In some cases, medication may be appropriate. Within families, she says, the way of communicating with each other and how each person supports the other can be essential as a part of a prevention strategy. 

If, however, there’s a sense that something imminent is about to happen, Dr. Rappaport is clear about what to do: “Call 911. Avoid discussion, because you want to make sure the person is safe.” 

The connection between suicide and mental illness is strong, and both doctors agree that the stigma of this condition, while easing somewhat in the mind of the public, still persists. But Dr. Rappaport suggests that the shame an individual feels comes around function. “If someone can’t hold a job, can’t go to school, or destroys relationships, that’s where the shames comes in.” But she urges sympathy. “We should have the same level of compassion for people who are struggling with mental illness that we do for those with other medical illnesses,” she says. 

As to the family and loved ones left behind following a suicide, Dr. Rappaport is struck by the sense of an “absolute bereft feeling” they have. People may experience post traumatic stress syndrome and may torture themselves with the “what if” surrounding suicide. She cautions people to recognize suicide as the “tip of the iceberg,” and to know that multiple factors have already taken place when a suicide is completed. 

Her guidance to those who have lost family members or loved ones to suicide is to seek support groups or counseling if needed. “I hope they can find a renewed purpose,” she says, “and that is usually trying to prevent this from happening to anyone else. They should not feel alone or feel any kind of shame.” 

And her message for those contemplating taking their own life? “Mental illness is treatable, no one is expendable, and losing anyone to suicide is a terrible loss. Help is available.”

MMS/Richard Gulla