Suicides: Not just a winter problem

One such study, published in 2005 by F. Stephen Bridges, investigated 865,928 suicides in the United States between 1971 and 2000. His research found a significant seasonal rhythm of suicide occurrence with a peak in April and May. A 2012 study titled Seasonality of Suicidal Behavior acknowledges a seasonal suicide peak in Spring, but states the cause is unknown and new small spikes are appearing at other times of the year as well.

Regardless of the time of year, suicide is a public health concern that needs to be explored on many levels, including through public education, cultural competence, and clinical awareness of the signs and symptoms

"Whenever someone makes a conscious decision to attempt or complete suicide, often friends and family ask themselves what they could have done to prevent it," says Lancaster's Karen Rizzo MD, president of the Pennsylvania Medical Society (PAMED), stating that in 2012 there were 1,613 suicides in Pennsylvania. "It's an alarming public health problem that needs to addressed in a clinically compassionate way being culturally sensitive to the needs of those seeking to find answers to their personal loss."

According to data from the Pennsylvania Department of Health, the largest number of suicides in 2012 was committed by those between the ages of 45 and 54 with 361, followed by the 55 to 64 age group with 286.

Reports from the American Association of Suicidology indicate Pennsylvania is ranked 29th in the nation for suicides per 100,000 people. Montana, Alaska, and Wyoming unfortunately have the highest rates.

Nationally, data from the CDC suggests there were 39,518 suicides in 2011. In addition, more than 487,700 people were treated in emergency departments for self-inflicted injuries.

Very likely, says Michael A. Bohrn, MD, FACEP, president of the Pennsylvania College of Emergency Physicians, the actual number of people trying to hurt themselves is higher.

"We only know of the patients who end up in emergency departments," said Dr. Bohrn, who practices in York. "There are plenty more non-fatal attempts who will try to deal with everything on their own and not seek care. This is a bigger problem than only the patients we see in hospitals and emergency departments."

While Pennsylvania statistics suggest an older demographic when it comes to suicide, Erich Batra MD of the Pennsylvania Chapter of American Academy of Pediatrics says younger individuals are vulnerable too. In 2012, there were 68 individuals under the age of 20 who decide to end their lives by completing suicide. Another 134 between the age of 20 and 24 died by suicide.

"Our data shows that up to 80 percent of suicides by those 21 years and younger are probably preventable," says Dr. Batra of Palmyra, pointing the 2014 Pennsylvania Child Death Review Annual Report. "Knowing the signs of suicide and how you can help might save a life."

According to the 2014 Pennsylvania Child Death Review Annual Report, of the deaths reviewed in 2011, 45 percent of those who died by suicide used a weapon and 43 percent died from asphyxia.

The advocacy efforts of members of Pennsylvania Youth Suicide Prevention Initiative (PAYPSI), mental health consumer groups, and other interested public health advocates drove the Pennsylvania legislature to pass House Bill 1559 in June 2014. Dr. Batra and PAMED staff member Deborah Ann Shoemaker played a crucial role in educating the state legislature on the importance of addressing suicide prevention efforts in the public school system. The new law will require schools to adopt a youth suicide awareness and prevention policy including staff training beginning with the 2015-'16 academic year.

Child and adolescent psychiatrist Robert E. Wilson, MD, PhD, president-elect of the Pennsylvania Psychiatric Society and active PAMED member, says the following are risk factors:

• Previous suicide attempts

• History of depression or other mental illness

• Alcohol or drug abuse

• Family history of suicide or violence

• Physical illness

• Feeling alone

• Stressful life event or loss

• Easy access to lethal methods

"It doesn't mean that a person with those risk factors will attempt or complete suicide," says Dr. Wilson who practices in Erie. "But keeping these areas in mind may help friends and family members keep a closer eye on a loved one, particularly if they're exhibiting warning signs."

Dr. Wilson says one important warning sign not to dismiss is when an individual expresses their desire to hurt themselves, no matter how trivial. Mood changes and increased substance use are other possible signs.

"As a friend or significant person of choice, if you suspect a loved one is showing signs of emotional instability, it's important to create a safe environment and to connect them with the help they need," says Dr. Wilson. "Mental health experts are available and can be found through hospitals, clinics, and physician offices. In addition, national hotlines are set up to help."

The National Suicide Prevention Lifeline is available 24/7 and can be reached at 1-800-273-TALK (8255). Many local communities also possess suicide hotlines which can be found by state at http://www.suicide.org/suicide-hotlines.html. When in extreme duress, report immediately to your local emergency room for assistance.

"Everyone -- physicians, teachers, clergy, and all members of the public -- plays a role in preventing the unnecessary loss of life through self-infliction," says PAMED's Dr. Rizzo. "Knowing the warning signs and how to guide someone to help can make a difference."