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By Nadin Abbott
March 1, 2012 (San Diego) -- One San Diegan commits suicide every day. We read of the most spectacular cases in the press, but on average, 365 local residents take their own lives. According to the County, “…as a cause of non-natural death, suicide ranks second, behind only drug/alcohol overdoses, and ahead of motor vehicle crashes.”
How does this compare to the national rates? San Diego actually has a higher suicide rate than the nation at large. According to the Centers for Disease Control, suicide ranks tenth in causes of death nationwide.                                 
Why are so many more San Diegans killing themselves? People are also killing others, as in the case of several murder-suicides in East County over the past year.  After repeated questions to the County Health Department, we found no conclusive answers. The economy, domestic violence, and mental illness were factors in some, but not all of the cases.
These statistics are just the tip of the proverbial iceberg. Suicide rates also vary according to age populations, ethnic groups and location in the county.
For example, suicide is highest among Caucasians (whites). According to the County, “The racial/ethnic distribution of suicide is weighted heavily toward the white population. Whites account for 80% of suicides although they comprise only 52% of the total county population. The suicide rate for whites (17 per 100,000) is more than twice as high as any other racial or ethnic group. This disparity is much more pronounced among older adults, where the rate among whites (24 per 100,000) is five times the rate of non-white populations.” Firearms remain the chief means to commit suicide.
San Diego is also home to many veterans. Nationally, 20% of all suicides are among veterans, though only 1% of Americans have served in the armed forces.  More Vietnam veterans have now died from suicide than the 55,000 who were killed in Vietnam. Suicide rates are also high among recently-returned veterans from Iraq and Afghanistan. Alarmingly, suicide is 1.5 times higher among veterans with traumatic brain disorder than among healthy individuals.
The positive news is that suicide is increasingly seen as a public health matter and not as a moral failing. Depression is a medical condition. According to Kay Redfield Jamison (in her book, Night Falls Fast: Understating Suicide), when a forensic psychiatric examination is done, it is found that depression is one of the underlying causes. It is also a treatable condition, with both physical means and medications.
The other good news is that the United States now has a strategic plan on how to deal with suicide. This was started in 2003 under the Bush administration. The latest report came in 2010 and is called Charting the Future of Suicide Prevention
This progress review pointed out where things are better, and where things are not. For example, it applauds the Veterans Administration for its efforts in dealing with depression and suicide among this population. It also points out that there is still much to do and that States have to have their own plans.
California and San Diego have plans. Suicide costs a lot of money, as well as heartache. San Diego has a program called, “Up2Us.” It has specific items on its site, developed for specific populations. It is also a public health approach that admits the reality that we have a problem. When compared to the National Statistics, we have a long way to go.
So what can you do?
The first thing to realize about this is that like preventable diseases, such as diabetes, there are risk factors and protective factors for preventing suicide.
Selected Risk and Protective Factors in the General Population:
Risk Factors
  • Some major physical illnesses, mental disorders, and substance use disorders  Barriers to accessing health care
  • Stigma associated with help-seeking behavior
  • Easy access to lethal means (e.g., firearms or poison)
  • Lack of social support and sense of isolation Cultural/religious beliefs that accept suicide
Protective Factors
  • Effective clinical care for physical illnesses, mental disorders, and substance use disorders                                                                                  
  • Easy access to a variety of clinical interventions
  • Support for help-seeking behavior
  • Restricted access to lethal means (e.g., firearms or poison) Strong connections to family and community support Cultural/religious beliefs that discourage suicide
(Source: Examples of risk and protective factors selected from U.S. Department of Health and Human Services (HHS), Public Health Service, National Strategy for Suicide Prevention: Goals and Objectives for Action, SMA01-3517, Rockville, MD, 2001, pp. 35-36.)
If we remove barriers to accessing health care, or even the social stigma that comes from seeking help, we reduce the risks. There is also another reality, and that is that the chief means of suicide in San Diego are firearms.
The silence around it has to be broken, and talking to someone can help. The most important question is, what do you do if you are having thoughts of suicide?
When is it time to ask for help?
You should consider asking for help and seeking treatment if you have more than just a day or two that seem “blue.” The first step is to recognize your emotions; feeling down all of the time is not normal. Wanting to isolate from family and friends is not normal. Believing that you are worthless is not normal.
Who should you approach for help? Medical professionals, as well as family and friends are great places to start. Clergy can also be supportive. Seeking help from mental health professionals is also a must, since depression needs medication to balance brain chemistry. Depression can also be treated in an organic way. Regardless, depression is nothing to be ashamed of, and it has nothing to do with “will power.”
Suicide not only takes a life, but affects family and friends. When somebody jokes about killing themselves, take it seriously. When somebody threatens to kill themselves, don’t simply dismiss it.
Granted, talking about suicide is the most obvious of warning signs. According to the American Foundation of Suicide Prevention, these are the other most common warning signs:
  • Unrelenting low mood
  • Pessimism
  • Hopelessness
  • Desperation
  • Anxiety, psychic pain and inner tension
  • Withdrawal
  • Sleep problems
  • Increased alcohol and/or other drug use
  • Recent impulsiveness and taking unnecessary risks
  • Threatening suicide or expressing a strong wish to die
  • Giving away prized possessions
  • Sudden or impulsive purchase of a firearm
  • Obtaining other means of killing oneself such as poisons or medications
  • Unexpected rage or anger 
What do I do?
If you find yourself considering suicide, the county mans an Access and Crisis line: (888) 724-7240. According to Lisa Contreras (Group Communications Officer, County of San Diego Health and Human Services), people can also dial 211. Either of these actions will put you in contact with trained staff that can help you immediately.
The County is also running a program called, “It's Up To Us.” This program is a gateway for citizens to openly talk about mental health and mental illness. Materials at the website were designed to take into account different cultural needs in the county. The main point is that we need to talk openly about this important issue and recognize there is no shame.
If you are a veteran, the VA also has a crisis line. This is 1-800-273-8255 press 1
The most important thing you can do is pay attention to your feelings, or those of family members. Realize there is no shame and act in a positive manner. Finally, if you are feeling really depressed and news breaks of a suicide, do not watch the coverage. Instead, reach out and seek help at one of the phone numbers above.


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