With suicide rates on the rise, clinicians need more training to spot the warning signs

New data that shows suicide is on the rise across the country and a pair of high-profile celebrity deaths by suicide are putting renewed attention on an issue that can have a profound impact on healthcare professionals.

The latest Vital Signs report from the Centers for Disease Control Prevention provided stunning data which found the suicide rate in the U.S. has increased in almost every state since 1999, and in half of the states by 30% or more in that window. In 2016, at least 45,000 Americans aged 10 or older died by suicide.

The report also found that more than half (54%) of people who die by suicide have no known mental illness diagnosis prior to their deaths.

Suicide is the 10th leading cause of death in the U.S., and one of just three causes of death that is on the rise, according to the CDC.

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The CDC's data was released last week as the deaths of celebrity chef and television host Anthony Bourdain and fashion designer Kate Spade—both by suicide—grabbed headlines. Joe Parks, M.D., medical director of the National Council for Behavioral Health, told FierceHealthcare that both the report and the news about Spade and Bourdain highlight how suicidal thoughts can impact anyone.

"I think what it does is it shows it can happen to anybody," Parks said, "and being loved by the public and being successful doesn't protect a person from being depressed."

Suicide rates nationally are a major public health issue, but mental illness and suicide risk also significantly impact healthcare professionals themselves. An estimated 400 physicians commit suicide each year. 

Physicians and other mental health professionals may be more likely struggle with their mental health issues in silence, according to Pamela Wible, M.D., an Oregon-based family physician who tracks physician suicide on her blog. 

"After collecting so many stories over the past five years, I believe ignoring doctor suicides just leads to more doctor suicides," Wible wrote in a column earlier this year. "Suicide is preventable, but we have to stop with the secrecy." 

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Behavioral and mental health are not a key focus of many medical curricula, said Lisa Wolf, Ph.D., R.N., director of the Emergency Nurses Association's Institute for Emergency Nursing Research, in an interview with FierceHealthcare. She said this means young doctors and nurses have limited exposure to how to best recognize warning signs.

Wolf and her team's research into the state of behavioral health screening in the emergency department identified significant gaps in identifying patients at risk of suicide and ineffective use of resources to encourage these patients to open up about their problems. The speed of activity in the ED can prevent clinicians from building the necessary relationships with patients to address their behavioral health problems.

"We're trying to find this magic bullet tool to identify a person at risk and it just doesn't exist," Wolf said.

It can be especially hard, she said, as 78% of patients who go on to commit suicide deny having suicidal thoughts at their final interaction with the health system. So simply asking if they've considered suicide may not be enough.

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Having a stronger ability to identify the warning signs of suicide can also help healthcare professionals spot them in their peers—and themselves, Parks said. "We don't train doctors and nurses near well enough to ask for help for themselves," he said.

Wolf and Parks both said that working in medicine, particularly for physicians, can lead clinicians to set unattainably high expectations for themselves, and many young doctors are swimming in debt that can lead to financial problems. Personal issues like these can be one of the first signs that someone is struggling with mental illness, Wolf said. Having an awareness of issues in the local community could lead to a quicker intervention when someone is at risk.

"It's just important to be aware of and cognizant of what's going on in your community," Wolf said.

Deborah Stone, a behavioral scientist at the Division of Violence Prevention at the CDC's National Center for Injury Prevention and Control and one of the study's authors, noted at a teleconference Tuesday to mark the report's release, that there are several other warning signs providers can keep an eye out for, such as:

• Isolation
• Increased anxiety
• A sense of being trapped or a burden on others
• Increased use of drugs or alcohol
• Extreme mood swings
• Sleeping too much or too little
• Referencing or mentioning a desire to die
• Seeking out ways to commit suicide, or planning a suicide attempt

"There are a lot of things that all of us working together can do to prevent suicide," Stone said.

RELATED: Initiative aims to prevent physician suicides

Parks said the element of isolation is key, and people are extremely unlikely to commit suicide if someone else is with them. Simply asking if someone is considering suicide is unlikely to plant the idea in their head, he said—but it could stop them from taking their own life.

"If you're worried enough to ask, they've been thinking about it for a while," he said.