Can midlife malaise lead to suicide?

Chris Caulkins awoke at 2 a.m., rolled over and panicked. His 38-year-old wife, Mary, who had battled depression for years, had not come home.

For two weeks afterward, hundreds of St. Paul friends and strangers searched for her, including Tim Hopkins, an emergency medical technician, whose determination was relentless. "I also suffer from depression," he told Caulkins, a paramedic who worked with Hopkins on many occasions, "and I really want to help."

Mary, mother of a 5-year-old girl, was found in her car two weeks later, dead of a drug overdose. Three and a half years after that, Hopkins, 43, a father of five, took his life with a gun.

Their tragic stories are becoming less surprising to public health officials. A recent analysis of nationwide death rates from 1999 to 2004 found suicide rates increasing nearly 20 percent among people in their mid-40s to mid-50s. For men and women 35 to 44, suicide ranked as the fourth most common cause of death.

Canada's baby boomers are also likelier than people in other age groups to take their lives, said Brian Mishara, director of the Centre for Research and Intervention on Suicide and Euthanasia at the University of Quebec in Montreal. Canada's overall suicide numbers rose by 10 percent in 1999, largely the result of so many people in their 40s taking their lives. The suicide figures for people of that age jumped by 24 percent, while teen deaths attributable to suicide dropped by 6 percent.

Health officials are quick with caveats. The increase might largely be the result of more accurate reporting on cause of death, as suicide sheds its stigma. And other risks, including car crashes, cancer and heart disease, are far deadlier to boomers and those slightly younger.

Yet Dr. Alex Crosby, a medical epidemiologist with the Centers for Disease Control (CDC) and study co-author, said the findings are "something to look at more closely. We're really grappling to understand this better," he said, noting that boomers, compared with their parents, have had higher suicide rates throughout their life spans.

Women at risk

While long-term studies are needed, many say they're happy to see attention finally focused on a group for whom research has been sorely lacking: women. While the largest number of suicides among women has been in the 45- to 54-year group for decades, the CDC study measured a 31 percent increase in just five years.

"We need to get a sense of what's going on with this generation of women," said Silvia Sara Canetto, a psychology professor at Colorado State University, whose rare research focuses on women and suicide worldwide. The problem of female suicide, she said, "is under-regarded and under-studied."

One reason, she says, is that far more attention is placed on those who "complete" the act. Four males die by suicide for every female who dies, mainly because men choose deadlier methods, such as firearms, while women more often choose poisoning. But women make at least four attempts for every male attempt. Women, she said, are seen to "fail to die." "They're portrayed as weak, manipulative, impulsive. They're not taken seriously."

Like men, women suffer from mental illnesses, (including anxiety, schizophrenia and depression), alcohol and drug abuse, and social isolation, factors linked to suicide. Both men and women face divorce, job shifts and financial struggles, too.

Keeping her memory alive

Caulkins, 39, who has remarried, thinks about Mary frequently. "It keeps her alive to me." Acting associate dean at Century College in White Bear Lake, he also speaks about the devastation of suicide as a volunteer for SAVE (Suicide Awareness Voices of Education; www.save.org), as well as voicing the encouraging news that depression is largely treatable.

On a recent weekday morning, students in a packed lecture hall heard Caulkins' talk grow personal. On a large screen, he showed family photos of Mary, set to music, when she was smiling and healthy. Toward the end of her life, he told the students, "she had to be bathed by my mother when I'd go to work. She would cry for days."

They had married in 1996, after meeting at Shriners Hospital in Minneapolis, where both worked. Mary was a "genuine" person, a good listener, very down-to-earth. The pivotal event, Caulkins now believes, is when they decided to have a child. She went off her medications "and just lost her chemical balance in her brain. She could never get it back."

They adopted daughter Bethany, now 11, in 2000. "We naively thought that having a child would solve the problem," he said. "But no matter where you go, there you are."

One of the most zealous searchers for Mary was Hopkins, whose wife, Angie, said he didn't come home for four days. "He wanted to find her so bad," said Angie, 38, an independent sales rep and mother of boys age 3, 4 and 7. In 2001, clinical depression had been diagnosed in her husband, who also had two older children. They tried everything, she said -- counseling, seven medications, shock therapy. "He told me, 'I wish I had cancer. I could die from it or get better. This I will never beat.'"

Hopkins didn't find Mary. But he was happy, Angie said, that Chris Caulkins could now have "peace."

The Sunday before Hopkins took his life three years later was a particularly bad day for him, Angie remembers. "But Monday was particularly great. He came home early to make dinner with me. He played with the kids. I thought, 'This is great.' Now I think he knew it was going to be over."