Stefan Gingerich
Appearances
Health Chatter
Suicide Part 2
And so that's part of it is, you know, understanding how to cope with negative emotions and not allowing those negative emotions to manifest into something like suicidality. Another part of it is firearms. You know, I think when you look at the cause of the fatal injury, over half of all suicide deaths among males occur by firearm. That's not true of the females. It's closer to a quarter or 20%.
Health Chatter
Suicide Part 2
With females, it tends to be predominantly poisonings or overdoses, drug overdoses. And that also plays into
Health Chatter
Suicide Part 2
the there's the lethality of the mechanism that also needs to be considered where um you know a gunshot wound to the head there's not a lot of of opportunity for intervention medical life-saving um interventions of any kind whereas with the poisoning there might be a little bit of time for some sort of life-saving intervention yeah um and so it's it's just that is a big part of it
Health Chatter
Suicide Part 2
And when you look at the non-fatal injuries relative to the fatal injuries, you see that difference in the cause of the injury come up as well, where 60 to 70% of the non-fatal injuries are poisonings and just a tiny sliver of them are firearm related because of, again, the lethality of the firearms.
Health Chatter
Suicide Part 2
Right. No, I think that's a good question. And I think that's one of the areas where um, identifying the intentionality behind any event, I think there's room for improvement. We need to get better at those things.
Health Chatter
Suicide Part 2
Um, because like you said, the, the suicide by, um, police intervention, you know, people talking about, they're going to go intentionally, essentially pick a fight with police and, you know, they, they don't really seem to be, they don't have an intentionality behind it. They're just somewhat ambivalent as to whether they live or die from the interaction.
Health Chatter
Suicide Part 2
You can see the similar sort of thing with just reckless behavior in general. And so you say there's gray area between intentional and unintentional. And that's one area where we do need to improve our ability to understand what's happening in these events. I think, you know, suicide rates have been increasing in most populations, if not all populations, particularly in Minnesota.
Health Chatter
Suicide Part 2
And so when you talk about, you know, when you were younger and people didn't talk about suicide, there probably wasn't as much suicide around at the time, you know, 15, 20, 30 years ago. And that is maybe particularly true depending on which population we're talking about. But you're absolutely right.
Health Chatter
Suicide Part 2
I think, you know, with regard to violent deaths and firearms, every population is not affected the same way. And so in certain geographies, age groups, racial groups, homicide is a much more pressing and prevalent and present issue than suicide.
Health Chatter
Suicide Part 2
Well, within that community, I think we need to look at things like historical traumas and lack of economic opportunities. Those are some of the key risk factors in those communities within the American Indian population in Minnesota. When we talk about risk factors, we also like to talk about protective factors because we're all going to face adversity, so we need to have resilience.
Health Chatter
Suicide Part 2
We're all going to face hard times, so we need to have these support systems around us. We're doing work at the health department with the American Indian community to try and increase those protective factors, those resiliency factors. And it's slow work, it's difficult work, and it's definitely an area that we need to focus on.
Health Chatter
Suicide Part 2
On the other end of the sort of what you talked about from the perspective of the Black community in Minnesota, Officially, they do have the lowest suicide rate of the four or five major racial groups in Minnesota.
Health Chatter
Suicide Part 2
When we have talked to members of the Black community, particularly in the Twin Cities area, they've talked about saying those numbers don't necessarily reflect what they feel is the reality.
Health Chatter
Suicide Part 2
And so this is another place where there are opportunities for better understanding of what's happening in given specific incidents because of the less common, less traditional mechanisms of suicide that they talk about, whether it's, you know,
Health Chatter
Suicide Part 2
Increased drug use, sort of reckless drug use, reckless driving, interactions with police, interactions with other members of the community who they know may be dangerous. So just thinking about that, like I said, the gray area between intentional and unintentional is something that we at the health department are looking into understanding better.
Health Chatter
Suicide Part 2
And one of the ways that we can do that, I don't know if we've mentioned this before on the podcast, is the violent death reporting system, the National Violent Death Reporting System, of which Minnesota is one part of 52. And so we just launched a dashboard for the Minnesota Violent Death Reporting System that provides a little bit more detail on the circumstances behind some of these cases.
Health Chatter
Suicide Part 2
And we're hoping that can springboard us into getting the data into people's hands so that we can get a better understanding and guide prevention efforts.
Health Chatter
Suicide Part 2
yeah that's i think that's a very good question um having not had the honor of getting to my 60s yet i can't speak from personal experience you'll get there i promise i mean i'm hoping um you know i i have lived through my 20s and i have lived through my 30s and so um i think you know it's it's gotta be something different for each five or 10 year age group. You know what I mean?
Health Chatter
Suicide Part 2
You know, as, as epidemiologists, we love to put these age groups into buckets and they don't really always fit the best with how life actually goes. Because, you know, you think about the adolescence and high school is very, very different from college. And that, you know, it separates at about 18, 19 years of age. And then we like to group the 20 to 25 or 30-year-olds.
Health Chatter
Suicide Part 2
It's like, yeah, but the early 20s are very different from the late 20s. And so I think when we think about that, it needs to be considering what each of those age group stressors are. A good example that is not necessarily in the data, but I was talking about a few months ago with some colleagues, we were looking at the prevalence of alcohol use by gender and age for suicide decisions.
Health Chatter
Suicide Part 2
This is something that we found from the Minnesota Violent Death Reporting System. And I noticed among females, in the late thirties and forties, this alcohol prevalence just spikes. I mean, it's skyrocketed. And so this is all among people who have died by suicide in the past five years, five or six years. And so I asked a few of my female colleagues who I had gathered were in that age group.
Health Chatter
Suicide Part 2
I didn't ask their age because that would be rude and uncouth. Um, But I said, what's, you know, you strike me as a woman in your late 30s, what's happening? Why is it? And they said, you know, it's very specific to that age group, but you've got often young kids, elementary and middle school kids.
Health Chatter
Suicide Part 2
You've got parents who are probably needing a little more assistance with various day-to-day activities. Maybe you're caring for multiple generations in your own household.
Health Chatter
Suicide Part 2
and because your kids are past this like toddler stage you have a little more freedom and encouragement by your female friends to have a drink every now and then and so it's like there's just this pervasive presence of alcohol in all these scenarios and they're super high stressed and so when we think about
Health Chatter
Suicide Part 2
these different age groups, people in their 50s, maybe they're managing college tuition, maybe they're managing adolescents who are having rebellious episodes and that's very stressful for them. Maybe they've lost their job at a certain point in their career and they really are down about starting over.
Health Chatter
Suicide Part 2
Maybe it's all of those things all at once because what we often hear about suicide and we know about suicide is it's not usually one thing There's a tipping point. They talk about, you know, the drips filling a cup and finally you get enough drips in that cup and it overflows. It's not the one drip that overflowed it. It's all the drips before. It's the straw that broke the camel's back.
Health Chatter
Suicide Part 2
It's not the single straw. It's all the straws before. And so each of those straws, each of those drips are going to be different depending on the age group. And there's a very good possibility that by the time you get to 60, 65, 70 years of age, many of those things you've gotten through, like you said, you've been able to survive them and adjust to them, and you've built up that resiliency.
Health Chatter
Suicide Part 2
But then also, nationally, these numbers are a little more reliable than in a population the size of Minnesota. 80, 85, 90 years old, those suicide rates are some of the highest in the country on a year-to-year basis. So there does seem to be these sort of peaks and valleys across the age spectrum with suicide rates.
Health Chatter
Suicide Part 2
And I think the reasons for that are very different depending on which age you're talking about.
Health Chatter
Suicide Part 2
So I'm gonna, go ahead. I think you're onto something. So as we mentioned at the top of the episode, my former job was with Stay Well Health Management in workplace wellbeing. And one of the questions that we would ask all the participants on the health assessment was different sources of stress.
Health Chatter
Suicide Part 2
And one day, you know, I was talking to some of my colleagues, and they're like, you know, I'm super stressed about this. I wonder if that shows up in the data, or is it just me, right? So I said, well, let's look. And we looked at the prevalence of each of these different stressors by age, and it was incredibly different. So childcare, obviously, that's a stressor for people who are in their
Health Chatter
Suicide Part 2
late 20s, 30s, sometimes into their 40s, not at all when they're in their 50s and 60s and 70s, right? Been there, done that. Exactly, right. But job responsibilities, not as big of a stressor when you're in your 20s, starts to creep up in your 30s and then into your 40s and 50s, super common. So, like you said, depending on the age, the stressors are different.
Health Chatter
Suicide Part 2
Depending on the stressor, you're going to see a very different age profile. And I think when you're thinking about preventing suicide in a given age group, you have to factor that in and understand where those people are coming from. And that's true of racial differences, of gender differences, geographic differences, everything.
Health Chatter
Suicide Part 2
Yes, yes, that is true. One of my favorite charts to show people, you know, this is a podcast. And so all my cool visuals are just really useless. On the plus side, I didn't have to shave today. So I'm really happy about that.
Health Chatter
Suicide Part 2
I like to show people this chart that shows all 50 states in the District of Columbia ranked on a bar chart from left to right. On the left-hand side, you've got the states with the lowest suicide rates and on the right-hand state, you've got the states with the highest suicide rates.
Health Chatter
Suicide Part 2
And one of the things that I like to point out, so I'm looking at it right now, New Jersey, New York, Massachusetts, Maryland, Connecticut, California, with the exception of California- Illinois, right. With the exception of California and Illinois, they're all in the Northeast, but they also have these high population centers, high population density, They tend to, I should say.
Health Chatter
Suicide Part 2
There obviously are places in New York, upstate New York, beautiful. Outside of the cities in California, beautiful. Not so many people. On the other end of the spectrum, however, Wyoming, Montana, Alaska, New Mexico. Again, there's a geographic component to it just in terms of where they're located. But Alaska is not close to any other state, really.
Health Chatter
Suicide Part 2
But we talk about population density, and there's this correlation between high population density, lower suicide rates, lower population density, higher suicide rates. It's not perfect, of course. There are gonna be some exceptions, but that plays out at the state level. It plays out at the county level in Minnesota.
Health Chatter
Suicide Part 2
So when we look at Hennepin County, Ramsey County, Anoka County, some of these counties around the Twin Cities that have higher population densities, the suicide rates do tend to be lower. They're not always lower. You're gonna find some exceptions. Northern Minnesota, very rural, very low population density. There tends to be higher suicide rates there.
Health Chatter
Suicide Part 2
I think that's part of it. I think that's part of it. When I first stumbled upon this, I showed it to my previous manager, John Raessler, who I think you know. He was with the Minnesota Department of Health for 35 years. He's still with us on a part-time basis. he took one look at this correlation and he goes, take out the firearm deaths. And I was like, oh, that's an interesting.
Health Chatter
Suicide Part 2
So I did that, took out the firearm deaths. Lo and behold, the relationship pretty much disappeared. And so when you look at the firearm suicide rates, you see that correlation, low population density, higher suicide rates. If you look at the poisonings and the suffocations, all the other injuries that result in suicide,
Health Chatter
Suicide Part 2
um that relationship is not as strong and so part of the the the issue driving that is access to firearms there do tend to be um a higher rate of firearms in rural areas than in urban areas but i think access to care is absolutely part of it as well yeah i mean if you know i i would guess i'm only guessing that if um anybody is contemplating these types of this type of thing um
Health Chatter
Suicide Part 2
I think the rates are increasing for younger generations. In fact, in Minnesota, in 2021, the highest rate by age group was 25 to 29. That shifts. It moves around a little bit just because the size of those populations is not very large, and so the estimates tend to get a little unstable over time.
Health Chatter
Suicide Part 2
um in 2022 it looks like the highest rate in the state is going to be or the highest rate among that sort of general age group is 30 to 34 and so we do tend to see increasing rates of of suicide in the younger adult age group but i do also think that there's a little bit more attention being paid to it lots of suicide prevention efforts go into high schools and middle schools as well as colleges.
Health Chatter
Suicide Part 2
There's increased awareness to reduce the stigma. And so, you know, it's possible, again, trying to put a positive spin on some things that hearing more about it might be a good thing. It might be intentional because we're raising awareness as opposed to, you know, the pessimistic interpretation is, hearing more about it means that it's happening more. And I think both are probably true.
Health Chatter
Suicide Part 2
Yeah, thankfully, those numbers are low enough now that it's difficult to make generalizations like that. I do think bullying, any sort of mental or physical abuse of any kind is a risk factor. We talk about adverse childhood experiences. The ACEs that are out there with things like having a parent in prison, having people who care about you as a protective factor.
Health Chatter
Suicide Part 2
And so we try to look at a lot of those different things and understand what's happening in all those cases, but mostly just try to get help for those kids who need it. One of the patterns that we've noticed over the past couple of years is there's an increasing number of hospital-treated self-harm and suicide ideation among 10 to 19-year-olds just in the last year and a half or two years.
Health Chatter
Suicide Part 2
And we do see a pretty strong seasonality to that, where the number of cases in hospitals in Minnesota of teenagers being treated at the hospital for self-harm or suicide ideation is The number of those cases is higher during the school year. It increases in September and October and stays pretty static throughout the winter with a small decrease in December associated with the holidays.
Health Chatter
Suicide Part 2
And then it comes back down, really drops pretty sharply in June after school tends to be out. And again, there are two sort of competing interpretations of why that might be happening. Number one, relates to the bullying that you mentioned, Clarence. And so if you're in school, you have no choice but to face your bullies every day. They're there. There's no way to get around them.
Health Chatter
Suicide Part 2
And it can be very stressful and troubling. When you're out of school, that's not the case. In the summertime, you've got a little bit more separation from those experiences. And so that might be contributing to decreased treatment in hospitals for suicide ideation. On the flip side of that,
Health Chatter
Suicide Part 2
when you're in school, there are more adults, they're trained to see things like depression and anxiety and suicide ideation, and they're mandatory reporters. And so if you've got a student who
Health Chatter
Suicide Part 2
is experiencing these sorts of things, there's just a higher likelihood that somebody in the school is going to notice it and report it and get the help that the student needs, as opposed to in the summer when they may not be in school and their parents might not be trained to see that.
Health Chatter
Suicide Part 2
They might not be as present as all of those teachers in school and counselors and everybody else that are in schools.
Health Chatter
Suicide Part 2
Yeah, I was just going to say, I could talk about this for a while because I've given presentations on exactly what you're saying. often and at great length. But before I do that, I just want to like right off the top mention, if anybody listening is having a mental health crisis or considering suicide or knows somebody who is, the number is 988. Call that, text it 24-7.
Health Chatter
Suicide Part 2
I mean, I think a couple other things would include, you know, if, like you mentioned, somebody talks about or mentions plans of suicide, if they have known people who have had suicidal experience or died by suicide in the past, You know, thinking about those individuals who have access to firearms, I think, is also a factor to consider.
Health Chatter
Suicide Part 2
We know that veterans are at a higher risk of suicide as well as National Guard members. Anybody in a high risk or a high stress profession, you know, whether it's a medical doctor, emergency room, those sort of firefighters, police officers, the sort of natural helpers that are out in the community.
Health Chatter
Suicide Part 2
And we also talk about those natural helpers as being resources, obviously, but when you continually drain the same resource over and over and over again, that can become an issue. And so I think the other thing I'd mention is, you know, it. It's not going to hurt to ask. So if you're concerned about somebody, check in on them. Ask them if they're thinking about suicide.
Health Chatter
Suicide Part 2
Take it seriously if they mention thoughts of dying or joke about dying. And don't overlook those types of experiences, I think, because like I said, it never hurts to ask. And then keep 988 at the front of your minds. We mentioned that at the top of the show, 988. Dial it just like 911.
Health Chatter
Suicide Part 2
You can get the help you need. That's nationwide as well as throughout Minnesota, which is where I focus.
Health Chatter
Suicide Part 2
You know, pause the podcast, call that number, come back and listen to us later. Exactly. And as you mentioned, so the trend with regard to suicide in Minnesota, which again is where I focus all my attention and nationally is not a good thing. It's not what we're hoping to see. The numbers have consistently gone up over the past 20 plus years.
Health Chatter
Suicide Part 2
I do my best when I talk about this with the Suicide Prevention Task Force yesterday or suicide prevention coordinators across the state. to try to find some bright spots. And this podcast is one example. The task force is one example. There are lots of people working hard on these issues to bring a comprehensive public health approach to preventing future increases in suicide.
Health Chatter
Suicide Part 2
And at the same time, this is a 20-year trend that we've seen. And so back in 2001 in Minnesota, the rate was 9.6 per 100,000. And now it is, you know, most recently the estimate for 2022 that we're calculating is 14.3. So that's a pretty substantial increase, you know, about a 50% increase or so.
Health Chatter
Suicide Part 2
And, you know, putting that into context, we think about, you know, something like weight loss and heart disease. Dan, I know you know a lot about this. You don't turn that around in a day and a half. You don't turn around heart disease in a day and a half. You don't turn around a 20-year trend in even a year or a year and a half.
Health Chatter
Suicide Part 2
And so what we kind of are looking for at this point is a slowing of the increase, maybe a few years of decreases that could signal perhaps we're reaching a point where the numbers might start to come down a little more consistently. We've seen a couple of hopeful signs. The optimistic side of me looks at 2017 and 18 in Minnesota, where the numbers came down in 2018 relative to 2017.
Health Chatter
Suicide Part 2
Nationally, those numbers came down in 2019 and 2020, surprisingly enough, with regard to the pandemic and the other social issues that happened in 2020. And so those two years of decreases
Health Chatter
Suicide Part 2
give you know the optimist in me a little bit of hope that that we're seeing something change whereas in the previous 20 years at least again in minnesota we had only seen two years of decreases over a 18 15 year period so like i said the numbers are going up if you look at the 20-year trend it is increasing yeah um
Health Chatter
Suicide Part 2
You know, the pessimistic side of me looks at 2022 and the preliminary numbers already show us the highest number of suicide deaths in Minnesota of any year in the past 20 years and probably decades before that. There were 835 suicide deaths in Minnesota in 2022. And that, like I said, works out to a rate, a preliminary rate of 14.3 per 100,000, which...
Health Chatter
Suicide Part 2
I'm expecting will increase to be the highest rate that we've had in state history.
Health Chatter
Suicide Part 2
So at this point, with 988 launched really in full force less than a year ago, that data has not been analyzed to look at the prevention aspect and how many actually enumerate the number of cases we might have prevented. I think the other complicating factor is that the profile, the sort of the epidemiological background of the people who tend to call those numbers
Health Chatter
Suicide Part 2
And the people who are treated in hospitals for suicide ideation and non-fatal suicide attempts is very different from that of those who die by suicide. And I can talk about that a little bit, but I want to invite Clarence in because you mentioned him chiming in on that as well.
Health Chatter
Suicide Part 2
Yeah, so I've heard a number of different theories just sort of passed around. And I think as years go by, as more data comes through from the pandemic and from years after as well, because there was the pandemic and then we're coming out of the sort of emergency phase of the pandemic now. As those things start to shift, then we have better comparisons.
Health Chatter
Suicide Part 2
A few of the different hypotheses that I've heard are related to having a common enemy. So as COVID reared its ugly head, everybody could focus on, you know, blaming things on the virus as opposed to internalizing whatever is happening in your life and saying, well, you know, I'm super stressed right now and I'm depressed right now and I lost my job. but that's because of COVID.
Health Chatter
Suicide Part 2
It's not because of anything reflective of myself. So that's one theory. Other theories, when I look at the age distribution of what happened in 2018 and 19 and 2020, every age group under the age of 65 in Minnesota had a lower suicide rate in 2020 than in 2019. Every age group over 65 had a higher suicide rate in 2020 than 2019.
Health Chatter
Suicide Part 2
And so that gives me at least some clues in terms of, you know, I think about isolation and not just like physical isolation, but also the resulting social isolation where it's possible that people over 65 who are higher risk for COVID complications and death may have isolated themselves more And we know that isolation, lack of social connection is a risk factor for suicide and suicide thoughts.
Health Chatter
Suicide Part 2
The other aspect of it is, you know, if you're living alone and, you know, it's possible that people over 65 are more likely to live alone, you may have more opportunities to cause self-harm, to attempt suicide than if you're living alone. in a family household where you've got young children or teenagers around. And we know that schools were closed. So kids were at home all the time.
Health Chatter
Suicide Part 2
Parents were less likely to be at home alone. So there was more at home time. So that may have contributed to fewer opportunities, as well as just a growing awareness that if you're spending more time with your teenager, or if you're spending more time with your spouse, or your boyfriend, your girlfriend, whoever it is that you're living with,
Health Chatter
Suicide Part 2
you might notice that they're having mental health issues. There was an increased awareness of mental health issues during COVID that people would attribute to COVID, but may have also had an effect on suicidal thoughts and experiences that might have protected some people from those self-harm events.
Health Chatter
Suicide Part 2
In other words- I think that it's possible, sure. I think we probably are getting a little bit better at recognizing suicidal experiences and reporting, reducing the stigma around suicide. When you reduce the stigma around something, you do tend to find more of it. We've seen that in other cases as well.
Health Chatter
Suicide Part 2
I think our measurement isn't perfect, but that is one of those optimistic sort of positive points is if we can get better data, and I think we have good data, but it also can be better, we may be able to find ways to guide interventions, develop interventions, and point those interventions in the right places.
Health Chatter
Suicide Part 2
as well yeah that's that's a similar pattern nationally where you see males tend to have a suicide rate about three to five times higher than females and it's going to vary based on the year it's going to vary based on the location um it varies based on age group as well as racial groups um so there are some variations there but that's definitely one of the the more persistent patterns that we see
Health Chatter
Suicide Part 2
So there are, there are a few potential reasons. And I think, you know, this is probably a good time to point out that epidemiology is always focused on
Health Chatter
Suicide Part 2
the large group which is everybody and it's nobody right and so when i make generalizations like this this is not to say that every male fits into these categories as we as we all know so with that as as preamble i'll say men tend to not be great at managing their emotions they don't talk about their emotions as much as women um with apologies to the the guys on the podcast