Midlife Suicides Show Surprising Increase

The midlife crisis just got a lot darker than buying a fancy sports car or having an affair. The Centers for Disease Control and Prevention (CDC) say suicide rates among middle aged people in the United States have increased significantly in a recent five-year period.

The CDC's analysis showed that suicide rates among people age 45 to 54 increased almost 20 percent during the period studied (1999 to 2004). In that same period, other age groups experienced smaller increases or even declines.

Overall, more than 32,000 people die by suicide each year in the United States. Nearly 80 percent of suicides are committed by men, although women attempt suicide more often than men. Within the 45 to 54 age group, the suicide rate for women increased 31 percent from 1999 to 2004.

The increase among middle-age people is puzzling to physicians and statisticians. That's because suicide has stood out as a major risk among other age groups, notably teens and young adults, where it is the third leading cause of death, and among elderly people, where the highest suicide rate can be found among white men over age 85. The attention to suicide risk in the very old and very young has led to awareness programs among families, schools, medical professionals and caregivers.

But such attention is lacking, or perhaps less developed, in the middle age group. Many adults in their 40s and 50s may be more focused on the health (mental and physical) of their children or parents. At the same time, they may be neglecting themselves.

Not only is the age group a surprise for a higher suicide rate, but so is the jump in the rate. But it's not easy to figure out why.

The most common risk factors for suicide include mood disorders (such as depression and bipolar disorder), substance abuse and other mental health conditions such as post-traumatic stress disorder. Depression itself is the major risk factor for suicide. The American Psychiatric Association indicates that up to 15 percent of depressed people die by suicide.

Although antidepressants may be used to treat depression, some of them may actually up the risk of suicide especially for teenagers. As a result, the U.S. Food and Drug Administration has added its "black box" warning label to certain antidepressants. But even the intended effects of antidepressants can increase suicide risk. For example, if they help improve a person's energy levels, that extra energy could be used to act on an impulse for suicide.

Changes in medications may also be associated with suicide. No studies have been done on the subject, but the time period of increased middle age suicide overlaps with a change in the use of hormone replacement therapy by menopausal women, who fit in this age group. Hormone replacement therapy (HRT) was used for many years by women in their 40s and 50s to counter the side effects of menopause, including hot flashes and mood swings.

In 2002, a national study indicated that long-term use of HRT increased the risk of blood clots and breast cancer. Although short-term use for early symptoms was acceptable, many women stopped taking or never started HRT.

More recently, the FDA began investigating Chantix, a newer smoking cessation drug that may increase moodiness and suicidal thoughts in patients who take it.

Societal change may also affect suicide risk in middle age, either in the form of a more mobile, less connected society with more single-person households, or in an age group more likely to be facing change such as job changes, divorce, remarriage, serious illness and caregiving for elderly parents.

We may never figure out why so many more people are committing suicide. Even if a person's medical or mental health history is well known before a suicide, there's no way to know their thoughts and reasons at the time of the suicide. A study of suicides in Japan found that less than 40 percent of suicides left notes.

If you or someone you know is considering suicide, get help. Contact a medical professional or call a suicide hotline. If you cannot find a local number, call the National Hopeline Network at 1-800-SUICIDE or National Suicide Prevention Lifeline at 1-800-273-TALK.