As she interviewed surviving members of suicide victims' families for her final annual report, retiring Anoka County Medical Examiner Dr. Janis Amatuzio said she asked the usual questions: Has there been a divorce? A court case? A loss of sorts?
"For the first time in all the years I've done this, I'm hearing things mentioned like, 'He lost his job. She lost her house. We're in foreclosure,'" said Amatuzio, arguably Minnesota's best-known coroner and a respected author on the subject of death. Amatuzio -- the county's coroner since 1993 who is contracted to do medical examiner's work in eight Minnesota and three Wisconsin counties -- said she is hearing similar stories. "In counties where I am medical examiner ... Anoka does not stand out," she told the Anoka County Board this month.
Is the beleaguered economy driving people to suicide? While some experts say that foreclosures, salary cuts and pension reductions are not causes of suicide, local medical examiners say the correlation between a rise in suicides and rise in unemployment in recent years is too obvious to ignore.
In Dakota County, there were 27 suicides in 2007, when the jobless rate there was 4.3 percent, according to a study furnished by the Minnesota Regional Medical Examiner's Office in Hastings. In 2008, the numbers were 40 suicides and 5.3 percent unemployment. In Hennepin County, suicides rose from 109 in 2007 to 127 last year. In Ramsey County, there were 44 suicides in 2007, but 59 last year.
Anoka County had 33 suicides in 2007, and 44 in 2008. Last year's total represented 4 percent of all deaths in the county, the highest percentage during Amatuzio's 17-year term. The average age of suicide also changed markedly -- from 33 years old in 2007 to 48 last year.
When asked about a possible connection between economic woes and suicides, Dr. Lindsey Thomas, the coroner who oversees several southeastern Minnesota counties for the regional office, responded by asking, "How can you separate that?
"People are vulnerable because of underlying mental illness," Thomas said of suicide victims. "But when you live in a time or place with a lot of background stress," she said -- citing war, losing a house, or even the anxiety that comes when you think you may lose a job and you're struggling to make ends meet -- "you are more susceptible, more prone to suicide."
Not enough research
But is it the loss of a job or a house that triggers someone suffering from mental illness to commit suicide? Or is it the experience of loss, period?
"The only thing relative to the economy that we know of related to suicide is the unemployment rate -- that's the sum total and there's nothing more," said Dr. Dan Reidenberg, executive director of the Bloomington-based Suicide Awareness Voices of Education (SAVE). "There is no significant research anywhere in the world that show economic impacts associated with suicide, other than employment."
A recent study by Sharmila Raghunandan, a Macalester College student who served as an intern in the regional medical examiner's office, shows a correlation between the rise in suicide rates and jobless rates the past four years in Dakota County.
"I think we're seeing in Hennepin County what Dr. Amatuzio is seeing in Anoka County, what Lindsey Thomas is seeing in Dakota County," said Dr. Andrew Baker, Hennepin County medical examiner. "Anecdotally, we hear the same stories Janis mentioned -- just got laid off from a job, lost a house -- but we're hearing them with more frequency now."
The 10th leading cause of death in Minnesota, suicides peaked in 1986, at a rate of 13.6 per 100,000 persons, said Jon Roesler, the Minnesota Department of Health epidemiologist who supervises the injury-violence prevention unit. Suicide numbers for 2008 in Minnesota have not yet been made official, but the preliminary count suggests that 590 people took their lives in Minnesota last year, or 11 of every 100,000 persons.
Life's a struggle
"Has it [the suicide rate] gotten worse? Yes," Roesler said. "The economy may be a contributing risk factor, but it's not the cause.
"Life happens and life is painful -- and most people who go through these things survive them."
Thomas agrees. But she says that just because few studies concerning the overall economy and suicide have not been publicized, don't disassociate the two.
"My aunt committed suicide 40 years ago," but it was as if it didn't happen, Thomas said. "It's like child sexual abuse. That was happening in the 1950s, but people didn't talk about it.
"We often don't know why somebody did something. But we know somebody did something. And we're learning about the contributing circumstances."
Amatuzio, who retires at the end of the year, would like to see a different kind of study.
"We should be teaching how to deal with conflict and how to deal with loss," she said. "That would be the source of a great study."
Paul Levy • 612-673-4419