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Suicides rose during '90s, peaked in '97

Sunday, November 16, 2003

By Jim McKinnon, Pittsburgh Post-Gazette

Before he came to the United States from Nigeria eight years ago, Dr. Bennet I. Omalu never had seen suicide, sometimes described as the last act of a desperate person.

Dr. Bennett I. Omalu has recently completed a study of the suicide rate in Allegheny County. (Steve Mellon, Post-Gazette)
Click photo for larger image.


Related graphics:

Suicide in Allegheny County

Age distribution

Marital status

But while working the past four years at the Allegheny County Coroner's Office, Omalu has been moved not just by the numbers of people who die by their own hand but by the impact those deaths have on the families and friends left behind.

"I'd never encountered suicide in my life until I came to this country. I found it enigmatic," said Omalu, 35, who works as a forensic pathologist and neuropathologist specializing in fatal brain injuries for the coroner.

"I just couldn't understand what would make a person take his own life. Things can't be that bad."

Actually, things have gotten worse.

According to Omalu's two-year study of suicides from 1990 to 1999, the rate of suicide has more than doubled, from 5.5 per 100,000 in 1990 to an average of 11.07 per 100,000 for the 10-year period.

In those 10 years, 1,447 of the deaths investigated at the morgue were determined to be suicides.

"[Suicide is] usually the end point of a lot of problems -- mood disorder, substance abuse or an undertreated or untreated psychiatric disorder," said Dr. David A. Brent, a psychiatrist at UPMC's Western Psychiatric Institute and Clinic.

It occurs more often than homicide in Allegheny County, more than AIDS.

"Suicide, therefore, constitutes a major public health issue," said Omalu, who also is an epidemiologist and teaches at the University of Pittsburgh.

"Suicide is, first, a medical problem. As epidemiologists, we are tracking the root cause of diseases, like suicide."

But what Omalu's raw numbers don't show is why there have been more suicides. That's because there hasn't been a comprehensive study of the issue, something Omalu hopes to spur with his research.

One of the effects of suicide, Omalu said, is social, leaving to suffer those who knew and loved the person who has died.

"By preventing suicides, we are actually protecting our own selves, because we don't have to become victims," he said.



I used to honor my day of birth
Cherish life and place it first
But now I view it as a curse
Dig my grave and rent a hearse
I hear the clock ticking in my mind

-- the last verse of a poem written by a 20-year-old suicide victim



 
 
Suicide stats

The suicide rate in Allegheny County mirrors the rate across the country.

A study of incidents in 1992 by the Center for Disease Control's National Center for Injury Prevention and Control show:

Suicide took the lives of 30,484 Americans in 1992, about 11.1 per 100,000 population.

More people die from suicide than from homicide in the United States.

On an average day, 84 people die from suicide and an estimated 1,900 adults attempt suicide.

Males are at least four times more likely to die of suicide than are females. However, females are more likely to attempt suicide than are males.

In 1992, white males accounted for 73 percent of all suicides. Together, white males and white females account for almost 91 percent of all suicides. Suicide rates are higher than the national average for some groups of Asians and American Indians.

Suicide rates generally are higher than the national average in the Western states and lower in the Eastern and Midwestern states.

Nearly 60 percent of all suicides are committed with a firearm.

   
 

The worst year for suicides in Allegheny County was 1997, when nearly 14 of every 100,000 people took their own lives. The increase was due, in large part, to a spike in the number of adult male suicides that year.

Gradually, the rate has declined since then. The county's 10-year rate of 11.07 per 100,000 is slightly higher than the national rate of 11 per 100,000.

That means about 85 Americans each day, more than 31,000 a year, commit suicide.

In the past two decades, suicide has assumed epidemic proportions in the United States and has remained one of the 15 leading causes of death, Omalu said.

Overall, men have killed themselves about four times more often than women, whites almost nine times more than nonwhites. The age group between 31 and 40, for all genders, accounted for 24.5 percent of all suicides, more than any other group in a 10-year span of ages.

People between ages 60 and 96 committed about 23 percent of the suicides over the study period.

"We're an older county, and the suicide rate goes up with age," Brent said.

The youngest person in Omalu's study was 13, and the oldest was 96.

"At some point, I encountered this 20-year-old white female, a very deep-rooted, intelligent woman who had this book of poems [including the above verse]," Omalu said.

Omalu was perplexed and intrigued, because the young woman came from what appeared to be a loving family. She had potential for a bright, fruitful future.

Partly because of her death, Omalu said, "I didn't want to recognize suicide as an option for some people."

Public health authorities already are equipped with extensive literature on the subject. Treatments frequently are based on the psychiatric, psychosocial and public health aspects of it. A gap in the information has existed because of a lack of forensic literature, Omalu said.

Understanding the patterns and forensic characteristics, Omalu said, can help public health officials take steps to prevent the incidence of suicide.

Reason often a mystery

It's not always clear why someone commits suicide. In more than 71 percent of the 1,447 cases autopsied and investigated by the coroner, no note was left behind.

The methods used are less nebulous. Simply put, nearly half, 48 percent, of all of the county's suicides were committed with guns from 1990 to '99.

Firearms, then, would seem a likely place to begin when taking steps to prevent suicide.

"A weapon in the home seems to increase the risk for suicide," Brent said. "A lot of people keep handguns for their own protection, though."

It would be better, Brent said, if more people kept their weapons under lock and key, limiting the probability of homicide, suicide or accidental death and injury.

Omalu, when asked how best to curb the suicide rate, was more adamant.

"Keep away guns from people," he said, tapping on a table with every word as he repeated the phrase.

A second preventive measure is love, based on Omalu's study that shows people were less likely to harm themselves during times when friends and families traditionally are together.

 
 
'He is a phenomenon'

Dr. Bennet I. Omalu, 35, attended boarding school as a youth and, by age 21, had graduated with a medical degree from the College of Medicine at the University of Nigeria.

Though athletic -- his personal best in the 100-meter dash was 10.3 seconds -- much of his childhood and formative years were spent in classrooms and reading books.

In 1990, he was house physician in pediatrics and later, an emergency room physician, both at Enugu General Hospital in Nigeria.

His career brought him to the United States eight years ago as a visiting research scholar in cancer epidemiology in the School of Public Health at the University of Washington in Seattle.

He did a residency in anatomical and clinical pathology at Harlem Hospital Center in New York while at the College of Physicians and Surgeons of Columbia University.

"He's an extremely bright guy and we're fortunate to have him," Allegheny County Coroner Dr. Cyril H. Wecht said of Omalu.

Four years ago, Omalu joined the coroner's office. Wecht said he was the first neuropathologist, a specialty in brain injuries, to serve here, and one of a very few people of his kind in public service anywhere in the country.

Next spring, Omalu is expected to complete his master's degree in public health from the University of Pittsburgh.

He plans to begin law school next fall.

"He is a phenomenon and a brilliant young man," Wecht said.

   
 

The fewest suicides in his study occurred during the month of December, a high holiday season in many cultures when folks don't find themselves alone. Other winter months show fewer suicides than warmer months.

Fifty-nine percent of suicide cases in Omalu's study were by single people -- those who were divorced, widowed or never married. Married victims represented 36 percent of the deaths, though some of them were separated from their spouses.

"We should become more family aggressive," Omalu said. "We should stop divorcing. Marriage is not a game. Get married. Stay married."

Inevitably, some people still will find themselves susceptible to suicide. For them, there is no substitute for treatment, Brent said.

At Western Psych, Brent heads the treatment services for teens who are depressed and are at risk for suicide. The programs provide additional help and support families and survivors.

Psychotherapy remains a staple for treatment, along with carefully selected medications.

Drugs, Omalu said, can be a concern when working against the tide of suicide. Some of the older, more toxic antidepressants and anti-psychotic medications have been abused by victims in the past, resulting in suicides by overdose among 14 percent of those in the study.

Omalu called on physicians to be more observant and reactive when they notice tendencies in a patient. He cited a 40-year-old study in the United Kingdom that showed that about two-thirds of those who attempted suicide had visited their family doctor within the week before the event.

Many are high achievers

Omalu said suicide wasn't a new phenomenon, noting biblical examples such as Samson, Judas Iscariot and King Saul.

A common thread among the cases he studied, Omalu said, is that many of them involved high achievers.

"Some people falsely assume in their endeavors in life that, 'I can be judged by what I've achieved,' " Omalu continued. "But life is not all about achieving. If you want to succeed, you are bound to fail sometimes. There are people who don't have the psychological capacity to deal with disappointment. This capitalistic economy is all achieve, achieve, achieve."

At the Allegheny County Health Department, the increase in suicide rates already is being examined as a serious issue.

Guillermo Cole, spokesman for the Health Department, said public health professionals found that virtually all suicide victims suffered some form of pain that they deemed too extreme to bear.

"We're trying to get to the bottom of that," Cole said.

He said the reasons for suicide were as complex as the people who see their lives as unbearable. An effort will be made to determine whether those who have attempted suicide had access to and the resources to obtain the treatments available to prevent it.

Health officials agree that family and friends can help in prevention, too. They can intervene tactfully, directing a loved one to professionals when that person's pain and depression are revealed.

Media should be careful and responsible when reporting incidents of suicide, Cole said. Glamorizing or overpublicizing such events sometimes has made it appear a more acceptable answer to people's problems.

Allegheny County Coroner Dr. Cyril H. Wecht, a leader in national forensic pathology and Omalu's boss, said strides could be made in the prevention of suicide through education.

That burden, he said, lies with experts in sociology and psychiatry.

From the forensic standpoint, Wecht said, authorities have become more willing than in the past to declare certain deaths to be caused by suicide.

"There is a stigma. It goes with the stigma associated with mental disease," Wecht said. "As a society, we say we're more tolerant. We've got to recognize [suicide] and call it what it is."

For his part, Omalu said, his hope is that his study will bring more attention to suicide.

"With my multiple specialization I can look at it from the perspective of three disciplines [as a medical doctor, forensic pathologist and a neuropathologist, and an epidemiologist]," Omalu said.

"My objective was to find out what I could from a coroner's perspective and a personal perspective that could be useful in preventing suicides ... so that people will lead better lives from the lessons we learn from dead people."


Jim McKinnon can be reached at jmckinnon@post-gazette.com or 412-263-1939.

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