Commentary: We must understand the causes of anxiety and suicide

(Photo: Scott D. Pierce) Taryn Hiatt, left, an area director for the American Foundation for Suicide Prevention, and Salt Lake Mayor Jackie Biskupski at a youth suicide prevention conference.

“An ounce of prevention is worth a pound of cure.”

Benjamin Franklin

The Utah congressional delegation should be applauded for its support of legislation to reduce the tragic rise in suicides over the last 20 years. A readily available and easy-to-use suicide hotline is an important step in providing at-risk individuals access to immediate help.

But what other measures are needed to contend with what is clearly an epidemic of self-inflicted premature deaths in Utah and across the entire country, whether intended or by accident? Although the U.S. Centers for Disease Control and Prevention asserts that there is no single cause that can be attributed to this national trend, we know that serious, life-impacting anxiety, depression and chronic pain are at an all-time high and strongly correlated with suicide attempts.

The 25 percent increase in the suicide rate has mirrored similar upswings in other harmful behaviors and chronic illnesses. These include parallel increases in diabetes and obesity-related mortality, gun violence deaths and drug overdose fatalities.

These various, and often inter-related causes of morbidity and mortality can be seen as the most severe signs and symptoms, or maladaptive responses, to the broader social distress we as a country have been experiencing over the last two decades. Since the turn of the century, we have witnessed exponentially rising housing, education and health care costs, pervasive job insecurity and the most significant economic downturn in several generations and U.S. involvement in armed conflict and military operations in 39 percent of the world’s countries. The war on terror appears to be unceasing, as does our own internal political infighting. We cannot pretend that these high levels of conflict and stress do not take a toll.

Clearly, using prescription drugs incorrectly or self-medicating with potent and potentially addicting mood-altering drugs and alcohol is a recipe for disaster. But neither should we merely pity, condemn or report on these tragic outcomes while neglecting the impact of psychological and physical distress that lead so many down this path. Until we deal more effectively with root causes of hopelessness, preventable suffering and intractable pain, and their effects on health and unhealthy behaviors — leading to what has been aptly described as “deaths of despair” — these trends are not likely to be reversed. Urgently, there needs to be far greater support for interdisciplinary pain and mental health treatment programs that can complement and supplement our strained primary care resources.

The root causes of increased rates of suicide and some of its triggers, including poorly managed pain and mood disorders, are complex. Nonetheless, we can all be advocates for our own health and well-being, and that of all those we care about and love, by calling on our elected leaders to back more comprehensive solutions to address these devastating consequences of our collective social distress. An “ounce of prevention” may be a good start, but to tip the scales toward “cure,” acknowledgement of underlying causes and far greater investment in proper diagnosis and effective treatments is required.

Perry Fine

Perry G. Fine, M.D., is a professor of anesthesiology at the University of Utah School of Medicine, Department of Anesthesiology, Division of Pain Medicine, Pain Research and Management Centers. He has been practicing medicine, teaching and doing research at the University of Utah Hospitals and Clinics for 33 years. The opinions expressed here are his own and do not necessarily reflect those of the University of Utah.