State searches for solutions to alarming rise in suicides

Alarmed by a sharp rise in suicides, state health officials are undertaking an ambitious new data-collection effort to probe why near-record numbers of Minnesotans are taking their own lives.

For reasons that confound medical authorities, Minnesota's suicide rate jumped 29 percent between 2003 and 2011, more than double the national rate of increase. Last year, 683 Minnesotans died by suicide, up from 496 in 2003 and one short of the record in 2011, according to state data.

"Why are we becoming more suicidal in Minnesota?" asked Jon Roesler, epidemiologist supervisor at the Minnesota Department of Health. "The answer is that we don't know. And that's disconcerting."

Baffled by the trend, public health officials are about to overhaul the way suicide data are collected and reported across Minnesota. Instead of simply relying on death certificates, which often lack key details, the state in January will begin collecting data from a wide range of sources — from county coroners to law enforcement agencies — to piece together a more complete picture of each suicide.

Of all the public health risks in Minnesota, the rising suicide rate is among the most confounding. Historically, suicide rates tend to rise and fall with economic cycles; rates reached an all-time high during the Great Depression and hit their lowest point in 2000, after the long boom of the 1990s. However, in Minnesota, the suicide rate actually jumped sharply as the economy rebounded after the severe downturn of 2008-2010. The suicide rate is growing fastest among middle-aged adults, mirroring a national trend.

Although murders get more attention, Minnesota now records nearly seven suicides for every homicide; suicide is now the second leading cause of death among Minnesotans aged 15 to 34, after accidents such as car crashes.

Yet state officials are at a loss to explain the trend — in part because information on suicides is scarce. Public health officials in Minnesota still rely heavily on death certificates, which list the cause of death and basic demographic information but give few clues on underlying causes. For example, a death certificate may list "death by overdose" without identifying the drug type or if the overdose was a suicide, medical examiners say.

Because suicide is often an impulsive act, state officials want more information on how people obtain lethal means such as firearms and drugs. One study found that one in four younger people who attempted suicide but survived said they deliberated less than 5 minutes before attempting to kill themselves. Many survivors report instantly regretting their decision moments after they took the decisive step.

"If we're going to prevent suicides, we need to know the risk factors," said Dr. Andrew Baker, chief of the Hennepin County medical examiner's office. "Do we have a lot of untreated depression out there? Do we have people with bipolar [disorder] who are not taking their medications? That will be in the person's [medical] file."

Jennifer Dunbar of Elk River said she deliberated "less than 15 minutes" before attempting to hang herself this June in a hospital room at Mercy Hospital in Coon Rapids. When she awoke in the intensive care unit, Dunbar had to be restrained by hospital staff to prevent her from tearing out her breathing tube. "I was angry that I was still alive and breathing," she said.

Months later, Dunbar said she still struggles to understand what drove her to such a desperate act. Was it the medications she took for bipolar disorder? Her sense of isolation? Her recurring memory of being sexually assaulted during her time in the military?

"All I know for sure is my mind was racing with negative thoughts, and I just needed to shut the whole thing down," said Dunbar, 42, who is undergoing treatment at Mercy. "Suicide is always in the back of my mind, but the act is impulsive."

Oregon, one of the first states to join the NVDRS system a decade ago, found that 80 percent of older adults in the state who died by suicide had a chronic illness. As a result, the state now encourages physicians and other health providers to ask people suffering from certain chronic illnesses if they have contemplated suicide within the past year, and to connect them with mental health services.

"The data has been invaluable," said Lisa Millet of the Oregon Health Authority. "We are now able to … make the case for stronger prevention efforts with hard facts, not just anecdotes."

Dave Slavens, board chairman of the greater Minnesota chapter of the American Foundation for Suicide Prevention, has lost two brothers to suicide. His younger brother, Jesse, killed himself just weeks after being turned down for treatment at a Department of Veterans Affairs hospital. His older brother, Shane, overdosed on antipsychotics and alcohol. Slavens wonders how many other suicide victims resemble his brothers and if targeted interventions could have prevented their deaths.

"It's a public health issue," Slavens said. "How can you address suicides if you don't even know the scope of the problem?"

Chris Serres • 612-673-4308